Is omeprazole still necessary with 7mg prednisolone?

[Sandy1212]

Hey guys,

Great news! Im slowly getting down the pred again, hopefully this time i’ll finally be off them (or at least reach 5 and below). Anyways, so Ive been taking omeprazole because the drs said it was extra protection as high steroids can irritate the stomach. Cool, never had any indication of any different but then never really went more than a day not taking it when on high. So as ive said im on 7mg pred now, and id like to know if it is okay to stop the omeprazole? It’s not the end of the world to keep taking it but i do get bloated from it a lot and if i can take one less tablet then why not, you know?

I have stopped before on it (with dr approval) on a lower dosage but when i did it again when i got lowered again a different dr said that it was ‘naughty’ of me lool so now im confused.

[miccika1]

Depends on you. If you have heartburn or gerd with 7mg you should take it. If not, then don't add it.

[Sandy1212 in reply to miccika1]

I dont think i do; i guess ill give it a try and see. Thanks for posting! ☺️

[PMRpro]

Ask over on the PMRGCAuk forum - many of us there don't use PPIs because of their downsides but all of us are on pred and frequently at above 20mg for many months. Taking pred in the middle of a meal or with plain natural yoghurt is often enough.

If you decide to stop the PPI then you must taper the dose - preferably halve the dose first and again if you are on high enough a dose. Then try to extend the time between doses if you can and then miss odd days - if you stop suddenly you are likely to develop what is called rebound acid production where you produce even more acid than before the PPI and it can be hellish. Switching to famotidine is another way of getting off the PPI, it reduces acid production but in a different way and once you are off the PPI it is easier to wean off the famotidine (replacement for ranitidine which was withdrawn last year).

[Sandy1212 in reply to PMRpro]

Thanks pmrpro! I am on 20mg tablets, is there a lower than that? I was going to do every other day take it and reduce like that, does that seem okay? I never experienced any sort of acid/stomach issues they literally put me on omeprazole straight away from when i was first diagnosed and was on high steroids just as a precaution

[PMRpro in reply to Sandy1212]

There are 10mg tablets OTC and even a 5mg dose for children but I don't know if you can get that OTC.

From the data sheet information:

Administration advice:

-Tablet and capsule formulations should be swallowed whole, without crushing/chewing.

-The delayed-release capsule may be opened and sprinkled onto a tablespoon of applesauce and swallowed immediately. Do not chew or crush granules.

-The delayed-release oral suspension may be emptied into a small volume of water, allowed to thicken (approximately 2 to 3 minutes), and swallowed within 30 minutes. Remaining material should be mixed with more water and swallowed immediately.

So a delayed release capsule can be split to get a lower dose.

This insistence you MUST have it is a pain - and I think it is now being dissuaded, telling doctors to wait and see if it is needed,

[Sandy1212 in reply to PMRpro]

Ill have a look at the information sheet and see what it says, thank you for the details!

[panther50 in reply to Sandy1212]

Hi Sandy I don’t think so. As Miccika says only if you have stomach problems. If you’ve taken it for some time you will probably experience the rebound that PMRpro explains. This lasts for a couple of weeks or so and is your body’s response to the drug being withdrawn. However bear with it treat it with drinking gaviscon, hot water bottle etc (whatever helps) and you will come out the other side.

I went from PPI high dose to cutting down and then switching to ranitidine. When that was suddenly withdrawn from the market I had a few bad weeks of rebound but now manage with gaviscon alone. I had stomach issues so was given it initially for this not for the steroids that I’m on. Prednisone can come EC coated to protect the stomach, but this has to be requested.

PMRpro’s suggestion of coming off via famotidine is a good one and may make transition easier if you have difficulty stopping it. You may not though if your stomach has been fine.

[Sandy1212 in reply to panther50]

Thank you panther50! Will keep your advice in mind when I do come off it in case i have some side effects. I have got a pharmacist consultation next Monday so i have noted pmrpro’s suggested famotidine and your support for it. Much appreciated! 😊

[panther50 in reply to Sandy1212]

No problem. I was prescribed cemitidine when I couldn’t get ranitidine (after I rejected them putting me on a PPI). I never tried it in the end, it’s still in my drawer just in case. I think anything that ends in -itidine is in the H2 blocker family 😀 so there’s a few to try, if you don’t get on with one.

[Sandy1212 in reply to panther50]

Ahh okay thanks good to know !

[Mamamia21 in reply to PMRpro]

Hi PRMpro, I have been reading this thread with interest as I was told by the Dr yesterday that I should be on Omeprazole to protect my stomach. I have been on steroids for 5 years averaging around 10mg and never had any problems with my stomach as far as I am aware. Is this something I should be taking? Don't really want to add more if unnecessary. Your advice would be appreciated.

[PMRpro in reply to Mamamia21]

I've been on pred for nearly 12 years and have NEVER taken a PPI and as far as I know have no problems. Taking pred with food, in the middle of a proper meal, is ideal and many of us on the PMRGCAuk forum take pred within 3 hours of a meal, with plain yoghurt (especially Greek) or another snack. Lots of discussion on that forum about it.

PPIs themselves contribute to loss of bone density amongst other long term adverse effects as well as often causing gut problems - if my husband takes them he almost takes off with bloating and wind and it takes weeks to recover at all, I think he was ill and not eating for months last year after being given them in hospital, leading a decided deterioration in his health.

[Mamamia21 in reply to PMRpro]

Thank you! That is what I was thinking so will steer clear of them.

[Cas70]

Hi Sandy - I was on 5mg Pred and was given Omeprazole - I didn’t get on with it and gradually withdrew from it. The advice given you is good -taper off it. Taking Pred with natural yoghurt is excellent for me - I occasionally get heartburn but take a simple over counter remedy. Personally, I don’t tell the Dr when I drop a med - just the chemist. I do believe we can be over prescribed- at least you tried it. Ginger is great for acid reflux, as is cider vinegar . Best of luck and give it a try.

[Sandy1212 in reply to Cas70]

Hi Cas, thanks for the info! I will give it a try ☺️