Omperazole and MTX

[Windonmyface]

Hi, I’m wondering if anyone has had experience with taking both the proton pump inhibitor Prilosec (omperazole) for acid reflux and methotrexate at the same time. (I live in the States and am not sure if your ppi has a different name).

I’ve been on omperazole for many years, but recently my pharmacist told me it interacts with MTX. My rheumy never mentioned it. I asked her about it through the patient portal, she didn’t really answer my question about whether it was bad to be on both drugs. She agreed, however, to send in a prescription for famotidine (Pepsid) which is an H2 blocker and not nearly as effective. My heartburn/acid reflux has been horrendous since I’ve cut back drastically on the omperazole. I was just wondering if anyone else has experience with these two drugs.

Also, I’ve recently switched from oral to injectable MTX, 25 mg per week, in the hopes that my stomach pain would go away. It hasn’t! Has anyone else continued to have stomach pain with the injectable form of MTX? It has helped my arthritis, but it certainly has messed up my digestive system!

[helixhelix]

I have been on MTX and Omeprazole for 10 years now (and omeprazole longer than that). There are lots of drug combinations that are not ideal, and pharmacists will have that noted down in their manuals. They are not “you must not” recommendations, but “use carefully”.

But sometimes we have no choice, and since we are well monitored any problems with this combination affecting out livers and kidneys should be picked up early. There is one woman on here Medway Lady who has suffered kidney problems as a result, but this is very, very rare.

(I’ve just looked up the British Formulary recommendations which say “Omeprazole decreases the clearance of Methotrexate (high-dose). Manufacturer advises use with caution or avoid. ” We are not on high doses, that is cancer patients who have to take 35mg a day)

[Windonmyface in reply to helixhelix]

That’s a very good point about us not being on high doses of MTX. At 25 mg, I had thought I WAS, but not really when compared to cancer treatment levels.

[Niao]

Yes, I raised this question with both Rheumatologist and Gp when I started methotrexate as I'd read the same thing that helixhelix refers to. I've been on omeprazole for many years. Was told it was ok at the doses of MTX we're on. However on picking up my prescription fir omeprazole last week, I noticed there was a note on advising me to take as small a dose as possible due to the interactions with MTX and was only given enough to last me a month at one 10mg tablet a day. I was previously given 3 months supply at a time and allowed to take up to 40mg on occasions when needed.So, it is supposedly OK to take both but I always make sure to take omeprazole at a different time to other meds.

[Windonmyface in reply to Niao]

Yes, it’s the pharmacists that give the alerts about these drug interactions, it seems. Today is my injection day, so I’m biting the bullet and not taking an omperazole tab until tomorrow.

[Niao in reply to Windonmyface]

Yep, you should be fine taking the omeprazole on the same day if you wanted, just leave a good few hours between. Just noticed springcross below. Yes, every time I have tried to cut back on omeprazole in the past I have had serious problems with rebound reflux!

[Windonmyface in reply to Niao]

Good to know, Niao! I may well be popping that omperazole before the day is over.

[Niao in reply to Windonmyface]

😄 Me too unfortunately, taking one right now!

[springcross]

Hi Windonmyface. When you cut back drastically on Omeprazole, did you do it gradually? If not, you could be getting rebound reflux due to the sudden drop. Somewhere on the internet there is advice on how to decrease, particularly if you have been on them for a long time, as you have, but unfortunately I can't tell you where. If I come across it, I will post the link to you. Good luck. x

[Windonmyface in reply to springcross]

I think that’s exactly what happened, Springcross! Just three days of no omperazole sent me into a tailspin. I sent a message late last night to my doctor and he gave me detailed advice on how to taper off if I decide to do so.

[springcross in reply to Windonmyface]

Oh that's really good, glad you've got the instructions on how to do it. 🤞 x

[nomoreheels]

Hiya Windonmyface. I was diagnosed seropositive in 2008 & taken omeprazole from day one, MTX was added the following year. Since 2010 I’ve injected MTX but still prescribed omeprazole, initially 20mg but 40mg for around 6 years or so. In total 12 years of omeprazole & 11 of MTX concurrently, 40mg & 17.5mg at the mo.The issue is that there are potential issues taking both together in high doses, this doesn’t apply to the low doses we take, or rather rarely does. Maybe this is where the confusion has arisen with your Pharmacist? If you were to take a poll I’m pretty sure that most of us taking MTX also take a ppi, omeprazole being the most commonly prescribed one initially, due to the other meds we take which can be hard on our tums, NSAIDs & pain relief being just two. As we have regular drug monitoring bloods any serious issues will be flagged up. Ultimately we need to ensure we protect ourselves from secondary issues such as gastric ulcers, heartburn & reflux problems... we don't live in an ideal world with RD unfortunately so we've to weigh up benefits & given the risk is low we're prescribed ppi's alongside MTX.

Just as info as you questioned it the major brand of omeprazole in the UK is Losec but generally as we're not governed by medical insurance we're prescribed a cheaper generic so usually just say the medicinal name of omeprazole.

I hope this is helpful.

[Windonmyface in reply to nomoreheels]

Thank you. It’s very helpful to hear people’s personal experiences with this drug combo. I had gastro-esophageal reflux problems for years before going on methotrexate last February, so it’s a no-brainer that I would have trouble on MTX.

[medway-lady]

Famotidine is a much better med. and I had an acute kidney injury from Omeprazole although it is very, very rare, it is not a drug without risks. If your'rein the USA you'd be aware that more evidence is becoming apparent that long term Omeprazole is not good for anyone. I don't know about it reacting with MTX as I was taking LEF and have never had any sort of acid reflux at all. I'm now prescribed Cimitidine which is also an H2 blocker and these really are better and your lucky to get them here as a lot more expensive than Omeprazole. I also had regular blood tests and am very lucky that the injury which was sudden, unpredictable and totally painless was picked up so fast and I spent 14 days in hospital. My kidneys were permaantly damaged and to be honest kidney failure is a heck of a lot worse than RA. The damage which was investigated by the NHS and the subject of a serious incident report was sadly something which could not be prevented, it was just a bad accident and one from which I will never recover from. So although I do understand your feelings about Omeprazole it does seem that your health care provider is really on the ball and acting in your best interest. Give the Famotidine a good go it may take time to work the Cimitidine is an alternative but I'm sorry I don't know the trade names as in the UK we only use the generic name.

[Windonmyface in reply to medway-lady]

I’m so sorry your kidneys were so badly injured by omperazole! Thank you for giving your personal testimony—it means a lot.

[Windonmyface]

Thank you for all your helpful stories and advice. My primary care doctor, in a message this morning, wrote, “I would rather not feel miserable and take a little risk than feel miserable (and risk esophageal narrowing/stenosis) because you have a concern about a rare side effect.” Then he gave me detailed instructions on slowly tapering off omperazole (taking 3 or 4 months to do so).

I think I’m going to go ahead and try a very long tapering off of omperazole and hope that I don’t suffer like I did last night! Again, thanks for your input.

[Niao in reply to Windonmyface]

All the best🙂

[medway-lady in reply to Windonmyface]

Sounds like a good doctor ! and it's nice to read he/she has helped you.

[springcross in reply to Windonmyface]

That's brilliant, I'm so pleased to hear that. I wish you all the best with it. xx

[cakenomore]

Hi , I was in the same position as you although I hadn't been on omperazole as long. My Rhmy wasn't worried at all but pharmacist was concerned. I take high levels of folic acid and vit D and omperazole can interfere with the obdorbtion of vitamins and nutrients apparently, as well as all the other side effects it has. I chose not to risk it. I'm also being investigated for gluten intolerance. One of the symptoms is heartburn and severe fatigue not just all the gut problems that you would associate with intolerance. So it might be worth experimenting with your diet to see if certain foods cause different reactions. You can get blood test for intolerance. It might shed some light on a symptom that we all tend to just accept. I hope you can get some relief x