Do most of you take Omeprazole as well as Prednisolone?

[DiSaw]

I have been taking Omeprazole, a proton pump inhibitor, to protest my stomach lining from becoming ulcerated by prednisolone. I take 20mg a day. I understand that when I am on a high dosage of prednisolone this is necessary; is it still necessary when I get below 5mg of Prednisolone? Omeprasole can come in 10mg form, but my pharmacist said I should continue with 20mg - and my slight body (only just over 7 stone), has nothing to do with it. Omeprazole has unwanted side effects and I believe that when it is stopped there is a rebound effect.

[Kendrew]

Others with more knowledge will be along shortly but I was told I must take omeprazole as a precautionary measure when I started taking pred.

I refused and said that unless I began to manifest symptoms that indicated a need for them then I would not be taking yet another medication with more potentially harmful side effects. Three years later, I still haven't needed them! I'm very diligent with my efforts to protect my gut and take all necessary measures to prevent needlessly irritating it. So:-

- I take gastro-resistant pred

- never take my pred on an empty stomach

- eat gut friendly food such as live natural yogurt, occasional sourdough, sauerkraut, etc

- no alcohol

- no hot or spicy foods

Obviously for some people there will most definitely be a need to take omeprazole and if there's evidence or medical history to support this then it must be accepted as a necessary part of treatment.

I'm also fully aware that my circumstances may change and I accept that at some point I may indeed need to take omeprazole.

[HeartMe in reply to Kendrew]

I live in the U.S. and never heard of gastro resistant Prednisone. Is this specific to your country?

[Kendrew in reply to HeartMe]

Hi HeartMe,

I'm afraid I can't answer that but others may be along who can.

I knew they were available here and specifically requested them. My GP was a little reluctant at first, maybe because they're slightly more expensive...I'm not sure. However, I'm reasonably convinced that they've contributed to me not requiring a PPI for the past 3yrs.

[DorsetLady PMRGCAuk volunteer in reply to HeartMe]

Had a quick look online couldn’t find reference to gastro resistant Prednisone but in UK we have Prednisolone-which is slightly different-so maybe check with your doctor or pharmacist.

[PMRpro Ambassador]

I've been on pred for over 13 years and have never taken it or anything else routinely. My rheumy does courses of infusions of NSAIDs b=for an additional back problems - and he makes me take something them because of having NSAIDs and pred at high doses together.

[Newplodder]

Hi. I have only been diagnosed since June and was also prescribed a PPI..in my case lansoprazole. I took it for a week and then stopped, for similar reasons to Kendrew. So far, I have had no issues, but am also very careful to take my pred immediately after a meal. I suppose I can't be certain there is no damage happening to my stomach lining, which just hasn't yet manifested itself as symptom, but I'm obviously hoping not! Hope all goes well for you

[PMRpro Ambassador]

It doesn't appear to be a normal action for patients on pred here in Italy.

[DiSaw in reply to PMRpro]

Thanks - it's always interesting to hear how treatment varies in other countries.

[nallufl24]

I only took it on 60 mg prednisone. When I got to 40 mg, doctor said I could stop. I never took it since with no problems

[DiSaw in reply to nallufl24]

Thanks, that's helpful - I'm down to 5 mg

[bakingD]

Hi

I had terrible gastritis and had an endoscopy which showed that , consultant wanted me on Omeprazole but I had it a few years ago and got rebound gastritis when I stopped it, so was reluctant to restart it.Once I went onto gastro resistant Pred it all healed up nicely and I have been fine - can even eat spicy foodsSo it isn’t really necessary and can cause osteoporosis so I decided to try to do without.

[Bcol]

Morning, I've been on Omeprazole on and off for many years, with no discernable problems, but as I'm now on a fairly low dose of Pred I have wondered about asking the doc about stopping it. If you do stop please bear in mind you need to taper off slowly and not just stop or you are very likely to get a nasty rebound.

[DiSaw in reply to Bcol]

Thank you - I went onto 10mg Omeprazole (reduced from 20 mg), but spoke to a pharmacist and she was insistant that I should be taking 20 mg - but I suppose her knowledge is what she gets from the drug firms and not medical knowledge of individuals. I'll go back on 10 mg and try (very difficult), to discuss it with me GP.

[Grammy80]

When initially diagnosed, I was put on omeprazole because I'd had bleeding ulcers and another stomach bleed from WAY too much Ibuprofen after a fracture. My current GP took me off it and substituted sucralfate or brand name Carafate. No problems after three years~~that has been my experience.💕

[Suetum]

I took it initially as I was getting indigestion but then read on here about taking my pred with yoghurt and never needed it again

[Koalajane]

I have never been prescribed a PPI. I just take my prednisolone with my breakfast

[DiSaw in reply to Koalajane]

Are you in Britain? Would you mind telling me your approximate age ?

[Koalajane in reply to DiSaw]

hi, yes in UK and 69

[ubaoz]

I can sympathise with wanting to get off any medication which might not be needed.

I've never needed to take anything like omeprazole, even at the high pred doses used for GCA. I do always take my (uncoated) pred with my morning Greek yoghurt and nuts breakfast though.

At 40-50mg of pred I got a slight bit of mild indigestion, but I found ginger tea sorted that out pretty easily. My GP was fine with me not taking anything as a preventative. He also said that any problems in that area would tell me in no uncertain terms if I needed to change my current routine.

We are all really different in our various reactions to pred, so you need go with what works best and feels most comfortable for you.

[Daffodilia]

I take it - started when gp prescribed after a few years on pred

[calibriel]

I’ve been on lansoprazole ever since I’ve been on pred (2+ years), and my doctor advised me to continue with it as long as I was taking pred, even at a very low dose. I’ve never been on a very high dose of pred, although I’ve been hanging around in the low doses for quite a long time: currently on 3 tapering to 2.5. I’ve never identified any side effects specific to the lansoprazole, although obvs I’d prefer not to be taking so many prescription meds (I’m also on two different ones for hypertension). Something is definitely messing with my bowel habits. I know we’re told not to aim to get off the pred altogether, but I suppose I’m hanging out for that to get off the lansoprazole too …

[DiSaw in reply to calibriel]

I feel the same - I wouldn't mind staying on a very low dose of Pred. if it didn't mean also staying on the Omeprazole

[Viveka]

I have pred with a museli including dollups of natural yogurt and put the pill/s in the middle of spoonfull/s of yogurt rather than with liquid. Trick I heard on the forum. Also restrict liquid around the time of taking pred until absorbed. Unless anyone has a history of stomach ulcers etc this should hopefully do the trick. Never took O, its not great for long term use though I understand some people appreciate it for short periods of time for chronic reflux - but as members say, if coming off do it slowly.

[Tinkabell555]

I’ve been on multiple meds for SLE for a couple of years, including pred. I was only advised this year to start lansoprazole (GP not my rheu) for preventative reasons. I’ve started it reluctantly this week, but am I at risk of side effects if I don’t really need it? I’ve been given no advice really

[Kendrew in reply to Tinkabell555]

Hi Tinkabell555,

Any medication, whether taken as a preventative measure or because theres a proven need will always carry the risk of causing side effects.

You'll have read here how some people have taken PPI's with little or no side effects too but unfortunately there's no way of knowing which category you'll fall into.

I would still always advocate not taking any medication without evidence for the need to, but thats my own personal opinion and others may think differently.

You will have to formulate your own opinion and decide what's best for you.

[PMRpro Ambassador]

The thing that always surprises me is how they make so much hoo-hah about pred and bone density but never mention the PPIs in that connection. For some people, PPIs cause appalling GI problems and for about a third of patients they don't work at all, They were never designed to be used non-stop over long periods as many UK doctors do. I can see the point of using them if you need them - but not handing out an automatic prescription "just in case".

[DiSaw in reply to PMRpro]

Thanks for your reply - that fits in with how I am feeling

[Molly555 in reply to PMRpro]

thanks for this comment I wasn’t initial prescribed a PPI but a pharmacist reviewing my prescriptions said I needed it, I haven’t taken it as I don’t really want to take more meds and have never had any stomach issues apart from heartburn at night only when I know I have overindulged. I didn’t know about side effects. I’m happy to take meds if I need them, but the case for PPI’s seems as ever complicated.

[ImC_]

Hi DiSaw,

I’m not keen on taking any more meds than I have to. Took oneprazole once briefly with some other drug and one or other of them was very disagreeable so I’ve avoided it.

I have my prednisolone very early and my breakfast very late so I have the pred with a dollop of plain thick yoghurt (not set which seems slightly sour at 5am). If no yoghurt I have a bit of banana.

Done this since my initial 15mg. 2 years ago. Not moderated my eating or drinking habits otherwise.

[HeartMe in reply to ImC_]

Thanks everyone for the yogurt tip. I am having gurgling a lot lately but not regular acid reflux. I know it can be silent too. I hope this helps as I get side effects anyway from Omeprazole.

[ChrisinNam]

I was prescribed 10mg Omeprazole many years ago, way before Pred, because of a need to constantly clear my throat. Dr said it was non-acid reflux. When I was put onto 20mg pred the Omeprazole was increased to 20mg, but after a couple of months I dropped down again to the 10mg one. I always take my pred with natural proper Greek yogurt (not Greek Style) and have never had any issues. I'm beginning to wonder if I need the Omeprazole.

[ubaoz in reply to ChrisinNam]

In your position I'd be wondering too. I might be showing my ignorance, but just using logic, if your reflux was diagnosed as "non-acid", then why do you need something in the way of a medication to reduce acid? Could it perhaps be something to discuss with your doctor at some stage?

[ChrisinNam in reply to ubaoz]

Yes, indeed. I wasn't aware that Omeprazole could cause bone thinning, no-one has ever mentioned it before. (What would we do without this site?) I'm absolutely certain that the term used all those years ago was "non-acid reflux", and as you say, what's the point, then? I'm now thinking about tapering off the Omeprazole, since I go to quite a lot of trouble to get proper Greek yogurt for breakfast. Hmmmm ..... GPs, who needs 'em?

[ubaoz in reply to ChrisinNam]

GPs do have their uses 😀. I do agree though that sometimes they need to be kept on their toes! Given your non-acid reflux diagnosis was made some time ago, then perhaps it's not unreasonable to ask for a review of that prescription under the circumstances?

[ChrisinNam in reply to ubaoz]

Yes, you're right. If I could get to the pharmacy easily (can hardly walk just now) I would indeed do that.

[Hildalew]

Before PMR I was a person who had very rarely taken pills but at some point in late middle age I somehow acquired a belief that for many people, a 'dose' of natural yoghurt taken with or before pills was a 'good thing'.

I don't remember being advised about potential stomach damage from Prednisolone in October 2018 when I was diagnosed but I may have just not taken any notice because I had already decided to use good, plain yoghurt to accompany any pills.

9 months later - having presented my repeat prescription for Pred - I was telephoned by a GP who was on 'prescription duty that day - who said she would prescribe me Omeprazole for my 'stomach problems' - I told her I had no stomach problems and she replied that she would prescribe it any way because I would get those problems in the future - because of Pred.

I collected the box of pills but have never taken it and have kept up my practise of taking yoghurt just before and alongside Pred. I have not had any stomach problems to date and, (crossed fingers) have been on 0 Pred for the last two weeks. (Just under 4 years since I was diagnosed.)

PS My system does not like cow's milk so I have goat's milk yoghurt or, occasionally a vegan version.

[DiSaw]

ThanksHildalew. I wonder how long most people on this site have had PMR for - I suppose those who recover after a year or two don't stay on the site?

[PMRpro Ambassador in reply to DiSaw]

They vary from weeks to heading for 20 years and everything in between. There are a few who have been off pred in under a couple of years - and I think most of them are the ones whose PMR symptoms started after the Covid vaccine. Few people who are off pred quickly hang around - but some who look quite a while or who had a tough time do hang around a bit to help.

[DiSaw in reply to PMRpro]

Thanks for your reply. I developed PMR just as the first lockdown eased up but before any injections and initially came off Prednisolone after just under a year.......... but after about 4 months (and yes, soon after I'd had my first vaccination), the symptoms started to return and by the time I managed to contact my GP my inflammation markers were much higher than they had been the first time round. I've just been contacted about having my 4th Covid vaccination - one more thing to worry about!

[Tiggy70]

I’ve been taking medication for acid reflux for years. At least 10 years on Omeprazole currently on 20mg. I have regular episodes of IBS so the PPI is to control that. I also have a sliding hernia. Neither my doctor or pharmacist have suggested at my medication reviews that I reduce or stop it. I don’t think I have any side effects from it but I do worry about my bone density.

[HeronNS]

No. Only advice I ever got, from both doctor and pharmacist, was to take with food. Which I've always done. Starting dose, however, was 15 mg, not higher. A PPI should not be taken longterm as it can lead to nutritional deficiences by preventing proper absorption of micronutirients. This is why PPIs are implicated in bone thinning, which is one of the the things pred is supposed to cause so why doctors casually prescribe a PPI, "just in case" (like they do bone meds too) in some jurisdictions I do not know! Think they are best used only when there is a proven need.

[pata63 in reply to HeronNS]

My GP put me on Omeprazole when I was first diagnosed with PMR (April 2019) and on 20 mg. I was familiar with Omeprazole because my wife Jan has taken it for some years because she has acid reflux which led to Barrett's esophagus. As soon as I got down to a lower dose I asked if I could stop the Omeprazole and was given instructions on how to stop. I've not had any problems since. I've been on 5mg since Oct 2019 with the occasional application of sick day rules when I had various other things happen.

On behalf of my wife Jan I'd be interested to know more about the micronutrients which are not properly absorbed and what we might do about it. Jan also has some bone thinning (maybe Osteopenia level, I'm not sure) but her GP hasn't suggested anything be done about that. I'm in the clear in the bone department because I've got very dense bones. Always have. When I was first diagnosed with PMR I was sent for a DEXA scan and the results were so high nobody mentioned bone density again. I'm 70 and have 97th percentile bone density for a 30 year old. Unfortuntaely other body parts aren't quite so wonderful. 😉

[PMRpro Ambassador in reply to pata63]

Mainly calcium and magnesium in the context of bone health - particularly as use of pred also can lead to excessive loss of these through the kidneys.

gut.bmj.com/content/65/Supp...

[HeronNS in reply to pata63]

As PMRpro says, the elements which are very important for maintaining bone density include calcium and magnesium. In case your wife doesn't know, if she chooses to take supplements it's a very good idea to take calcium separately from others as calcium tends to interfere with the absorption of elements like magnesium and iron. I don't think there's any difficulty with vitamins. She would benefit from taking Vitamin K2 (not K1) and getting as much exercise, particularly weight-bearing (can be as simple as a daily walk), as reasonable. Most of us, especially females, do lose bone density as we age so it's a good idea to try to keep what we have!

[Iamfedup in reply to pata63]

Ditto your age and bone density after three years of Predl Lucky us !

[Sharitone]

I was put on omeprazole as a matter of course when I started on pred. I had digestive problems so went up to 60mg when on a high pred dose. Now back to 20mg. Each time I reduced, I used Gaviscon as a back-up, so didn't have any rebound problems. However, I have got bone density issues