Help please

[QAGS]

I am on 30 mgm daily of Lansoprazole for upper Gastric reflux. I have had 2 Gastroscopies which show sliding Hiatal Hernias I take 20mgm MXT orally every week which has been a total success from Day 1 five years ago. I also have B12 injections every other month. Now I read that both of these meds are not to be taken with Lansoprazole as they reduce absorption . my mouth is sore, my tongue red raw, I have no appetite and am excessively tired...advice please.

[vonniesims]

Speak to your pharmacist

[KittyJ]

I’m sorry but we can’t give medical advice, you need to to speak to your doctors and tell them what’s going on, they’ll think you’re ok unless you tell them. I will add I’ve been on mtx and lansoprazole for as long as I can remember and have never been told not to take either. I hope you get some help soon.

[helixhelix]

After a couple of years on MTX orally I started to get mouth ulcers. It happens. Eventually swapped to injecting and the ulcers went away. So these ulcers could be entirely unrelated to your other drugs.

I have also been taking a PPI (like lansoprazole) with MTX for the last 12 yeara. In an ideal world one wouldn’t, but sadly with RA we don’t live in an ideal world and have to make compromises. You need to talk to the medical teams you are prescribing for you.

[Scottishlad]

My late wife used to buy B12 from an online pharmacy in Germany and injected herself monthly as she felt the B12 injections she was getting through the NHS wasn't sufficient.

However as stated above, PPIs only affect the absorption of dietary B12.

I've been on Omeprazole for a long time and my B12 has been marginal for a while. While the levels aren't low enough to justify injections, my GP suggested taking a B12 supplement. She said to buy over the counter as they were much stronger than prescription ones. I've bought 1000ug from Holland and Barrett and they have bought my blood tests up to the middle of the normal range. To be honest I haven't noted much difference in my overall health as I have other issues at moment.

[wedgewood in reply to Scottishlad]

Well that’s great if the tablets work for you They unfortunately don’t help me at all -only injections keep symptoms at bay .

[Tourk in reply to Scottishlad]

Make sure your vitamin b12 comes from Methylcobalamin. As with most vitamins how they are made makes a difference in how effective they are.Do you take vitamin D as well ?

[Scottishlad in reply to Tourk]

My B12 is from Cyanocobalamin, but as stated my blood tests now comfortably in normal range rather than on bottom edge of normal. I do also take vitamin D.

[Haz58]

Are you on folic acid?

[Scottishlad in reply to Haz58]

I was on folic acid for a while before I started MTX. So my dose was changed from daily to 6 days a week (ie everyday except MTX day).

[Runrig01]

The use of MTX with a PPI can increase the level of MTX in your system. However this is only an issue at high doses, like when used as a chemotherapy drug for cancer, and not the doses rheumatology patients take. Ulcers are a common side effect of MTX even in those not using a PPI. Not sure what dose of folic acid you’re on, but it may be able to be increased to help. There are little buccal steroid tablets that you can get to dissolve where the ulcer is and ease inflammation and pain, so you could maybe discuss that option with your pharmacist or specialist. They contain 2.5mg of hydrocortisone which works out at 0.6mg of prednisolone, so very small doses.

Re Vit B, as others say because you’re not taking it orally, it won’t interfere with absorption of MTX. I took both oral for a while, and found I was still fatigued. When they tested my levels Vit B was below range. I then realised the absorption issue. I changed to a sublingual version, and when tested 3 month later was slightly above range. I now use a 1/2 dose of the sublingual to keep me in range.

[Joanneforbes]

hi I found myself in the same position as you but if it helps I was told it was ok by my consultant. I too gave HHernia reflux etc I even take 40 mg day and night

I switched onto injection form which I found better as it by passsed stomach to help with my reflux. All the best x

[Seatgeorge]

First port of call the pharmacist, explain to him or her, if no joy then demand a doctors appointment, good luck

[Rupert2001]

As another reply has suggested, lansoprazole can increase the methotrexate level in your system not decrease it, but this is only a problem when taking high doses of methotrexate, which is not the case for you. You don’t say how long you have been taking lansoprazole for your hiatus hernia but it could be causing the symptoms you are having with your tongue and contributing to your tiredness as it can upset lots of things such as your liver and kidneys and calcium and magnesium. I am sure your GP would be happy to check this out with some simple blood tests.

[QAGS in reply to Rupert2001]

I have been on the Lansoprazole for 3 weeks

[Rupert2001 in reply to QAGS]

If the tiredness etc have only started since starting the lansoprazole it will definitely be worth mentioning this to your GP.

[madme1]

Quags you have to speak to your rhuemy team or your GP. Over the years ive got tough and asked questions as well as the fact i no longer take their responses at face value. Like you I'm on Omaperazole but only 7.mg of Metho. I got reduced from 6 2.5mg tabs to 3 because of stomach issues. I too have a sliding hiatus hernia. Don't go away quietly make a noise and speak up. I hope you get the help you need.

[QAGS in reply to madme1]

thank you, good advice . I would never have thought of questioning my MXT. I have been on 20mgm weekly for 5 years, but this stomach issue is making me feel so unwell. I feel alone in this. GPs don'rt seem to understand. As you suggest it is the rheumy team who will know more. In fact I am thinking of seeing my Rheumatologist privately to get the finite advice.

[madme1 in reply to madme1]

Tiredness is one of the reasons why RA is labelled the sleeping sickness. I have found it is affecting me more when travelling as a passenger in the car. I'm constantly yawning and dozing off.