My mum (recovering from GCA) is currently tapering from a 60mg dose of Pred - 10mg reduction every 2 weeks, it will be down to 30mg on Sunday but nobody has advised us to reduce any of the other 10 different types of medication that she is on, including a high dose of Omeprazole - 40mg per day.
She has been experiencing not-quite-liquid diarrhea but some surprise emergency 'toilet situations' in that area that I am assuming is to do with the changing balance of medication.
I have a phone call scheduled with her GP tomorrow but would be grateful for any advice anyone might have.
Med list:
Ramipril 10mg per day
Bedranol (propranolol slow release) 80mg per day
Calcium and Vit D chewable tablet 2 per day
Amitriptyline 10mg per night
Aspirin 75mg per day
Felodipine 5mg per day
Hypromell eyedrops 3 drops per day
Omeprazole 40mg per day
Pravastatin 40mg per night
Prednisolone 40mg per day
Alendronate 70mg per week
Written by
Jeromekjerome
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Blimey - I'd have the runs if faced with that lot!! How many were added post GCA?
I'd start with stopping the calcium and vit D for a week or two and see if that helps, a week or two without it won't hurt. I would ask the GP for another acid medication besides the omeprazole - it can have gastric effects that can appear at any time, not just at the start. I would also at some point try a few weeks without AA - again a few weeks without won't do any damage.
Your GP may agree to try leaving those out all at once and reintroducing them very slowly if that does the trick. They do tend to forget that while drug X may not do something, in combination with drug Y and/or drug Z it can be a very different matter.
I have to say, my first question would be why she is on THREE different hypertension medications. There must be some way of sorting that out.
Has she had a dexascan? If not, I would say no alendronic acid until she's had one to see if it is needed. Loss of bone density is NOT inevitable with pred even at high doses - I'm just PMR but both jinasc and Celtic of this forum had GCA and high dose pred but their bone density was fine all the way through.
If she’s been on the hypertension meds for some time, it was the practice to give a cocktail of drugs, but times have changed, and nowadays GP is more likely to prescribe just one - so discuss.
As for the others, agree with previous replies try cutting each medication for a trial period and see if any improvement.
I’ve been thinking about your mother and wondering how she’s coping. A difficult time and such a collection of medications as well, (very much the same as mine actually, give or take. )She certainly doesn’t need this extra worry.
😮 I didn’t take half of that lot but I do know for a fact that high dose Pred made me loose, Omperazole made it 10 times worse (a week in) and high dose Calcium gave me chronic wind and indigestion too. Magnesium was the same. In the end I took separate vitamin D, bought my own lower dose calcium, halved the magnesium tablet. I took Ranitidine until I started enteric coated Pred which helped enormously. I argued that cost wise it was the same because I wasn’t needing Omperazole or Ranitidine and bought my own Gaviscon. As PMRPro says, a bit of omission and reintroducing get to the bottom of it, pardon the pun.
Totally agree with the others , discuss which of these drugs can be omitted at present if they were only originally added ' just in case ' rather than helping reduce risks in your Mother's case with so many drugs in the system their side effects could now be eclipsing the benefits.
Ask if it is possible to stop AA now until she has a Dexascan . They give it ' just in case ' because it's cheaper to do that than to order the scan to check if it's required.
Ask if it is possible to try a different stomach drug than your PPI and give it a week to see if using something else with a little portion of probiotic yoghurt and a little honey with each group of pills . You do need to taper down the dose of a PPI over a week to ten days to reduce withdrawal symptoms that can cause their own stomach issues like extra acid , diarrhea or constipation and cramps.
Ask why she is on three separate drugs for Hypertension , what is each for , are they all doing different jobs , and if so , isn't there another medication that can do all these jobs using on pill or infusion .
Increase her water intake upto 2 litres a day as all the toileting will be making her system dehydrated even if she isn't thirsty and this will add to the symptoms , side effects and can cause some malabsorption of both her drugs and any vitamins.
I would keep the Vitamin D and increase Vitamin C even if you choose to reduce the Calcium intake for a week or two until changes are made and her system settles again . There is the possibility that she will be getting more rundown.
Ask for an Electrolyte and Kidney / Liver blood profile to be done . If she has been suffering with Diarrhea for a while and is older her Potassium , Magnesium and Sodium levels could be imbalanced so you may need to make changes to improve these as these can also affect your bowel and urine habits .
She could try having small lighter meals for a few days while her system rebalances of basic foods like rice , banana , eggs , toast . Reduce foods with insoluble fibre during the time she still has diarrhea,as this can increase bowel functions.
It may also be worth checking that there isn't a Bacterial imbalance in her stomach from all the changes or she could have an infection which may be being masked by the fact that some of the issues began before it , so getting a full check up or giving in stool and urine samples may be beneficial to cover these possibilities. These could be taken to the surgery to be sent off while going for the blood tests without needing to see the GP in person they can approve them by phone and then you could arrange a face to face appointment for the results.
So sorry , she has been through so much already , keep us posted xxx
That is a ridiculous amount of tablets. It is definitely worth checking. As PMRPro says why does she need three heart tablets? They reckon if you take more than five different tablets a day the chances of any of them being contra indicative is usually around 100%.
Hi the omeprazole dose seems high unless she has previously had stomach problems, like an ulcer. I’m on 10 mg of omeprazole daily and it appears to give adequate protection and no unwanted side effects
I'm not going to add to what others have recommended as I believe everything has been said about the need to examine the true need for so many medications.
However, I do want to say how fortunate your Mom is to have you there to support and advocate for her. I can't imagine how difficult it's been for both of you after losing her sight and coping with all of this. She is very fortunate to have you and must be a pretty amazing lady herself.
Spoke to the GP who has advised dropping the Omeprazole by half as well as the amitriptyline, keep an eye on things and if problems continue to make an appointment. It's a bit disappointing that nobody we have been seeing other than me thought about reducing the other medication whilst the steroids are tapering tbh. I'm not exactly clear headed at the moment, or experienced in this.
He also told me that he had brought up my mum's case in their practice meeting and it has been officially recorded as a significant event and will be investigated. The practice has officially took note that a patient with no blood indicators can still have GCA if they have the other symptoms and should be given steroids until proven otherwise. I think I have to be the one to prompt this same kind of thing at the hospitals involved.
I was very glad to hear that though - I think I'd go mad if I heard it happened to someone else after this.
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