Omeprazole

[Miserere]

Omeprazole has been added to my prescription - so far I haven't taken it as I'd rather take as few medications as possible. It seems to be recommended with steroids and alendronic acid - is it necessary? I have been encouraged to take AA due to osteopenia but, again, not entirely sure if I need it. Any information appreciated. Thank you.

[Kendrew]

I have been on pred, AA and a couple of other meds since May 2019. I refused omeprazole until such a time as I had evidence that I required it! I take my meds with either a meal or with some live natural yogurt and have gastro- resistant pred. So far...no omeprazole required. I would also question the need for AA at an osteopoenic stage of bone health and look towards diet, exercise and calcium, Vit.D3 & Vit. K2 supplements first. AA may become necessary though if bone health deteriorates.

I don't know your full case history so you need to weigh up your own personal circumstances before making any decisions.

Look at FAQ'S section where you'll find lots of advice on these subjects.

[Miserere in reply to Kendrew]

Many thanks, Kendrew. I suspect I don't need either - nothing has changed to make me think I do. I'll stick with the yoghurt and always take steroids after breakfast anyway.

[PMRpro Ambassador]

What are your t-scores? Whether you need AA in response to "osteopenia" depends on the degree - it is a term that ranges from almost normal to almost osteoporosis. I have osteopenia - I have never taken AA and in 12 years my bone density has hardly changed and is still well within the range that doesn't require more than vit D and plenty of dietary calcium. Nor have I ever taken a PPI (omeprazole)

[Miserere in reply to PMRpro]

Sorry, I have to show my ignorance - what is a T-score? Also, having had a flare at 6.5mg, increased to 7.5mg and then to 10mg I am now struggling to reduce to 9mg. Is this 'normal'?

[Miserere in reply to Miserere]

OK - I have looked up T-score. My dr gives minimal information after tests - just said I had osteopenia and she prescribed AA. I have requested access to my med records as this is the only way I am going to know these things I think. Also, I feel I had better stay at 10mg for two or three weeks until things really settle, so I've probably answered my own questions. Thank you for the information.

[PMRpro Ambassador in reply to Miserere]

It is certainly a very common experience and a primary reason we bang on about going slowly so you don't overshoot and not ignoring the signs of a flare because once it is established it can be very difficult to get under control. But sometimes the actual underlying disease activity that creates the inflammation has ramped up - and then you may need a higher dose of pred as a result.

[Miserere in reply to PMRpro]

Thank you - I shall remain at 10mg until it settles. It's just so disappointing and I could kick myself for decreasing too quickly once I reached 7.5mg but it had been so easy up to that point. Now feel I am going to be on catch up for ages. Thanks again.

[PMRpro Ambassador in reply to Miserere]

That's the point - the further away you are from the dose you need, the easier it is to reduce. Really, the closer you get you should slow down even more. You aren't heading for zero - you are looking for the lowest effective dose and if you have got to 7.5mg it is going to be a relatively low dose. If you are lucky, you will get to zero but you can't take it for granted.

[Miserere in reply to PMRpro]

Thanks again, PMRpro - GP is supportive but was keen to stay at 1mg/month reduction. Even I felt that might be pushing it once I got to 8mg so reduced the reduction to 0.5mg. It's all a learning curve. Fingers crossed I can settle at 10mg and then reduce gradually.

[PMRpro Ambassador in reply to Miserere]

The basic rule is a step down shouldn't be more than 10% of the current dose - that is 1mg at 10mg, the lower you get, the more the % increases.

[Muffin2019]

I have been,on it over 10 years, take it in the morning with my vitimins and other medicine , I Also sleep on a slanted bed 2 and a half 2 by 4 piece under the legs of the bed. No side effects so take it it does work.

[Daffodilia]

I think it is to protect stomach from pred - I take Pantoprazole instead

[USAGCA in reply to Daffodilia]

The proton pump inhibitors do protect the stomach, but prednisone doesn’t damage the stomach. Prednisone makes it hard for the stomach to heal after it has been damaged.

[Miserere]

Thank you all for your knowledge and advice

[Hidden]

I started to take Omeprazole when first diagnosed with PMR in 2019. I was told steroids can cause a bleed in the stomach. I took them for a while but stopped. I take Risedronate 35mg for osteoporosis. Alendronic Acid at 70mg was too much for me. Good luck with your taper. I started 7mg today, with one day 6mg. More 7mg with only the odd day of 6mg. Wondering whether to go down by 0.5mg instead of a whole mg now I'm getting a lot lower. Just hope I don't run into the same problem when I reach taking 6mg....GCA happened so went up again....been reducing ever since March.

Anne

[Miserere in reply to Hidden]

Good luck with your tapering, Anne - I hope it works for you this time. I have decided that I shall taper slowly, 1/2mg at a time now and only when I feel comfortable. I got to 6.5mg before the flare and that was tapering 1/2mg/fortnight - now I realise that was too fast as there was still a little discomfort at 7mg. If I get as far as 5mg I shall take it even more slowly. Take care.

[Hidden in reply to Miserere]

I've been using the 'Dead Slow and nearly Stop method....seems to be working for me at the mo. You can find this regime on the Forum. Dorsetlady sent it to me.

[Predsharer]

It does seem incomprehensible that GP’s don’t tell you your test results and then go on to explain the reasons for the medication offered. How can we possibly be in control of our own bodies and take care of ourselves properly?I have access to my medical records and discuss all recommendations from my doctor in relation to what I know about my physical and mental health history, how my body functions and the risks involved in taking or not taking any medication offered. Do we really all have to fight for this? Thank goodness we have this forum to offset such arrogance.

[Miserere in reply to Predsharer]

Hopefully I shall have access to my records shortly. I wonder if it is easier for GPs just to tell you what they think you need rather than listen to questions etc. It saves time which is what they say they are short of. Proactive patients are not always welcomed.

[Predsharer]

Your DEXA scan scores may not be on your general records, mine weren’t for some reason. I do not take medication, even though I am in the osteoporosis category. I asked for a FRAX score, which I asked the rheumatologist to give me and then looked at the risk. I decided not to take the medication as I felt I was taking too much other medication, but would reconsider if my DEXA scan shows no improvement, at a later date (they have agreed to do another in 18 months). I have an excellent book called‘Your Bones’ by Lara Pizzorno that I can highly recommend and would be a very good read for you as you have osteopenia.

[Miserere in reply to Predsharer]

I shlal look for the book, Predsharer - thank you.

[Pr0jection]

I take goat's kefir and probiotics instead of omeprazole. I also have diverticulosis and gastritis which flares up from time to time and the goat's kefir certainly helps, along with plain Greek yoghurt. I was also offered AA but declined as I exercise, take calcium and Vit D3 as well as K2, magnesium, Vit B complex and biotin. All the best to you....

[Miserere in reply to Pr0jection]

I take probiotics, fish oils, D3 and K2 and L Glutamine in powder form so I sort of think I am doing all I can - I could try adding in more yoghurt or some kefir. Thank you.

[Pr0jection in reply to Miserere]

Oh yes, I forgot to add that I also take cod liver oil. So many different supplements to remember each day, but you're certainly doing the best you can.....

[Bcol]

Hi Miserere, It was suggested that I take AA when I started this journey but I asked for a DEXA scan first so that we could discuss the options. Scan and FRAX were excellent so doc and I said we would look at it again in two years time. I've taken Omeprazole for many, many years now and, as far as I know, no adverse problems/reactions. The only "extras" I take are Vit D and K2.

[Seekingasolution]

I was advised to take omeprazole after getting a bit of ‘dyspepsia’ with pred. ( I was nursing my terminally ill mother at home at the time with oesophageal cancer so that probably had something to do with it ) as the dyspepsia became worse and I was worried I was permanently damaging my own oesophagus, the dose was upped to double. The ‘dyspepsia’ became a whole lot worse ! I then read on here that Omeprezole doesn’t suit everyone and it was this medication that was causing the pain! It’s even written on the side effects list in the packet ! Even the NHS says it should be a short term medication. I asked for coated pred- problem solved. As for tapering... I’ve come to accept that it’s a bumpy journey. You can only do your best and even on the dead slow stop regime , and not unlike my bathroom scales it’s like Bridget Jones’s diary ! Up and down !

[Miserere in reply to Seekingasolution]

Indeed, I have the same type of scales here in my bathroom

😆. I shall ask about coated pred - for some reason my GP prescribes these at 2.5mg but not at the others. It's all a learning curve, isn't it?

[Seekingasolution in reply to Miserere]

Interesting ! I was told they don’t do coated pred in 1 mg tabs ! 🤔

[PMRpro Ambassador in reply to Seekingasolution]

Well they DO! There was a shortage last year which made it difficult until the new manufacturer came online - several posts on the forum about them. There wasn't 1mg e/c until 2016 but they have been available since.

I really don't get the GPs - mixing the types of pill is not helpful as it messes up the absorption. Plain pred takes about an hour or 2 at most, e/c takes anything from 4 to 7 hours depending on the amount of food in the gut.

[LizMitchell in reply to Miserere]

Gastro Resistent Prednsolone is available in the UK in 5mg, 2.5mg and 1 mg tablets! I had to ask my GP for them about 4 years ago. The cost is only slightly higher than the normal prednisolone tablets, so don’t let your GP tell you they are too expensive to prescribe or too difficult to supply. I take them at bedtime, so they start to work at the optimum time to deal with the daily inflammation in the early hours of the morning. So many obvious advantages with minimal impact on your gut, so for me it’s a “no brainer”

[PMRpro Ambassador in reply to LizMitchell]

2.5mg e/c is CHEAPER than 2.5mg non-coated pred (which is also available though a lot of doctors and pharmacists claim not to know that either!