Rivaroxaban and Omeprazole : I have been... - AF Association

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Rivaroxaban and Omeprazole 

Treschere profile image

I have been advised by text from my surgery that as I am taking Rivaroxaban I should start taking Omeprazole 20mg daily to help reduce the risk of a gastric bleed. Looking at the side effects of Omeprazole I am seriously wondering if I shall start taking it! It seems as if I am chasing my tail, one tablet after another to counteract the effects of the previous one.Does anyone have some helpful experience or thoughts on this?

104 Replies
BobD profile image
BobDVolunteer

I think that if you are taking rivaroxaban as instructed ie with a proper meal then this is overkill but just my opinion. I hate ppis with a passion as they actually made my reflux worse and when I investigated found out why they should not be used long term. Bad idea.

Treschere profile image
Treschere in reply to BobD

Thank you. That's what I wondered about, I usually have a plain piece of brown bread and a hard boiled egg for breakfast which is considered by some on here as adequate

BobD profile image
BobDVolunteer in reply to Treschere

The guidance last year follwing some strokes by people on the druig was a meal containing some fat.

Treschere profile image
Treschere in reply to BobD

Yes hence the egg. I am one of those people who could quite happily leave breakfast and last until 1/2 pm, so I try not to eat too much otherwise I am starving hungry by 12.

BobD profile image
BobDVolunteer in reply to Treschere

Why not with evening meal? Ok I know nothing as I have been on warfarin for so many years with zero issues.

Treschere profile image
Treschere in reply to BobD

I think it is advised to take in the morning and as I have other medication as well, it just makes sense to take it all at once, I will forget otherwise.

Spinners profile image
Spinners in reply to Treschere

I take mine with my evening meal, as advised by my cardiologist.

Treschere profile image
Treschere in reply to Spinners

I don't have a Cardiologist as yet. It has taken 10 months to get an Echocardiogram, so I am being managed on the medication I was put on after my overnight stay last August.

Spinners profile image
Spinners in reply to Treschere

After my stay in hospital I saw mine privately as I was worried. He is an EP. I choose him on line, for this reason and because he also worked in the local NHS. The private appointment enabled him to explain what was happening and what could be done. He then referred me to the NHS for cardioversion. My choice, as the wait was not that long. Since then I have seen him as an NHS patient, lengthy wait in a crowd, rushed appointment, and if I hadn’t had the private appointment I would have been much more worried. If you can afford it, it would be well worth talking to an EP privately so they can explain what is happening and get your medication sorted out.

Staffsgirl profile image
Staffsgirl in reply to Treschere

I take mine after the evening meal, partly to avoid taking it at the same time as another medication. Don’t like the thought of having a single cocktail of two medications. It has worked well for me for over three years.

Bucerias profile image
Bucerias in reply to Treschere

I was advised to take at night with my evening meal. My cardiologist suggested that was because it wears off and you are more susceptible to a stroke in the early hours of the morning. I have no idea where this is accurate or not.

Becksagogo profile image
Becksagogo in reply to BobD

I take mine with my evening meal, with no problems that I am aware of.I too am on Omeprazole but mine was to help with the statin that I take,!

BobD profile image
BobDVolunteer in reply to Becksagogo

PPI's are such clever drugs which perpetuate the problem they are supposed to stop. Having been down that slippery slope many years ago and managed to claw my way back out I would never go there again.

waveylines profile image
waveylines in reply to BobD

😊😊 maybe Ill move to Warfarin then Bob if the latest new fangle blood thinner tablet has me bleeding all over the shop again !!! I did say to EP maybe my blood are thin enough already......he wasnt amused...lol. Didnt like my idea of half a tablet either. 😂

Tapanac profile image
Tapanac in reply to BobD

Out of curiosity Bob why bad idea as hubby has been taking either omniprazole or lansoprazole or pantoprazole for about 40 years. He seems ok …. I think!

BobD profile image
BobDVolunteer in reply to Tapanac

See my reply to cassie below.

fabjabfab profile image
fabjabfab in reply to BobD

I agree entirely with Bob. I was ‘forced’ to take omeprazole with my Edoxaban, made me feel worse than rotten. I was told to stick with it, they added anti inflammatory, anti sickness, then painkillers - I rattled as I walked. I stopped taking everything but my Edoxaban which I take with a large glass of milk or a big breakfast. Works perfectly for me.

I have been on Rivaroxaban for 6 years and it has not caused any gastric problems. I do take mine with my evening meal, how long have you been on Rivaroxaban and have you had any problems with it, it seems strange for your surgery to suddenly advise you to take Omeprazole. Over the last 6 years I have had about 5 virus infections that ended up with me in hospital and taking steroids for a week. On one of these occasions I was given Omeprazole to take with the steroids, I asked why and was told by doctor because steroids can affect your stomach. I took them home with me but did not take them as I had no problems before with taking steroids and had heard on here that Omeprazole had very mixed reviews. It would be interesting to know if others at your surgery who take Rivaroxaban or any anticoagulant have been advised to take them!! They can all cause a gastric bleed.

Cassie

Treschere profile image
Treschere in reply to cassie46

Hi Cassie, I have been on it since last August, I am due my annual medication review so I guess it is to do with that.

cassie46 profile image
cassie46 in reply to Treschere

So you if have not had any gastric problems whilst taking them, sounds as if you have a GP at your surgery who is just dishing them out regardless whether the patient has had any problems! As per may above reply about being given PPI's I did say to the ER doctor that I had not had problems in the past with steroids, his reply was they could cause gastric problems so take the PPI, I would rather keep my consumption of medications to the minimum, I have enough of a cocktail of drugs already. I would ask your GP on Friday when you see them why, I would not accept the answer that Rivaroxaban can cause a gastric bleed, as I said before this would apply to all anticoagulants. As CD said some GP's seem to dish out PPI's to readily. I have not seen anywhere that Rivaroxaban is recommended to be taken in the morning, I thought it says in the leaflet to be taken with a main meal. Be interesting what your GP's reply is.Cassie

BobD profile image
BobDVolunteer in reply to cassie46

Cassie what I discovered was that the lower sphincter in the stomach needs an acid envirnoment to open and pass food down into the gut. Remove that acid and food remains far longer than necessary in the stomach causing even more bloating and reflux. Hence a viscous circle. Use of PPIs for short periods (a couple of weeks max) is fine but I know far too many people who have been on them for years who will never be better and are actually getting worse year on year.

Auriculaire profile image
Auriculaire in reply to BobD

Plus the acid environment of the stomach kills off nasties and helps with the digestion of certain foods. Long term use of PPIs can cause all sorts of damage .

Treschere profile image
Treschere in reply to cassie46

Hi Cassie,The recommendation was not my GP's but the Pharmacist's who works with the GP's.

Having read up some medical reports last night I am now wondering whether I should move to Apixaban as there is less incidence of internal bleeding from what I have read so far. I take it in the morning to go with my other medication, I am not retired and have a busy schedule that means remembering to take tablets is easier in the morning. Of course if I go to Apixaban I will have to set an alarm, but there again no food needed just water.

SuziElley profile image
SuziElley in reply to Treschere

I’m on Apixaban and my GP put me on Omeprazole as well. I have no issues with it. Everything is fine, no side effects. I did have a long talk with my GP about it when he first prescribed for me. He assured me it was a good move and is, in fact, on it himself.

Buffafly profile image
Buffafly in reply to SuziElley

I had a very bad experience with Lansaparole so when my GP prescribed omeprazole because ranitidine was withdrawn I just quietly put it in a drawer! I messaged my GP to say I wasn’t happy to take it and have never had a response…..

Apixaban is for life usually. PPIs were not meant to be taken long term and time has shown that long term use is associated with with all sorts of nasty consequences ie chronic kidney disease , bone fractures, vit B12 deficiency, magnesium deficiency ( not good for afibbers) .

I was also automatically prescribed PPI for several meds - I ditched them & as long as I stick to my regime of when I take them & with what - never had problems.

There is a case for taking them if you have proven acid reflux to protect the oesophagus but I agree with Bob - over prescribed!

Thank you CDreamer

I didn’t take one that was suggested in the past as it seems to stop absorption of magnesium amongst other things!

You could just change to Apixaban. No dietary requirements and taken twice a day so doesn’t need to be so ‘strong’ I think.

Treschere profile image
Treschere in reply to Buffafly

That is worth looking into thank you, I have a doctor's appointment on Friday afternoon so could think about that with him.

Cumbremar5 profile image
Cumbremar5 in reply to Treschere

I'm on apixaban it causes acid reflux with me

I have been taking apixaban for 4 weeks. No problems so far! The cardiologist advised me to take an anti coag and to talk it through with my GP who gave me a few days to research the noacs (new oral anticoagulants) which I did. The GP wanted me to be confident with my decision to go ahead and take them. It had come as a big shock to me! I was grateful for my docs sensitivity. I decided on apixaban which the doc said was also her preferred choice. This is part of my afib journey so far. I have been greatly helped by many contributions on this forum .

SuziElley profile image
SuziElley in reply to Buffafly

See my other reply. I’m on Apixaban and take it twice a day. My GP also prescribed Omeprazole. I have no issues with it, especially after a very long chat with GP about pros and cons

I was on Rivaroxaban for a couple of years, until I was diagnosed with erosive gastritis, gastric ulcer and recent bleeding. The report stated that the cause was Rivaroxaban.I cannot tolerate any PPI’s for more than a couple of weeks, so I was given ranitidine (not prescribed any more) to help heal my stomach issues.

Personally, I would rather take something to protect my stomach if I could tolerate them.

If they have that effect then surely other options should be explored first and Riveroxaban used as a past resort? I was on Riveroxaban and it caused me to bleed for all orfices -most unpleasant. Been off then for over a year so about to trial Axiban. Hope thats better!!

Treschere profile image
Treschere in reply to waveylines

Axiban? a new drug, as it isn't coming up on Google wavylines

waveylines profile image
waveylines in reply to Treschere

Oops typo sorry. Apixaban

Try not to take omeprazol like BOBD I agree can make reflux worse. Savpid avvoio you take a higher dose. Coupled with which research proves they can cause cancerous polips in your stomach. Also they line the stomach to the extent vit b12 is not absorbed with additional problems. Avoid avoid avoid is my advice.

Treschere profile image
Treschere in reply to Cumbremar5

I don't have reflux and never have, so they obviously think it just best to safe guard against it, which I am not happy to comply with.

Rennie's work for me

Bisodol tablets are excellent too. ☺️

Buffafly profile image
Buffafly in reply to Windlepoons

Gaviscon as necessary

I was put on this for gastric problems but found that after a year or two I have had bone loss. Apparently this causes bone loss and fractures and B12 deficiency. I found out when I started having fractures.

Treschere profile image
Treschere in reply to bassets

Yes I read this, and this is one of the main reasons for being against taking it for me.

waveylines profile image
waveylines in reply to bassets

Yes it causes problems with absorption.......thyroid hormone tablets are another one. I avoid it like the plague!!

My gp offered me lanzaprole recently as Riveroxaban had caused a stomach bleed. Having had it prescribed for acid reflux many years ago I refused. The cure is worse than the problem. I asked to be changed to Apixaban which I am hoping will be better than Riveroxaban, which has caused me to be anemic and resulted in the cancellation of my ablation.I was happy and healthy before AF started at age 60. Taking no medications and then here we go down the drug route and my body goes haywire. I am very wary of anything I'm offered regarding medications now and do a lot of homework on the possible effects.

I am so with you on that, always been medication averse from a young age, took the minimum when needed and stopped as soon as I could. Recently its one thing after another with medications chasing effects of other medications. Wish I could stop with them all.

I agree. You have summed it up perfectly.🤔☹️

That's a bit like me, no tablets then three tablet's the fourth is a why???

You've been advised according to the latest medical research and guidance from the government's NICE agency. Gastrointestinal bleeding events in people aged 65 and over, especially, can be life threatening and PPI medicines such as omeprazole have been shown to reduce these by 70%. Side effects from PPIs (even despite what you have read on the packaging leaflet or elsewhere) are very unlikely and are vastly less common than bleed incidents. Reports of increases in dementia on PPIs have been shown to be unfounded and not supported by evidence.

I do feel that it is potentially dangerous for non-medically trained individuals to offer individual medical advice on an internet forum when it goes against that from a personal doctor. Ask questions, of course, but then always trust professional advice, which is always evidence based and tailored to your own specific medical history.

qmul.ac.uk/blizard/ceg/medi...

Steve

tabletphobic profile image
tabletphobic in reply to Ppiman

I don't think ill of you for saying that, its the opposite. I want true facts

Ppiman profile image
Ppiman in reply to tabletphobic

I could have worded that better, I’m sorry. I have edited it. I wasn't meaning that you would think ill of me. I tend to feel that medical advice for serious conditions such as of the heart, with each of us having specific medical histories and different heart issues, we should trust the experience and training of our doctors with their caring nature, experience and knowledge.

With regard to preventive treatments such as this one, naturally, most people will speak from their experience of not suffering with a haemorrhage, but when looked at nationally and internationally, this is a real risk of anticoagulant therapy, especially as we get older.

Treschere profile image
Treschere in reply to Ppiman

Thank you, I have been reading medical reports based on research findings rather than straight internet. Plus I am not near 65 yet!😃

Ppiman profile image
Ppiman in reply to Treschere

I was that golden age two years ago. I wish I were younger though! And I wish you well. Enjoy your youth!! :-)

Steve

Auriculaire profile image
Auriculaire in reply to Ppiman

Having had my health compromised for over 30 years by prescriptions that did me harm and in the majority of cases were just not necessary I completely disagree with you. As for evidence based that is a laugh. Previous editors of both the BMJ and the NEJM (the most prestigious medical journals on the planet) have said that the medical research that is published in journals is not reliable and has not been for at least a couple of decades due to the overweening financial power of the pharmaceutical industry. You only have to look at the billions of $/£/€ these companies have been fined for lying about the safety and efficacity of their products to see there is a major problem. All the doctors who prescribed Vioxx , Avandia , Mediator etc etc were giving " professional advice" whilst these drugs they were prescribing were killing their patients. This is a negative side to prescription drugs that cannot be ignored. Indeed it is a leading cause of illness and death among the elderly as the number of medicines mount up. There is hardly any research done on the cumulative effects of polypharmacy. To give a drug that was not meant to be taken long term to prevent a possible side effect of one that is prescribed for life is IMO irresponsible. Some doctors are worse than others. Some are a bit incompetent and some completely rubbish. We get examples of them described regularly on this forum. And NICE is not omniscient either. They change their advice though often far too slowly ie recommendation of GET and CBT for ME/CFS. This was based on a peer reviewed study that turned out to be complete rubbish . The "treatments"were actively harming many patients and despite the howls of the ME/CFS community it took NICE a long time before they realised the PACE study that they had based their advice on was garbage . And according to NICE large numbers of people should be on statins. Their latest advice on statins was contested at the time by many doctors.

Billblue profile image
Billblue in reply to Auriculaire

Nice comments I tend to agree

Ppiman profile image
Ppiman in reply to Auriculaire

Hi - yes, I do know where you are "coming from", but, in the end, we have to trust to trained and experienced professionals in the full awareness that they, and all human institutions, can be fallible and even, if rarely, corrupt or corrupted.

As far as NICE is concerned, well, I would say we have no choice but to trust to their professionalism and judgment since their decisions use so many checks and balances. The idea that we can gainsay the decisions of such institutions is rather arrogant and foolish in my view.

Anticoagulants are an important cause of morbidity and mortality, especially in older people. PPI drugs have been shown to reduce intestinal haemorrhaging by over 70% in that group and have been shown to be relatively safe, and, of course, vastly safer than anticoagulants. That is the reason NICE have changed their prescribing guidelines, and it is an internationally agreed change, so far as I know.

Prescribing a drug prophylactically is not in any way "polypharmacy" in the pejorative way you use the term, surely? It is common sense.

Where health is concerned, we have to use what resources we have to make the best decisions for ourselves, but for most people, the only truly worthwhile resource is a good doctor - one with humanity, education and experience. Of course, doctors make errors, and some are poor at their job. That's why we need a brain on our own shoulders, but, when push comes to shove, conspiracy thinking gets us nowhere useful and trust them we must.

Steve

Buffafly profile image
Buffafly in reply to Ppiman

My GP said if I had any queries about medicines I should ask a pharmacist as they are the experts! I am going to ask a pharmacists advice re omeprazole next time I get a chance 🤨

Ppiman profile image
Ppiman in reply to Buffafly

In the US, that seems to be more the prevailing view but, for me, my doctor is my source of information since he decides my drugs. The pharmacist I know is more likely to limit what he says to what is on the packaging leaflet. :-)

Steve

Buffafly profile image
Buffafly in reply to Ppiman

My point is, does the doctor decide or are they just following recommendations?

Ppiman profile image
Ppiman in reply to Buffafly

Aha - well, as our individual medical histories are all different, for chronic conditions, we will surely get what is specific to our needs. But what is any profession, except for following in the footsteps of others, as it were? There are a limited number of treatments.

I don't doubt my own doctor's education, integrity, compassion or experience. That said, over this last lockdown year, my doubts have increased.

Steve

Auriculaire profile image
Auriculaire in reply to Ppiman

Well you might think you have to trust them . I don't and I have good reason not too stemming from my personal past experience. Apart from anything else there is controversy in medical practice. There are cardiologists who would not agree at all with NICE's statin guidelines who think statins should not be used at all in primary prevention. The medical consensus changes over time . The history of medicine is full of errors . Taking a drug to head off side effects that might be caused by another drug is a step on the road to polypharmacy given that all these drugs have side effects. Many old people are taking up to half a dozen or more different things. What's more their doctors have no idea whatsover what these combinations are doing to the body because there is no research done on this. When push comes to shove I know my body better than any doctor having lived in it for 69 years and my instinct and experience tells me that the less meds I take the happier it is. Given that the two main problems I suffer from -asthma and afib - were both provoked by other medical treatments I am very reluctant to take the drugs to control these but do so with a great deal of resentment. I don't doubt my GPs integrity , compassion or experience. He is good at diagnosis and listens. But he sure was ill educated when it came to prescribing an FQ for a suspected UTI. What's more I was pretty sure I didn't have one and my instinct and knowledge of my own body was correct as the urine analysis came back negative. So he gave me a dangerous drug for nothing. Why? Because the equivalent of NICE here said that was the thing to do.

Ppiman profile image
Ppiman in reply to Auriculaire

In a way, I agree with you. Hunches, however, are no substitute for science. The problem for doctors is that they don't always have the science to hand (or aren't knowledgeable, interested or perhaps even capable). This is where NICE comes in with its recommendations, as they will have reviewed the latest research. Also, personal research can be useful, here, except that interpreting data is difficult for a non-specialist. That things change over time goes without saying, but medicine is at least partly an art (or guesswork...), still.

I suppose doctors shouldn't prescribe against a "suspected" UTI, ideally, since lab tests are quick and easy to ascertain antibiotic sensitivity. The risk was in the delay causing the potential for the UTI to develop into pyelonephritis, I guess.

Steve

Auriculaire profile image
Auriculaire in reply to Ppiman

I agree with you that medicine is partly an art. I would go further and say that because of enormous individual differences it will always remain more of an art than a science. The attempts of bodies like NICE to give clinical recommendations for everything lead to a one size fits all medicine which actually can be disastrous for some individuals . It is particularly bad for women given that the body of medical knowkedge and research accumulated over the last 70 decades is based mainly on the male body. Women have been assumed to be just smaller versions in all but sexual differences and this is now being shown to not be true. EBM is in theory a good idea. Often the "evidence" is shaky.

Ppiman profile image
Ppiman in reply to Auriculaire

You’ve raised the fascinating issue of clinical trial gender imbalance before. I hadn’t quite realised its implications. Recruitment for trials was always a problem, though, and was generally left to the clinicians. Certainly, for childhood drug studies, it seemed to me that that girls were recruited equally to boys (this was for infection, allergy and asthma drugs).

I’m not sure it was assumed that men and women would react similarly to all drugs but in many cases, I imagine the pathology and outcomes will be similar. I suspect men are more likely to sign up for a clinical trial, for various reasons, and that women have been excluded more often owing to fears of pregnancy or lactation (all amplified by the thalidomide tragedy, most likely).

From what I’ve read, it does seem now that trial designs are being tailored to ensure gender balance.

It’s one more artefact from our patriarchal past that modernity is slowly redressing.

Steve

Auriculaire profile image
Auriculaire in reply to Ppiman

Not only were women excluded in the past but apparently female lab animals were not used either as hormonal differences at various times of oestrus cycles would make interpretation of results more difficult.

Ppiman profile image
Ppiman in reply to Auriculaire

That would be for the early pre-clinical research, I should think, where aspects such as absorption and metabolism are being considered. But are you saying that the hormonal effects aren't even studied or, worse, are ignored (even in Phase 1-3 trials) such that when women are later treated, the doctor's fingers need to be crossed?

Thinking back to the one or two studies in which I was directly involved, I can't recall their being any female volunteers, it's true. It's all very fascinating where an androcentric mindset can lead.

Steve

Auriculaire profile image
Auriculaire in reply to Ppiman

Yes. Until the mid 90s there were very few women in phase 1-3 trials. Partly because of the necessity to make sure no pregnant women were included but also because hormone cycles might mess up the results. As you say androcentric mindset. But as a woman I don't find it fascinating. I find it infuriating. Most of the drugs licensed before this were never tested on women and the dosage was determined for men. And they wonder why women get more side effects! Then put it down to their anxiety ! It is still going on. I find it appalling that no pregnant or lactating women were allowed in the covid phase 3 trials but they are being encouraged to be vaccinated. How can you say that something is safe for a group of people when you have no data?

Ppiman profile image
Ppiman in reply to Auriculaire

Aren’t you ignoring the incredible advances in in vitro testing that can now be done, driven mainly by the need to stop animal testing? I’m also sure that female animals were and likely still are used in testing.

Steve

Auriculaire profile image
Auriculaire in reply to Ppiman

Now female animals are used but for drugs thst have been on the market for many decades they were not used in the preclinicals and female humans weren't used in the clinicals. It is highly unlikely that these drugs will be all reassessed but some have been and it has been found that the recommended dosages were actually overdosing women. Animal testing does not reveal all the untoward effects drugs might have on humans . Nasty surprises often pop up in post marketing.

Ppiman profile image
Ppiman in reply to Auriculaire

Capitalist driven science has too many failings for my liking but it looks as if we’re stuck with it. We should be grateful for the likes of our top university science departments but even they aren’t immune.

Old drugs were very poorly tested at times. Aspirin is one such, but it’s likely safe enough.

Steve

Lizty profile image
Lizty in reply to Ppiman

Thanks for that clarification. However, to me this complementary use of PPIs is new information. Hence the number of replies on the subject! It has certainly not ever been mentioned to me by my EP or GP. According to the criteria, I don't fall into the category for needing to take these just yet.... but I will definitely raise this with my GP. Long term use of PPIs is not a road I wish to go down. [I am on Riveroxaban}

Ppiman profile image
Ppiman in reply to Lizty

I agree. I have reflux problems, so I am already "hooked" on lansoprazole, presumably for life. It seems that these drugs are safe, however.

Steve

My SOH was prescribed Omeprazole ("to protect his stomach") and Rivaroxaban in 2016 following a TIA, he has been on them since with no problems. I have been on Omeprazole for acid reflux since its trials in the 1980's, needing 20mg twice daily for a long time, with no obvious side effects.

Hi, I take Edoxaban similar anticoagulant to the one you take. I also take Omeprazole because I have gastric reflux. My symptoms were a lot of mucous in my chest. Acid can cause bronchial and lung problems because they have to protect themselves from dangerous gastric acid by overproducing mucous. That was just a by the way. It is a cat and mouse game with medication. Anticoagulants can lead to stomach bleeds which are not to be underestimated. I have no problem taking the Omeprazole and the Edoxaban. I am only glad we have these medications which can lengthen our lives considerably and enable us to manage our various conditions. Best wishes.

shipyard profile image
shipyard in reply to Peileen

Hi Peileen. I agree with all of your comments much wisdom has spoken, which strength of Edoxaban and Omeprazole are you taking and how long have you been on them?

Peileen profile image
Peileen in reply to shipyard

30mg Edoxaban which is the dosage for weight of 60kg and under. And 20mg Omeprazole which I take at night. I’ve been on both about two years with no problems. I do take a multivitamin/mineral just to ensure there is no lack due to the reduction in stomach acid.

shipyard profile image
shipyard in reply to Peileen

Really appreciate your info... take care and keep on going on, Gb both of you, we have a wonderful Lord Jesus who loves us dearly.

Ppiman profile image
Ppiman in reply to Peileen

PPI drugs are showing themselves to be very useful, so I'm pleased to read your views and experience. They protect from erosion of the oesophagus, Barrett's oesophagus and more. Sadly, they have no effect on pepsin which, for some, can still lead to problems with sore throats and coughing. We lead precarious lives at times and once the bits start to wear out, well - we have to do our best and, I, for one, am very grateful to our doctors and even our pharmaceutical research companies, even with their somewhat chequered history.

Steve

I am taking Rivaroxaban and I used to take them in the morning after Breakfast but my specialist told me that I should be taking them with my evening meal because of more Fat content. I am also taking Esomeprozole when needed so not everyday. Have been doing this for 4 years now and so far so good.

Ppiman profile image
Ppiman in reply to Bowcat

I was told that that was an early recommendation but now that food of any kind is sufficient so it is fine to take them first thing. I was also told that PPI drugs, to be most effective, need to be taken first thing on an empty stomach with a glass of water, an hour before any food. Differently, statins, apparently, work much better when taken in the evening.

Steve

Im on apixaban and was advised over 12 months ago by my GP that it is now their guidance to also prescribe omeprazole.

My concern was having read the patient leaflet it would be the 3rd medication Im on with constipation as a side effect!! She said most people get diarrhoea . Im clearly not most people!!

Ppiman profile image
Ppiman in reply to Pointysticks

I doubt that you'll get any side effects after a few weeks, but nausea and constipation apparently can be problems at the beginning. I was told to take the capsule on waking with a glass of water, an hour before food, for best effect.

If you do feel constipated I can highly recommend Sunsweet Prune Juice. I have spent years trying different things but that one has sorted me out. Thank goodness. In fact, my lovely wife stews Bulgarian organic prunes (from Amazon) in a mix of Sunsweet Prune Juice and water and that works to perfection.

Steve

If you take Rivaroxaban with a large meal - take the tablet in the middle, then you should be OK without the Omeprazole. Obviously see how you get on and then take a decision.I think it's overkill by your Doctor. Good luck

Ppiman profile image
Ppiman in reply to manabouttown

See how you get on? What can that mean? See if you bleed or not? No - I am afraid I trust to the NHS experts on this one.

Steve

manabouttown profile image
manabouttown in reply to Ppiman

Yes it means see if you start bleeding and if you do either change the rivaroxaban or start taking the omeprazole. I also think it might be a good thing to go privately and see a consultant cardiologist as NHS doctors don't have the time to spend enough time with the patient and consider his/her individual situation.

Ppiman profile image
Ppiman in reply to manabouttown

You mean to wait until you start bleeding before taking a preventative medicine? But the bleeding is internal and thus potentially life threatening. That’s why the prescribing advice has been changed, I gather.

manabouttown profile image
manabouttown in reply to Ppiman

I'm no doctor, but presumably you would see blood in your faeces.

manabouttown profile image
manabouttown in reply to Ppiman

Remember the rivaroxaban isn't that strong -provided you're on a standard 1 tablet dose.I take mine in the evening with my dinner rather than in the morning- that way you still have food that you have eaten during the day and you then take it with that meal.The rivaroxaban doesn't stop your blood from clotting ,it slows down the clotting process.

Ppiman profile image
Ppiman in reply to manabouttown

I didn’t think that rivaroxaban was in any way a weak drug. It’s similar to warfarin in its effectiveness.

This is interesting even if the statistics are rather less meaningful :

aafp.org/afp/2019/0515/od4....

Omeprazole/PPIs were only ever meant for short term use but manyvpatients are left on them for years withcno review by the doctor. They just seem very keen on putting patients on these types of Big Pharma drugs whether they need them or not.

Jane😥😎❤

Begs the question why ? I don't trust tablets on the whole and will always think, question now why needed in order that I'm not taking unneccessarily ( thanks in part to Dr Gupta for that ) in my parents day I got the impression that Dr's were viewed as all knowing not to be asked questions. Not now its ridiculous they are human beings.

Ppiman profile image
Ppiman in reply to JaneChapple

I agree with you partly except that that is surely now out-of-date information from when the drugs were first launched. Since then, very many long-term studies have been done and vast numbers of people worldwide who would otherwise have been at real risk of the evils of erosive oesophagitis and Barrett's oesophagus (and worse) have been saved from that fate.

Steve

I take rivaroxaban with my evening meal and have done so for 2 years. No problems at all!! Use to take lansaprozole for heartburn - heartburn trigger paroximal AF for 12 hour episides. Careful what I eat and drink is the best advice. Cut out red wine altogether! . No heartburn for 6 months. Yipee!

I took Rivaroxaban initially with no ppi and had no issue. Then changed to Apixaban as that's taken twice daily and I had been anaemic due to monthly cycle (they then allowed me to stop taking anticoagulants for one week each month). No ppi with Apixaban either. The only time I have taken a ppi was omeprazole for 6 weeks following my ablation, to protect my oesophagus following the procedure. Best to have a chat with your GP.

I am on them as I have to take aspirin 100mg. It is to stop bleeding of the stomach I think with the Aspirin. I take it first thing in the morning and then wait a bit and take the aspirin. Am I supposed to take it with food then. I didnt know that there was something not good about Omeprazole. I thought it just coated the stomach!!

Ppiman profile image
Ppiman in reply to Surreychica_1

Omeprazole and other PPIs were under the microscope a few years ago but have been given a reprieve as the early fears have proven unfounded (i.e. of a link with dementia). There can be rare issues with osteoporosis and magnesium deficiency in a few people, I gather, but these are rare.

Steve

Surreychica_1 profile image
Surreychica_1 in reply to Ppiman

Thanks for that Steve, I was a bit worried as I expect I will be on them for some time to come!!

Ppiman profile image
Ppiman in reply to Surreychica_1

I tried to come off lansoprazole about three years ago but failed magnificently. I've come to think that they are good drugs, even if - as some here suggest - the lesser of two evils.

Steve

This is a good explanation gaviscon.co.uk/health-blog/...

In your case you definitely need it so don’t be put off!

I do so not really put off. Always thought they were innocuous, I used to give them to my cat when she had kidney disease. She was on it for years.

Hi. I take esomeprazole with apixiban [i previously took rivaroxaban] . In the past I hadn't tolerated the "prazoles" very well but after nearly a year this one seems ok. I discussed at length with my GP and decided that protecting my stomach against a bleed was a sensible precaution. I do agree that we seem to fall into the trap of taking a string of medicines to deal with side effects but, in this case, it made sense to me.

This has turned into an interesting debate, thank you everyone for the comments. I had a long conversation with my GP. No Omeprazole needed, but I asked to be started on a statin, as try as I might with hereditary high Cholesterol level, I can't get it down to a safe level and my Qrisk3 is 21% at 63! My leg rash is caused by the Amlodipine, so as they say, onwards and upwards.

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