Now that my GP has their own pharmacist I had a conversation with one the other day. She was concerned I wasn’t taking omeprazole and I explained my reasoning behind it. When first diagnosed six years ago I started it along with alendronic acid totally oblivious as to why. After a few months and realising I was on a long journey (never thought it was going to be this long 😨) I did some research, found this forum and decided I didn’t need these extra drugs. I take my prednisolone with food/yoghurt.
The pharmacist thought I should now reconsider. I don’t have any stomach issues and feel all is well. She warned me that I might not know if I had ulcers until they were there.
Am I being daft and should I now start taking it? Still on 7.5mg and started sulfasalazine at the end of January.
Anybody’s thoughts would be appreciated.
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Lochy
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I guess we can only go on how we feel and it is your choice . I know acid reflux can be silent but often there are other signs like slightly sore or hoarse throat in the morning. A little cough especially in the mornings can be a sign too. Personally yoghurt or anything else, even Omeprazole didn’t fix my Pred acid problem so I had to use coated Pred.
So far I haven’t had any reflux etc and I suppose 6 years into this I have tended to forget about the PPIs. I do have the enteric coated 2.5mg tablets which I tend to use at night. Will stick as I am unless I notice any of the symptoms you mention. Thanks
I was already on omeprazole 20mg before started pred in dec due to heartburn but for the last few months I've had to take an extra one at night as well cause it bad and also take peptac when and if I need more.
I was on 20mg omeprezole as I had dyspepsia with prednisolone. It got worse so I upped it to 40 mgs. Still bad- actually worse so I asked for an endoscopy..... ! Now realised two things through this site- coated prednisolone would have probably avoided the dyspepsia , and many people can’t tolerate omeprezole. Now stopped the omeprezole ( tapered or pain is worse) and the pain has gone altogether! My doctor said I was probably stressed !! I don’t think he’s read the research that the PMR Pro has read !
I already use the enteric coated in the evenings as I split my dose and have done for a few years. I’m not too worried it’s just when it’s mentioned you suddenly wonder so thought I’d see if anyone else had similar experience.
Why on earth are they suggesting you take a PPI such as Omeprazole in that case? I must admit the pharmacist’s assistant said I should take it as “everyone took it who was on steroids”!! I just take some hard cheese when I have my pred.
I reckon she just saw a gap I’m my medications ! I gave her my reasons and we left it that I’d think about it.......I think she discovered when she spoke to me that I was quite on the ball and wouldn’t just follow. I am trying to be sensible at the same time though.
I'm sure I recently saw an article that said PPIs should NOT be handed out automatically as they are finally realising they aren't as innocent as their manufacturers would have you believe.
I don’t think the pharmacist was too worried but I think she felt obliged to bring it up. After all these medications seem to come in a package and some are surprised when you’re not following the guidelines. If I ever speak to my GP again I might ask his opinion and request a check up.
I had potential symptoms of silent reflux with PMR long before pred - sore throat, cough blah blah - I've always accepted that as part of my PMR and it is definitely better on more pred.
I’ve developed an intermittent cough since starting sulfasalazine but that is a known side effect. Very hard to work out all the differences as there are so many side effects for the medications we are on!
OMG. Thank you for publishing ! I have an elderly relative in a West Sussex hospital at this very moment, on long term omeprezole for no apparent good reason, being investigated for a couple of TIAs ( MRI etc clear) and nursing a very painful wrist fracture. Plaster off but OA is very sore. I think the risk factors etc need to be looked at in her case in case the solution is right there.
In that article it states you shouldn't take enteric coated if on PPI. My pharmacist or consultant never informed me of that. In Ireland you can only get enteric coated in 2.5 and 5mg. The 1mg are not coated. I think I'll stop taking it now as I'll be on 5mg and they're coated.
I wasn't entirely clear if it was "don't" because they shouldn't be combined or "don't" because there is no need for both.If you stop the PPI - taper the dose, don't stop cold turkey.
it could well be that the PPI changes the pH of the stomach, making it more alkaline. The whole point of enteric coated is that the coating is resistant to the acid in the stomach and requires an alkaline environment for the coating to break down - so that means that in the higher pH of a PPI-treated stomach the pred might break down, and that cancels out the whole point of the enteric coating.
I don't take Omeprazole either. I have always been fine just taking pred with yogurt or milk. Almost 4 years later and still ok. All meds have some sort of side effects so why take it if you can avoid it?
Hello Lochy, I take Lansoprazole 15mg x twice daily and have been previously taking Omaprazole for some years. I was diagnosed after an endoscope examination as having an ulcer in my oesophagus. I have no side effects from this drug and it has resolved my ulcer. Not sure if that helps you but that is my experience. Best, Charles
Yes, it's another PPI. Someone else has mentioned Pepcid - that is famotidine, the general alternative to ranitidine/Zantac since it was withdrawn. They are H2-antagonists - do the same in reducing acid but by a different mechanism so different side effects.
I take Famotidine, or just make sure I take the Pred with food as the idea of taking anything is to stop the pred causing stomach bleeds on an empty stomach, which is rare but possible
The 'zoles don't agree with me at all so I won't touch them, and also since it would be another long-term med to take with more side-effects and withdrawal problems. But I have posted about my experience before and plenty of people wrote that they take them without problem and are happy to do so.
Funnily enough after almost 3 years on pred, now down to 3.5, a packet of omeprazole was included with my prescription this month, no explanation. Due to the advice on this forum I have taken the steriods after food or yogurt, never been advised by my doctor or rhuematologist about stomach protection.
I’m not sure if they can determine if it will definitely get worse after a few years on prednisolone. We are all different and tolerate medicines differently. Have you started taking it now? It’s a conundrum do we start taking it just in case??
When diagnosed with PMR doctor asked if I got indigestion. When I said occasionally she added omeprazole 20mg to prescription. When I took it a few years ago I only had 10mgs and OH only has 10mg with his naproxen. So I’m considering stopping it as I always take pred with food anyway and I’m wondering whether it is that that is giving me the swimmy head feeling rather than pred or PMR. I can always start it again if I need to.
Every time I speak to one of the drs at the surgery they try to get me to take PPI’s. I explain that I take gastro resistant tablets and have a large breakfast but they say although that will help I should still take them!
I’m prescribed two a day, I only take one, but I think that’s because I already have a hiatus hernia, and two,or three days a week I have to glug Gaviscon at 6am. Which rather proves I might as well just drop the one Omeprazole?!
I don’t take Omeprazole anymore, after someone on here mentioned it affected their bowel. I was having a similar problem which has improved since stopping it. Should we take them ? I don’t know but I do think a lot of meds have a sting in their tail.
I take 80mg per day of Pepcid AC. I was on 20mg per day. I had an endoscopy last June that showed stomach was bleeding . Last endoscopy, this past month shows there is still some blood in stomach. Prednisone does not just cause surface irritation to the stomach. Prednisone causes actual chemical changes in the way the stomach works. Some type of medication to protect the stomach is necessary. I also take liquid Gaviscon per my gastroenterologist instruction . I do not like the muscle aches caused by Pepcid, or the aluminum in the Gaviscon. But the stomach bleeding is serious. I am on Actemra to try to get off of prednisone. Down to 6mg. per day. That may not sound like a lot, but when one figures that is 180mg. per month, that is a lot of steroid damaging the chemistry of the stomach. I have been on prednisone off and mostly on for 10 years.
Am hoping Actemra will help me get off prednisone. The stomach damage caused by prednisone is very real, and can be very silent for a long time. If your physician recommends something to protect your stomach, take it seriously. I don't tolerate PPIs, and do well on the Pepcid. It does not cause osteoporosis like a PPI, but does cause muscle aches at high doses.
"It does not cause osteoporosis like a PPI" - it can do since any lack of acid in the stomach reduces the absorption of calcium. So I think do aluminium containing medications like Gaviscon.
I have had stomach issues for a very long time. I experienced weight loss, nausea, became full very easy. My stomach hurt. Hurt so bad Gaviscon and 20mg Pepcid daily did not touch it. Blood pressure was skyrocketing at night while I slept. Stomach irritation was the cause. my stomach has been bleeding for a year. Biopsy taken during first and second endoscopy shows damage consistent with a medication. Started Actemra 3 months ago. Down to 6mg. prednisone. If SEd is down after next infusion I will start dropping to 5mg. It takes me about 7 weeks to drop 1mg, while on Actemra. Prior to Actemra I could not get below 10mg. SED would shoot up in the 90s. On 80mg. Pepcid ac daily. Appetite improved. Anemia improved. Blood pressure greatly improved since I started on 40mg. Pepcid at bed time. I just generally feel better.
I also take my prednisolone with yoghurt. I used to suffer badly with gastritis and was recommended to try goat's kefir, which is a natural probiotic. I take it 3 times a day, only a small sip, along with a probiotic from Healthspan uk. I've had a trouble free 3 months since I started taking it. Like you, I was prescribed various medications, the latest is Alendronic Acid because my scan showed osteoporosis in vertebrae L1 in my spine (only there) although there's been an improvement in my bone density elsewhere. I've decided against taking it and I know my rheumatologist will be very upset with me but I'll just have to weather the storm. Like you I'm on 7.5mg and hope to start the slow taper next week. Good luck....
It’s a minefield out there sometimes isn’t it?So glad we have this site. I just read the link that PMRpro sent , it’s quite an eye opener. I’ve been diagnosed 5 years this year with PMR, about 2 years ago I asked to reduce from 20mg to 10 mg of omeprazole , now I only take them every 2-3 days and like you I never had any problems anyway so not sure why they load us up!!
And so far since reducing I have not had any problems.
I’m on 2 mg of prednisone so hopefully I’ll get off the omeprazole soon. I’ve also stopped taking AA since January as been on it three years . I do lots more walking with a weight vest and have altered my diet so fingers crossed.
I guess the choice is yours but the more information you have the better the decision you can make.
Hello, I was a bit older than you when I started, but seem to have almost the same experience. I was initially given the 3 medicines but decided to take only the prednisilone. I have been taking it since early 2017 always at breakfast time. The pharmacist at my local gp is keen to help and so has recommended the stomach and bone medicines, but I have not had them prescribed. She also recommended the accrete vitamin d which I do take, and it tastes nice, bonus!
Since I am taking a blood thinner (Dabigatran) twice a day I was happy enough to start 20mg Omeprazone when I started Prednisolone a few weeks ago on PMR diagnosis. Started Pred at 15mg, down to 10mg in 2½ weeks, now on 9mg.
That is good news about Actemra. I must get off prednisone because of the damage it is doing . Prednisone's stomach damage is insidious. It is working quietly, doing damage before symptoms appear. Once there is burning pain, nausea, weight loss, and ultimately bleeding, it is too late. Healing from that type of stomach damage takes a long time. From my personal experience, 10 years on Pred, 20 plus years with PMR/ 10 with GCA, it is best to prevent the stomach damage. Your analogy is spot on. Prednisone is not just a stomach irritant. Prednisone changes the chemical and physical structure of the entire digestive system. Yogurt coats the stomach and makes prednisone less of an irritant, but does nothing to prevent the chemical and physical changes to the gut. Some people have stronger stomachs, some more sensitive, but over time prednisone will cause changes that can lead to bleeding and ulcers. I still stand by my original statement. If a physician recommends an acid reducer to protect your stomach, do what the doctor says. From my personal experience Pepcid AC, in a higher dose is preferable to the proton pump inhibitors. The risk of osteoporosis and stomach cancer is greatly reduced .
Hi,I had acid reflux and was on 20 mg omeprazole before I started Prednisone. In the US we do not have coated Pred - apparently it can be special ordered on occasion but a months supply is several thousands of dollars!! So my reflux got worse and after 2 years last September I had to have surgery on my esophagus - I had polyps and it was inflamed but worse it was closing off so it had to be stretched. The recovery was very painful!!! So now on another 20 mg omneprazole at night and 10n mg famitdine at night. None of this stuff is good for you but it allows me to eat. Mind you I am not a drinker or a smoker. I avoid citrus and some other things. Lemonade had been my big offender but had no sense of it until it got worse very quickly.
So take the coated one and think about omeprazole maybe for "suspect" or evening meal?
The coated pred you are talking about is not enteric coated pred - that is only available in the UK. The coated version you can order at vast expense in the US is a modified release formulation. The coating breaks down after 4 hours in the stomach so it can be taken at 10pm and releases at 2am which is the optimum time to take prednisone to minimise morning stiffness in RA and PMR. Luckily it is rather more reasonably priced in Europe - and where I live, paid for by the healthcare system.
Yes you are correct. I stopped remembering when I registered the cost!!! I applied for Italian citizenship over 2 years and I passed the interview etc but still waiting for papers which they say will take years!! So I can't buy it there!!
I've not bothered- too expensive and while I would rather have EU citizenship, I don't think it is worth it at this stage of my life! Wasn't sure about the language test either - I live in a German speaking region, 95% of the residents identify as German-speaking, my Italian probably wouldn't cut the mustard!!!
Wanted it for several reasons. Family born there. Want to live in France near Italian border and don’t want to have to leave after 3 months. Also would want access to healthcare if something happened. Also husband would not have citizenship.
My very defined acid reflux and gerd has seemingly disappeared, so I often asked the gastro specialist if I could quit Nexium. The answer was always no, even though I pointed out the warning about using it for more than 14 days in a row. He just said that was for other people, not for me. Evidently, I have silent acid reflux and a recent upper endoscopy, a chest CT and then a thoracic MRI (CT and MRI were for other issues) shows a large sliding hiatal hernia containing the majority of the stomach. Then I was diagnosed with Interstitial lung disease and the pulmonary specialist said it was very important that I continue taking Omerprazole as a therapy for the lung disease. I do wish that doctors would better explain the reasons for needing a drug. My point is that there may be reasons for omerprazole than taking prednisone. Try to make your doctor explain. I'm still not good at that.
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