Omeprazole query

[Lclmlbls]

My GP prescribed Omeprazole when I first had pred as I had had a few issues pre PMR with acid reflux. I have no acid reflux at all now. I have found out recently I have a hiatus hernia (through a CT scan for an unrelated stomach pain which has now completely disappeared).

I am picking up from various posts that its not good to stay on Omeprazole long term. Should I be trying to come off it? If so what is the alternative?

I hope to book a telephone appointment with my GP tomorrow to discuss my pred taper and any other issues - this possibly being one of them.

I'm grateful for any advice.

[PMRpro Ambassador]

If you have a hiatus hernia I can't see the GP being too keen on you stopping the omeprazole. There are other PPIs - I don't know that the long term implications for them are any different. There are alternatives - famotidine and cimetidine are H2 antagonists and only slight less good at stopping acid production with different side effects.

[Lclmlbls in reply to PMRpro]

Thanks for your quick response. I am fine with Omeprazole, no apparent side effects. I hadn't really thought anything about it until I saw a few things people had posted about trying to get off it. I just wondered it is something I should be trying to do. What are the long term effects of Omeprazole?

[PMRpro Ambassador in reply to Lclmlbls]

A bit disputed but recently they have established a link of long term use of PPIs with dementia - but that isn't proof they cause it,

healthline.com/health-news/...

They may increase the risk of loss of bone density and so osteoporosis, due to malabsorption of calcium and magnesium. In association with pred, that risk is probably increased as pred interferes with absorption of calcium and magnesium too. There are other issues because of the total lack of acid - it is there in the stomach for a purpose after all!

ncbi.nlm.nih.gov/pmc/articl....

[Lclmlbls in reply to PMRpro]

Thank you for that very useful, but slightly disturbing information. Pre PMR I had reflux when drinking fizzy water daily. Reflux subsided when I stopped drinking it. The GP probably prescribed Omep because of that (the hiatus hernia was not known until 2 weeks ago). I'd rather not take any drug for reflux if its not necessary. Do I need a stomach protector with pred? I've seen others mention eating yoghurt before taking it. Is that enough of a protection?

[PMRpro Ambassador in reply to Lclmlbls]

All I can say is that I have no apparent gastric problems and I have never taken a PPI in 14 years of pred except when my rheumy wants to do a course of neural therapy which involves a course of high dose NSAID infusions. But otherwise here, "stomach protection" has never been mentioned.

[Lclmlbls in reply to PMRpro]

I explained to my GP my concerns after reading the article and she listened to them. She agreed I should stop the omeprazole and see how it goes. She said to contact her if there were any problems and she would prescribe a lower dose or something different. Although to be fair my digestive system is better than its ever been since starting omep! but thats not the issue is it, its the long term effect. I'm glad to hear of others who have been taking for many years without any bad effects. But like pred, its all down how the individual reacts.

My GP is very supportive but had never heard of cutting a tablet in half!!

[PMRpro Ambassador in reply to Lclmlbls]

Don't, whatever you do, just stop it cold turkey or you are very like to have problems. Taper it over a few weeks at least/

[Lclmlbls in reply to PMRpro]

in the same way as pred?

[PMRpro Ambassador in reply to Lclmlbls]

The usual suggestion is to start by halving the dose every week or so until you get to the lowest dose. Then have odd days without , getting them closer together until you are off it

[Lclmlbls in reply to PMRpro]

They are capsules so I cant cut them. The GP didn't offer a different strength or to taper them. I don't know what to do now 🤔

[DorsetLady PMRGCAuk volunteer in reply to Lclmlbls]

Try every other day initially , then increase the days without one until you get to no days….

[Lclmlbls in reply to DorsetLady]

Thank you, I will try that.

[DorsetLady PMRGCAuk volunteer in reply to Lclmlbls]

Okay, but they do come in smaller strengths which GP may prescribe to help you, but thought they might have suggested that..🤔

[PMRpro Ambassador in reply to Lclmlbls]

What dose are they?

[Lclmlbls in reply to PMRpro]

They are 20mg. I take one an hour before breakfast.

[PMRpro Ambassador in reply to Lclmlbls]

Omeprazole can be bought OTC - as tablets not capsules and available in 10mg doses. It is one of the drugs that only a pharmacist can sell. But you can split capsules - just pull them apart carefully and take some out. You can mix it with yoghurt or apple sauce to make it easier.

[Lclmlbls in reply to PMRpro]

Many thanks for the suggestion of splitting the capsules apart. What would your recommendation be for tapering - so many days at 10mg and then 5mg?

[PMRpro Ambassador in reply to Lclmlbls]

It is usually halve the dose for a couple of weeks - see how you get on with less. Then drop dose on odd days and slowly increase the days without - bit like using the slowed tapers to reduce pred.

[Lclmlbls in reply to PMRpro]

Many thanks, grateful as always for the advice from everyone. 10mg it is from tomorrow. 🌻

[piglette in reply to Lclmlbls]

One in four women over 40 have an hiatus hernia apparently. We were discussing it in a meeting we had the other day and interestingly statistically the members of our meeting backed the statistics.

[Lclmlbls in reply to piglette]

That’s interesting. A very high proportion.

[piglette in reply to Lclmlbls]

It is suprising I thought too.

[Lclmlbls]

Many thanks for your help. I can now discuss this with my GP.

[GrandmaPirate]

I am on Omeprazole since 30 years 40mg/day long before my PMR because of reflux problems and related damage in the oesophagus. When I got PMR 3 years ago the rheumatologist insisted to continue Omeprazole. This year I had another gastro-endoscopy and there were no abnormalities.

[Crochetgirl65_ in reply to GrandmaPirate]

Good to hear some positive news having been on Omeprazole and Lansoprazole (?) for nearly 10 years

[Plains in reply to GrandmaPirate]

Me too!

[Bobbury]

I've been taking Omeprazole for many many years too many to count. I have a hiatus hernia. Orginally I was prescribed Omeprazole for that sole condition. I developed PMR some years after the hiatus hernia. The Omperazole has servered the two conditions without any problems whatsover. Occasionally if I have over eaten I do feel a reflux coming on, I just take another Omeprazole which always deals with the problem.

I hope this helps!

[Lclmlbls in reply to Bobbury]

thanks, that is reassuring

[Ruthie_64]

Please wean off the ppi slowly! My daughter was prescribed omeprazole and wasn't told to wean and just stopped. She had such bad rebound effects that she ended up having linx surgery. I've been on preds for 6+ years now. Only time I have heartburn or indigestion is on high doses. I just take gaviscon as and when needed.

[Lclmlbls]

Thanks for everyone’s advice. I won’t be able to make contact with my GP until Tuesday so will follow Dorset Lady’s advice and try alternate days.

In addition to the article recommended by PMR Pro I found this medicalnewstoday.com/articl...

There is no mention of how to stop taking it that I could see, but there is some useful information which I hadn’t been aware of.

I am hoping to stop it altogether and just use something like you have mentioned, Gavison, as and when required.