Alternatives to Omeprazole?: I am 3 months into my... - PMRGCAuk

PMRGCAuk
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Alternatives to Omeprazole?

I am 3 months into my PMR journey, currently on 21mg of Pred. My GP was very keen to start me on Omeprazole when I first started taking the steroids, but I resisted - thinking I could protect my stomach by taking them with yoghurt as some of you have suggested. I'm also taking Aloe Vera every day.

However, in the last week or so I've started to get some twinges of pain in my stomach and my GP's words that I "don't want to end up in A&E with gastric bleeding" are ringing in my ears.

So I've just taking the Omeprazole packet down off the shelf, but I'm concerned about the side effects of another "heavy-weight" medication on top of the steroids. Especially the effect on bone density, and also it can reduce your white blood cell count (mine is quite low already).

Does anybody have any alternative suggestions?

Many thanks.

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Hi Katie, I actually was given coated pred from the start which did not seem to cause the same problems as uncoated, so I have never taken PPIs with it. You could try Zantac which is an older drug for stomach protection and possibly gentler and was a forerunner to the PPIs such as Omeprazole. I must admit everyone seems very keen on giving me PPIs, rheumatologist, GPS, pharmacist.

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Thanks Piglette. I will ask my GP about getting some enteric coated pred, that sounds sensible for starters. Thanks also for the info on Zantac being gentler than Omeprazole.

Kind regards

Kathryn

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Enteric coated is available in 5mg, 2.5mg and very recently 1mg in UK. All different colours which helps!

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I have taken Lansoprazole - a proton pump inhibitor for more than a decade due to an acid reflux problem shared by all my siblings. So far I appear to have had no side effects - and have not found this to be a problematic - but actually an effective drug. As I was already taking it when I had to take Prednisolone for PMR/GCA it didn't present any special issue for me. I still take my Pred each am with thick unsweetened greek yoghurt and this has generally worked well protecting my stomach. However as another option - in some countries at least you can get enteric coated Pred which might suit you better.

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Hi Rimmy, thanks for the suggestion of enteric coated pred, which was also mentioned by Piglette. I think I'll start with that and see how I get on.

Best wishes

Kathryn

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Hello, another answer to go into the mix. I can't take PPI's like Omperazole as they don't agree with me and I also have cyclically low Neutrophils. I also have a history of gastric reflux and diary upsets my gut, especially now for some reason. I tried Ranitidine successfully as have had before years ago, but this time round after two weeks I got rebound acidity and my gut went on strike, refusing to work properly and digest fats. Even with Ranitidine, ordinary Pred gave me raging acid so I had to change to enteric coated, not ideal for GCA I gather. Anyway, it has been fine as long as my stomach is very empty when I take it (unlike uncoated) and for two hours after. I take a slug of Gaviscon Advance (lower salt) at night shall I do now. So far so good.

I have seen many patients as a nurse taking all of those meds with no problems too. As with all meds, you'll find stories on both sides, you just don't know which one you're on. You do need to protect your stomach and oesophagus though, one way or another.

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Thanks very much for that detailed reply. I'll definitely give the enteric coated a go. And maybe the gaviscon would be a bit more gentle than the omeprazole.

By the way, how have the GCSEs gone? Mine has got last exam (product design) on Monday, then we can forget all about it - until results day!

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Five weeks of slog finished on Friday. The games console is now getting some heavy use. No idea how things went; you can never tell with daughter No2 who gives nothing away. Could go either way....

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I also take Ranatine ,one 20 mg in the AM and one 20 mg in the evening,It seems to work without the side effects of Prilosec which I took for years.I am currently taking 14 mg a day,just dropped from 15mg on Friday.My primary care physician is great and slowly dropping the dosage by 1 mg Every 3-4 weeks as long as I don't have a flare.

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Ranitidine (brand name Zantac) does exactly the same with different side effects. The real difference between it and PPIs is minimal - though to listen to the stories from the drug reps you'd think it was the best thing since sliced bread and SOOOOOOO much better. It isn't that much better!

If you are in the UK, as piglette says, ask for enteric coated/gastroresistant pred. Your GP will probably say it is far more expensive - no it isn't since the difference is minimal now and you also won't have a second prescription charge involved.

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Thanks PMRpro. It's bad enough having to take steroids (although I'm very appreciative of them), but don't want to get on the slippery slope of taking more meds to stop the side effects, and then more meds to stop the side effects of those, etc etc. Will try the coated pred first...

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There are other "razole" meds to do the same job. I found Omeprazole to be the least contentious but most effective. My regular blood checks show nothing untoward same with bone density which is compromised with Pred in any case. I take Accrete, Vit D and calcium combined.

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I swapped from Omeprazole to Lansoprazole as I found it was giving me diarrhoea. My GP tells me he is not allowed to prescribe enteric coated Pred because I am on a 'prazole and was when all this (GCA) started. I was hoping to have the enteric coated variety to minimise the impact of the dose.

I do worry about the different approaches there seem to be. Is anyone doing any research on this condition given the impact it has on peoples lives, or are we all just muddling along with guidelines that were set when Pred was first found to be a treatment

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Hi Tigger, if you have enteric coated he probably won't have to prescribe a 'prazole. I am not sure what he is trying to say though, it does not make sense, what is the difference if a tablet is coated or not? What was his reasoning for saying this, was it cost? It seems a strange thing to say.

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Hi Tigger, why not ask your pharmacist if they know the reason behind your GP's remark. I always find pharmacists to be helpful and knowledgeable. I looked into the relative cost of coated and uncoated pred and as far as I could see, there was a fraction of a penny in it, per tablet. (We're so cheap to run!) Again, the pharmacist will be able to give you the EXACT costs, if that's the reason.

New Scientist issue 17th June had a very interesting article on inflammation and mentioned work being done on identifying an 'off switch' for inflammation - something we produce in our bodies called 'resolvins'. It also mentioned that a drug is being trialled at the moment, but not for PMR/GCA. It's being used in Cystic Fibrosis and skin conditions. It's called anabasum and "....it is proving to work as well as a steroid.....but with fewer side effects." Maybe too late for us by the time it gets on the market / approved for PMR & GCA, but it does show that research is going on.

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Asked the Pharmacist - he said the enteric coated was much more expensive and didn't work very well. Go figure. Have been taking the Pred after consuming a small amount of plain yoghurt as I saw suggested by someone- that does seem to help a bit. Interesting to hear of the research I must have a look.

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Hi Tigger, did the pharmacist take into account that you would not need a PPI with enteric coated thus saving money? It would be very interesting to see where the pharmacist has seen any documented evidence that the enteric coated "did not work very well". I must admit pharmacists are usually more helpful than that.

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Did he look it up? Things MAY have changed BUT...

A dispensing pharmacist told us 3 years ago that the price difference is NOT that great:

30 tablets plain pred: £1.31

30 tablets PPI £1.86

2 x dispensing fees, for pred and for PPI, approx £2 (varies)

Compared with

30 tablets enteric coated pred £1.86

1 x dispensing fees, for pred, approx £1

And removing one set of side effects for PPIs - priceless...

I can't check, I don't have access to BNF online (only for use in the UK) - maybe someone could?????

At one time, when GPs were told to avoid using enteric coated there was a big difference - but the manufacturers subsequently increased the price of plain pred which reduced the difference.

Enteric coated works fine - the studies where it didn't work so well were in patients with gastric conditions. It takes a lot LONGER to work - because it takes a lot longer to get to the blood stream, being absorbed much further down the gut instead of directly from the stomach. But you can take it at night before bed - and it is there ready and waiting next morning (and it is a lot cheaper than Lodotra which is designed to be used like that!).

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Hi PMRPro, MIMS has

Uncoated

1mg tab, 28=76p.

5mg tab, 28=86p.

25mg tab, 56=£75.00.

Coated

1mg, 30=£1.91.

2.5mg, 28=£1.14.

5mg, 28=£1.18.

Lodotra

1mg white tab marked NP1, 30=£26.70

2mg white tab marked NP2, 30=£26.70; 100=£89.00.

5mg yellow tab marked NP5, 30=£26.70; 100=£89.00.

Omeprazole

10mg, 28=£7.90.

20mg, 28=£6.18.

40mg, 7=£6.20.

Gastroresistant tabs.

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So at a quick gander - plain pred plus the PPI costs significantly more than enteric coated pred alone. Am I right?

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Absolutely, significantly is the word!

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And that is without the dispensing fee for the pharmacist.

The PPI has shot up in price - poorer sales maybe?

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Exactly!

Perhaps everyone has gone back to Zantac. I was involved with the launch of Zantac for Glaxo so have a warm feeling for it. It seems only a couple of years ago but it was the 1980s. Time flies when you are having fun.

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Doesn't it just ;-)

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There are a lot of groups doing research - all over the world. A new drug for GCA has recently been through Phase 3 clinical trials and is already approved in the USA. The last guidelines for GCA were published in 2010 (pred has been in use for about 60 years) and the newest are about to be published and have already been presented to rheumatologists at a meeting in Glasgow last autumn.

I think your GP is indulging in a bit of wriggling - being on omeprazole for something else doesn't stop him giving you enteric coated to be doubly sure. If you don't need the 'prazole for something else then it would save him money...

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Muddling pretty much. But only because we get our heads in order and then the flipping medics decry our work and say you can't do that! Next time that happens, my response will be " watch me"

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Hi

Just had negative stool sample for bug, GP requested endoscopy as I have not had one for 20 yrs the last one confirmed hiatus hernia.

I have asthma, hypothyroidism, gord, reflux & silent reflux, with numerous chest infections, recent hospital acquired pneumonia. I can have periods where my iron drops and I need iron infusions reason for iron loss never diagnosed.

I have been on a gluten free diet for 15+ years. I take 2 375mg carbocisteine twice a day, losec (omeprazole) 2x 20mg twice a day with 300mg ranitadine at bedtime.

My acid reflux is bad, I sleep using a pillow lifter so I can sleep more upright. I've just started using peptac peppermint liquid as gaviscon in no longer helping on a night, to stop acid reflux burning my oesopagus & throat.

Most nights I now have a productive cough, I get secretion stuck in my throat & larynx area, which makes me cough and wheeze. I hack up thick sticky mucus and or frothy white secretion. Some nights I vomit in my sleep and am in danger of aspirating, if the acid bile type vomit comes up while I'm asleep. The other week the acid bile came up while I slept it was so acidic it burnt my skin on my arm and breast. Which is why I ask my GP for further tests and treatment.

The hospital rang me today told me to stop taking my pm losec & ranitadine, as they gave me an endoscopy appointment for next Tuesday at 9am.

I noticed nice guidance suggests stopping meds for at least 2 weeks.

Not sure how I'll cope tonight having not taken the losec or ranitadine. 4.5 days off the meds will be tough.

Interested in threads on site about Nissan fundop op and work of Professor Morice at Hull.

Thanks for info about asking GP for enteric coated ranitadine.

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Are you in the right place here if you are interested in Nissen fundoplication etc? This is a forum for polymyalgica rheumatica - nothing to do with hiatus hernia etc.

What I can tell you is that my SIL had a fundop and it turned her life around, it was a real miracle. Don't know any details, jsut that she had it.

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Thanks for that

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