Aspirin and Prednisolone

[susanspurs]

Hi I’ve been on 75mg of aspirin for a long time together with my blood pressure medication. Someone just pointed out to me that aspirin is anti inflammatory and is listed on the prednisolone leaflet as a drug that could cause bleeding in the gut or ulcers and they shouldn’t be taken together. I’ve been on prednisolone for four and a half years starting at 25mg and I am maintaining on 5mg. So can they be taken together?

[PMRpro Ambassador]

Looks like it if you have been fine so far! I don't think I would worry too much.

In the past it was recommended that patients with GCA be put onto low dose aspirin together with their pred - so they have been taking both together. The new guidelines will remove that recommendation because it doesn't seem to have much benefit. However, I imagine you are on it for another reason?

[DorsetLady PMRGCAuk volunteer]

I was on aspirin pre GCA and took it all the way through my Pred journey (4.5 yrs 80mg- zero). No problem, but I did take s PPI (Omeprazole).

As PMRpro says if you were going to have a problem it would have occurred by now!

Just for info, my aspirin was part of a cocktail of drugs for high BP - thoughts have changed now, so if it’s for that might be worth checking with GP.

Since I’ve been off Pred, lost weight and Knee Op my BP is on the low side - so no tablets any more.

[Hidden in reply to DorsetLady]

Hi DL, I would be interested to know if you had any problems coming off PPI's. I have been on 15mg Lansoprazole (PPI) for many years and find that when I try to reduce i.e taking tablet every other day, after about fourth day the symptoms stomach ache return. Very strange indeed. It might mean I am dependant after many years of PPI,s

I might try the slow taper technique to see if that works.

[DorsetLady PMRGCAuk volunteer in reply to Hidden]

Hi,

Pre GCA and Pred I was never on a PPI despite the aspirin - never had any stomach problems either. PPI only prescribed once Pred added in (so took it for 6 mg) - once I stopped Pred asked GP if I needed to stay on PPI, he said yes because of aspirin. I explained it had never caused a problem before, but he was adamant until last month when he decided I didn’t need to take the BP medication any more (aspirin and Ramipril).

When I queried tapering it to come off, he said ‘no, just stop it,’.

No adverse reaction - but I do have a very strong stomach - very little affects it!

Just lucky that way I guess.

Have you tried any OTC medication to help you through the taper?

[Hidden in reply to DorsetLady]

No, no other antacids, but might be worth a try. I will have another go after my holiday to Italy next week. The reason why I am concerned is because the bad press regarding PPI's. There is a lot of research about the adverse affects of taking them long term. If I look it up on the NHS wed site, they say 'nothing to worry about' The thing is they are defending something that they recommend.

Hey Ho, happy days!

[DorsetLady PMRGCAuk volunteer in reply to Hidden]

Yes that’s true. Whatever medication you take it has some side effect, it’s a matter of balancing the good it’s doing against the bad! Obviously in some illnesses like heart disease or cancer then it’s easy to say “you need to take this to save your life”, in other instances where the disease is not life threatening, you have to weigh up the options! Do you improve one thing to maybe worsen another?

Anyway, enjoy your holiday first, and then think about when you get back.

[Hidden in reply to DorsetLady]

Thanks DL, yes obviously think about it.

[Berylholley in reply to Hidden]

My husband took omeprozal for 10 yrs had a terrible rash come on his back, had to come off it straight away.

[Cheshy72 in reply to Berylholley]

How did he respond to coming off right away. I tried cutting down after 15 yrs of Omprozole and ended up in bed for 2 days. Going to the doctor on 15th September to try and sort it out.

[Berylholley in reply to Cheshy72]

Not well at all, I didn't realise at the time but he had an awful few days. I had asked the doctor twice if he should come off it and she said "no". The switched him onto Ranitidine.

[Cheshy72 in reply to Berylholley]

What a nightmare some of these drugs are. I now have osteoporosis. Probably taking Omprozale for 15 yrs hasn't helped and now Pred. But I did not even think of side effects when first diagnosed. Its only being on this site that i have been alerted .

[PMRpro Ambassador in reply to Cheshy72]

It probably helps if you alternate the omeprazole with ranitidine while you try to stop the omeprazole.

When you stop taking a PPI something called rebound production of acid happens - even more production of acid happens than before the PPI was taken. You have to cut the dose of PPI down slowly - just like reducing pred - in the hope of avoiding that. The ranitidine works in a different way so sometimes after a time on that you can reduce the dose without extra acid being produced - and sometimes get off altogether.

[Hidden in reply to PMRpro]

I like the sound of that, it's time I tried that method.

[Cheshy72 in reply to PMRpro]

Thanks for that. Trying Low Carb diet at the moment and hoping eating more healthily will be beneficial . Every day is a struggle as my preferred food is high carb. Lost about 2 kg but really could not care less about food at the moment we are concentrating on proteins and steamed vegetables or salads. No rice, potatoes bread, cake, scones, biscuits. I do have a glass of wine at night and a few olives and Feta cheese. I should have taken control of my weight at the beginning but I think it was such a shock to get a disease I had never heard of or anyone I know for that matter. You are right there are worse things to have. Been taking Pred for 12 months now. currently on 7 where I am stuck.

[Hidden in reply to Berylholley]

That's interesting, I too have a rash on my back, I have seen specialist and even they don't know what it is. All they say is it's harmless, don't worry about it. It might be harmless but if I strip off to swim, it looks as if I have the plague. 😣

[Berylholley in reply to Hidden]

I think he was prescribed either Betnovate or Dermavate cream, I had to dot it all over his back and it cleared it up.

[Hidden in reply to Berylholley]

Yes, I have had various creams such as those you mention. The rash as such is not a spoty rash, it looks more like Granuloma Annulate but it's not. It comes and goes. Sometimes it goes completely and the starts off as a small red patch and itches. Sometimes I can't feel it at all. I think that I am a bit of a medical mystery. At one stage a test showed a negative antinuclear antibody result which made it less likely that the skin problem was due to subacute lupus erythematous but could not be excluded completely. Dermatologists have given up on me

Happy days 😉

[podo]

I was taking 75mg asprin together with Pred early in my treatment, after 18 months I had a Gastric Ulcer which then took 2 years to heal using 40mg Omeprozole. So for me, asprin is definitely out! Didn't enjoy the four resulting endoscopies either. Today, 15 years on, taking my Pred (only 3mg now) in coated form.

[susanspurs]

Thanks for your replies. I feel mostly reassured but I will discuss it with my GP and my specialist next time I see them. I was on Lanzoprazole for a while when I took Alendronic Acid but stopped them both as Dexa scans were ok and I was feeling so over medicated what with BP meds and bowel stuff following a bowel resection. I’m doing ok though - since I’ve been on steroids I’ve had a shoulder op and had two knee replacements and have recovered very well. By the way my PMR symptoms started following my major bowel surgery and five weeks in hospital - lots of complications!. I’ve always wondered if there was a connection...

[PMRpro Ambassador in reply to susanspurs]

The stress may have been the final straw for your immune system - and who knows what a bowel resection does to your microbiome, which they are realising is an important adjunct to the immune system, Wonder if anyone has looked at that...

Yup:

ncbi.nlm.nih.gov/pmc/articl...

mentions the development of autoimmune diorders post-op.

[FRnina in reply to PMRpro]

Thanks so much for the link. Learning a lot from your input, not only about PMR/GCA but also learning, via such links, how the gut works. Now going to take care of the microbiome (no idea what that even was until very recently). Stress avoidance and eating lots and lots of vegetables of all different colours seems to be what will help. The upside of this illness (if you can call it that) is that I'm becoming very health conscious. Am, as ever, very grateful to all forum contributors for experience-sharing and support. Thanks everybody!

[susanspurs]

Thanks PMRpro that’s really interesting. I had a major infection from mesh for a prolapse which had spread to my bowel. The bit they removed left me with bile acid and fructose malabsorption but I’m lucky to be here. Then I got C-difficile in hospital so I’m sure the microbe balance was really messed up. I was also carer for my late mother who had dementia and was quite severely disabled so I had loads of stress to deal with too. I do feel that all this could have caused the PMR. But we'll never know.

[Joydeck]

I've taken 100 mg aspirin, every second day, for a decade. With PMR diagnosed, last October, I've taken the aspirin with lunch rather than breakfast, hoping several hours of separation would minimize stomach lining issues.