Nausea and vomiting - at 7.5 / 8mgs Pred?

[strawclutching]

Hi Folks,

Just wanted to pick all your super human brains again if that's ok, you lovely people!

Have had a lot of problems lately, but most debilitating over last few weeks has been nausea - so bad it stops me eating and sometimes I vomit about an hour after eating. Two weeks ago was bringing up some blood - around a dessert spoon each time, so went to A&E - it was a Friday evening - lots of unmasked drunks, etc. Anyway, bloods were near as normal they said and most likely the steroids had irritated my stomach a bit. Bye bye. But the problem continues. Have just tried tapering to 7.5mgs from 8mgs Pred but pelvic pains did not subside and had some jaw ache too so went back up to 8mgs. Jaw ache gone after just 2 days. Just to add something else which could be the nausea culprit - have also been tapering Omeprazole over the last 5 weeks from 80 mgs per day (Whaaat???? - I know, way too much) down to 40 mgs (Way hey! - but still too much). Had hoped to drop down again this weekend but with all the stomach issues, not sure. If it was an acid problem, I'm not tasting any acid in the vomit - sorry if anyone's just eaten.

Rang the rheumatology nurse yesterday and she looked at my Pred tapering plan and insisted I stuck to the 1mg drop every 4 weeks - I'd been going slower, taking signals from my own body. She said I should be down to 6 mgs by now and must get them down faster according to consultant's plan. She agreed with A&E verdict and says my stomach sickness will lessen as the Pred dose goes down. I sheepishly said ok but still took the 8mgs this morning - will spend time on naughty step later. I'm just bamboozled that if Pred was causing the stomach problem - by the way I've been on enteric coated ones since December - why didn't I have the problem before?

Have also given up the statins (ten days ago) as they used to give me stomach problems - have tried several types but the latest low dose Rosuvastatin seemed ok - however not planning to re-introduce it unless absolutely necessary, just covering all bases. Food intake is always the same plain boring stuff so can't be that. Have fluid retention in legs despite low sodium levels and low sodium intake - could be Amlodipine to blame. Grateful for any thoughts and advice.

[Lolabridge]

I’ve not experienced those problems taking Prednisolone but it does sound as though you have a sensitive stomach. We’re you advised to taper the Omeprazole? Under the circumstances I think you need to follow the medical advice you’ve been given and contact your team if or when any further problems arise.

[strawclutching in reply to Lolabridge]

The GP told me ages ago the high dose of Omeprazole was dangerous long term and I must get it down. I was put on 80 mgs last October after an endoscopy. I was given uncoated Pred without any stomach protection at the beginning of the GCA treatment which started all my stomach issues, but they settled after a few months. Until just a few weeks ago. Thanks for your quick reply Lolabridge.

[medway-lady in reply to strawclutching]

There are alternatives and I agree with Lola and I'd say stay off the self medications even an innocent OTC could have a build up effect and beware Omeprazole it is not good long term and make sure your blood is tested whilst on it. It can have long lasting and very dangerous side effects. Bromelian is a derivative of Pineapple I seem to recall and not good with blood. I'd say never take any unprescribed meds even ones classed as foodstuffs without the agreement of your RA team.

[strawclutching in reply to medway-lady]

Thanks Medway Lady. Do you think it's safe to continue dropping the Omeprazole by another half despite the stomach issues or should I wait an see?

[Lolabridge in reply to strawclutching]

I really don’t think we can advise you. Please contact your GP for proper medical advice.

[strawclutching in reply to Lolabridge]

Ok thanks.

[medway-lady in reply to strawclutching]

I think ask your medical professional. If they say cut down then thats what I'd do. But I would make sure it was ok to take all the other non prescribed stuff as well. x

[strawclutching in reply to medway-lady]

Thanks Medway Lady. Will speak to the GP on Monday.

[happytulip in reply to strawclutching]

80mg is an acceptable dose of Omeprazole if treating acute gastritis which might be what they found on the scope? I agree that long term PPI isn't ideal but neither is an ulcer. I have been on 40mg of Omeprazole for over 5 years as it is needed. I suppose its about the risk vs benefit. Dropping down further or switching to a different PPI like lansoprazole or pantoprazole may be best discussed with your GP?

Given that you have vomitted blood after eating I think dropping your stomach protection further would be quite risky. When did you last have a scope? You may need another one?

[strawclutching in reply to happytulip]

My last scope was October 2020 when I was put on 80 mgs. Omeprazole. Must say I was surprised that after vomiting blood two weeks ago, A&E didn't mention the possibility of an ulcer. I haven't had any stomach pain, but have had more stomach bloating than usual and felt unwell. Five years is a long time on Omeprazole. Have you maintained calcium levels and other minerals in this time? Any other side effects?

I will discuss with the GP on Monday and hope to get something positive from it. Telephone appointments haven't been too productive over the last 18 months. Thanks Happytulip.

[happytulip in reply to strawclutching]

I have to have a PPI with all the meds I'm on. Oh I come off I hey gastritis and reflux unfortunately. I am prescribed calcium as I am also on high dose pred.

I get a full MOT. Don't worry, I was a nurse for 15 years so I scrutinise all my results. I'm lucky to have very good consultants and GPs. Very lucky.

If you have had more bloating I wonder if they need to test you for H.pylori. although you would have to come off omeprazole for two weeks prior to the test. The only other diagnostic test that I am aware of is a scope and biopsy.

I too am surprised that A&E didn't consider an ulcer. If you are on pred and need high dose PPI them bringing up blood is a red flag.

Did you vomit it up or cough it up?

Either way, I hope your GP is helpful and it gets sorted.

[strawclutching in reply to happytulip]

The blood was in my vomit, so definitely from the stomach. Been reading about stomach bacteria changes with PPI use and how it can cause gluten intolerance which in turn can cause nausea, bloating, vomiting and frequent UTI's. I get a lot of UTI's. Maye I'll try cutting out the wheat and see what happens. I found a home test kit for H Pylori (finger prick) on the internet for £19.99. I wonder why the NHS don't do something as easy as that?

[happytulip in reply to strawclutching]

I think a blood test is available but a stool sample is the bog standard test.

I am gluten intolerant but than was all before I started omeprazole. In actual fact the PPi has helped things.

[oldtimer]

This does sound as if it needs a bit of sorting out - it's complicated isn't it. Firstly the amlodipine - yes that can cause the oedema, so that needs reducing/changing.

But the nausea and sickness should not be happening. What's that due to? That's more than just reflux. What other medications are you on that could be causing it? Is there something else that needs investigating.

Write it all down, and say firmly and persistently to your medical team that it needs investigating!

[strawclutching in reply to oldtimer]

I'm taking Losartan 100mgs and Amlodipine 5mgs for blood pressure and 8mgs Prednisolone enteric coated; 4,000 IU's vitamin D and K2, Bromelain and organic digestive enzymes, stomach friendly vitamin C - the last 5 supplements have been taking for many months without a problem. I have an online consultation with Rheumatology on 12th. August. I will write everything down. Thanks so much Oldtimer.

[Mmrr]

Some useful advice above, I would add you should taper prednisolone under guidance from your rheumatologist, but at your own pace too. Just because a reduction of 1mgs every 4 weeks is suggested doesn't mean it is not flexible. Coincidentally I struggle getting from 8 to 7.5 mgs too. I've recently reduced to 7.5 and can feel myself heating up. This is my3rd attempt.

[strawclutching in reply to Mmrr]

Thanks Mmr. Must say I've had more easy going rheumatology nurses than the one I had on Friday. She was a stickler. How long did you stay on 8 mgs before trying to go to 7.5? The nurse I spoke to said going down half a milligram was way too cautious. I just think it's wise. In my case any way. I hope you manage to get down to 7.5mgs. Could be third time lucky.