I wonder if I really need that PPI

Hi everyone. This is my first post and I have a question, although I understand that there might be several different viewpoints.

Since being diagnosed with PMR I have been taking both Prednisolone and Lansoprazole. I started off taking them both with my breakfast in the morning, which without deviation consists of a big bowl of porage with a banana in it followed by two cups of coffee. I also often have a glass of homemade Kefir at some point later in the morning.

Recently I decided to try a new pred regime for two reasons and have started taking my meds at lunchtime rather than with breakfast.

Reason one being that I want my calcium rich breakfast to be fully absorbable and not interfered with by the pred and vice versa.

Reason two being that I thought it might be worth a try taking the pred a bit later in the day : 4-5 hours later in fact, on the theory that it might help to alleviate the morning stiffness a bit if I take it a bit later in the day, which in turn means that it will be more active in my body when the inflammation starts to build up in the night than it was previously when I was taking it at 6 or 7 am with breakfast. I'm only on day three of this experiment but am cautiously optimistic that it might be working as I feel a bit better in the mornings. My sleep is unaffected by taking it later in the day.

So to my headline : For a while near the beginning I had decided that the Lansoprazole was possibly a bit vestigial and stopped taking it for a couple of months, but started again when I went to hospital for a minor procedure and while chatting to the surgeon he told me quite sternly that I should start taking it again as there is a high risk of stomach ulcers from the pred, so I did, but having done some further reading I wonder if I really DO need it and thought I would throw the question open to all for some opinions. As far as I am aware I have no stomach problems whatsoever.

[Koalajane]

I don’t know the answer to this. All I can say is that for over 5 years I have been taking my prednisolone with my breakfast, I was not prescribed a PPI and as far as I know I don’t have any stomach problems

[SnazzyD]

From what I’ve seen the usual gold standard docs work to is that PPI’s must be prescribed with Pred, end of. My docs got very twitchy when I refused to take them because all the ‘azoles make me feel peculiar and I didn’t want the reduced calcium absorption as I had osteopaenia. As I was really struggling with gastric reflux I said I wanted coated Pred (UK) which I got after proving it was the same cost as the ordinary Pred plus Omperazole, especially if I bought my own Gaviscon for flare ups.

Read on this forum and plenty of people don’t take it and with their own approach manage to be fine. However, gastric reflux can be apparently asymptomatic and lead to something call Barrett’s oesophagus which is where the cells change from the acid damage and can become precancerous. Sometimes a clue can be a dry morning cough if it’s happening at night due to lying down.

In short, nobody can say what your personal risk is. The docs sell it hard because they don’t want to be negligent but that doesn’t allow any personalised decisions. There are pros and cons. One thing to bear in mind is that stopping PPI’s suddenly can cause a worsening so it’s best to tail them off.

[PMRpro Ambassador]

Put it this way - I have never taken a PPI in the 13+ years I have been on pred! Only if I have needed a course of NSAIDs to deal with a nasty flare of myofascial pain syndrome - and even then, I shelled out for famotidine (not covered by the healthcare system here) rather than take a PPI.

It does seem to be a very English-speaking fear - no fuss made about PPIs here that I know of.

[Towdy]

13 years non enteric coated pred on empty stomach upon wake I h and for me no issues.

[Hidden]

Thanks for the replies. I'll continue researching and make a decision on how to continue..

[PMRpro Ambassador in reply to Hidden]

If you DO decided to stop it - you must taper the dose over several weeks or you will suffer from rebound acid production.

[Lyndaki in reply to PMRpro]

By taper the dose, do you mean take alternate days then increase the daily gap between taking? Only my Lanzoprazole is a capsule & so can’t be divided. Thanks

[PMRpro Ambassador in reply to Lyndaki]

Depends what dose you are on - if you are on a higher dose halve it as appropriate, As far as I know it comes in 30 and 15mg doses. You can buy the lower doses OTC but if you are on 60mg, halve it to 30mg. If you are on 30mg, halve it to 15mg. Then miss alternate days.

You CAN divide capsules - bit fiddly but you can open the capsule.

[Lyndaki in reply to PMRpro]

thanks, I’ll give it a go!

[Purplegloss in reply to PMRpro]

I have been on 30mg Lansoprazole for over 5 years now, and wonder if I should ask my GP if I could go down to 15mg as a trial after all this time.

[PMRpro Ambassador in reply to Purplegloss]

No harm trying

[Purplegloss in reply to PMRpro]

If my GP is ok with 15mg do I have to still use some of the old dose of 30mg or just start straight away?

[PMRpro Ambassador in reply to Purplegloss]

I don't know to be honest - but no harm in alternating 30 and 15 for a week or two

[Purplegloss in reply to PMRpro]

OK thanks, I will see if he is happy to reduce the dose.

[Hidden in reply to PMRpro]

I read somewhere that there should be no problem coming off lansoprazole in one fell swoop, although to be honest I can't remember where I read it. I'll research it further.

[PMRpro Ambassador in reply to Hidden]

Depends how long you have been on it.

pubmed.ncbi.nlm.nih.gov/291...

" Daily PPI exposure for more than 4 weeks is likely to trigger a rebound of acid hypersecretion about 15 days after discontinuation, and lasting from a few days to several weeks depending on the duration of the exposure."

[Bcol]

It's going to be a personal choice in the end, there are many here who do take it and many who don't. I've been taking Omeprazole from the beginning of my PMR journey and for many years earlier with my OA and with no apparent ill effects. I take it at least half an hour before my Pred which I take very early morning 02:00 -03:00 with yogurt and usually a banana, which seems to get me through the day/night pretty happily.

[Hidden in reply to Bcol]

That's an interesting medication regime. Do you set your alarm and get up especially or are you a natural night owl? I'm usually in bed by 10pm and that's me till morning.

[Bcol in reply to Hidden]

Never set an alarm, just awake. It also a good time to take the Pred as it it gets into your system ready for when the nasties come out to play around 04:00-04:30. Quite a number of us here take it at that time (uncoated Pred that is)

[PMR2011]

I took Pred for 8 years, never took a PPI and never had a problem. I was a stickler for taking it after food tho.

[Blackcat1M]

I have acid reflux and have taken pred for over eight years with a pot of probiotic first thing in the morning and it has not affected me, but I am careful what I eat.

Never was I offered any PPI by my doctor.

[Karenjaninaz]

Acid blockers were recommended by my rheumy, at the start of treatment, to protect my stomach against ulcers. I do have a sensitive stomach. However, I found that PPIs gave me so much wind that I had wind crackling under my skin called crepitus. Right now I take my prednisone around 2:30 in the morning with a soy milk smoothie and Pepcid.(famotidine) For awhile I went without it at lower doses with no problems but when I was given mega doses of pred, in hospital for something else, I had to start all over again tapering. My belly started bothering me so I restarted the famotidine. I am now on 9 mg and I still take it. I know, when the time comes, I’ll need to taper- it perhaps at 7 mg.

[KASHMIRI1]

Good morning, my rheumatologist at my last appointment was emphatic about the importance of taking PPI meds with steroids as the damage can be done before the symptoms get going and then its another problem to deal with.

[PMRpro Ambassador in reply to KASHMIRI1]

Like many things - I think it is a personal opinion.

[KASHMIRI1]

Not if you have had an experience of gastritis

[PMRpro Ambassador in reply to KASHMIRI1]

That is a different matter altogether. I meant rheumy opinion - mine has never made such a statement. He does insist on stomach protection when I have to mix an NSAID with pred - but the NSAID itself can cause stomach problems.