Is omeprazole necessary?: Now that my GP has their... - PMRGCAuk

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Is omeprazole necessary?

Lochy profile image
Lochy

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.

62 Replies

Read the side effects - can cause aches and pains just like PMR.

Your body your decision about 'add -ones'.

Lochy profile image
Lochy in reply to jinasc

Agree! Too many add ons offered and in the beginning difficult to know.

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.

Lochy profile image
Lochy in reply to SnazzyD

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 !

If you are really worried you could always ask for the enteric coated variety, otherwise if you feel fine why change?

Lochy profile image
Lochy in reply to piglette

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.

piglette profile image
piglette in reply to Lochy

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.

Lochy profile image
Lochy in reply to piglette

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.

piglette profile image
piglette in reply to Lochy

The trouble is often they want to show themselves to be in charge!

PMRpro profile image
PMRproAmbassador

Never taken a PPI and don't intend starting now. If they are that concerned - they should send you for a scope.

The second page of this lists the potential adverse effects.

westessexccg.nhs.uk/your-he...

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.

Lochy profile image
Lochy in reply to PMRpro

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.

Interesting article which I feel backs me up.

PMRpro profile image
PMRproAmbassador in reply to Lochy

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.

Lochy profile image
Lochy in reply to PMRpro

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!

PMRpro profile image
PMRproAmbassador in reply to Lochy

Especially when they hand them out like sweeties - you have to add in possible interactions ...

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.

Roryfederer profile image
Roryfederer in reply to PMRpro

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.

PMRpro profile image
PMRproAmbassador in reply to Roryfederer

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.

Going by this

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

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.

Roryfederer profile image
Roryfederer in reply to PMRpro

Thank you for your reply. I will take one every other day and then every 3rd day.

I haven’t been prescribed any PPI in my 4 years of PMR I just take it with my breakfast

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

Lochy profile image
Lochy in reply to ThunderB

Is that just a different type of omeprazole? Don’t know that I’m aware of all the differences.

PMRpro profile image
PMRproAmbassador in reply to Lochy

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.

tangocharlie profile image
tangocharlie in reply to PMRpro

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

Lochy profile image
Lochy in reply to tangocharlie

Assume that’s another PPI? Have you always taken it? I know you haven’t had an easy journey either so just wondering.

tangocharlie profile image
tangocharlie in reply to Lochy

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.

healthunlocked.com/pmrgcauk...

I take pantoprazole instead

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.

Lochy profile image
Lochy in reply to ChrisMcT

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??

ChrisMcT profile image
ChrisMcT in reply to Lochy

No I'm not adding to the cocktail of pred, paracetamol and osteocare.

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.

PMRpro profile image
PMRproAmbassador in reply to Decsgran

Don't stop it cold turkey - taper the dose over a few weeks or you may suffer rebound production of acid.

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?!

PMRpro profile image
PMRproAmbassador in reply to Frewen1

Be careful - there are good reasons to take a PPI, hiatus hernia may be one.

Frewen1 profile image
Frewen1 in reply to PMRpro

Hmm. Ok, as usual I defer to your wisdom, perhaps I’ll stay with the one.

PMRpro profile image
PMRproAmbassador in reply to Frewen1

No reason not to try - but bear it in mind if any symptoms worsen

Frewen1 profile image
Frewen1 in reply to PMRpro

🙏🌸

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 it but I only do so because I have a Hiatus hernia.

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.

PMRpro profile image
PMRproAmbassador in reply to phebamom

"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.

Roryfederer profile image
Roryfederer in reply to PMRpro

I didn't know PPIs cause osteoporosis!!!

Lochy profile image
Lochy in reply to phebamom

Did you start to have symptoms? Is that why they did an endoscope ?

phebamom profile image
phebamom in reply to Lochy

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.

DadCue profile image
DadCue in reply to phebamom

Thank you for the warning about GI (gastrointestinal) bleeding. I took "stomach protection" the entire time I took prednisone for PMR. The whole issue boils down to whether or not a person wants to accept the risk of having GI problems. I personally never developed too many problems with my GI tract so there are two possible conclusions:

1) I didn't need stomach protection

or

2) the stomach protection worked.

I don't know which was true. Stomach protection may not prevent GI problems but at least it acknowledges that the risk does exist. It is sad when someone suggests since it doesn't happen to them, then nobody else needs to worry about it. That is like doing research with a sample size of one person. The same holds true for all of the side effects of prednisone.

I think there is some risk of a GI bleed when taking prednisone. The risk increases for people taking blood thinners so that was the main reason why I took omeprazole. I have taken care of people in the hospital with severe GI bleeding. The situation sometimes involved blood transfusions to replace the blood being lost. To say it mildly--it was a huge mess.

The real clincher for me was when someone pointed to the visibly "thin skin" that was developing on the outside of my body. Then they said that it was likely happening on the inside of my body too where it can't be seen.

I have been taking Actemra for over two years. Inflammatory arthritis was diagnosed many years before PMR was introduced to me. I got completely off prednisone and have been off for more than a year. The thin skin on the outside isn't so thin anymore.

Lochy profile image
Lochy in reply to DadCue

What a great analogy!

phebamom profile image
phebamom in reply to DadCue

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 .

DadCue profile image
DadCue in reply to phebamom

In a hospital setting, a patient on corticosteroids would probably get stomach protection whether they wanted it or not. Patients were more compliant when hospitalized and were not overly concerned with what medications they were receiving. They tended to be too sick to care that much. Generally speaking, outcomes were better than if patients treated themselves.

I was a "pill pusher" for hospitalized patients. I was responsible for making sure patients received the medications that were ordered. I sometimes felt guilty about all the medications that were deemed to be "necessary". I could use some discretion for patients who refused treatment but I needed to inform the doctor. The doctor didn't always accept "no" for an answer. Sometimes it was mandatory to clearly document "patient refused" and that the risks of refusing were fully explained.

There were some patients who would take a handful of pills and swallow them without any water or just a sip. I could easily imagine the pills sitting in their stomach and burning holes in their gut. I had to insist they take their pills with an adequate amount of water. Some people refused that request too claiming it wasn't necessary.

I think Lochy is wise to say, "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."

Sometimes it is just a matter of having a talk with your doctor. I have refused medications in the past but I always get my doctor's opinion rather than listening to some stranger on the internet. Had I listened to the "advise" from the internet, I would have refused Actemra and probably still be taking prednisone.

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.

Good luck to you x

Carole

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.

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?

Good luck!!

PMRpro profile image
PMRproAmbassador in reply to bluegirl7

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.

bluegirl7 profile image
bluegirl7 in reply to PMRpro

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!!

PMRpro profile image
PMRproAmbassador in reply to bluegirl7

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!!!

bluegirl7 profile image
bluegirl7 in reply to PMRpro

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.

Thanks everyone for your contributions. Like all medications it’s about personal choice as everyone has different issues.

I will try and chat to my GP although it’s pot luck having to phone daily to try get an appointment.

I just worry that after 6 years on prednisolone I should be much more wary.

I have the gastro resistant 2.5mg tablets which I presume are designed so we can avoid the PPIs?? If I just use then will that help?

I still have no stomach issues but am aware of the ‘silent’ nature of potential problems.

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