Have managed at last to have a dexa scan this coming week. Have been feeling dizzy and unwell since being prescribed omeprazole a couple of weeks ago. Before then I had bad stomach pains for a couple of weeks. Asked GP if I could have enteric coated pred. He refused on the grounds of cost and me on a low dose 5mg. That’s when he prescribed the OMP. I told him on the phone the side effects I was getting with them. So he had me in on Friday and gave me a steroid injection in my shoulder and to stop taking pred. It is only a day ago and am still feeling ok. I don’t know if this process will keep the pain away for any amount of time? Has anyone else experienced this and as I have had two of these within the last 6 mths am wondering if they are safe? The first one was in my other shoulder as I had an impingement of rotator cuff. Feeling slightly better being off OMP for a few days. Was also experiencing a mid back ache.
Hope this makes sense you lovely lot.
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Marjorie237
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Someone, probably PMRpro , posted an item showing that the cost of ordinary pred plus a PPI was no cheaper than coated pred on its own.
I don't know about substituting a steroid injection for your current dose of daily pred. You'd think if a steroid injection worked we'd all get that instead of taking pills for years on end.
My thoughts entirely! I presumed that the injection would travel around my achy bits and replace the pred. Don’t understand the difference.
Jinasc he did mention Ranitidine but surely enteric coated preds would be the surer way of protecting my stomach if they didn’t disintegrate until they reached the correct place in my small intestines?
I am at a loss, but I know that I am so much better off than a lot of you and feel I should not be making such a fuss. Just trying my best to keep on top of it.
You make as much fuss as you want , having stomach problems on top of the PMR pains is horrible , it makes you even more tired and miserable.
Have to say that I am getting more and more annoyed each day about Doctors putting budgets above the benefits to their patients.
Especially , as someone else has pointed out , when you add the cost of the various medications together , plus any other tests and medications they have to add on if you suffer more side illnesses , it costs the same , or is often cheaper for them in the long run to prescribe the more expense drug anyway.
Keep a close eye and good notes on how you feel in terms of pain , and in general , with this sudden change in treatment , as although it may feel beneficial now , in the long term it may not be the best thing for the job .
No, me actually. This was price about 6 months ago - can’t get recent prices but don’t imagine changed that much - nor difference between Landsoprozole and Omeprazole -
Pred Dose. Plain. Enteric
1mg £0.50 £1.92
2.5mg. £1.30. £0.95
5mg. £0.70. £0.97
For Landsoprozole costs are -
15mg - £0.73p
30mg - £1.07
I have had steroid injections in my knee & hip (prior to replacements) and recently in my shoulder (all for arthritis) - and, according to my GP because it is localised to that particular area only it will not affect the inflammation in your body caused by PMR,GCA or any other reason.
The reply from gifford7 seems to contradict that - maybe different thinking between the US and the UK! Or specialists and general practitioners! Whatever - can’t say that when I had injections for arthritis whilst on lower doses of Pred I noticed any difference in my GCA.
Plus in UK you can only get 3 injections per year - so what happens if the effect wears off within 2 months?
Those sort of injections are into the joint and won't affect the rest of the body. PMR and GCA can, however, be managed with depot-medrone injections: they are intramuscular and release the steroid slowly over a period of weeks, gradually falling off in level so it is a natural taper. When the symptoms return - you get the next injection. They are mentioned in the 2015 Recommendations.
So the shoulder injection Marjorie237 has had may or may not do the trick depending how it was administered? I'm thinking if I had such an injection there's hardly any muscle tissue in my shoulder area to absorb a long-lasting dose. Would that make a difference in how fast the medication was released?
It will release much more quickly around the shoulder and be excreted within a few days probably. Needs lots of muscle to slow it down and the formulation may be a bit different - not sure there, but the administration is different for different needs:
1. one of the main side effects from omnaprozole is aches and pains....... he can presrcibe Ranitidine (used to be called Zantac and it is the best and actually costs less, according to my pharmacist.
2. Why has he taken you off pred...........you still have PMR and you should never just stop them abruptly - until you know you are in remission and that your adrenal glands have woken up. .
"5. The panel conditionally recommends considering intramuscular (i.m.) methylprednisolone as an alternative to oral GCs. The choice between oral
GCs and i.m. methylprednisolone remains at the discretion of the treating physician. In one clinical trial, a starting dose of 120 mg methylprednisolone i.m. injection every 3 weeks was applied (23)." Link:
Thinning of skin and soft tissue around the injection site
Temporary flare of pain and inflammation in the joint
Tendon weakening or rupture
Thinning of nearby bone (osteoporosis)
Whitening or lightening of the skin around the injection site
Death of nearby bone (osteonecrosis)
Temporary increase in blood sugar
Limits on the number of cortisone shots
There's concern that repeated cortisone shots might cause the cartilage within a joint to deteriorate. So doctors typically limit the number of cortisone shots into a joint.
In general, you shouldn't get cortisone injections more often than every six weeks and usually not more than three or four times a year."
Please do distinguish between the TYPES of steroid injection and the dose involved.
The 2015 Recommendations are talking about deep intramuscular injections which release slowly over a period of weeks, how long depends on the dose which may be 40, 80 or 120mg, and then they are repeated. I know of a few patients on the forums who have had PMR and also GCA managed this way.
The Mayo article is talking about intraarticular injections - and those are the ones which should be restricted to not more than 3 per year.
Since the injection was into the shoulder [joint] I assume it was intra-articular as described by the Mayo article. From rxlist.com :
"Suitable sites for intra-articular injection are the knee, ankle, wrist, elbow, shoulder, phalangeal, and hip joints. Since difficulty is not infrequently encountered in entering the hip joint, precautions should be taken to avoid any large blood vessels in the area. Joints not suitable for injection are those that are anatomically inaccessible such as the spinal joints and those like the sacroiliac joints that are devoid of synovial space. Treatment failures are most frequently the result of failure to enter the joint space. Little or no benefit follows injection into surrounding tissue. If failures occur when injections into the synovial spaces are certain, as determined by aspiration of fluid, repeated injections are usually futile."
Hi there Marjorie237, that's disgusting that your gp refused to prescribe enteric coated pred! I did have to fight my last Dr for mine but got them, and since change gp. I have no problem now. My argument was that I'd paid and still pay enough taxes, so bring them on! And they don't cost that much more anyway, especially if it means, as it did for me, that I could stop the lansoprazol which counteracts the cost of them anyway! Silly man!
Omep made me feel horrible too. Ranitidine was only effective for me for a few weeks then I got rebound acid. I argued that the cost of enteric minus stomach protector that I wouldn’t need made it cost effective. Any top up needed was from Gaviscon Advance (lower sodium than ordinary) would be bought by me.
Injection into a joint, hmm. I don’t think I’d want a concentrated steroid around my joints for any length of time, plus the fact I’d like a systemic steroid around my system to deal with any inflammation I cant yet feel. I don’t know if an injection gives the same effect as a pill systemically. Also, given that PMR can go on for a few years, are you expected to keep being injected?
Depo-Medrone may be used locally or systemically, particularly where oral therapy is not feasible...............................
Depo-Medrone may be used by any of the following routes: intramuscular, intra-articular, periarticular, intrabursal, intralesional or into the tendon sheath. It must not be used by the intrathecal or intravenous routes (see section 4.3 and section 4.8)."
"Intramuscular administration:
1. Rheumatic disorders
Rheumatoid arthritis"
"On average the effect of a single 2 ml (80 mg) injection may be expected to last approximately two weeks."
When oral therapy is not feasible and the strength, dosage form, and route of administration of the drug reasonably lend the preparation to the treatment of the condition, the intramuscular use of DEPOMEDROL Sterile Aqueous Suspension is indicated as follows:
Ophthalmic Diseases
Sympathetic ophthalmia, temporal arteritis, uveitis and ocular inflammatory conditions unresponsive to topical corticosteroid
Rheumatic Disorders
As adjunctive therapy for short-term administration (to tide the patient over an acute episode or exacerbation) in acute gouty arthritis; acute rheumatic carditis; ankylosing spondylitis; psoriatic arthritis; rheumatoid arthritis, including juvenile rheumatoid arthritis (selected cases may require low-dose maintenance therapy). For the treatment of dermatomyositis, polymyositis, and systemic lupus erythematosus.
For Intra-Articular Or Soft Tissue Administration
(See WARNINGS)
DEPO-MEDROL is indicated as adjunctive therapy for short-term administration (to tide the patient over an acute episode or exacerbation) in acute gouty arthritis, acute and subacute bursitis, acute nonspecific tenosynovitis, epicondylitis, rheumatoid arthritis, synovitis of osteoarthritis."
Temporal arteritis is mentioned, at least the ophthalmic version, for i.m. administration of steroids.
I would interpret this to include the whole spectrum of GCA, LV-GCA, & PMR.
This is also confirmed by the 2015 PMR Recommendations previously mentioned.
------------------------------------------
"5. The panel conditionally recommends considering intramuscular (i.m.) methylprednisolone as an alternative to oral GCs. The choice between oral
GCs and i.m. methylprednisolone remains at the discretion of the treating physician. In one clinical trial, a starting dose of 120 mg methylprednisolone i.m. injection every 3 weeks was applied (23)." Link:
What in the name of goodness is he trying to do? MAKE you ill? For goodness find someone who understands considerably more about tapering off pred - you really do need more time than that after 6 months of pred. What dose did you start at? You should NEVER stop pred suddenly, whatever dose you are at.
I'm seriously unimpressed by your GP - if he wanted to use an injection to let you taper off the pred using it it should have been a deep intramuscular injection, into your bottom - not in the area of a joint.
"Special precautions should be observed when administering Depo-Medrone. Intramuscular injections should be made deeply into the gluteal muscles. The usual technique of aspirating prior to injection should be employed to avoid intravascular administration. Doses recommended for intramuscular injection must not be administered superficially or subcutaneously." (from the data sheet)
If your symptoms started after adding omeprazole, that would be enough for me to use Zantac instead, which is fine, just as good.
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