Omeprazole query

[Wheelygood99]

Recently diagnosed and on prednisolone; also prescribed Alendronic acid (weekly dose) and Omeprazole. I thought my GP said that as I have no history of gastric problems to only take the Omeprazole in the evening before I take the alendronic acid the next day. But she has prescribed enough for once daily not once weekly. Did she mean to take it every day in the morning, except for the day before the AA when I should take it in eve? I'd prefer to take one less drug anyway so do I really need it? My next follow up is Jan 12 so will ask her then but wondering if in meantime I can just stop it as I've only used it once per week up to now.

[PMRpro Ambassador]

Difficult to say - most doctors who prescribe it do it for the pred, not for the AA. Do you actually NEED the AA? Have you have a dexascan?

I imagine the prescription for omeprazole is fairly standard at daily, just means the prescription will last longer.

[Wheelygood99 in reply to PMRpro]

I'd rather not take the AA either. Not had a DEXA scan, just 'bone profile' in blood tests which were all fine. I guess the GP thought it advisable, I'm 62, my mum has osteoporosis (88) but I'm very active and fit for my age . Maybe I should have queried it more but there was a lot to take in at the diagnosis

[PMRpro Ambassador in reply to Wheelygood99]

I took 4 AA tablets - by which time I had done my homework and discussed it with a different GP. He agreed with me it was reasonable to wait until I had had a dexascan as there were things emerging that suggested they weren't the magic pill it is claimed - the results were osteopenia in the mid to upper numbers, normally not a reason to treat with more than calcium and vit D supplements. The figures had not deteriorated much in the 12 years after that - I am due another dexascan really. I have never taken another AA tablet. Means I have no problems with getting dental work!! Were you told to get a full dental check BEFORE starting AA? You should have been.

[Bobbury in reply to Wheelygood99]

I wouldn't take AA. As you will see from what PMR pro says, take a Dexa scan first. I had the same situtation but with advice from PMR pro to take a dexa scan and guess what, my bone density is absoulutely fine.....!

[FearFracture in reply to Bobbury]

I agree with those saying get a DEXA before you start on bone meds. Additionally, I recommend getting bone turnover marker (BTM) tests too prior to taking any bone meds. Reasons I recommend this are, if your bone turnover isn’t high or elevated, bisphosphonates won’t do much good. Secondly, you need baseline BTM numbers to check to see if bone meds work. Ex. if you get BTM tests before starting any bone meds and your numbers show high or elevated bone turnover and then you start taking alendronate, 3 months after starting the alendronate you can have BTM tests done again and if you numbers are lower you will know the alendronate is working but if they are not you can look for another solution instead of continuing to take a drug that isn’t working.

The key is to have baseline BTMs done prior to starting the alendronate (or other bone meds).

[Wheelygood99 in reply to FearFracture]

Amongst the tests that were done at diagnosis time was 'bone profile' which measured serum calcium, corrected serum calcium, serum inorganic phosphate, serum total protein, serum albumin, and serum alkaline phosphatase. All were within normal range. What does that tell me?

[DorsetLady PMRGCAuk volunteer]

Hi, and welcome,

Maybe that’s what she did mean… and as PMRpro says please request a DEXA . You may be more prone to osteoporosis for family reason, but as you say if you don’t need AA then why take it. I took it for 4 years [with good reason] with no problem but it’s certainly a drug that doesn’t suit all.

There is a load of information in the FAQs regarding bone health - so have a a look at that - as well as plenty of other information -

healthunlocked.com/pmrgcauk...

[SnazzyD]

I refused AA until I had had aDEXA scan. Turned out I didn’t need AA. What was interesting was that it turned out I already had osteopaenia having lost 10% of my bone mass since the DEXA scan I had 11 years previously after having my ovaries removed aged 41 to induce menopause. Given that my vitamin D was also found to be in my boots, it is likely the double impact caused it. Saying that, most people have some level of osteopaenia when they get older. My point is that had I not had it, nobody could have known whether the Pred had caused a rapid decline or not. Another DEXA after 3.5 years on Pred starting at 60mg, showed a further 3-3.5% loss, not 13.5% as it would have seemed. If I need to go on Pred again, that is useful information.

I didn’t take AA because I thought my personal risk factors with some side-effects were too high.

[Koalajane]

I was told to have AA first thing in the morning on an empty stomach. Then to be upright for half an hour.

I took 4 doses and my doctor rang to say don’t have any more until you have been to the dentist. I stopped then and asked for a bone density scan which showed I didn’t need it just d3/calcium

[DogAgilityObsessed]

I refused to take AA until a DEXA scan showed I’d already got osteoporosis. That was three years ago and about six months in to PMR and pred. I take it once a week first thing in the morning and my new rheumatologist suggested trying to wait an hour (rather than half an hour) before anything else. You also need to drink lots of water with it and remain upright. (Do the ironing?)

I also take omeprazole. Once a day. I used to think it had to be taken half an hour before the pred but new rheumatologist says it can be at any time (I guess that’s because it’s coated). I’m currently taking two a day but I assume I will be advised to reduce that as I come down on pred (currently on 40mg).

[DorsetLady PMRGCAuk volunteer in reply to DogAgilityObsessed]

(Do the ironing?)

Please refrain from swearing on this forum …..or giving me a heart attack first thing…😳

[DogAgilityObsessed in reply to DorsetLady]

Ha ha! Ironing was suggested by the lovely lady who ran the Taunton based PMRCGAuk support group. I thought it was a good idea (in theory).

[Merryfield in reply to DogAgilityObsessed]

I turn on Call the Midwife or a sappy Hallmark movie and iron away, with a sit down about every 20 minutes. 😉

[herdysheep in reply to DorsetLady]

😂😂😂

[Stills in reply to DorsetLady]

Best laugh I’ve had this Xmas thank you

[PMRpro Ambassador in reply to DogAgilityObsessed]

Once you start taking it the effect is for a full 24 hours - so it doesn't matter what time you take the omeprazole. I wonder if the rheumy has ever tried doing nothing involving bending for over an hour? Given there are other options including monthly and annual infusions ,,,

[DogAgilityObsessed in reply to PMRpro]

My rheumy is a man so can’t do more than one thing at a time. And I do pick up dog poo!

[herdysheep in reply to DogAgilityObsessed]

🤣 Hope you have told dog to hold on for 30 - 60 mins

[Stills in reply to DogAgilityObsessed]

Another good laugh thank you, thus is better than than the two Ronnies

[piglette]

I personally would not take AA until I had had a Dexascan that proved I needed it. My GP is always going on about me taking AA, as it is on his tick off list. Long term pred=AA. My Dexascan results are all positive.

[LindyMc]

Just a thought, I am v aware of the vitamin/ mineral depletion by both prednisolone and omeprazole which in some cases compound each other and as a result might consider discussing broad spectrum supplementation with gp as well as dietary review to get more of the good stuff in naturally.

[Wheelygood99 in reply to LindyMc]

Good idea. I am already taking Vitamin D3 with K2, vitamin C, omega 3, magnesium, and plenty of dietary calcium. Recently become enthused by kefir and planning to make my own!

[Candles1970]

I take mine daily as it’s a protector for your tummy

[Handloomweaver]

I take both of those - alendronic acid once a week. Omeprozole daily to protect my stomach from the steroids.

[Orange_2022]

Omeprazole was prescribed to me but I read the leaflet and the side effects (including the risk to bone density), meant I didn't take it after the first month. I take my Pred after breakfast of lots of Greek yoghurt. Need to line the stomach.

I didn't take the prescribed AA either but eventually convinced my GP to arrange a Dexa scan and I'm at the higher end of Osteopenia so I take the weekly pill now. No issues 8 months in although I'm being very careful to look after my teeth. My dentist said there would be no issue with dental treatment except if it was surgical so if dental hygiene and regular checks are kept up things should hopefully be OK. (Assuming you can find a dentist!). But I'd rather not take AA - I spoke to the Royal Osteoporosis Society before I did as they are super helpful and knowledgeable. Free helpline.

[Wheelygood99 in reply to Orange_2022]

Thanks for your input. I've stopped Omeprazole now and will follow up with the osteoporosis society . I'd rather not take AA if poss but reasonably happy to take for 6 months or so, hopefully by then I'll be on a lower dose of pred. I take my pred with plenty of breakfast like you. I'd had a dental check up around the time of diagnosis and he said the risk of dental problems for surgery was about 1 in 10,000 so not too bad

[Orange_2022 in reply to Wheelygood99]

Sounds sensible. I think you'll have to take AA for longer than 6 months, if you need it, as it doesn't have an instant effect. ROS have exercises on their site too and Vits D and K2 and maybe magnesium are good ideas as I think you know. Good luck!

[Floridafan]

If you prefer to not take Omeprazole ask your GP for enteric coated Prednisolone. Quite a lot of us take these as there then shouldn’t be any need for any PPIs to be taken.

[Wheelygood99 in reply to Floridafan]

Great idea

[Dancing1973]

Hi id take your emeprazole . I was diadnosed with PMR about 7 years ago . I too was given AA plus pred but no stomach protective med. I ended up with a tummy bleed and have now got chronic gastritis. I still have to take 5mg pred each day but I dont take any added vitamins but I take emeprazole morning and night. I try and have a good diet and healthy lifestyle. I wish id been given a stomach protector from day one

[oscarina]

have heard that stopping a PPI abruptly after taking it for several months or years can lead to rebound overacid stomach and for some chaps cause stomach bleed and ulceration. any info appreciated as i dont want to continue a med that has dementia as a side effect.

[DorsetLady PMRGCAuk volunteer in reply to oscarina]

Just taper off it fairly slowly… depending what dose you are on… if you can halve your daily dose initially that’s a good start.

If you cannot do that, then just drop one day in first week, 2 days second week, 3 days 3rd week etc.

But maybe have some other antacid medicine available in case you need it.

[oaktree5 in reply to DorsetLady]

Tnx DL, gastro MD agrees w/ your advice, but also to give up my Baileys. and even Guinness!

[DorsetLady PMRGCAuk volunteer in reply to oaktree5]

Hmmm ..you win some, you lose some 😉

[phebamom]

medicine.wustl.edu/news/pop....

Sorry for the long address. Read this and make sure you have good kidney function before taking a PPI long terms. They are only meant to be taken for two weeks maximum. If Pepcid AC works for you, it is a better choice than a PPI.

I always refused any bisphosphonate, AA included. I have serious stomach problems, and now have a bone marrow disease, so a bisphosphonate is not an option for me. Listen to PMRpro and others. Get a Dexa scan and do not take any drug unless you truly need it. As the old saying goes, there is no such thing as a free lunch. Everything we do and take has a consequence. It is tiring and difficult to be one's own health advocate. But, it is necessary. We are all different and respond in a different manner to a medication. Always do research on meds, ask a lot of questions, and listen to your own body. Sounds to me like what you really need is vitamin D3, and calcium

[Krzgrldre]

do you mind my asking what caused your loss of mobility ?? Mine was caused by prednisone I had been taking it since I was a teen and now at 38 I found out it destroyed my hips