ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2017) 50 P186 | DOI: 10.1530/endoabs.50.P186

Lodotra (delayed release prednisone) is variably absorbed, and should not be used in adrenal insufficiency

Jennifer Zhang, Sirazum Choudhury & Karim Meeran

Imperial College, London, UK.

Replacing glucocorticoids in patients with adrenal insufficiency is challenging, as endogenous cortisol levels rise before waking. Currently we use steroid replacement first thing in the morning. Administration of a delayed release preparation last thing at night, if reliable, could mimic the rise in cortisol that occurs before waking. Lodotra is a modified release prednisone that has a delay in the onset of action, and when given last thing at night, might cause a rise in levels before awakening. We investigated the reliability of Lodotra absorption and conversion in the liver to prednisolone. Single doses of either standard prednisolone or Lodotra 5 mg were administered in the morning. Samples for serum prednisolone were taken at intervals.

Results: Lodotra was absorbed with a 5-h delay in one volunteer (see figure), so that if the drug is taken at bedtime (11pm), a rise on prednisolone levels would start at 0400 h, consistent with the circadian rhythm.

Lodotra was not consistently absorbed in all three volunteers. Volunteers 2 and 3 showed negligible to low levels of prednisolone absorption for a 10 hour period. Food intake did not change absorption in any of the volunteers.

Conclusion: Because of its variable absorption, we cannot recommend the use of Lodotra for primary or secondary adrenal insufficiency.

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