I was told at a Cardiac Rehab session 2 weeks ago that I should have been prescribed a proton pump inhibitor to go with my dual anti platelet pills when I was discharged from hospital after heart attack over 2 months ago, but it had been missed. I queried it, as it’s not listed as a standard in the BHF list and I’m not at high risk of gastrointestinal issues like it says in the NICE protocol, but they insisted and sent a request to my GP.
I had a text on Wednesday to say he’d prescribed omeprazole. But when I requested it through the NHS App on Thursday, he’s rejected it today.
I’m confused. And don’t know why the GP hasn’t let me know what’s behind his U-turn! Anyone else had a PPI prescribed and then refused? Is is a standard post MI, like cardiac rehab nurses told me? Or only for those at risk and need it, like NICE guidelines state?
Written by
BlueDays24
To view profiles and participate in discussions please or .
I’ve been reading posts on this site for some months and have noticed that people who list their medications after cardiovascular events usually show a proton pump inhibitor.
However, there was a change in recommendation about two years ago such that Omeprazole wasn’t recommended to be prescribed alongside clopidogrel (at least that’s how I remember it)
To get to the bottom of this I suggest you speak to the pharmacist employed by your doctor’s group of surgeries, failing that your dispensing pharmacist. They should have this sort of thing at their fingertips. Gp’s are generalists, pharmacists are specialists.
Apart from being prescribed for reflux disease (which is why I take them) PPIs are apparently usually prescribed when there is a chance of gastro upsets due to the effects of taking other medication in order to 'settle the stomach' particularly when anti platelets like aspirin are involved. Some people definitely do need this protection it seems but not others from reading on here. If you have managed two months without a PPI and have not had any gastro upsets so far then maybe you don't need to take them. I certainly question the need for any medication when it may not be needed. So I suggest you contact your GP surgery to find out why they have rejected your request because at the end of the day only they will know the real reason which could just simply be a mistake, or equally a genuine reason. Finally be aware PPIs come with a chance of side effects like all medication, although they don't seem to affect me, and that's another reason not to take them unless they are necessary, but that's down to your GP to advise you on the potential outcomes.
not really related to the drug issue, but I’d be watchful of the ‘Rejected’ and ‘Approved’ stamps on the NHS app as I’ve found them not to be as accurate as they should be.
I’d check directly with your chemist as to whether they’ve processed the order.
Just check with your gp ...my presriptions are often "rejected" on NHS app and Patient Access...they never have been in reality. I do wish soneone would sort this bug though.
Thanks for your replies. I did talk to the dispensing pharmacist at the practice dispensary about this medication when collecting my other pills, but he said they were all dispensers and couldn’t discuss the medication. And the practice receptionists are so very adept at refusing my requests to talk to my GP, or any GP. I ended up in tears at the front desk last week when they said no, no appointments until January, and they can’t book anything in January as the schedules aren’t out yet. It is very frustrating.
I’ll gather my strength over the weekend, and try and get an answer next week before they shut down for Christmas.
It's extremely frustrating isn't it when that happens!
When I went to the pharmacy back in 2018 only to be told the GPS had refused to issue my prescription as supposedly I was due for a check up which I hadn't been told about I had made a fuss and demanded I receive my prescription and the pharmacist had rung the surgery and had demanded they give me my prescription and they backed down and gave me it so I took it and changed surgeries as that was appalling!
I think you have good reason to be very grumpy with your GP practice. So far you have been denied an understanding of the reason you are being denied your omeprazole prescription. However the reason might be as EdtheDead has pointed out below regarding the interaction of omeprazole and clopidogrel if you are taking that as part of the dual anti-platelet treatment. Nonetheless other PPIs are available e.g lansoprazole, on the assumption you actually need a PPI, and so far your GP prartice has failed to resolve the matter. If I were you and didn't get any resolution next week I would write and submit a letter of complaint, attention the practice manager, pointing out that it it is causing you unnecessary stress which you could do without. When I have done this in the past, matters have usually got resolved very quickly.
If you're taking Clopidogrel then no GP worth his/her salt will prescribe Omeprazole. It took the intervention of my pharmacist to change this to Lansoprazole.
Good point. Omeprazole and Esomeprazole (Nexium) are both 'discouraged' to be prescribed alongside Clopidogrel, which is why I was changed from Nexium to Lansoprazole when I took Clopidogrel for 12 months following my NSTEMI.
Back in 2018 I got extremely frustrated after my old surgery refused to issue my prescription claiming that I was to go in for a check up before I had it and I refused to have the check up and made a fuss at the pharmacy and the pharmacist rang the surgery up to insist I have the prescription ASAP and they backed down and said OK just this once!
What I did was I collected the prescription got it dispensed at the pharmacy and then changed surgeries to one that can't do enough for me and have stayed with them ever since!
With respect when that other surgery did that that was appalling!
I’m on Ticagrelor not Clopidogrel so that’s not the issue. And the cardiac rehab nurse requested that my GP issue the prescription. But then the GP issued it, and 2 days later rejected his own prescription.
My logical brain says there must be a reason, although maybe it’s an NHS App gremlin rather than a considered decision as some have suggested.
Maybe the GP checked the NICE guidelines and realised he shouldn’t have prescribed it without reason, even if the Cardiac Rehab nurse asked for it.
If only it was a straightforward matter to “talk to your GP” but I’m having real problems getting past the receptionists to anyone medical who might know what’s going on.
After my heart attack i was prescribed lansoprazole alomg with the usual cocktail of drugs. I have to say a few months avo I ran out and on day 3 I knew all about it with really bad heartburn and pain in my stomach. Settled again as soon as I got the prescription x
After my TAVI in July in 2023 my surgeon prescribed only Clopidogrel (in addition to the Ramipril and statins I was already on). Two or three weeks later my GP messaged me to say I should be on a PPI and suggested Omeprazole (!!! see above). My surgeon insisted that I didn't need a PPI. Then the GP messaged to offer me a choice between Omeprazole and Lansoprazole. I didn't reply, then she issued a prescription for the latter. For two or three months after the OP I'd been experiencing severe bloating and violent wind, so I took the pills, with immediate relief. Nowadays I take them if I've slight discomfort. Recently I saw a cardiologist at my local hospital, and he agreed with my policy.
As some others have previously posted, the dual prescribing of clopidogrel and omeprazole are contraindicated due to the effect this PPI has on the efficacy of clopidogrel. Any pharmacist should pick up on this if prescribed, and advise going back to the GP for an alternative PPI to be prescribed.
I had my prescription rejected last week. I ordered two weeks early because of Christmas. However apparently you can only order when you have 2 weeks worth of your prescription left, and I had 3 weeks. Beurocracy I’m afraid, rather than common sense sometimes!
I've been told by a gastroenterologist that only high risk people for gi bleeding are advised to be on PPI medication while they're taking dual antiplatelet medication. People with history of peptic ulcer or prior gi bleeding or are also taking other meds that can irritate the stomach lining like high dose aspirin or steroids are put on PPIs. If you're still concerned, don't hesitate to check with your GP or cardiologist though.
That’s what the NICE guidelines say too. But 2 cardiac rehab nurses were adamant I should have been prescribed a PPI when I was discharged from hospital, and that it had been missed rather than being an appropriate choice by the cardiologist at the time.
It’s difficult when you get contradicting information from the cardiac ‘experts’, who you might expect to know the latest guidance on optimum treatment after a heart attack.
I’ve only ever met my GP once, but I’m sceptical he knows more than the cardiac nurses do - at that one appointment, he suggested stopping both Bisoprolol and Ramipril just 2 weeks after the heart attack, against the cardiologist’s advice! And I can’t get access to ask my cardiologist about something so relatively minor in his grand scheme of things.
This issue once again raises lots of different opinions from nurses, consultants, doctors, patients. It is your body, you have heard all the different opinions, time to make your choice.
You may have already tried this, but, if not, it might be worth contacting your cardiac rehab team again and explaining what has happened, especially as they sent the request through for the prescription. Maybe they can contact the GP surgery and get some answers for you about what happened with the prescription. Anyway, I do hope you can get it sorted out without any more unneeded stress.
Just to add, I am also taking ticagrelor after a heart attack in August and was prescribed Lansoprazole when leaving hospital.
My experience of Lanzoprazole (PPI) was dire - violent diarrhea and exhaustion. Ironic when you consider it's prescribed to prevent gastro issues when on aspirin. I was prescribed it only for the 3 months when I was on higher dose of aspirin.
Like your experience cardio nurses were dead keen on it , but as soon as I was moved to lower dose of aspirin I stopped. I make sure I have breakfast before the pills and have had no issues .
For me the lanzoprazole delayed my recovery after OHS by months. Personally I'd avoid the pills .
I’ve still not had an explanation from the GP (despite asking at the surgery several times for his reason for prescribing and then rejecting), but when I told the cardiac nurse who’d asked the GP to prescribe it about the situation, she just suggested that I take the second Ticagrelor after food too - which seems a much better way to protect my stomach than taking another medication which can cause magnesium deficiency.
Three weeks later, and during an appointment with another GP, the message came through to her to say my GP had just made a mistake when he’d rejected my prescription for the PPI. Meanwhile I’ve read up on risks and benefits, and decided not to bother as I have no stomach acid issues.
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
Recovery 
Cardiac rehab class, a bit disappointing at the moment 
Underhand Tactics
Good news
