Coming off PPIs when taking 4mg prednisolone

[Karendeena]

I have been getting excessive flatulance, intermittent diarrhoea and general stomach discomfort over the last few weeks. I have been taking Lansoprazole with prednisolone since the end of May. I also take the anticoagulant Apixaban as I have afib. Due to the stomach problems my doctor swapped me to esoprazole which isn't any better. She has now decided to stop the PPI and told me to take pred with food and gaviscon if I get heartburn. Obviously I am concerned for a stomach ulcer in particular because of the risk with anticoagulants. Has anyone got any advice or found themselves in a similar situation? Thank, Karen

[SnazzyD]

Are you in the UK? If so, why can’t the doc prescribe coated Pred or am I missing something? If you do come off PPI’s you should do so slowly so you don’t suffer from rebound acidity, but the doc should know this.

[Karendeena in reply to SnazzyD]

Thanks snazzyD, no she's told me to just stop them! Yes, I am in the UK and I believe there is an enteric coated prednisolone but I read on the NHS fact sheet that it shouldn't be prescribed but I don't know why. She told me yl take gavisvon if I get any heartburn etc. Didn't have acid reflux before, not sure why I would get it when I stop, any udea?

[SnazzyD in reply to Karendeena]

It may be down to cost. I argued that it cost the same as uncoated Pred plus a PPI. I had costed Pred and bought my own gaviscon. As to the rebound acid. See this, mistake number 8

ueg.eu/a/170

and one from NZ that has a sample protocol

medsafe.govt.nz/profs/PUArt...

[PMRpro Ambassador in reply to Karendeena]

Because if you stop a PPI suddenly there is a rebound effect which can often result in the production of far more acid than usual - not sure of the exact mechanism but for a short time it can be very high and cause reflux even in people who have never had a problem before.

[PMRpro Ambassador]

I am on a DOAC, Pradaxa, and pred with no PPI. No problems thus far. But you could try an H2 antagonist instead - either famotidine (Pepcid) or cimetidine (Tagamet). They are older but really not much less effective than the PPIs - despite what the marketing would have you believe.

[Karendeena in reply to PMRpro]

Thanks PMRpro, going to give it a go without the PPI like you and just take the pred with food Is pred at low doses really that vicious?

[PMRpro Ambassador in reply to Karendeena]

I don't know. Seems to depends on the doctor!! Mine never mentions a PPI unless I need NSAIDs for something and I take relatively high dose. It seems to be an English-speaking preoccupation.

[123mossie]

Hi karendeena I came off ppi as I didn’t fancy taking something I could possibly do without. I’m on a low dose now but have 1/2 a banana pre pred, some have yoghurt & seem to be ok

[mtrafter]

I met with my GP this week over this very same issue (had been on 40mg of Pantoprazole since diagnosis 4 yrs ago have had same GI issues over last 6mths, reduced PPI to half dose 3mths ago with some lessening of symptoms) sought advice on stopping PPI altogether, advised not to cease immediately but to step down further to try the 20mg alternate days to see if any rebounding occured and if so change to ? Tagamet or famotidine as has been suggested by PMRpro.

[Karendeena in reply to mtrafter]

Hi mtrafter, my doc wants me off all but the steroids for the weekend but she has prescribed famotidine but says the side effects are still stomach related. Will wait and see

[S4ndy]

I take 5mg of Pred a day. Came off PPIs about 2 years ago due to digestive problems. At first I was very acidy but it got better within a few days. I now take my pred with live yoghurt and use Peptac (cheaper than Gaviscon) medicine or Rennies if I need something. I usually find I only need antacids at night and only if I've eaten late.

[crazyknitter]

It is worth trying lactose free milk. I am on prednisone 4 mg daily and omeprazole 20 mg daily and had so much wind, mostly downwards rather than upwards. Someone suggested I change my milk and it worked like magic.

[Sharitone]

Bit confused here. I have a barrage balloon where my stomach used to be, and was given first 20mg, then 40mg of Omeprazole to stop this. AA was also replaced with denosumab. But people here are saying PPI causes bloating.🤔Thanks for the milk suggestion, crazy knitter, as I would love to wear sthg that doesn't have a huge elastic waist!

[PMRpro Ambassador in reply to Sharitone]

Is that barrage balloon wind or is it fat? That is one of the places pred makes you develop fat deposits and it can be quite pronounced.

[Sharitone in reply to PMRpro]

Well, it doesn't wobble! And it increases as the day goes on. I lost 12lb suddenly with PMR/GCA, but put 10lb straight back on with high doses of pred, so I' m sure some of it could be redistributed fat! Mind you, It feels like there is about 10lb of fat on my face...

[PMRpro Ambassador in reply to Sharitone]

Have you tried low carb? It does work on pred weight ...

[Sharitone in reply to PMRpro]

Yes, not eating many, and the weight gain has stopped. Not too bad, with a net loss of 2lb, but just can't get the exercise!

[PMRpro Ambassador in reply to Sharitone]

It has been shown that exercise doesn't really significantly help weight loss unless it is very high intensity - more than most people could or would do. Mostly it is because the exercise makes you even hungrier!

It is probably going to be slow - though some people do lose quite quickly, MrsNails did very well. I don't have too much difficulty not gaining weight but losing does take more discipline! I lost 35lbs of PMR and pred associated weight gain but it took me 18 months. It stayed off though until 2 years ago. I got my act together at the start of Lent this year and have lost over 5kg since.