I'm currently taking 7.5mg Prednisolone daily, down from 30mg in August. The rheumatologist was surprised when I answered that I wasn't taking any stomach protection, and have been given lansoprazole. I haven't had any real problems with my stomach, and as I have bad osteoporosis, am worried about taking this medication. I've also got a problem with my parathyroids, which is messing up my calcium levels. Any thoughts, reassurances?
Lansoprazole : I'm currently taking 7.5mg... - PMRGCAuk
Lansoprazole
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Are you taking the esoteric coated pred? If so you probably don’t need a PPI. If you are not taking the coated variety, some people do need a PPI , but a lot of people just take some yogurt at the same time they take the tablets. That should work if you have not been having stomach problems.
Hi Piglette, thanks for replying. I asked my Doctor if taking the coated pred would be sufficient but he said no. Perhaps I should take coated ones with yoghurt as you suggest, and keep the lansoprazole on standby if I do get stomach problems.
Why not? I don’t understand doctors, they seem to have a tick off list, taking pred - yes - take a PPI. Taking pred a while - yes - take Alendronic Acid or equivalent. No checks done it seems. I must admit it does annoy me to a certain extent and then I have an argument with them!!
That's another one they want me to take - alendronic acid - but it doesn't work properly if you have pHPT apparently.
I have not heard that. I did see a research paper from Oxford University showing that Alendronate acid worked better with hyperthyroidism than a placebo.
This is parathyroidism, a stupid name which means 'near the thyroid' and is actually nothing to do with the thyroid. It causes calcium to be taken from the bones and redistributed in other places, like kidneys, heart etc. Taking alendronic apparently just coats the brittle bones with hard bone, leading to higher fracture risk.
Sorry I meant that parathyroridism, it was the spelling thing that made messed it up!! Alendronic Acid has that effect though.
I'm impressed as most people have never heard of it, me included!
I spent thirty years working for the drug industry!
I’m on alendronic acid one a week and have no problem.
I’ve been on alendronic acid for a few months and I’m ok with it
Very true! My GP googled osteoporosis and up came Prolia. I had the first injection but after checking different sites and the possible side effects decided to change/improve my diet and not have Prolia.
She quizzed me about it and was vrry negative! I then suggested that before I make a final decision I would like to have a parathyroid blood test and a test from the same draw for D3 and B12.
She REFUSED!!
How much yoghurt should one take? Is a couple of tablespoons enough?
Probably a tablespoon
Love the idea of an esoteric coated pred - a few exotic colours or stripes perhaps? Much more exciting than boring old enteric coated!
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Your osteoporosis is almost certainly entirely due to the parathyroid problem - are they not doing something about that?
Not everyone has gastric problems with pred - I have never taken a PPI and I have no problems. If it hasn't been a problem in the past at higher doses, why does he expect it to be one now?
Hi PMRpro, I've had 1 appointment with an endocrinologist so far for the parathyroid problem - I was supposed to see him 2 months later, but in reality, it's going to be 4 or 5 months until I see him again! Surgery is the only cure for PHPT. I don't know why rheumatologist said about stomach protection, and I'm keen not to take tablets if I really don't need to. It's good to know that not everyone has problems with pred and so, as I replied to Piglette, I'll take the pred with yoghurt and keep the lansoprazole until/if needed, I think.
Some people actually get side effects from the PPI. I was given it years ago , thought I had to use it , came off it and used yoghurt with meds instead . Have only ever used it during periods of Pancreatitis since . If you find you start to get the stomach issues while using coated tablets and Pred I think that's the time to start taking a PPI and definitely not resist the idea when the need is definitely there. You have to decide based on your own individual health issues really but I don't take things 'just in case' , and not with health issues relating to Parathyroid or Thyroid or Endocrine issues , I was also checked for PTH , luckily it was clear.
That makes a lot of sense Blearyeyed - we'd all be taking a lot more medication 'just in case' if the doctors had their way, but one tablet seems to lead to another etc. However, if problems start, that's a different matter.
I have been on pred for 14 months and havnt taken a stomach protector i have not had any problems. I also dont always take my pred with anything. I try to remember but get sidetracked quite easily.
That's good to know Yellow bluebell., although I do take mine with food - I have a morning routine so I don't forget lol.
Until the parathyroid problem is solved no bone med will do you any good. Solving the parathyroid issue plus good diet and appropriate exercise may actually be enough to preserve and improve your bone health. If you were fine at 20 mg without a PPI I don't know why you'd need one at 7 mg! Best wishes.
Thank you HeronNS. All the replies here make more sense than the doctor's. Best wishes to you too.
I have been taking prednisolone for nearly 3 years and never taken or been prescribed a PPI. I always take my Pred with food and have never had a problem
Me too, four years now on the regular prednisone and no PPI. I always take it after breakfast and have not had any problems.
Same for me.
12 months after taking pred. every now and then I began to suffer with heartburn, but did nothing about it other than take my pred with milk or yoghurt. Never ever suffered with heartburn before. Over the last few months my heartburn became increasingly worse, so I asked my G.P. for the coated pred. She refused to give them to me and put me on Omprazole. I really couldn't see the sense in this since Omeprazole has it's own side effects, so I took one as and when. Things - gastric-wise - became worse, food sticking in my gullet and almost choking, still she would not give me coated pred, but sent me for a gastroscopy. It was found I had a very inflamed oesophagus, plus a slight hiatus hernia . I do wonder if my G.P. had given me the coated pred. I would be having this problem.
I also order online and ask for the coated ones. Also had an appointment with GP who verbally refused to give them. However, each time I order, I still ask for the coated ones, to no avail.
My GP refused even though I had problems swallowing then and said they cost more money!
I spoke with my rheumatologist who prescribed the enteric coated ones
Someone has costed out the difference in price between regular pred + PPI and coated pred, and apparently it's negligible.
I have just written a rambling reply Heron and hit the wrong button before I had finished it, don't know where it's gone. I wont go into all of it again, have to cook dinner, but the long and short of it was that it would cost an extra £12 per month for the gastic coated pred. I have 4 packs of 1mg per month. The pharmacist worked it out for me. I have been told by one of the nurses that they are cost-cutting in the practice.
Did they include all aspects? Like not needing a PPI - which costs the same as the pred but incurs a second dispensing fee for the NHS to pay the pharmacist? Unless charges have changed a lot. that seems a lot of difference.
Was chatting to the pharmacist about it when I went to collect, he said had I asked my GP why she would give them. I told him I hadn't, but I think it was cost. He went and worked it out and told me the gastric coated ones would cost £12. more per month. I have four packs of 1mg each month. One of the nurses did tell me that they are cost-cutting in the practice. I did mention to my GP that a side effect of Omeprazole was osteoporosis as also with pred. So now I am taking two kinds of tablet which could cause osteoporosis. Her reply was "Well we will deal with that if it happens". Of course she will, with another pill with different side effects!!!
Found my first reply. What an idiot I am.
Yes, HU is a puzzle sometimes. Seems to have a mind of its own. I find it particularly difficult when using my tablet as replies do occasionally vanish into the ether (really vanish, not just post themselves unexpectedly like yours did). Anyway, did that price difference take into account you wouldn't need the PPI or was it just the price difference between the two forms of pred?
It was the price difference between the two preds.
So an accurate representation would include subtracting whatever the PPI costs. 
A few years old but here is what I was thinking of:
healthunlocked.com/pmrgcauk...
Thank you for that Heron. My present dose of pred. is 2 consecutive days 2mg. and 1 day 3mg. Tried 2mg. recently for 1 week, but, although no pain, I felt very shaky, so went back to one day 3mg. 2 days 2mg. Will extend the 2mg to 3 days after Christmas, a busy time, a lot of shopping. I take my pred. 10pm, sometimes later, and mostly I really don't feel like taking it at all. My highest dose has been 7.5mg. because my system reacted very badly to pred at 15mg. 10mg and 7.5mg.
I have been on 2 and 3 mg. for a year now. Such a low dose, so why am I getting such an inflamed esophaegus. No chance of my getting the coated pred. unless I get it privately, although now I have a hiatus hernia I have to take omprazole anyway for six weeks. It is helping with the heartburn I can't deny. Forgot to take one today. Now I am going to take that revolting tasting pred with some kefir and off to bed. I am going to a Christmas lunch tomorrow, just hoping I don't choke on the food, as I did at a golf club dinner a few months ago. Must say, I'm half asleep as I'm writing this, so hope it makes sense.
It makes sense and when you read this tomorrow morning I'm going to suggest that you take your evening pred at least half an hour, possibly an hour if you can manage it, before you lie down. That alone will help protect your esophagus.
Surely if you can show the difference between uncoated with a PPI and gastro-resistant without a PPI is measured in mere pennies you could get it prescribed? You are someone who would benefit from the gastro-resistant version.
Yes, I'm sure I would benefit from a coated, but my GP categorically refuses to prescribe them. Will do what you suggest Heron and take them an hour before I go to bed. At the moment I take them just before and then literally zonk out. Used to read myself to sleep, but these days I'm asleep as soon as my head hits the pillow.
PPI like Lansoprazole etc doesn't agree with me (and I don't trust it either) so my GP recommends I take Ranitidine or just be careful and always have the Pred with food.
I have never taken Lanzaprozole, but always take a big tablespoon of yoghurt before my pred and have not had any stomach problems. I would stay off it if possible if you already have bone density issues. It really irritates me that there seems to be a disease pathway and everyone is given the same advice regardless of their individual circumstances. I was also summarily told to take Alendronic acid; I argued that my bone levels are fine (only one reading out of 5 only just in the osteopoenic range) and I do a lot of weights in the gym 4 days per week, play golf and do Parkrun, so I don't feel I'm in a high risk category for osteoporosis. Current advice on Alendronic acis is it should only be taken for 2 years anyway and then reviewed, as its effect is to increase the brittleness of the bones. I have reduced from 20 to 3mg over 18 months using the DSNS method.
Fight your corner and good luck!
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