Omeprazole

[Hopelessatbest]

My GP has suggested I take Omeprazole with my 15mg of steroid. Does everyone do this?

[Bcol]

Good morning, fairly divided opinion on the forum with this one. I do, and have done for many years with no obvious or discernable problems, others will argue that it's not neccessary and has its own side effects. I also take my Pred early in the morning with some yogurt and usually a banana.

[piglette]

I take the enteric coated version of steroids so do not need it. Some people just take yogurt or similar instead.

[SheffieldJane]

It didn’t agree with me so I took Pred with yoghurt then got Entric coated but now have diverticula disease due to the final insult of Actemra / Tocilizumab.

[potterylady in reply to SheffieldJane]

Hi Sheffield Jane, so Actemra caused diverticulitis? I hope I don't get it too. Yikes. So sorry.

[SheffieldJane in reply to potterylady]

I can’t say for sure but Pred and Actemra are hard on the GI system. There are warnings about Actemra if you have diverticulitis.

[potterylady in reply to SheffieldJane]

I don't have it yet, and hope I don't get it. So far so good.

[PMRpro Ambassador in reply to SheffieldJane]

To be fair SJ, for some people. Neither pred nor Actemra have been a problem for me so far and that is 14 years of pred!

[SheffieldJane in reply to PMRpro]

Iron constitution. 🙂

[PMRpro Ambassador in reply to SheffieldJane]

Cast iron gut certainly!!!!!!

[Kendrew]

I was told I should take Omeprazole as a precautionary measure when I began steroids but I said "No thankyou"!

I wasn't prepared to take a medication without real evidence that I required it, particularly when for some people it can also cause some unpleasant side effects.

I take enteric coated prednisolone, after food, and 4yrs on I still haven't needed it! If my situation changes and a need for Omeprazole presents itself, then of course I will reconsider the situation.

Everyone is different and you will have to weigh up your own risk factors for taking it or not..... I'm just hilighting that it isn't automatically necessary.

[Polygolfer in reply to Kendrew]

be mindful that your gut lining doesn’t deteriorate over night. Years back when I was taking Naproxen to compete whilst nursing a lame knee I also forfeited Lansoprazole and regret it.

[Kendrew in reply to Polygolfer]

Thankyou for your comment. I'm sorry you had some problems when you were taking Naproxen and hope you're ok now.

I have a nursing background and so I definitely understand that too.

I'm very vigilant about being mindful of the warning signs though and have alternative strategies in place to help protect my gut.

It's worked (so far) for me but of course things could change and I'm always mindful of that.

[Koalajane]

I was not prescribed it and 6 upyears on have no problem. I always take my prednisolone with breakfast

[Polygolfer]

yes, Lansoprazole in my case (it’s similar) - protects the lining of the gut

[Seekingasolution]

I had a bit of a pain in the gut - just at the connection between oesophagus and stomach I now know - which freaked me out somewhat as there’s a history of oesophageal cancer in the family in the same place. So I was prescribed omeprezole.. and as the pain increased I was told to double the dose. Pain increased as well !! Turns out omeprezole doesn’t suit everyone and looking at NHS guidelines it’s only supposed to be prescribed temporarily. As others have said - the coated pred is a better option or try taking it with food

[alangg]

Like you, I was started on Omeprazole with Pred before I discovered this forum. I took both for a couple of weeks but then (after a chat with my GP) I stopped and just carried on with the Pred with no discernible adverse reaction.

But I am fortunate in that I have never (knowingly) had a stomach ulcer or suffered badly from indigestion, heartburn, etc. so I was happy to take the risk.

It should probably be a conversation to have with your GP. The last thing that you want to do is to stop taking a drug that has been prescribed for you and then have to go back in with the very symptoms that the drug was there to prevent!

[Broseley]

Good point, Alangg. I was prescribed omeprazole when I started pred. My prescription says to take it for as long as I am on pred. I've done as I was told with no side effects. However I can always discuss it at my annual medication review.

[PMRpro Ambassador]

I have never taken omeprazole in the nearly 14 years I have been on steroids except when my rheumy is also using NSAIDs for specific problems. I have always taken pred related to food and have never had gastric problems at all.

[Seashoreshanty]

i take omeprozole every morning just before steroids … for years and i am fine.

[Exflex]

Yes, since starting Pred. three and a half years ago. Still take omeprazole even though I’m in 1.25mg of Pred. I understand there’s a need to wean one self off. Guess that would be something like a DL taper over 4 or 5 weeks. Omeprazole is the least of my worries.

[oscarandchloe]

No, I won't take it. I did when I was on a very high dose of Pred, probably for about a year but I know it is meant for short term use and long term there are possible health problems. My husband has acid reflux and took it for over 4 years, suddenly his kidneys almost failed with no previous indications of damage and the doctor immediately took him off it. We read up about it and kidney damage is a possible side effect. Can't prove it! I'm now on a low dose of Pred and take it with glass of kefir as I wake up.

[MrsPractical]

I was given Lanzoprozole right from the start but I do have a history of suffering badly from reflux which was treated for a short time with the same drug. I had been on lanzoprazole for about 18 months after being on Pred. I was hospitalised with low sodium having had a seizure and my lanzoprazole was stopped and replaced with a low dose of famotidine which I don’t think works as well because I have had indigestion most days following my evening meal. I presume famotidine isn’t so prone to lowering sodium but no one has told me this and currently waiting to see my gp on follow up.

Sheila

[Purple-Owl]

My current doctor keeps bugging me to take Omeprazole daily for my 5mg uncoated Prednisalone dose. However I disobey, and only take it once a week, half an hour before my weekly Alenronic Acid dose. I take my daily pred just after breakfast and have been doing so for 3 years of pmr with no ill effects.

[TJ70 in reply to Purple-Owl]

My rheumatologist stopped prescribing it once I got below 10mg - said it wasn’t needed

[PMRpro Ambassador in reply to Purple-Owl]

You really shouldn't be taking it just before the AA - practically anything will interfere with AA and cause problems! No reason you can't take it immediately before bed - the effect lasts long enough.

"Omeprazole takes around 1 hour to block the production of stomach acid, and its maximal effect occurs around 2 hours after taking the pill. The action of omeprazole can continue for about 3 days."

And although it does work like that, it is most effective when taken consistently. But as you see - for the AA, better to be taken sooner ...

[Purple-Owl in reply to PMRpro]

Thanks for your knowledgeable advice PMRpro. In future I will take my one weekly Omeprazole the night before I take my weekly Alendronic Acid.

[PMR2011]

Nope, I was on Pred for 7+ years and did not take any stomach protector like Oneprazole. Alway took Pred with food and never had any problems.

[Tiggy70]

Hi Hopelessatbest (I’m sure you’re not!). I suffer with episodes of IBS and have been taking Omeprazole for acid reflux for over 15 years. I was taking it before being diagnosed with PMR (2.5 years ago) and have continued with it with no discernible side effects.

[Pr0jection]

Instead of omeprazole I take goat's kefir which calms the stomach for me and has the added advantage of Vit K2. For several years I have also taken probiotics for occasional gastritis and diverticulitis. There have been comments about whether one should take probiotics with steroids but I haven't noticed any problems.

[gaqke10]

Just to show how different people are . . . about 20 years ago my body stopped making enough stomach acid and I wasn't absorbing proteins and minerals. I had to eat four meals a day just to stop losing weight--and I wasn't even hungry! I had to start TAKING stomach acid (betaine hydrochloride) with each meal. So not only do I not take an acid-blocker with my prednisone, I take EXTRA stomach acid with each meal. Nevertheless I do take my pred in the morning with yogurt or cottage cheese. I take the betaine hcl about an hour later with breakfast.

Anyway, as with a lot of things, there is such a thing as too much and not enough. I would suggest that people who previously did not have an excess or deficiency of stomach acid just take their prednisone with food and see how that goes. A deficiency of stomach acid that you may arrive at after after taking acid-blockers for a long time can cause depression or anxiety or osteoporosis or various other symptoms from lack of proteins and minerals.

[Southmead]

I was diagnosed with Acid Reflux disease 20 years ago, and was prescribed 2 Omneprazole pills a day, in fact one worked perfectly, no heartburn at all. I took them along with my Pred dosage with no ill effects at all. Last year my wife and I gave a up eating meat for while. By chance I discovered without eating meat I had no need of Omneprazole. Once in a while when I do meat I will take one, in short I had not problem at all interacting the drugs.

[Poshcards]

Hi, I was prescribed it to help with my methotrexate, it lines your stomach, I have taken it for years now and been fine x

[PMRpro Ambassador in reply to Poshcards]

You don't know what longterm use is doing behind the scene - they make a song and dance about pred and osteoporosis, but PPIs are just as guilty and why they shouldn't be used continuously.

[KC6755]

I took Omeprazole for two years with PMR and it played havoc with my gut . I was told it was not ideal to be on it long term . I have since been swapped to Famatodine , touch wood no problems as yet.

[Merryfield]

I am fairly ignorant about all the possible meds involved in treating PMR (except for the steroids) and do not understand the purpose of taking the acid reflux med omeprazole. I take Nexium every day after breakfast to treat my acid reflux and have had no side effects that I know of. But it is not part of my PMR regime.

[PMRpro Ambassador in reply to Merryfield]

It is used because pred can irritate the stomach and they want to avoid any problems as a result.

[Merryfield in reply to PMRpro]

Thanks. Always taking with food might be a good solution.

[Stills]

note my diagnosis is Stills Disease which for me manifests as RD. Diagnosed aged 17 in 1979 and took uncoated steroids for 5 years but interestingly also enteric coated Aspirin in high dose. Maybe they didn’t know so much about steroids then.

Currently I’m taking omeprazole for an as yet undiagnosed episode of unexplained weight loss (16 pounds in a month) tests pending, but the first thing Dr said was peptic ulcer caused by drug regimen back then over 40 years ago….. hmmmm not sure about that!

I’m osteoporotic as no preventative prescription given in 1979 and bone mineral lay down was apparently at a crucial time in those years if 17-22 so I’m not keen to stay on omeprazole for longer than necessary. I’ve also had bad headaches whilst taking it and aim to reduce from 40 mgms to 20 over a month then every other day to nil , unless symptoms worsen of course.

[Hopelessatbest in reply to Stills]

My doctor agreed to the gastro resistant Prednisolone so I am not currently taking stomach protectors (although they want me to do so). I am waiting for a DEXA scan appointment and will see what that says before travelling the AA road which the doctor also wanted me to do. Had a scan around 8 years ago (now 71) where bone density was excellent. I am now taking Vit D and Calcium of my own doing and see my doctor for a first in person follow up on Wednesday. Having to test blood glucose levels regularly is a pain but I am told I must do it. I don’t have Diabetes and have had the HbA1c test just before diagnosis of PMR but know the steroids can cause diabetes. So far tests are fine.

[PMRpro Ambassador in reply to Hopelessatbest]

"Having to test blood glucose levels regularly is a pain but I am told I must do it"

In 14 years I have had only about 2 fasting blood glucose tests as part of routine bloods. Hba1c is far more informative about the risk of steroid induced diabetes - odd spikes of high glucose may never register on a finger stick test depending on the time they do it.

[Hopelessatbest in reply to PMRpro]

Interesting. My doctor has told me to test every few days and given me a kit. This was after my PMR diagnosis. Seemed very definite about that. Guess they all have their own views.

[PMRpro Ambassador in reply to Hopelessatbest]

They do - and some are crackers!!!! If all of the patients on pred were given diabetes monitors the NHS would collapse even further than it is now! Never come across that at all.