Methotrexate and omeprazole: Good morning everyone I... - NRAS

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Methotrexate and omeprazole

Bon1
Bon1

Good morning everyone

I have avoided taking omeprazole for ages because I just wanted to avoid adding yet another drug to my huge list! However my stomach is sore and my gp is insisting because of the Prednisolone that I take. However I am a little concerned because he also told me there was a “theoretical interaction” between mtx and omeprazole to do with emilination of mtx.

Do you take the two together and is this a known thing?!

Bon

X

19 Replies

Potentially, but I’ve taken omeprazole since diagnosis in 2008 & MTX the year after & my kidneys haven't reacted. I can't say I’ve been specifically told about the two together, I'm on a low maintenance dose of prednisolone, have been for nearly 8 years, but have always had an NSAID. Are you prescribed enteric coated pred if your GP is insisting it's that? If not, ask him if you should be that being the case!

Drug monitoring bloods keep an eye on our creatinine & urea levels so if there are any spikes it will be picked up.

Bon1
Bon1 in reply to nomoreheels

Thanks so much NMH. It certainly seems as though many people are taking omeprazole with no ill effects. The enteric coated pred sounds like a good idea. I’m going to ask my Rheumatology dept about that. Take care.Bon

X

Never heard of that ... being on pred it is super important to take... I ended up with gastritis (a precursor to ulcers) because I was given Pred 10 years ago for 2 weeks after a severe asthma attack... any nsaids and you should take omeprozole/lanzoprazole ... omeprozole being the weaker dose of the two. It is one to worry about where the effects of not taking it to protect your tummy are great and long lasting. I have been on lanzoprazole for over 10 years... had to go to up to esomeprozole because I was on Sulfasalazine but now I’m off that I am back down and I am taking methotrexate by injection and have been on 30mg pred since august with 20mg before that since jan 2020. I’m taking enteric coated pred etc.

Bon1
Bon1 in reply to bubblyalex

Thanks so much for your reply. I think this bout of gastritis I’m having was actually sparked by a recent short course of high does pred for an allergic reaction. Is Lansoprazole better/ stronger than omeprazole? Bon

X

bubblyalex
bubblyalex in reply to Bon1

👍🏻 that would make sense. Lanzoprazole is the next step up from omeprozole if omeprozole isn’t enough... then it is esomeprozole after than.

It is on the list of possible interactions, but only as one to watch. Your MTX blood tests will pick up and problems before they become problems.. i have been on both for 11 years now without so much as an early sign of any interactions developing. There are of course also risks with Omeprazole itself, albeit hugely rare.

As ever, we are between the devil and the deep blue sea. Your body, your choice!

Bon1
Bon1 in reply to helixhelix

Thanks HH. So true...it’s all shades of grey once you’re a grown up isn’t it? And I’m useless at making decisions! Good to hear you’ve had no ill effects though...

Bon

X

It's about risk and balance. You have already got a sore tum so is there a choice? I'd say probably not and in fact am the very rare case of incurring an acute kidney injury from Omeprazole. But its so rare its only affected a handful of people in the UK and less than 100 worldwide so I'd still have taken it as the risk is so infinitely small. Omeprazole is a safe drug taken by thousands of people in the UK and you'll get regular blood tests to check your kidneys and liver function so as long as you do the blood tests then you should be be fine. All medications have risks; paracetamol does kill people and yet most of us take it without a second though. I don't know about interactions sorry. x

Bon1
Bon1 in reply to medway-lady

Thanks so much ML. I don’t know why I’m having a mental block about this when some of the other meds I take are so much more “poky”. I’m sorry your kidneys have been hurt - hope it doesn’t impinge too much on your quality of life.Bon

X

Hi i have lupus and i believe it was my immune system itself that attacked my stomach. I tried all the different types of PPIs before it finally calmed down and was nervous about taking prednisone for this reason. I always had the enteric coated ones and actually had no problem from steroids. After 10 years after going from Pantoprazole to ranitidine (which was suddenly withdrawn due to a cancer risk) I have finally weaned myself off and manage with just occasional Gaviscon tablets. No one ever reviewed or suggested I trying to come off. Anyway my point is you may not be on these forever. I think they can calm your stomach when it’s bad but they aren’t always added to your list forever. I know prednisone can affect your stomach (may depend on dose) but I know many people who take it without any problems. It could be something else.

Bon1
Bon1 in reply to panther50

Thanks so much Panther. I was kind of hoping Gaviscon might suffice for me too! But I get the impression that something more systematic might be the way forward. Encouraging that it might not be permanent!Bon

X

Omeprazole is widely prescribed to many people. I take it first before my other meds. It protects the stomach , as far as I know it is important to protect the linings of the stomach. I have a hiatus hernia so very necessary for me to take it. Good luck to you , hope you get sorted.

Bon1
Bon1 in reply to rabbits65

Thanks so much rabbits. My mum had a hiatus hernia and used to take omeprazole too.

I’m the same as you, I tried to avoid omperazole as I take 5mg pred as well as azathrioprine I’m always feeling nauseous my stomach always sore, makes no dif to me even if I take the omperazole later in the day! Are you on 20mg omperazole

Bon1
Bon1 in reply to RubyWoo6

Hi Ruby. I’m on a maintenance dose of 7mg at the moment but have been on some whacking great amounts in my time. I think what started this bout of gastritis was actually three days on 30mg that I was prescribed after an allergic response a while back. Annoyingly a dermatologist later told me that they don’t prescribe high dose pred for urticaria any more . 🤦🏻‍♂️

panther50
panther50 in reply to RubyWoo6

I’m no expert, and I don’t know if this helps, but when omeprazole didn’t work for me my GP at the time tried changing dose, switching to lanzoprazole until finally I was put on pantoprazole which did work. At the time pantoprazole was more expensive so they always started with omeprazole first.

Ailsa-NRAS
Ailsa-NRASAdministrator

Hi thereThere is no interaction between MTX and a PPI (stomach protection) that so I would recommend you follow the advice of your Dr and take it. It is in all guidelines that PPIs should be taken with any anti inflammatory medication- I have been on MTX for 30 odd years and numbers of times during that time when I’ve been on steroids or NSAIDS I have always taken a PPI to protect my stomach. Hope that helps.

Bon1
Bon1 in reply to Ailsa-NRAS

Thanks ailsa I appreciate your response and it makes perfect sense. I should probably just get over myself and follow the advice!Bon

X

Best advice is to take the advice of the medics (and I used to be one.)They’ve dealt with all our problems and then some over all the years and know about drug interactions. It’s good advice that’s been given on the forum. Most of us have had to take stomach protectors with prednisolone - and you should be on enteric coated for long term use - without any problems. I have been on variations of Omeprazole for 25 years as I’ve been on Pred for 32. (despite what drugs I have alongside it I can’t ever come off it) and it does make a difference to how your stomach and gut feel. Nothing worse than RA and stomach problems! Good luck and hope you settle down soon on whatever combination you’re given.

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