What about Pepcid (famotidine)?

[LIVEORDIEHEREIAM]

I am in the US and take OTC Pepcid (Famotidine) for the stomach effects of Pred. I notice that in the forum, most of you are taking other acid reducers. Pepcid rarely gets mentioned. So I'm wondering if I have missed a memo or something. Is Pepcid not recommended for people on Pred ? My reason for using it is mostly that the others are NOT RECOMMENDED for long-term use.

[piglette]

Good point. They are PPIs like Omeprazole and Lansoprazole, the two popular PPIs in this forum it seems. I wonder if it is a cost thing.

[PMRpro Ambassador]

Until fairly recently the usual H2 antagonist was ranitidine - but there was a manufacturing problem that led to contamination of the product from certain suppliers and it was withdrawn from sale worldwide. Famotidine has been the go-to H2 antagonist for only a couple of years and many doctors are unaware of it, just tell you you can't have ranitidine, here, have this PPI.

The marketing for the PPIs when they were launched was such that a whole generation of doctors became completely convinced that PPIs were the best thing since sliced bread and far far superior to the H2 antagonists - they aren't that much better but perception is all. In fact, there is evidence that about a third of patients do well with them, another third have awful adverse effects and for the rest they don't work at all to suppress acid production. Not that fantastic a recommendation you'd think!!

I imagine that in the UK it is very much a cost thing - the cheapest approved drugs bought in bulk by the NHS. Whatever the medication, they start with the cheapest ...

[LIVEORDIEHEREIAM in reply to PMRpro]

Thanks PMRpro! That does help make sense of it. Still, doesn't the NHS hear about things like the studies showing that PPIs are not good long-term ? Years on Pred and a PPI seems like long term to me!

[PMRpro Ambassador in reply to LIVEORDIEHEREIAM]

They will have seen it - and to be honest, long term use of PPIs isn't as common as it maybe feels here. There are places where the risks are far outweighed by the benefits. We aren't so convinced for most of us but we are only patients after all!! Snazzy covers it well just below here. It seems to be the UK that has this preoccupation with PPIs plus plus for pred users. Not met it here at all.

[Karenjaninaz in reply to PMRpro]

Pepcid.(famotidine) is an H2 blocker; Prevacid(lanzoprazole) is a ppi. I can use Pepcid the Prevacid causes a tremendous amount of cramps and wind.

[SnazzyD]

I remember when patients were being given the H2 antagonist type like yours and then the new kids on the block, the PPI’s, came and the H2’s were dropped and PPI’s could do no harm. Except in a few people they did and useful though they are, I think they were often prescribed indiscriminately and without review for long periods, ignoring the downsides. I have read some studies that say that H2’s are better for ulcers because they are better for nighttime acid. For reflux the PPI’s were said to be better. Ideally the doc listens to the patient and tries to find an option to suit them.

I didn’t get on with them in that they made my symptoms worse so I switched to the H2 which was great for a couple of weeks and then I got breakthrough acidity. In the end I had to have enteric coated Pred plus Gaviscon which was great for me.

[LIVEORDIEHEREIAM in reply to SnazzyD]

It sounds as if your Dr. was actually listening. Or you took the initiative and found a workable alternative!

[SnazzyD in reply to LIVEORDIEHEREIAM]

It was my plan but my GP always does what I ask if she can see the sense and there is no ego to get past when dealing with her. She is always interested in what the patient thinks. The one hurdle was cost because they do have to justify their prescribing so I went in with the sums showing Enteric coated Pred + patient bought Gaviscon was a bit less ££ than PPI + uncoated Pred.

[Sharitone in reply to SnazzyD]

Is the E/C pred much more expensive than uncoated?

[PMRpro Ambassador in reply to Sharitone]

It was at one time, it was claimed to be 17x as expensive but when the NHS then tried to restrict the use of e/c pred, the manufacturers put up the price of plain pred! Needing to use a PPI with plain pred adds to the cost - not just the cost of the tablets but also a dispensing fee which most doctors forget about as a cost to the NHS.

The difference is minimal these days - but it removes a layer of side effects if you use e/c pred.

[blueisgreen in reply to Sharitone]

I'm with Kaiser Health in the U.S. and I can't get the coated prednisone - they say it costs too much. So I've been taking omeprazole (sp?) for a couple of years now. No problems with it so far. I've never tried Pepcid.

[PMRpro Ambassador in reply to blueisgreen]

Enteric coated pred is only available in the UK. The other form of pred with a coating is Rayos but that isn't gastro-resistant, it is a timed release coating and is released in the stomach, just 4 hours later. And for some reason in the USA it is extortionately expensive - $2000 for what costs less than 30 euros in Europe!

[blueisgreen in reply to PMRpro]

Thanks for this info re coated prednisone. I truly need this acid reducer so I think I'm stuck with Omeprazole.

[PMRpro Ambassador in reply to blueisgreen]

There are others - different PPIs and H2 antagonists as well

[SnazzyD in reply to blueisgreen]

See my reply below on prices

[SnazzyD in reply to Sharitone]

Here is some pricing unless I’ve misunderstood it 1mg non-coated about 83p for 28.

2.5mg non-coated about £3.91 for 28

2.5mg coated about 1.26 for 30

and, get this

1mg coated £7.43 for 30!

bnf.nice.org.uk/medicinal-f...

Omeprazole 28 for about £9.30 so not cheap as chips

bnf.nice.org.uk/medicinal-f...

[PMRpro Ambassador in reply to SnazzyD]

Oooh - the price of omeprazole has shot up - used to be well under £4

[SnazzyD in reply to PMRpro]

I wonder too if the uplift in the 1mg is down to market forces due to the scarcity earlier, rather than actual cost.

[PMRpro Ambassador in reply to SnazzyD]

It usually reflects something that isn't used much so there aren't the bulk-buy discounts. Lot of effort to set up a run of that dose and the cost must be recouped over much smaller sales figures.Bet omeprazole has gone up because the demand is increased since ranitidine was withdrawn.

[Sharitone in reply to SnazzyD]

Ouch! Feeling rather guilty....Perhaps that is why some medics are so desperate to get people to reduce pred so fast? 🤔

[PMRpro Ambassador in reply to Sharitone]

Most of them haven't a clue about drug costs! If they did, they would be a bit more reticent about dishing out some of the less required stuff that causes adverse effects that they then hand out another drug to (supposedly) sort that out!!

[Floridafan]

I was prescribed Lansoprazole, Omeprazole and Rabeprazole. I couldn’t get on with any of them so consequently suffered with pain for years taking Cocodemal if things got too bad. Had all the tests and when I asked my GP if this is what life was going to be like for the rest of my life she more or less said “Yes”. I couldn’t believe that was true and so searched myself and came upon Famotidine (Pepcid) and haven’t looked back since. Oh, how I wish I had found this sooner. Mine is prescription only so I assume it must be stronger than the over the counter one. I had tried Ranitidine in the past. It had no effect and of course isn’t available anymore.

[PMRpro Ambassador in reply to Floridafan]

I'm appalled it didn't occur to her to try a different class of medication - must have slept through her pharmacy lectures!!!!

[fmkkm]

I’m in the US and have never needed an acid reducer. I was never offered one either, so I guess there is always the alternative of taking nothing?

[PMRpro Ambassador in reply to fmkkm]

Many of us don't ...

[artfingers]

I agree with Forwardmotion, I'm in the U.S. and my rheumy has never even mentioned any acid reducer, just take pred with food. Sheesh. I'm beginning to seriously wonder about her! Anyway, I shall ask my GP when I see her in a month. My OH takes Famotadine. Seems like my list of pills to take is growing longer every day, sigh.

[PMRpro Ambassador in reply to artfingers]

She is line with the majority of non-UK medics I suspect. They are usually used if you NEED them, not "just in case". The more medications you mix together, the more risk there is of interactions.

[SapoKiko]

I am in the US and my rheumatologist prescribed Omeprazole along with the pred from the get-go. Although it's only been about 6 weeks from diagnosis I don't think the Ome is bothering, hard to tell when Pred itself has so many issues of its own.

[PMRpro Ambassador in reply to SapoKiko]

Except when they start several things at the same time a) you can't tell which is causing what and b) a given drug may do x on its own but in combination with another drug, that dynamic changes. And the more drugs you add, the more the dynamic changes ...

For example, with prednisone and prednisolone I have had next to no problems. Methotrexae was added in the hope of reducing the pred dose but all that happened was that I experienced what are normally called pred adverse effects, if MTX potentiated the desired effect of pred, it can also potentiate the unwanted ones too.

[LIVEORDIEHEREIAM in reply to SapoKiko]

I started this thread because it is my understanding that all PPIs (Omeprazole being one of them) have negative health effects WHEN USED LONG TERM and we are in this long term! Pepcid is not a PPI.

[SapoKiko]

Good point to take us back to the topic at hand. I was providing my minimal experience without commentary, just fyi. From the responses, one thing we need to understand is the difference between what is available and prescribed in UK vs US. Looks like here in the US we don't have enteric coated Prednisone, that might be one reason to prescribe the ppi or pepsid. Not that it's a good reason! I would much rather have 1 med with nasty side effects than two, plus the possibility of negative drug interactions.Some googling didn't yield much re. PPI vs H2 anta studies long term, only effectiveness for gerd short term. And beaucoup warnings about long term use!

After this, you just KNOW I am going to discuss with my rheumy.

[DorsetLady PMRGCAuk volunteer in reply to SapoKiko]

“From the responses, one thing we need to understand is the difference between what is available and prescribed in UK vs US.”

Not just UK/US - many other places.That’s why we longtime members are always saying - check with your own medical protocols, and also urge all members to share in their profile the country of residence.

It’s easy to assume everybody’s treatment is the same as your own, it isn’t.

[PMRpro Ambassador in reply to SapoKiko]

Part of the PPI vs H2 antagonist story is superb marketing of the PPIs by the pharma companies. They took anything that looked really good and emphasised that - normal enough practice of course. The PPIs DO reduce acid production a bit better and it is easy to push "new improved". Non-specialists are particularly easy to convince - and it is GPs who tend to use them most. In fact it is said that omeprazole (for example) has intolerable adverse effects for about a third, simply doesn't work at all for about a third - and works well for the remaining third!!! But the doctor is so convinced it is a wonder drug that they tell the patient it is all on their head ...

[SapoKiko in reply to PMRpro]

Reminds me of my favorite statistics joke - "33% of the subjects showed marked improvement. Another 33% remained in a moribund state. The third mouse got away."

[PMRpro Ambassador in reply to SapoKiko]

Love it!!!!