Heartburn/reflux, coated pred?: Is this from... - PMRGCAuk


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Heartburn/reflux, coated pred?


Is this from the pred? I’m wondering about the timing of this symptom.

I’m currently on 25 mg. Tapered down from 40, been on the 25 for almost a month. (Rheumy wanted me on 20 by now but I stopped tapering due to a lot of stress, etc. )

I’ve had a lot more reflux, heartburn, that’s happening mostly after supper or at night. I take the uncoated pred after breakfast and with plain yogurt. I also try to sleep on my left side as suggested on the forum, this helps. Also fatty foods and nuts seem to make it worse. I’m eating low-carb, (sometimes go off the diet!).

My question? Would it be a good idea to ask for coated pred? Does it take this long for the pred to cause reflux/ heartburn if I’m taking it after breakfast and I don’t get these symptoms until after dinner or at night?

My rheumy wanted me on low-dose aspirin too, but I told her it bothered my stomach and she dropped it. Must be in the treatment guidelines here in the US as she’s mentioned it every time, “to keep the blood flowing”.

Thanks for any comments everyone.

20 Replies

Aspirin is in the last lot of guidelines - but has been/is to be removed from the newest lot which have not yet been published for some reason (waiting to add tocilizumab) despite having been the subject of a Dasgupta lecture at the Scottish rheumatologists PMRGCA meeting in Glasgow last autumn. There is no evidence thaat the benefits outweigh the downsides.

It would definitely be worth asking to try gastro-resistant pred if you were in the UK - but nowhere else in the world that I know of has it! There have been some people on the forums in the past who have bought gastro-resistant capsules and put the pred inside them - with success.

It could be the pred causing it and maybe it has been mild and has only just got bad enough to cause symptoms. BUT, it really ought to be investigated to be sure it isn't anything else.

What other medication are you taking?

Mstiles in reply to PMRpro

Only Lantanoprost for eye pressure.

I’ve been taking Tylenol for random aches and pains and to see if a headache could be related to GCA), and for knee osteoporosis I had before).

What should I be tested for?

PMRproAmbassador in reply to Mstiles

Just checking out the reflux and potential causes - probably with an endoscopy, looking at the gullet with a camera. Too many things get put down to pred and ignored as a result - hiatus hernia or problems with the sphincter closing the top of the stomach are possible. If it goes on for long or is severe it can cause damage to the gullet - which long term can cause other problems. Better to find it is "just" due to the pred than anything else.

Mstiles in reply to PMRpro

Thanks PMRpro

Katheryne in reply to PMRpro

I have PMR, hiatus hernia and osteoporosis. Nexium daily keep the hernia happy and Prolia by injection twice a year is supposedly halting the bones from crumbling even more. Nexium definitely works. I was on 40 mg initially and now down to 20 mg. Good luck, gastric pain and reflux is pretty horrible.


I have been prescribed lanomeprasole and take that in the morning. Later in the day (at least 3hrs) I take gaviscon tablets and this solves the problem of reflux and indigestion for me. Best wishes. Rae

Try this:

One organic lemon or uncoated one, 1 minute in microwave, divide juice into three, take with water (not too much) before each meal.

It works for quite a few people.

I take my Pred at the same time as you with live Greek Yoghurt and for no apparent reason get indigestion occasionally at night. It is quickly sorted with an over the counter remedy. I am only on 7 mgs. I think Pred can make your stomach tender and prone to irritation. I had one glass of rather sour fizz last weekend and got an acid stomach for about two days.

I take coated Pred. with yoghurt at 10.00 pm. after acid stomach on plain. No problem now.

Forgot to mention, coated only for 5mg tablets, my 2.5 are uncoated. Hope they may help you.

I had a lot of stomach pain and reflux on 55/40. They gave me remitadine and the coated pred. I have been fine since.

I started off with 60mg of prednisolone and experienced terrible heartburn/reflux and was told to take Omeprazole to alleviate it. I then read about coated prednisolone and haven't had a problem since and I don't have to take Omeprazole (which can come with it's own set of problems). In the UK coated prednisolone come in 10/5/2.5 and 1mg. Hope this info helps you.

Mstiles in reply to ipsidipsy

Yes I’m going to look into the coated pred. I’m in the US. I started on 40 mg in January, now down to 25, but didn’t have a problem until recently I might be beginning a flare, lots of stress recently

Rugger in reply to Mstiles

Stress can cause reflux and heartburn, so maybe help to deal with that might solve some of your digestive symptoms.

I think I've read that the only other form of pred available in the US is a 'modified release' tablet that you take at night, with food or within a few hours of your evening meal. The pred is then released at 2am to hit the inflammation. It's called Rayos and is expensive, I believe.

We can't get it on NHS prescription in the UK, but we can get the gastro-coated pred, which is the next best thing and cheap!

PMRproAmbassador in reply to Rugger

Rayos/Lodotra releases while still in the stomach - the outside coating splits apart to release a tiny dark red pill of plain pred. So if you have gastric problems it is likely to make little difference.

Rugger in reply to PMRpro

Thanks for that explanation - I wondered how it worked!

PMRproAmbassador in reply to Rugger

The taking it within 3 hours of the vening meal or with a substantial snack is important - to creat conditions that make the coating disinegrate bfore the stomach contents move further down the gut. I only found the document from the application for the patent by accident - and I haven't been able to find it again!!

Mstiles in reply to Rugger

Thanks Rugger. I’m wondering if I’m taking the pred at 8 am why does it take until evening fir the heartburn / reflux to kick in. Seems like the pred would be in my system way before then.


I put my prednisone into gel caps and it has helped with my reflux symptoms. I’ve also changed my diet to avoid things like vinegar, tomatoes and onions (some of my trigger foods). I get the gel caps from my pharmist each time I renew my pred prescription.

I’ve read on the forum that others have bought timed release gel caps on the internet.....with good results. I have not tried that.

Mstiles in reply to Mrs-CJ

Thanks! Good ideas

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