Lansoprazole - reducing dose

[Moonriver65]

Hi I have been on lansprazole 30mg since starting steroids 3 years ago. I am now down to 2mg steroids and want to reduce ppi as I have started having problems with digestion ( I think mainly fats) and diarrhoea some days, so I am losing too much weight, as I'm not eating properly. Has anyone else had these problems, please? I would welcome advice re reducing lansoprazole. Thank you.

[PMRpro Ambassador]

As with all PPIs you will need to taper the dose before stopping or you risk having rebound acid production which can be very unpleasant. The usual instructions are to reduce the dose if you can - it comes as 30 and 15mg capsules - for a few weeks and then start missing days - a bit like using a slowed taper for pred with none as the new dose. Some people find it handy to have Gaviscon handy just in case you have any problems. Or you can use an H2 antagonist as they are easier to get off afterwards.

[Moonriver65 in reply to PMRpro]

Thank you. I an currently on 30mg lansoprazole and having trouble digesting some food with occasional diarrhoea, so maybe I don't have enough stomach acid and I am very underweight. Should I just have 15mg say every 3rd day to start with for a couple of weeks. Then every 2nd day? Is that too slow a taper, do you think? Thank you

[PMRpro Ambassador in reply to Moonriver65]

I think halving the dose - i.e. get some 15mg tablets and use them daily is your first tack. If that is too much do it your way, That will be faster. And then do as you suggest with zero days,

Have you spoken to your GP? ANY change in bowel habit needs investigating. Have you lost weight or are you just a lightweight anyway?

[Moonriver65 in reply to PMRpro]

Yes I am seeing GP at the moment and having a few tests done. I think the weight loss is due to me not having been able to eat properly or enough for the last month, though I am low in weight anyway. GP has given me some 15mg tablets but perhaps I should wait for all my test results first, though I am panicking about my weight loss. I have asked for a stomach acid test but this would only be done if all results come back OK. GP. not convinced it is the ppis but it could be.

[PMRpro Ambassador in reply to Moonriver65]

Not a lot of point doing stomach acid while you are on a PPI - they stop the production almost 100%.

[MrsPractical in reply to Moonriver65]

Hi Having been on Lanzoprazole a couple of times I well understand the need to taper slowly. I have just got my husband down to 15 mg d from 30mg by doing alternate days to start with and then increasing the the number of days on 15mg before taking a 30 mg. Also when coming off them completely it is worth missing alternate days and doing it gradually till stop. I also found that chewing sugarless gum( not containing aspartame) helped when I stopped because chewing neutralises excess acid.

This time I was taken off lanzoprazole and put on famotidine but I haven’t investigated getting off that yet. I suffer reflux as well as the problem steroids can cause.

[Moonriver65 in reply to MrsPractical]

Thank you MrsPractical, that is all really helpful. Did your GP just swap the Lansoprazole straight to Famotidine, please?

[MrsPractical in reply to Moonriver65]

it was actually the hospital that swapped me because they thought lanzoprazole was contributing to making me have low sodium. It was a straight swap. At first I was put on low dose of famotidine, I was on 15 mg lanzoprazole but I found I was getting reflux so the famatotide dose was increased and that is fine. Hoping to get off that when I can finally quit Prednisolone but I will do it very slowly and start chewing gum again.

[Moonriver65 in reply to MrsPractical]

Thanks for all your info, MrsPractical 😊

[Lyndaki in reply to PMRpro]

can you get Lanzoprazole without prescription or do they have to come through GP? I’m currently on 30mg & would like to reduce but they are capsules not tablets so can’t be cut in half. Thanks

[PMRpro Ambassador in reply to Lyndaki]

You can buy the lower doses OTC.

You can open the capsules and take half the granules inside - think it suggests it if you can't swallow the entire capsule and mixing them with something to make it easier to swallow. But it is a bit of a faff.

[Lyndaki in reply to PMRpro]

Thank you!

[darkred in reply to PMRpro]

"You can open the capsules and take half the granules inside." Great suggestion...one I will be using.

[Moonriver65]

Of course - how obvious. May I ask one last question, please. How do people on ppi’s digest their food without acid?

Thank you.

[PMRpro Ambassador in reply to Moonriver65]

Poorly?????

pubmed.ncbi.nlm.nih.gov/200....

The trouble is, they were not developed for constant long term use - when we are told to take them the way they are often used alongside pred, the observations usually made to justify their use may be a bit different,

[Moonriver65 in reply to PMRpro]

Thank you so much for all your information,- much appreciated 😊

[Joseph14612 in reply to PMRpro]

I have been on Lansoprazole 30 mg for at least 20 years...Other PPI's before that, going back 45 years to the days of tagamet... but I think ulcers and hyniel hernia cleared up....I find this interesting and would like to get off it myself....but I get severe heart burn after a couple days. I was always annoyed doctors didn't investigate further.

[PMRpro Ambassador in reply to Joseph14612]

You cannot stop them cold turkey, that leads to severe rebound production of acid. You MUST taper the dose, first by working down to the lowest available dose and then slowly dropping a day now and again until you get to none, much like with pred but it doesn't have to be that slow, over a few weeks for each stage is usually enough.

If you have hiatus hermia, you may need something but other products may be appropriate.

[Popoy]

I would request either gastro resistance pred or omerprezole gastro resistance, if you can't get 1mg Pred gastro resistance which I'm having problems getting.

[Moonriver65 in reply to Popoy]

Thanks for your reply Popoy. I wondered about asking for coated Prednisolone, but have read somewhere that they can still upset your stomach. Nothing is straightforward, it would seem.

[PMRpro Ambassador in reply to Moonriver65]

I don't know anyone on the forums who has had stomach problems with e/c pred.

[AshPen9 in reply to PMRpro]

I haven't had any problems with e/c Pred, PMRpro. However, I had a meds review last week and was told off for not taking the Lansoprazole on my repeat prescription. I told him that I take e/c Pred and he said that they have found it doesn't give so much protection. I also take Clopidogrel. I said that I didn't want to take Lansoprazole because it wasn't kind to your bones. He said that it only had a minimal effect on your bones. I really don't want to take any more meds, so I'm going to take a chance. I always have a good slug of kefir and a big dollop of Greek yoghourt with my meds.

[PMRpro Ambassador in reply to AshPen9]

"he said that they have found it doesn't give so much protection", " it only had a minimal effect on your bones"

The trouble is, one meta analysis says PPIs increase osteoporosis risk

link.springer.com/article/1...

and another study discussed here

medpagetoday.com/resource-c...

says they don't. As usual, you pays your money and you takes your choice - but PPIs have other adverse effects, whether the average doctor wants to admit that or not.

And in terms of the e/c tablets, taking a PPI at the same time alters the pH of the stomach and that alters the way the e/c tablets are absorbed. They are designed to resist stomach acid so they pass all the way through the stomach to be absorbed in the different pH environment of the lower GI tract. If there is no stomach acid, the pH in the stomach is more alkaline and the e/c tablets may start to dissolve there, Somewhere there is a warning not to take e/c tablets together with an antacid medication.

Anyway - like many others I have never taken a PPI while on pred, 14 years now and no sign of problems. Polypharmacy is not good and causes different problems to just taking a tablet with maybe one or two other substances,

[Bluey-1 in reply to PMRpro]

I took a PPI when on plain coated pred at 60mg for a short time but have had enteric coated and no PPI since.

[Bluey-1 in reply to Moonriver65]

Of the many side effects of pred I’ve suffered, stomach problems haven’t been among them. I take enteric coated pred so assume they’ve done the trick to avoid stomach issues.

[Moonriver65 in reply to Bluey-1]

Thanks for your reply. I wish I had been given coated Pred and no ppi - sounds a much better option.

[Bluey-1 in reply to Moonriver65]

Ask for it. I emphasised previous stomach issues in the past when I was given plain pred by error once. It might be a bit more expensive but you don’t need the prescription for the PPI so it’s swings and roundabouts

[Karendeena]

Yes, Lansoprazole did this to me. I lost over a stone and had gastric problems, felt nausea and couldn't eat properly. Changed to Famotidine (H2 receptor) and things settled down. Nausea stopped and weight stabilised

[Moonriver65 in reply to Karendeena]

Thanks for your reply Karendeena. That’s good to hear. I need to check out if this would be ok whilst I am still on steroids, but after all my test results are back. Glad you feel better.

[Karendeena in reply to Moonriver65]

Thank you. Yes, it was a worrying time. I went to see a gastroenterologist things were so bad. I convinced myself I had cancer because I felt so ill and the weight loss worried me too. I had a CT colonoscopy but nothing significant was found. It was definitely the Lansoprazole

[Moonriver65 in reply to Karendeena]

I fear the same - horrible time. I am even worried about going without my pred and Lansoprazole (even though that may be the problem) in order to have a colonoscopy. I have just done a stool sample.

[Moonriver65 in reply to Karendeena]

Can I ask, did you just swap over from Lansoprazole to Famotidine or was it a gradual change, please?

[PMRpro Ambassador in reply to Moonriver65]

It is possible to just switch - the famotidine stops any rebound acid production from stopping the PPI.

[Karendeena in reply to Moonriver65]

Just swapped straight over, no problem

[Exflex]

Thinking I was still on Clopidogrel my GP switched me from omeprazole to lansoprazole- shortly afterwards (a week or two) I developed ‘slackness’. I reported back and informed him I had been off Clopidogrel for a few months. He switched me back and normal order was restored. He said lansoprazole can go either way, causing slackness or constipation - incidentally, my wife is taking lansoprazole and it doesn’t affect her.

[LilMoB in reply to Exflex]

I never had any issues taking Lansoprazole 30mg, once a day, usually around 11pm, and with Loperamide 2mg, JUST before bed.

I don't know what happened or changed, but I had to up my dosage to 2 a day. Probably because I had a 24hr PH study test, barium swallow and esophagus pressure test. The results probably suggested I needed extra dose.

But instead tried to put me on Esomeprazole 20mg, Twice a day. I have just had my 4th dose of Esomeprazole, and feeling things iv never felt with Lansoprazole 30mg.

Just spoke to a pharmacist and asked about it, he suggested I switched back to Lansoprazole twice a day, and tell my GP next time I see them.

[darkred in reply to Exflex]

"...can go either way, causing slackness and constipation." I took lansoprazole for 4 days (due to pretty constant heartburn and resulting poor appetite. ) Yesterday, I had disabling low abdominal pain for about 10 hours. What had changed? The lansoprazole. The low pain was a new one for me, something I don't want to repeat. This afternoon, a "Fleets" helped but it was a "hard problem" to solve. Exflex, thank you for verifying my suspicions about lansoprazole.