Medication timings?

[Theziggy]

I am on 15 mg prednisolone, ramipril, Omeprazole, and today have started azathioprine.

All these are to be taken in the morning with food, apart from the azathioprine which I am also to take with my evening meal.

Is it OK to take them in one batch in the morning?

Thanks in advance

[PMRpro Ambassador]

Good question! And one for which there probably isn't an answer. You can find intereactions for one on one use of medications, but rarely (i.e. never) for multiple situations.

I thought this was interesting re the pred/omeprazole question

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

since they suggest that only GCA-level doses or in combination with NSAIDs require its use. And although low dose aspirin has been used in the past as standard, it is now to be discouraged because the benefits do not outweigh the risks. This paper does also mention the combination of pred/PPI increasing risk of fractures in a synergistic manner.

mdedge.com/rheumatology/art...

points out that absorption of aza is affected by stomach pH - i.e. the use of omeprazole but I don't know if that would be avoided by taking the aza at a different time, i.e. 1 hour+ before the PPI. However - the immunosuppressive effect of the aza is likely to be affected by the PPI.

Irritatingly, this is behind a paywall

link.springer.com/article/1...

but suggests aza plus a PPI potentially increases liver enzymes. Worth bearing in mind.

Pred plus ramipril is said to increase ramipril adverse effects - but I assume you have been on it for some time?

And on the basis of that lot - I think I would ask about whether I really need the PPI ...

[Theziggy in reply to PMRpro]

Yes when I am on aza I have to go for liver tests on a regular basis

[DorsetLady PMRGCAuk volunteer]

Hi,

PPI should be taken in the morning either before or with breakfast - so I would take it before, then others after. Other than that PMRpro has answered - if still in doubt check with pharmacist.

[piglette]

There was something on the radio yesterday saying that it is much better to take blood pressure tablets at night to reduce strokes and heart attacks.

[Koalajane in reply to piglette]

Yes I heard that and now take my blood pressure tablets at bed time

[Hidden in reply to piglette]

Think SheffieldJane posted an article about it too

[piglette in reply to Hidden]

It has been floating around for quite a while. The Telegraph mentioned it a week ago and I think I read it in the BMJ (British Medical Journal) recently. It was on the World Service last night.

[PMRpro Ambassador in reply to piglette]

I understand it depends - if you are someone with low BP overnight anyway it may not be a good idea! You should really discuss it with the GP.

[Theziggy in reply to piglette]

I heard that, but it did say to consult your GP before changing to night time - article is here medicinenet.com/script/main...