omeprazole query

[Sibelius5]

is it advisable to keep taking Omeprazole before taking prednisolone as my doctor prescribes, or would breakfast eating beforehand be as effective? (In the interests of taking less drugs than absolutely necessary).

[Sophiestree]

it's a good question. I think the experts will be along but I believe if you have been on it for some time you need to reduce the use over time. I was prescribed it at the beginning of my journey but chose not to take it and so I eat well at breakfast instead. Don't seem to have had any issues and I have been doing that for 3 years. The only time I take it is if I want to take ibuprofen for back issues I have.

[Sibelius5 in reply to Sophiestree]

Thanks for this - helpful to know

[Thelmarina in reply to Sophiestree]

I think it depends a bit on what other drugs you take, and whether or not you have gastric troubles such as diverticular disease, acid reflux etc. Others will advise!

[Sumojo in reply to Thelmarina]

I’ve been taking it long before PMR for Barrett’s oesophagus. Must be over twenty years maybe more.

[DorsetLady PMRGCAuk volunteer]

Do you actually need them? Or was it just prescribed with everything else?

You can try weaning yourself off them, but don’t just stop otherwise you could have reflux issues

[Sibelius5 in reply to DorsetLady]

Thanks - I just got them with the Pred & assumed they were necessary - seeing my gp in a week so I’ll say I want off them if possible - meanwhile, they’re capsules so I’m not sure how I’d taper the dose - any suggestions?

[PMRpro Ambassador in reply to Sibelius5]

You could ask for a lower dose if there is one, It is also possible to open the capsules and mix as much of the powder inside as you want with yoghurt or apple sauce is often suggested (no idea why!) .

I have never taken a PPI except if needing a course of NSAIDs, as someone else said, It is assumed that pred will cause stomach irritation - hence the PPI for all. It seems to be a very English-speaking thing, especially the UK but also the USA. Not had it mentioned here.

[Sibelius5 in reply to PMRpro]

Thanks - so do you eat something before taking the prednisolone?

[PMRpro Ambassador in reply to Sibelius5]

I am on a delayed release form of pred which is designed to be taken within 3 hours of a main evening meal or with a substantial snack - being German they suggest bread and ham or cheese! SO I eat at 7.30-8pm and take it at 10pm-ish.

[PastelsinArt in reply to PMRpro]

Timings seem to be a minefield! I am currently taking my 2.5mg pred which is enteric coated first thing, the 1mg pred (uncoated) with breakfast. Then adcal and omeprazole at least 2 hours later. Second adcal and (if necessary) second omeprazole in the evening. Hoping all being properly absorbed but how would I know?

[PMRpro Ambassador in reply to PastelsinArt]

Do you really need the omeprazole? It isn't advised with enteric coated - which obviates the need for it anyway for most patients - since it changes the pH of the stomach and how the enteric coating works.

[PastelsinArt in reply to PMRpro]

Yes, unfortunately, I do need it for acid reflux which I've had for about 10 years before PMR and GCA developed. I started off only needing it sporadically, then regularly one per day. When I was on high dose of pred it was prescribed twice a day (I think that was probably unnecessary, with hindsight). Now I'm finding it hard to get back to one per day without reflux problems. I'm trying a gradual approach after recommendation from a pharmacist to "tough it out" failed.

[PMRpro Ambassador in reply to PastelsinArt]

Not impressed by suggesting "tough it out" when you have a history of acid reflux anyway!!! Very very gradual reduction over weeks if not months might do it.

[Sweetpeasoprano in reply to Sibelius5]

I always take my pred with a breakfast of Greek yoghurt and all bran. As someone else said, I take omeprazole if I want to take ibuprofen for other aches and pains that my current 0.5 mg pred doesn’t help. My rheumy told me I should take omeprazole when I began on 15mg, which I did until I’d reduced to a lower dose. My GP only prescribed it after my rheumy mentioned it. 🤷🏼‍♀️. I did ask my friendly local pharmacist, who said just make sure pred or ibuprofen are always taken with food.

[Hildalew in reply to DorsetLady]

I would ask the same question. I have, thankfully, been off Pred for a year or so now - but Omeprazole reared its head recently during an assessment related to feared memory loss. I sensed disapproval from the doctor who was carrying out the assessment when I said 'Yes, I was prescribed Omeprazole but I never took it' my story is:

Some time into my PMR/Pred journey, I was phoned by a GP (sounded young and 'new') who had been given the job of preparing the repeat prescriptions that day. I gathered that she had been given, or had found, the 'tick list' of medication for PMR and she noticed that hitherto I had not been prescribed Omeprazole for 'gastric problems'. I said that I hadn't had any gastric problems with Pred. Her reply was pretty much - 'Oh you will, so I'll prescribe it'.

I felt it only right to get the prescription filled but as I had read quite a number of posts on here from people who either already had gastric problems from before they started on Pred or had developed some problems since starting Pred. In many cases people had been prescribed Omeprazole;= - to deal with this side-effect of Pred, but it appeared to me that Omeprazole had made their condition worse.

I continued with my practice of always taking a dessertspoonful of natural, unflavoured yoghurt with any medication I was prescribed or prescribed for myself (eg aspirin).yoghurt Note: I found goat's milk yoghurt was more compatible with my system than cow's.

I was given this tip decades ago by a trusted friend.

I never had any gastric problems during my 41/2 years on Pred or since.

[DorsetLady PMRGCAuk volunteer in reply to Hildalew]

Did you mean to reply to me rather than  Sibelius5 ? ……no,probs, he should see it anyway.

[DorsetLady PMRGCAuk volunteer]

Miss a day once a week, them 2 days next week, then 3 days following week… and so on until you get to nil…

… or ask GP for smaller doses, although they might try and get you to change your mind….

[Sibelius5 in reply to DorsetLady]

Thank you

[piglette]

Are your tablets enteric coated or the normal white tablets?

[Sibelius5 in reply to piglette]

They’re capsule

[piglette in reply to Sibelius5]

I did not realise pred came in capsule form too. What is the capsule called on the packaging?

[PMRpro Ambassador in reply to piglette]

Think you may be talking at cross-purposes!!!!

[Sibelius5 in reply to piglette]

Yes I was talking about Omeprazole

[piglette in reply to Sibelius5]

Ah that explains it.

[piglette in reply to Sibelius5]

what about the steroids are they enteric coated or the normal what tablets?

[Fries in reply to piglette]

Following please.

[piglette in reply to Fries]

The steroids you have been prescribed are they white or coloured? What does it say on the packaging?

[SheffieldJane]

The advice has always been that as long as you coat your stomach with something like thick yoghurt this should be fine.

I have to say I did this for years without issues. I then began to get scary oesophageal spasms. Later I developed Large Vessal Vasculitis/ GCA and was on the higher doses of Pred again. I was put on Actemra/ Tocilizumab and began to get lower abdominal pain. Eventually I had a colonoscopy and an endoscopy and a camera test. Diverticular Disease was diagnosed and a small hiatus hernia. This was in spite of changing to Entric coated Pred early on. I think the Actemra finished it off. I now endure painful flares and pretty unhappy bowels and take Buscopan and Lansoprazole - basically I have to.

I only tell this story because I didn’t want the Omeprazole that I was prescribed and this all jumped up and bit me in the b*m.

Others will tell you that all has been fine and there are downsides to Omeprazole, but you just never know what is round the corner. It’s been hard and I do place it at the door of Pred ( my saviour) and Actemra.

[Caulkhead63]

I've stopped taking them and just have breakfast before hand and have been fine

[Mfaepink1973]

My Omeprazole capsules say on the pharmacy label NOT TO BE TAKEN WITHIN TWO HOURS OF TAKING PREDNISOLONE

[Rachmaninov2 in reply to Mfaepink1973]

I take Pantoprazole which I have just read can interact with Prednisone. I’m not sure if this also applies to Prednisolone, it’s all a bit of a minefield.

[PMRpro Ambassador in reply to Rachmaninov2]

It took some doing to find it but here it is:

"Pantoprazole may decrease the excretion rate of Prednisone which could result in a higher serum level."

So it could act as a steroid sparer!!! I imagine the same applies to prednisolone since prednisone is processed in the liver to make prednisolone which is the active substance and what is actuallu excreted.

[Rachmaninov2 in reply to PMRpro]

I appreciate you taking the trouble to find this information PMRpro. Thank you.

Very interesting that it could have a beneficial effect, I wonder if it might also increase any adverse effects of prednisone or prednisolone.

[PMRpro Ambassador in reply to Rachmaninov2]

If the blood level rises, very likely. That is one of the reasons they warn against licorice with pred!

It didn't take long to find - I knew the link would say it SOMEWHERE, It was identifying WHERE in the document that was the problem!

[Rachmaninov2 in reply to PMRpro]

Never been keen on licorice myself.

Many thanks for your help.

[Exflex in reply to Mfaepink1973]

That’s interesting, I wonder how long it takes for omeprazole to act on the stomach to protect it from Pred? I take the capsule then wait 30 minutes before taking Pred. Been doing this for nearly 4 years.

[PMRpro Ambassador in reply to Exflex]

Once you are on a PPI longer term. the effect lasts for more than 24 hours - so the timing becomes less important. It is just absorbed better on an empty stomach.

[Bcol]

I've been on them for the last three years or so with no problems and have always take them at least thirty minutes before food or other tablets. Now I'm down to a very low dose of Pred I'm tapering myself off them.

[Cfmad298601]

Like you I was prescribed these when I first started pred at 40mg. I continued with them for a few weeks, but just gradually stopped as I tapered down. I too was fed up with taking so many meds and I didn’t appear to have any bad stomach effects. I’ve continued to take my pred along with my milk kefir in the mornings and have no ill effects to far.

[Sibelius5 in reply to Cfmad298601]

Thanks - that’s reassuring

[Satya70]

I take the omeprazole in the middle of the night if I wake up or first thing in the morning an hour before breakfast. I had a stomach ulcer fairly soon after starting on prednisone so even though it's gone now I'm very careful to protect my stomach while on prednisone.

[Noni71]

I’ve been taking Omeprazole for over a year now. I take two in the morning along with 5mg of Prednisolone with my breakfast. I have tried going down to 1 capsule but got acid reflux. I too would like to take fewer tablets but guess Omeprazole is the least of our worries!

[Pr0jection]

When I stopped taking omeprazole due to potential problems with long term use, I started taking goat's kefir 3 times a day. This also helped my gastritis and diverticulitis. May not work for everyone but maybe worth a try.

[Sara_2611]

I have Omeprazole given to me by the hospital. I take it with my lunch along with my other lunch time tablets & ive had no problems

[Broseley]

I was initially told to take omeprazole 3 hours before pred. As I was told to take pred as early in the morning as possible, this meant taking the omeprazole at 4am! I queried this. The pharmacist said no, it's a mistake. You can take it prior to food or even with food then take your pred after you've eaten. However my hubby is on lanzoprazole and he has to take it 30 mins before food.

Incidentally, I stopped omeprazole for two weeks, to see if it was causing my diarrhoea. I didn't get any reflux. (My diarrhoea didn't improve either). My GP though, insisted that I continue with omeprazole while I'm on pred.

[liverbird12]

I stopped taking the omeprazole when I reduced my pred down to 1mg. That was a couple of years ago now but about a month ago I started getting some stomach discomfort and my GP put me back onto omeprazole. I have been taking it for a week and notice a reduction in stomach pain. As advised, I take it as soon as I wake up and have my breakfast (banana and tea) about forty-five minutes later.

[67Blue]

I was given 20 mg Omeorazole along with my 40 mg of pred. No instructions ! But a pharmacist said an hour before food and don't lay down after taking them.

So had Omep. then an hour later breakfast and then pred. The Omep stopped working last October, but a locum I finally talked to just said make a food diary and cut out anything which gives you reflux. (which was basically anything) Finished my Pred in Jan (2 years of GCA/ PMR) but can't get rid of the Omeprazole. Finally a pharmacist ringing on behalf of my Drs in crisis said 10 isn't much double it to 20, I assured her I had been on 20 for 2 1/2 years apart from the previous month I tried on 10. So she doubled it to 40 for a month.

Which made taking the Omep. twice a day and the calcium Vit D twice impossible if you have to leave 4 hours between

I am now back to 20, but following a strict Acid reflux diet --- nothing to do with the drs I might add also still awaiting the results of a gastroscopy I had in August, where he took 6 biopsies and found a small hiatus hernia. My diet is very bland and would like to think they will come up with something else-- other than Gaviscon which didn't work but refused to try me with anything else. So now it will definitely be a slow taper of some sort.

All very annoying as I didn't need the PPI before GCA/PMR, but maybe I would have had other complications if I hadn't taken them.

[Missus835]

I started on omeprazole many years ago and switched to pantoprazole because the omeprazole was no longer helping with GERD. In hindsight, it was probably anxiety driven. I've now been taking Rabeprazole for at least 4 years, which they doubled up when I started Prednisone and had been diagnosed with PMR. Some ppi's can contribute to brittle bones. I now have osteoporosis. I'm assuming it is from the pred/ppi combo. Even with the two doses I was having very scary esophageal spasms. Hopefully I will be able to wean ppi when Prednisone is at a lower dose. I take one in the morning and one mid evening about 2 hours before the Pred. I don't usually eat after supper so it's not taken with food. I no longer take ibuprofen due to BP issues, but wish I could because it was the only NSAID that helped with muscle spasms in my back. I try to be very conscious about the timing of my prescriptions as the number of pills I'm taking is increasing over time. Can be very daunting. Now on a BP pill and cholesterol pill. One of them is giving my stomach a fit. Maybe both. Have to talk with my NP about this, today. Food for another post, so to speak.

[Plains]

I have been on it for over 10 years, you should take it a half hour before you eat. You can take your prednisone anytime but the earlier the better in the morning.

[BruceBee]

My prenisone label says 'to be taken with food. or milk' which I have done for 2 years without issue. Unfamiliar with omeprazole except from this forum. To each his own, I guess..

[Tiggy70]

I take 20 mg Omeprazole, 10mg Prednisolone, Creon (pancreatic enzymes) Metformin and Alogliptin (diabetic medication) all together after my breakfast. 🤞no problems so far. I have to swallow 17 tablets a day and take most of them after meals. I would like to reduce/stop the Omeprazole but my pharmacist won’t let me!

[Viveka]

Haven't read all replies so sorry if repeating. If you are not on O now, why start taking it? Try having several spoons of yogurt before, then dunk the pred in the yogurt to swallow it, one spoon per tablet, then some more yogurt. Ordinary breakfast, say porridge, may not be enough. If this works, no need for O. (Also all the advice below about enteric, though I never had these even at GCA levels cause the yogurt worked fine.)

[rayon31 in reply to Viveka]

Been on esomeprazole for over 20 years for barretts oseophagus ,hiatus hernia,diverticulitis and gerd has kept my symptoms mainly at bay apart from occastional flareups tried different times to take tablet but works best about 1hr before breakfast.Side effects through taking for such a long time was polyp mass in stomach which is quite common for long term use.

[Meggsy]

I have taken Prednisolone with a banana at 3am for five and a half years with no problems. GP has never mentioned a PPI but I wouldn’t hesitate to take it if I needed to. Began 25mg, now 0.5mg.

[Sharitone]

I have had Omeprazole ever since starting on pred 3 1/2 years ago. At one point I was taking 60mg daily but was gradually able to come down to the standard 20mg as the pred reduced. However, I have compression fractures, and sensitive lower teeth, which I'm beginning to suspect may be due to the O. Also some benign polyps in stomach and consultant recently advised keeping O dose to minimum. So now I have been reducing to 10mg a day - there are 10mg capsules, so you don't need to open them. I alternated between 20mg and 10mg for a few weeks, and I'm using gaviscon to cover at night. But be warned, acid rebound is not the only withdrawal symptom! Among others, you can get insomnia and nasty nightmares. I'm hoping this will eventually fade away, and it is worth it to be taking less medication - but I'm not looking forward to the next stage, 10mg-0, and I shall take it very slowly.

[Merryfield]

i have taken nexium every day for years, but if you don’t have acid reflex, i would just eat something before. you will know soon enough if you need the spi because you will get heartburn.