omeprazole, adcal and prednisilone

[larkthebark]

Can someone please remind me of the mantra for taking these ?

I am sure i read not to take Omeprazole with Pred as it affects absorption and know for sure that Omeprazole affects the absorption of calcium and Vit B12.

I am currently stable on 5mgs but after 8 weeks my body is still saying no to further tapering but thats fine as after only 14 months since diagnosis I am pleased with my progress. Awaiting results of my Dexa scan and have a face to face appointment with my GP next week.

Am asking the question for a friend who has been told by her GP that after 4 years she should be over PMR !!!!!!

He told her to reduce her steroids but to start Omeprazole which she has been taking concurrently and I just wanted to confirm that they should be taken separately .

[mgrogers99]

I have been taking omeprazole twice daily for the entire time I've taken prednisone...over two years. Several years ago I had a GI bleed after taking steroids for asthma...so omeprazole has been my friend....no bleeding at all for these two years!!

[DorsetLady PMRGCAuk volunteer]

Omeprazole should be taken before meals, Pred best with or after food...this link indicates it does not interfere with Pred absorption.

pubmed.ncbi.nlm.nih.gov/897...

..and tell your friend to get another Rheumy!

[larkthebark in reply to DorsetLady]

Thanks Dorset Lady. my friend is having a terrible time as she also has osteoarthritis and her GP has decided all her pain is down to that and not PMR.She has a Dexa scan next week after pushing for one and is seeing a Rheumy in september.

It really is getting her down along with some of her family now with COVID.

thanks for link.

[PMRpro Ambassador]

Omeprazole affects the absorption of calcium because it combats the acid in the stomach and an acid environment is helpful in absorbing the calcium. But taking the ompreazole doesn't just work briefly, the effect lasts a long time. For the PPI to work effectively it needs to be taken half an hour or so before the meal that will lead to acid production - and it is claimed to protect your stomach from the effect of acid. However, maybe they should read the research:

pubmed.ncbi.nlm.nih.gov/236...

"There is convincing evidence showing an increased risk of ulcers and a poorer recovery from these when NSAIDs and systemic corticosteroids are used concomitantly; this is a combination for which a proton pump inhibitor should be prescribed. Conclusion: Systemic corticosteroid therapy only rarely causes a peptic ulcer."

i.e. if you don't take NSAIDs with the pred - you DON'T need a PPI.

You should take the AdCal at least 2 hours away from the pred as it is thought to coat the pred tablets and interfere with the absorption of the pred in the stomach. Pred also reduces the absorption of calcium lower in the gut by flushing it out in the urine.

Get your friend to offer this link to her GP to read:

practicalpainmanagement.com...

The link to the original work is at the bottom of the article. They found that half of patients need more than 6 years to get off pred - and only a third of patients are off pred in the claimed 2 years. We find there is quite a bulk of patients who need 5-6 years and the Matteson work isn't alone in confirming the length of time PMR can last.

[larkthebark in reply to PMRpro]

thanks , have forwarded links to my friend. Will be interesting to see what the response is !

[Predsharer in reply to PMRpro]

I am still very confused about the use of PPI’s this research that you quote here states very clearly that PPI’s are not necessary when prednisolone is prescribed for short term use. As all PMR sufferers take prednisolone for long periods and nearly always for years rather than months, then this research cannot be applied to,us. Further more, another piece of related research on here states that PPI’s are not necessary if patients take less than 1000 mgs. I am way over that and I have only been taking Pred since April.I am told by my rheumatologist that, whilst taking a PPI does compromise calcium absorption, protecting the stomach from prednisolone is far more important. She said that calcium deficiency can be measured for, whilst damage to the stomach lining cannot and suddenly people can discover they have an ulcer when it is too late.

It is just so confusing and quite frightening, along with all the other aspects of the treatment of PMR.

[Daffodilia]

I take pantoprazole mid morning separate from pred and Adcal and Alendronic Acid