At a medication review last week, the pharmacist at my local GP surgery mentioned that I should perhaps be taking lansoprazole to protect my stomach so that has now been added to my increasing list of medications.
As a bit of background, I was diagnosed with PMR in November 2022 and put on 15mg prednisolone which did absolutely nothing, and it was doubled to 30mg towards the end of December which helped a great deal. The pain was gone but fatigue was high. The physio I'd been seeing for bursitis in my hip had recommended I try to see a rheumatologist; my doctor was happy to refer me and I was lucky enough to see him in late January.
He recommended a tapering schedule and sent me off for a chest x-ray as he was thinking of trying methotrexate. However, the chest x-ray revealed a shadow so the round of scans and tests on the fast track cancer pathway began. I gave up smoking 8 years ago, but if you've smoked it's always possible and at that time I was still vaping. He also recommended a slow tapering schedule - 2.5mg per month. He also prescribed alendrolic acid, but advised me to get loose teeth sorted first (I already had osteopenia due to an early change in my late 30s/early 40s).
Eventually the growth in my lung turned out to be a benign hamartoma and it was removed, due to the size and location (4cm, and next to a major artery). This meant that the top lobe of my right lung was also removed. Whilst in hospital, the medication included omeprazole so I wasn't surprised when the pharmacist recommended something similar. I'd also had to change my slow taper to a really fast taper - from 30mg to 12.5mg in the period from the beginning of February to my operation date in early April.
Finally getting to the point, my question is - I'm currently taking the lansoprazole when I wake up at around 6.30 - 7.30 a.m. (depending on how much sleep I've managed to get, slight problem with insomnia at the moment).
I take my prednisolone at the same time (currently on 12.5mg, which I'm experimenting with splitting into 2 doses).
Should I be taking the prednisolone at the same time as the lansoprazole? I noticed that if I take it at the same time as my Adcal then it takes longer to absorb and reduce the morning pain level and it wasn't until yesterday that I saw something on here (article saved, as suggested) that Adcal can affect the absorption of prednisolone due to it coating the stomach and I was wondering whether lansoprazole could be having the same effect?
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ladygigger
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Lansoprazole reduces the acid produced by your stomach. Once you have been taking it for a time, the effect lasts around the clock, A study found that taking pansoprazole and pred together did not affect the absorption of the pred,
Which is what matters. Do you actually NEED the PPI? I have never taken once except if I need an NSAID on more than just odd occasions. PPIs don't do osteoporosis any good!
It was because I'd been on long term NSAID's (over 10 years) that I was happy to take the advice.. I can't take NSAID's at all now, just get the standard stomach ache reaction - and could never take anything stronger than ibuprofen.. naproxen used to send me totally doolally! I got off NSAID's after sciatica joined in with the back pack and a friend who was an acupuncturist offered treatment. I went along and signed up for a 6 week course, very sceptical. The 6 weeks came and went and I carried on - and I was off all pain medication within 6 months. It's just a shame that it doesn't work for PMR or I'd be over there like a shot!
On that case, you do probably need it. It is amazing how many doctors blithely assume that maximum dose NSAIDs and paracetamol are totally harmless but will run a mile rather than use a low dose of pred!
One thing, you should not take the Adcal at the same time as the pred, as the calcium affects the absorption. You should leave a couple of hours between taking the pred and the Adcal.
Thank you - I'd spotted an article on that a couple of days ago. I find it amazing that when drugs are prescribed that we're not given advice about mixing them with any other medication that we're taking!
This is interesting. I was told by my GP to take Omeprazole 30 minutes before taking the pred and assumed that Lansoprazole was the same type of drug. Hands up I don't take it at all and just make sure I eat well beforehand. But never taken it at the same time as pred.Sometimes I have to request it just to keep them quiet as I get nagged, but seems such a waste to me sitting in the cupboard.
Hmmm... perhaps I need to do some more reading - I'd replied to calibriel 's comment as having already been long term on a drug which affected my stomach I was just taking the medical advice!
There was a conversation here a week or two ago on this subject which I took part in. Briefly, I have always taken Lansoprazole with my pred - 1/2 hour to one hour before the pred, as it says on the packet - but the conclusion I drew from the conversation here was that as PMRPro says above the Lansoprazole may not be necessary, but that I should be cautious in withdrawing from it … so (I’m not an expert! please don’t follow me against professional advice! but this is based on my personal experience) I wonder whether, as you seem to have been OK without a PPI, there’s any point in starting on it? Whether in doing so you would be starting a relationship with another drug which would be hard to break - unnecessarily?
That's an interesting comment - and I can see that PMRpro has said the same thing.
I started taking it after a medication review by the pharmacist at my local GP surgery who was concerned that I hadn't been prescribed it as the same time as the prednisolone. I know that it had been prescribed when I was in hospital last month for the lung operation and assumed that perhaps it should continue.
I do have osteopenia - I also have previous history of a fracture. In 2008 I missed the top step of the ladder as I came out of the loft and landed on my coccyx. The shockwave travelled up my spine and crushed 2 vertebrae - another couple of inches in height lost. At that time, I'd already been on Adcal for getting on for 10 years: my mother had osteoporosis and it is hereditary. The GP I saw at that time just said that it would hurt for up to 6 months as I wasn't getting any younger (I would have been 54 at that time).
It took me over 2 YEARS to get referred for an x-ray. The pain was excruciating - up there with PMR pain - and the only thing I was prescribed was ibuprofen, in increasing doses - eventually ending up on the 400mg tablets, take 2 up to 4 times a day so 3200mg in total but I was never prescribed anything to protect my stomach from the NSAID. I have diverticulitis - whether that's age or NSAID use, I don't know so if they're going to prescribe something to protect my stomach, I'll take it!
For goodness sake - did no-one take/send you to the ED? The advantage of going there is instant x-rays if appropriate. As it was, that form of injury should have resulted in head x-rays as the shock travelling up the spine is a common cause of basal skull fractures. Happened to me ...
Unfortunately not. I eventually got referred when I insisted on seeing a different doctor at the practice. I was also sent for my second DEXA scan at that point (no appreciable change in around 10 years). Compared to that episode, the referral and treatment of my PMR (and then the growths) has been exemplary apart from the lack of information over medication.
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