Coated pred/ppi

[Iloveholidays]

Need some advice please.

Currently on 10mg pred, have been on uncoated pred apart from a couple of times when needed a 2.5mg tablet to make up dose which were gastro resistant/coated. I previously asked GP if I could have all coated so I didn’t need to take omeprazole and was told even if I took coated pred I still need the PPi. I queried long term use could increase risk of osteoporosis but this was dismissed 😔. So to get to the point, pharmacy which is attached to Gp do not currently have 5mg pred so I have been given 2.5mg coated tablets which I am currently taking. Is this a good opportunity to stop the PPi ? And can I just stop taking it, been on it since Nov 18. I always take pred with breakfast of fruit and Greek yogurt.

Another question how long does it take the gastro resistant to start working compared to uncoated pred?

Thank you

2.5mg and GP would not give coated

[HeronNS]

My understanding is you shouldn't just stop a ppi, or you could temporarily replace it with another med, like ranitidine, as there is a likelihood of rebound acid production. Eventually you should be able to stop the replacement med. I found this:

projects.hsl.wisc.edu/SERVI...

which suggests it takes a few weeks to taper off.

I note they suggest a form of liquorice. This is contraindicated with pred.

[Iloveholidays in reply to HeronNS]

Thank you. I thought 8 had read before about not just stopping taking a PPi , I was given it before dx as on strong brufen. I never had stomach problems prior to this and do keep wondering if I need it.

[Hidden]

Hi,

This question crops up often about Coated/Uncoated Pred & the cost implications; DorsetLady has recently posted a ‘Price List’ on Coated/Uncoated including the added cost of a PPI

Firstly, don’t just stop the PPI as you may get rebound reflux & it’s best to drop it to a lower dose first & then to alternate days but add in something like Ranitidine on the days you don’t take a PPI

Sorry, what l’m not clear about is, are you taking Coated or Uncoated at the moment? I understand you were taking both before they didn’t have any 5mg but can you confirm exactly what you are taking now?

Thanks

MrsN

[Hidden in reply to Hidden]

PS

Uncoated Pred usually starts working in around an hour, Coated Pred around Four Hours ie after it’s left the stomach.

So ultimately if you stay in Coated Pred you may need to take it earlier.

[Iloveholidays in reply to Hidden]

Currently 4 x 2.5mg to make up 10mg a day coated pred

[Hidden in reply to Iloveholidays]

So you may want to think about taking it earlier for it to have the same effect.

And, yes now is as good a time as any to Reduce then Stop the PPI but don’t forget to add in Ranitidine or something similar such as Zantac or the Pharmacy’s Own Brand. It’s worth mentioning it to your Pharmacist as they may well make a recommendation on reducing the PPI.

[SnazzyD]

Hello. I didn’t get on with uncoated even with PPI or Ranitidine (anti histamine type) actually made things worse. Though my stomach was oodles better, I still needed Gaviscon at night. Anyway, whether coated or uncoated if you stop the PPI suddenly you may well get rebound acidity. See this, “mistake 8”,

ueg.eu/education/latest-new...

[HeronNS in reply to SnazzyD]

That is a fascinating article. When you read about some of the symptoms people occasionally describe it might be as well to ask them if they are taking other meds besides the pred in case the reactions they are experiencing are not from the pred at all but from something else they started taking around the same time....

One thing I read quite a while ago was that PPIs were never intended for long term use.

[PMRpro Ambassador]

No, you can't just stop taking a PPI overnight - you need to taper the dose over a few weeks just like pred or you risk having rebound acid secretion. Or, as already suggested, you can use ranitidine/Zantac though even with that it is better to switch gradually and then stop the ranitidine slowly too though that should be less of a problem.

You don't usually require "stomach protection" when using enteric coated pred although some doctors think that the gastric effect is due to high levels of pred in the body in general and not just the direct irritation on the stomach lining. And as Snazzy says - some people do still have problems.

Personally, I think the minimal cost implication once you take the cost of a PPI into the equation is immaterial: the removal of a layer of potential side effects and interactions is worth far more.

Before they dismiss concerns we express - it would behoove them to check the facts ...

[Iloveholidays in reply to PMRpro]

Thank you, I felt beaten down by the GP so gave up trying to argue with him. I think i’ll leave it as it is for now and discuss if and when I have another Gp appt. I expect my next prescription of Pred will be back to the uncoated.

[Koalajane]

I don’t take coated Pred and not prescribed PPI. Like you I always take Pred with food

[Rugger]

I was on plain pred and a PPI, but asked my GP if he would prescribe coated pred, which he did. I tapered off the PPI in a similar way to the DSNS taper!

I take my coated pred at bedtime with a spoon of yoghurt, so that it's in my system in the early hours to deal with the cytokines when they're released. It seems to work for me.

Best wishes.