Dexamethasone (Steroids) - is it really a requirement to use along stomach protector?

[Boxing]

hello

Does anyone know if we need to use a PPI or H2 blocker alongside using steroids? Do you not?

I take my 4Mg dex with my cereal which is bran flakes and milk..

[Winner76]

Hi,

I take 5mg steroid along with lots of other tablets and was started on 40mg PPI straight away. I’ve heard so many negative comments about PPI so I got them to reduce it to 20mg.

[Boxing in reply to Winner76]

thanks! I can’t take PPI interacts with one of my medication. They gave me Famotidine instead.. not sure if we really need these I always thought if you have food with steroid it’s all ok

[Winner76 in reply to Boxing]

I’m not sure myself , I thought they were given to protect the stomach lining . I take Pantium. But since my transplant nearly 5 years ago I have constant stomach and gastro issues.

[modernmusic]

I have been taking Prednisone 5 mg for 3 months and haven't had any stomach problems so far. I don't take Famotidine or any other medications to protect my stomach from acid. I am 78 and will celebrate 2 years post transplant in March. I also have never had any problems with stomach acid. My wife has never had a transplant and she takes Famotidine for her stomach acid.

[Boxing in reply to modernmusic]

that’s good to hear! Didn’t the doctors recommend a stomach protector due to taking the steroids?

[modernmusic in reply to Boxing]

Not yet. My transplant coordinator likes to take things one step at a time. I'm not reporting any stomach problems so he's not prescribing any stomach meds

[redpanda67]

There are two reasons they prescribe PPIs after transplant. High dose prednisone can cause peptic ulcers, but once the dose is lower the likelihood of developing an ulcer is less than 2% (at least in healthy populations). Secondly, mycophenolate mofetil (MMF), can aggravate the stomach and cause nausea, heartburn, and bloating. MMF can also cause some serious gastrointestinal problems.

Transplant centers are avoiding long-term PPI use, and most are taking patients off PPIs at the end of their first year or when they have reached their low maintenance dose. PPIs can also interfere with the absorption of a variety of drugs, including prednisone and MMF, which is the other reason they are trying to avoid their use for the long term.

I stopped taking PPIs about 3 years after my transplant (20 years ago) because I was having a series of GI problems and the gastroenterologist took me off all "non-essential" medications. I never went back on Prilosec and have never really had too many issues. Although I do have some nausea caused by the mycophenolate, I have found lots of natural remedies that don't interfere with my other meds to prevent the nausea.

It really comes down to the individual patient and the transplant center. Some patients may need them because they have serious GI problems or take other meds that cause GI issues, and the additional burden of transplant meds makes it worse. Others may not.

Hope this helps.

[Boxing in reply to redpanda67]

thanks for the response much appreciated! I am on steroid temporarily to be honest. I am on 4Mg Dexamethasone. I just wasn’t sure if it’s necessary to take a stomach protector I haven’t for the month I been taking dex. I can’t have PPI because interacts with my other medication so they said to take Famotidine. I was wondering how likely is the risk for GI issue such as ulcer or bleeding from steroid if taken with food. I take mine with cereal which is with milk and banana

[HSP1965]

Pantaprosol gebruik ik.Bijna 5 jaar geleden getranspanteerd.

Kan echt niet zonder.