Been on steroids for suspected GCA not quite three weeks now - went down from 50 mg to 40mg after first week. Not generally feeling too bad though not as bright as I was in the first few days of steroid honeymoon. Am having some issues with loose and sudden stools which initially I thought were an antibiotic effect ( I was also put on 7 days of Clarithromycin which I usually tolerate well) but that course finished a week ago. I am taking my pred with food at breakfast and taking my usual 40mg per day dose of Omeprazole (20 mg morning and evening) , a probiotic and a multivitamin. The latter combo has not previously been an issue - been on it for several years due to longstanding digestive issues - but I’m wondering if it’s Pred side effects beginning to kick in and/ or whether there is some interaction with the probiotic or the multivitamin that might not be helping? I don’t have any stomach pain as such just some gut cramping prior to needing the loo pronto. Luckily it tends only to be once a day but it makes me nervous about going out without a change of clothes and a supply of Tena pants in case I get caught short. Has anyone else had this and got any tips on managing it. Will mention it at my next telephone consultation with Rheumy if it’s not passed off by next week as it must be affecting how much of the meds and how much nutrition I’m actually absorbing.
Prednisolone and diarrhoea : Been on steroids for... - PMRGCAuk
Prednisolone and diarrhoea
These kind of doses of Pred made me race to the loo in the morning. Just one explosion a day and that was it. It got better as the dose reduced, but by quite a bit.
Although you've tolerated that antibiotic well in the past you may have been a bit more prone to developing side effects this time just because of the systemic effects of relatively high dose (because of GCA) pred. The only thing I can suggest to you is that you try to (carefully, don't overdo it) add more probiotics, preferably in the form of a fermented food like kefir rather than pills. Unless you are already used to drinking kefir every day you should introduce with a small glassful and gradually increase the amount over a few days.
Kefir contains many more strains of beneficial bacteria than yoghurt, which is why I suggest it. When I first was introduced to kefir it was as a sweetened drink, but I gradually learned to mix it with unflavoured, and now drink plain kefir, don't even like the strawberry, etc, flavours any more! I recommend you avoid the sweetened versions right from the beginning as extra sugar is not likely to help your gut problems, even in the form of a fruit concentrate in otherwise natural kefir, or at the very least to add only a small amount of something to make it taste better to you.
If you have a dairy intolerance I think there are non-dairy versions available. We have a fantastic one here made from coconut, but sadly not exporting outside North America yet.
When I looked at The Cultured Coconut website I was led to this article, which may be of help:
cdhf.ca/en/antibiotic-assoc...
Interesting to read your comment about kefir. I suffered from mild diverticulitis and gastritis quite a few years ago now, and was put on omeprazole. I stopped taking it after a while and found that probiotics helped enormously. 2.5 years ago when I was diagnosed with PMR and started prednisolone I also started taking goat's kefir, just 3 large sips per day for the Vit K2 which I can't take as a supplement, and also to calm any potential stomach problems. I still take it and just up the dose slightly if I feel the gastritis returning. It's good stuff IMHO.
Your system has been assaulted with a combination of toxic elements, I am not surprised that it’s gone into evacuation mode. I don’t think that Pred alone would do this, not with the urgency you describe. Omeprazole can cause this kind of thing, as can antibiotics. It might be beneficial to discuss this with a pharmacist to see if they can advise on the effects of this mixture of meds and possible remedies. The doctor maybe able to change your meds, you ought to tell them about this reaction. I imagine that things will improve once your Pred dose comes down and your course of antibiotics is complete. I could never get along with Omeprazole and the like and protected my gut with yoghurt for years. I only developed issues when I added Tocilizumab/ Actemra into the mix. I hope you find a solution soon, it sounds miserable.
I've been on Omeprazole for several years with this combo and not had any real problems with the runs till I started on the Pred except for two or three occasions in the last couple of decades when I've been out to eat and had presumably dodgy seafood ( I'm not fish or shellfish allegic) or on my first day abroad getting used to different water.
But you haven't been on the mix you are now before - and a group of drugs can change the dynamics quite dramatically.
Quite hence my confusion
My suggestion would be to stop everything but the pred which is essential for GCA though you may need some stomach protection but an H2 antagonist has a different mechanism and so different side effects. Then if that sorts it you know it is the mix rather than just the pred. You need to discuss it with the rheumy though and emphasise how much it is interfering with your life.
I read this and was compelled to reply. I am reducing on pred and am down to 5mg a day, I started on 20mg and to be honest it's been absolute hell! In the beginning I had constant painful explosions with very severe cramps and this lasted all day everyday for over two weeks ... and some, I seriously just wanted to end it all. My lovely Doctor wasn't convinced it was the Pred, I was taken off all my other medication - of which there is a lot - and just took the Pred and Omeprazole but still no different. I was (and still am) literally a slave to the loo, I can't go out as when it wants to come out it just does regardless of where I am or what I'm doing. I was reluctantly reduced rapidly over a period of two weeks from the 20mg to what I am on now which is 5mg and my symptoms have abated somewhat. I still have episodes but not constantly all day maybe twice a day and there's no cramping or pain just the desire to get to the loo quick - sometimes I make it, sometimes I don't. It's an unrelenting circle of washing clothes, showering and cleaning up, very miserable. The Doctor is the expert and I have to go by what she advises but is it just coincidence that now I'm reduced to 5mg that my symptoms have improved? I don't know!
When I was first on pred I had the kind of diarrohea you describe - once a day (often in my case most distressingly in the middle of the night), urgent but without pain. It didn’t last long - sorry, it was such a long time ago I can’t be accurate about time, but certainly no more than a few weeks - and stopped without intervention. I’ve always assumed it was the drugs (I’m on Lanzoprasole as well). My bowel habits have definitely changed since I was on them
I had diarrhea from day 1 for the whole 8 yrs on prednisone. The only time I didn't was when I ate a normal amount of carbs.I unfortunately got every side effect of prednisone so cut nearly all carbs and still gained 70 lbs. Can't imagine if I ate carbs so having diarrhea was the least of my concerns. I found the softest of toilet paper.
Now off prednisone my bowels are back to normal.
I am new to this wonderful, useful forum and have already changed my practise, realising that I was tapering too quickly, so had a flare up. I've gone back to a higher dose of prednisolone- 9mg - and am feeling so much better.Anyway, I was prescribed lansaprozole 30mg in late June, plus 15mg pred. By August I had developed extreme early morning diarrhea. (Including during a long weekend glamping at a folk festival when I was caught short ...).
After trying all sorts, including a beige diet (rice, crisps, bread etc), I asked the gp to prescribe 15mg lansaprozole, and this made things way better.
Good luck.
I experienced the sort of problems you describe with Omeprazole and Pred so i stopped the omeprazole. It did make a difference but I still have some urgency issues on occasion. The trouble is that if you are prone to these problems all sorts of things can set you off and it takes time for your system to calm down - it can get you down. Kefir helps tho, really worth trying and you can buy the grains so easy / cheaper to make at home if you are in the mood - great advice. Thank goodness for modern too which gives me the confidence to go out. Good luck.
Yes. I had the same problem and so did a friend. She said get the doctor to halve your dose of omeprazole. He said no it is something else and sent me to see a consultant. The consultant said why are you here? If you had got what the doctor thinks is wrong I would be treating you with prednisolone which you are already on. The omeprazole will cause your problem I will tell him to half your dose. Happy ever after and changed to lansoprazole for added comfort! 😎
Had diarrhea for a week until put on Omeprazole and reduced prednisone dosage from 20 to 10mg.
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