Prednisolone and Omeprazole: Hi everyone I hope you... - PMRGCAuk

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Prednisolone and Omeprazole

Hi everyone

I hope you are all enjoying the lovely weather and progressing well with our common health issue. I recently asked about taking Alendronic Acid and got some good variable advice. I have been on it for just over a year and Like DL have had no major side effects but hate taking it. I decided to stop it 2 weeks ago as I am now only on 2 mgs of Prednisolone and will discuss with my Rheumatologist in 2 weeks

My current concern now is Omeprazole. I have also taken this with the Prednisolone but have recently read that it can weaken your bones and cause fractures so now considering 1. Do I restart the Alendronic Acid or 2. Stop Omeprazole also. I am not on any supplements as my calcium was raised initially but have since been within normal limits.

I have not had a bone scan but will also discuss this at my appointment. Does anyone take Omeprazole or had any problems with it? I have been fine with it but just worried about any effect on my bones without the Alendronic Acid. I am hoping That I can come off both due to low dose of steroids currently.

Sorry if the message is a bit confusing but any thoughts or current experience would be welcomed.

Positive thoughts and good wishes tomyou all

39 Replies
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My pharmacist told me to take them apart, pred in the morning and omaprazole at night - sorry I've got pred have and can't remember exactly why but it was something to do with efficacy and not upsetting the stomach. The real knowledge stars will tell you the full story 🤣

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Thanks for your reply. I have always taken them about an hour apart. I had no specific instructions given.

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It does seem counterproductive to take a medication to protect your stomach which is implicated in leading to bone thinning. Did you actually need to take the PPI or was it just prescribed along with your pred? Was AA prescribed because you already had osteoporosis or as a preventative measure when you started pred?

If the PPI and AA were prescribed along with pred "just in case" I don't suppose there's any reason why you shouldn't discontinue them both. I think I've read, however, that you need to taper off Omeprazole as there will be some rebound acid production if you stop suddenly.

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Hi HeronNS

I was prescribed Omeprazole and AA as a preventitive measure. No bone scan done and it does seem counterproductive. I will wean myself off and discuss a bone scan when I see my Rheumatologist. I will arrange a private scan if not referred for one.

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There is no reason why you can't stop omeprazole. The NICE recommendations are that patients taking Prednisolone should be offered a PPI and AA. The function of the PPI is to reduce stomach acid output and guard against stomach ulcers. That's the theory but in practice some patients have a lot of difficulty coming off PPIs because of the way they exert their effect. Rebound acid production is usually the problem. There are some excellent webpages which you may find helpful if you are one of the unlucky ones. I suggest you read some of them and then decide how to progress once informed. You are quite correct in saying that PPIs affect bone mineralization and indeed osteoporosis is listed in the PIL ( patient info leaflet). Goodness knows why NICE changed their recommendation away from Ranitidine (histamine H2 antagonist) which achieves the same result? A point which other readers may like to consider..... Not everyone gets stomach issues with Pred, so there is no need to take a PPI or H2antagonist. They can be used for temporary relief though the literature will tell you that PPIs take three days to start working. My personal experience does not concur.

I hope this helps.

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Being of a very cynical nature - maybe someone on the committee had undeclared interests in PPIs? It does happen. And many doctors believed the drug reps' spiel about PPIs being SOOOOOO much better than H2 antagonists. They aren't in fact.

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Thank you for the information and it has been very helpful. I have not had any major effects from taking it but have been on it for 13 months. Don,t feel I now need it with low dose Prednisolone.

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I have Barretts syndrome and have been taking a PPI for years - I take my PPI and Prednisilone in the morning together with Ramipril (for blood pressure) and vit D, Glucosamine (for knees), and a few other self prescribed supplements. Am I doing it wrong?

I never knew PPI's caused osteoporosis - maybe they cause my PMR???

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Hi. I also take mine in the morning so no you are not doing it wrong. I don’t think it would have caused your pmr but certainly it is a worry regarding the osteoporosis.

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I have needed to take drugs for stomach acid with my prednisone, but as I tapered below 6 or 7 mg I found I didn’t have the need anymore. At 2 mg, I would imagine you don’t need them anymore either. You could try going without for a day ...as PMRnewbie says you may need to taper off due to rebound acid...but that’s probably a minority of people.

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I also think that I don’t need it at 2 mg. I have missed a dose before when I ran out and didn’t notice any side effects. However, I will try alternate days.

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Hi Mitziecat

I have been taking Omeprazole for various reasons on and off for years, with no idea until recently about the risk of osteoporosis. Despite being very active until last year, my bone scan this year showed osteopaenia & borderline osteoporosis in my hips. I’ve been on pred since November, so unlikely to be caused by that. I am sitting in the GP waiting room right now awaiting a consultation on this very matter. I’ll let you know how I get on.......

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Hi Mitziecat,

Have taken Omeprazole and Lansoprazole before but both eventually upset my stomach ( have been PMR case for 5years) Thro' these learned fellow sufferers, I have taken thick unsweetened Greek yoghurt instead and so far so good -for a long time. I have a cup of tea

with 1/2 digestive, then small bowl of the yogurt with the other 1/2.every morning early. Breakfast varies -weekdays- cereals usually with a little more yogurt .Fri- boiled egg on toast ,Sat-fried egg and toast, Sun - almond croissant .

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Hi. Thank you for your reply. I have porridge and yogurts as part of my diet so will use as a replacement for Omeprazole.

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I can't take porridge or cereals or bread cause of my type 2 diabetes. I used to hate yoghurt but have force fed myself in order to like it - so I take a small tub of greek style yoghurt and a boiled egg in the morning with my tablets

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On discharge from hospital in 2017 is was given Lansoprazole 15mgs, to be taken half to one hour before the preds and aspirin. I researched PPI's and they do indeed cause weak bones so I tried without the Lansoprazole. I have thick porridge before taking the preds every morning and have so far been fine without the PPI.

After a Dexa scan and being given incorrect results from such I refused to take Alendronic Acid, I was given a death threat for refusing to take them.;-)

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Thank you for your reply. Was your Dexa scan result not good? And how is it now?

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Hi Mitziecat

When I eventually received the results, they said that I had Osteoporosis and I needed to start AA ASAP or the mortality factor of a hip fracture was imminent.

Alarms bells rang when I checked the results on a web site which I could understand. My results indicated Osteopenia. They got my height wrong, I was shocked to see that I had lost three inches in height so I measured it myself and I have lost just about an inch in height. They also got the BMI wrong.

A consultant did confirm Osteopenia in another follow up letter.

I researched Bisphosphonates and didn't like what I read.

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Hi again Mitziecat. So, saw GP. Expressed my concerns re: PPI’s. She’s not convinced but agreed to swap me to Ranitidine 👍🏼

Went on to try to persuade me to take Alendronic acid/any bisphosphonate. She put up a compelling case, but I said I was really nervous based on my mother’s experience and my past history of ulcers. She basically said that if I didn’t try I wouldn’t know, but asked me if I would be happy to see a rheumatologist, which I accepted with open arms. She dictated the referral while I was there and said it would take about 3 months. She basically said she didn’t want me regretting it in a few years time if I my spine collapsed - fair point. She’s started me on Adcal even though I told her I’m already taking calcium & D3 etc supplement. So we will wait & see what the rheumie has to say. Asked me what PMR symptoms I have. Checked for scalp tenderness and asked about headaches, blurred vision etc. Acknowledged it’s a complicated disease and how common it is, but how little people know about it. She was happy to leave my tapering pred to me and given me a load of blood test forms to check everything is on and repeat again in 3 months. Finished up by saying I’d exceeded my time - lovely!!! Xx

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If you have had ulcers I suspect that may be a direct contraindication.

rxlist.com/fosamax-drug.htm...

Did she check your calcium and vit D levels? No bisphosphonate of any sort without - if they aren't right it is a waste of time...

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Hi PMRpro. Thanks for keeping an eye on that. The Ca & Vit D levels are requested on the blood test form. I’m going to go to the Vampires to get them done tomorrow 🦇😱 Xx

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Thank you Nerak12 for your reply. Good that you have been referred and the Rheumatologist will probably decide if you should have the PPI and AA. I wouldn’t have thought the AA would be offered with your history. It is a worry about the long term impact on the bones and crumbling spines etc. We have to make our own informed choices after researching natural alternatives or finding out the state of our bones in the process.

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Mitziecat, it might be of help for you to hear that in spite of a 40mg Pred starting dose, I was never prescribed either Calcium +Vit D or Alendronic Acid and my bones remained fine throughout my years on steroid treatment. As far as Omeprazole was concerned, rather than it protecting my stomach, it caused stomach problems so was consigned to the bin after a few days. Likewise with Lansoprazole. Instead, I ate a 'live' probiotic yoghurt each day before taking Pred. As you are now on such a very low dose of Pred, as long as your bones are in good condition now, then you have done the right think in ditching the AA, BUT you should have had a DEXA scan done at the outset of steroid treatment so do get one done asap to find out the present state.

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Thank you for the advice and you are quite right. Priority to get a scan done to know if I am at risk of osteoporosis. Reassuring to know that you have never needed it. I think diet can and exercise can play an important part

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I so agree about diet and exercise - diet-wise I ate plenty of oily fish as well as calcium-rich food, and exercise-wise, once the PMRGCAUK symptoms were under sufficient control, I did Tai Chi and Nordic Walking, the latter being particularly helpful

for the bones.

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I read about the calcium and Vit D on this forum and phoned the GP and they were prescribed straight away - thanks to this forum.

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Yes, Calcium + Vit D is very important. Not prescribing it for me was an oversight on the part of both my rheumy and GP who both admitted it - each apparently thought the other had put me on it! Being long before these PMR forums - or in fact the PMR Charities were around (diagnosed over 15 years ago) - I knew nothing about it at the time - so long live forums such as this! I made my point regarding my experience to Mitziecat just to reassure her that she was unlikely to come to any harm without both the medications she was querying whilst on such a low dose of 2mg of Pred BUT at the same time emphasising that she must have a DEXA bone density scan to find out whether her bones needed treatment/supplementation in the first place.

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To be honest - I'm not sure how AA and omeprazole fit together anyway. Omeprazole can lead to reduced bone density all on its own - because it interferes with the absorption of calcium. AA requires adequate calcium to be available to increase bone density. Did you have your calcium and vit D levels checked regularly?

If you do decide to stop the omeprazole don't go cold turkey - it will lead to what is called rebound acid production. Reduce the dose slowly - or switch to ranitidine (Zantac) instead which also reduces the acid production but seems a bit easier to stop. Many of us never took omeprazole for all sorts of reasons but took pred in the middle of a meal or with yoghurt.

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Hi PMRpro

I have had both calcium and vit D checked regularly and both reported to be OK. My calcium was high at the outset. Apparently I was taking calcium supplements before my diagnosis when it wasn’t needed. I will taper off the omeprazole but unsure over what period of time.

Good to know that many has managed without it and no significant effects from not taking it.

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Dear Mitziecat

And then there is me. I have life-time Klinefelters Syndrome and have been on Omeprazole since 2001 because my body makes too much stomach acid. Osteoporosis is a side effect of Klinefelters because (sorry about this bit) my testes did not produce enough natural testosterone before I was born or before puberty to build my bones strong enough. Osteoporosis started sometime before I reached puberty when the male changes should happen. I know this because two of my upper spinal discs fused together when I was 14 and I developed a curved spine. Klinefelters was diagnosed in 1996 (when I was 46), when Testosterone Replacement Therapy commenced and I had the changes that I'd missed around 14. The osteoporosis stopped fracturing my ribs (I'd had 7 rib fractures before diagnosis) and I was at Osteopenia stage and the fractures stopped in 2003. So when G C A started in 2014 and I fractured a spine bone at L1 I said a very rude word, which I won't repeat here. Plus

I also have G.C.A. induced Osteoporosis because my blessed G.P. kept me at 15mg Prednisolone for far too long without referral to a Rheumatologist that happened two and a half years after diagnosis. The stomach acid had been investigated for many years by Heath Road Hospital doctors without them being able to work out what caused it. My G P at that time suspected that it was something genetic because I also had a very painful right breast. Klinefelters sufferers get small breasts! and my right one was very painful. She referred me to the Diabetes specialist at Heath Road who was also an Endocrinologist, and he took one look at my distorted facial features, very long legs and arms and compacted rib cage and said I think I know what's causing the problem but I have to do special blood tests to confirm the diagnosis. I can make you feel better and stop the fractures but the treatment will go on for the rest of your life. There are a more horrors but I will stop there. So, I'd been on omeprazole for years before I started Prednisolone and have never had any problems. I'm on 8.5mg Pred. because I'm coming down from my second flare which has been awful.

Bear in mind that I am different to most of the male population, I just have had a similar combination of the same drugs that you are asking about.

Best wishes

Colin

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Thank you for your reply Colin. So sorry to hear about your diagnosis. Sounds as though you have had a lot to contend with over the years. Looks like not everyone suffers long term effects. I just hate being on medication that I might not need, even if no problems with it.

I wish you well and thanks again for the information.

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I was prescribed Omeprazole by my GP when first diagnosed with PMR to protect my stomach. Some months later I was discussing all the meds I was on with my Rheumatologist as I wanted to take as little as possible. He asked why I was taking Omeprazole and if I’d had bad reflux. I told him I never had reflux. He said to stop taking it and said it’s only necessary if reflux is a problem.

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Thank you GerriMc. That is reassuring. I have reduced it to alternate days and due to see the Rheumatologist on the 20/07/2018. Will update after the appointment.

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I should hope so - since PPIs increase the risk of cardiovascular disease quite considerably! I do wish they'd stop handing out things "just in case".

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I was prescribed Omeprazole when I started on pred to protect my stomach.I take Adcal too.I've never suffered with reflux .I'm going to reduce and come off Omeprazole and take my pred with a little yogurt and my daily porridge(as I did this morning).

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I take omeprazole, pred, AA, as well as aspirin.

I was told to take the omeprazole 30 mins before food. I gave the aspirin & pred with the food

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Hi Janstr. With all the information received you might have to discuss with your GP if they are all required.

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Thanks Mitziecat, I have done that & am satisfied I need them at present. I have osteoporosis, so need the AA. I still had GCA symptoms on 40 mg pred & aspirin was to stop the pred dose going higher. Omeprazole is to stop stomach issues with the others

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I forgot to say that I have had reflux as well

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