Guidance reqd to taper off Omeprazole

[Exflex]

I’m taking 20mg Omeprazole each day and I’m approaching 4yrs.

(I’m currently taking 0.5mg Pred, and plan shortly to taper to 0.25mg, then similarly to 0mg).

Lots of negatives about PPIs, and I’ve been on them a long time… I’m thinking bone health and a raft of other issues.

1) Should I taper the 20mg tabs using 0mg as the new dose;

Or

2) Ask the GP for 10mg tabs and use this as the new dose. And then having concluded the 4 / 5w taper, use 0mg Omeprazole as the new dose over the same period?

Thanks.

[PMRpro Ambassador]

Get the 10s from the GP if you can but you can also buy 10mg tablets OTC. First switch to half dose and see how you get on. Then taper in the same way as pred using one of the slow tapers.

[Exflex in reply to PMRpro]

Thank you PRO, I will do that. 👍

[Exflex in reply to PMRpro]

Sorry, me again. I forgot to say I’m taking Aspirin 75mg daily, and will until I snuff it (heart plumbing). With this added knowledge would your earlier reply be the same?

[DorsetLady PMRGCAuk volunteer in reply to Exflex]

Just be aware aware that aspirin can cause stomach issues -is that why you were prescribed PPIs initially?

[Exflex in reply to DorsetLady]

Hi, I was prescribed Omeprazole 20mg along with Pred by Rheumatology (also AA, but I stopped ~12 months ago). Aspirin came later due to angina, and then Stent due to ischemia.

[DorsetLady PMRGCAuk volunteer in reply to Exflex]

Back in the day (long before GCA) when aspirin was part of a cocktail of drugs used I wasn’t on a PPI -but once I started Pred it was added in.

No longer on PPI as only on Candesartan for BP…

Hubby was on aspirin and PPI after heart attack and triple bypass…

[PMRpro Ambassador in reply to Exflex]

Plain aspirin or gastroresistant? Plain does add a bleeding risk - which is why it is no longer recommended for GCA patients as the risk outweighs the benefits. Bit different with a stent though

[Exflex in reply to PMRpro]

Dispersible Aspirin.

Oh yes, I only have to touch something and I bruise, especially backs of hands. In passing I showed one of the GPs who said, “it’s working then”.

But I do want to get off omeprazole.

[PMRpro Ambassador in reply to Exflex]

Mmm - but if your skin is like that - maybe the lining of your stomach is too. I'd really discuss it with the GP.

[Exflex in reply to PMRpro]

That’s a very good point indeed, I hadn’t thought of that. Dr’s appointment it is.

[MrsPractical]

Hi I know you have wisely decided to check with your doctor in your case. I just wanted to add that in the past when I was on lanzoprazole for acid reflux, I managed to get off it without difficulty by a very gradual reduction first of all to the lowest dose and then alternate days and so on. I also took to chewing sugar free gum as chewing produces saliva which also helps to keep acid under control. It isn’t easy to get hold of sugar free gum in uk though that doesn’t have aspartame in it which I have avoided for years. Lots of people use natural Greek yogurt to help protect the stomach. This may help others who feel they want to stop a ppi.

[paleolady]

Hi! I took Prilosec for 2 years and had a host of symptoms. I did 20 mg and cut them in half .I took 10 mg for a month and then cut that in half again. 5 mgs for a month and then cut down to 2.5 mgs. I had an upset stomach and felt unwell for weeks after stopping. Make sure to have a backup for returning acid reflux. I need an antacid maybe 2 times a week now. I do feel so much better off them. It is tough ,but stay with it.

[phebamom]

If your disease is not under control that will cause stomach burning and pain. There are a lot of factors involved in chronic dyspepsia. Prednisone is not the only cause. The illness; PMR/GCA causes stomach issues. Prednisone also thins intestinal tissue in the same manner it does skin and blood vessels. I watch the acidity level of the foods i consume. No soda pop, no juicy juices, etc. I Learned the Ph level of food and do not consume highly acidic foods. Switch from a PPI to an H2 blocker, Pepcid AC, etc. I am in kidney failure, and can't touch a PPI. PPIS can destroy your kidneys. I am no longer on any stomach medications for the first time in 40 years. I have lived on Tums, Gaviscon, Pepcid, PPIs of all brands, and now am not on any stomach meds. Tums is hard on kidneys, Gaviscon contains alginic acid. Stomach meds for chronic dyspepsia becomes like a dog chasing its tail. Stopping PPIs is hard because the acid temporarily gets worse. Go low acid. It took me about 3 months, but I found even when I don't follow the diet 100% I am still fine as long as I use common sense. The mind blower for me was learning how much damage the fruit juices were doing. Most commercial fruit juice blends have more sugar than soda and a lower ph than coca cola. Once I stopped drinking those juices things really began to turn around for me. I no longer bloat like I am 7 months pregnant, and I no longer have the constant gnawing pain in my tummy. I think there are at least two books available, One is called Dropping Acid, the other is the low acid diet book. I also make and drink a smoothie at least 5 times a week, frozen unsweetened fruit, milk and yogurt. Good gut bacteria is introduced with the fruit sugars to feed the good bacteria. It has worked so well for me.

[Stills in reply to phebamom]

Good advice here thank you. I was reading this after tapering from 20 x 2 mgms omeprazole daily with some rebound. I will stop drinking commercially produced fruit juice now. Thank you.

[Gossiplady]

Hi Exflex! So pleased you sent in your query about tapering Omprezole. I am in exactly the same situation. I have opened the 20mg capsule to halve the dose until my surgery changes my prescription as I was told by one of the HU mentors. How could we manage without them?

[Exflex in reply to Gossiplady]

I take it you’re opening one of the 20mg capsules and then roughly splitting the contents into two piles, roughly 10mg each. Not exact but near enough. Do you know whether the contents are time release or not?

[PMRpro Ambassador in reply to Exflex]

The suggestion originally came from a pharmacist. There is also this in the FAQs about omeprazole:

"Both the tablet and capsule have the same strength medicine, so they do not have any different therapeutic benefit. For people who have difficulty swallowing, there is a benefit to the capsules because you can open the capsules and mix the granules with applesauce to take instead of swallowing."

[Gossiplady in reply to Exflex]

No idea , but I am just trying it, but of course PMRPro will let us know. So dependable!

[Sharitone]

I recently asked my GP the same question, partly because it it says on the Omeprazole PIL that you shouldn't take it for more than 4 yrs, and partly because, like you, I was hoping to stop taking it.

His answer was that I needn't worry about the 4 yrs, because they were keeping an eye on all the things that can go wrong with PPIs - bone probs etc -and I should be symptom-free before reducing. And then he got me a gastroscopy🥴.

So I guess that's the question: are you completely symptom -free and likely to remain so?

[Exflex in reply to Sharitone]

Regarding PMR you never know, but currently I’m ok. As far as the stomach no issues but as PMRPro said it would be wise to discuss with a Dr before reducing since I’m also taking 75mg dispersible Aspirin daily. Pred is 0.5mg reducing to 0.25mg,