I wonder if anyone on the forum is taking both Thyroxine and Alendronic Acid (AA)? I am taking a cocktail of drugs, as so many of us are, but have put off taking AA since diagnosed with PMR in 2022 - cannot believe where those 2 years went...
I've been on Thyroxine (150 mcg/daily) for nigh on 40 years and have now decided to give AA a go, on my rheumy's insistence. I am borderline osteoporotic. As I understand it, there are no contra-indications but they should not be taken together at the same time, though both need to be taken on an empty stomach before breakfast, with a 30 minute break before eating. So, presumably, I can take AA first, leave for 30 mins/1 hour and then take Thyroxine and leave eating for another 30 minutes. Then it'll be steroids after eating. Talk about complicated!
Any advice, gratefully received. Many thanks.
Tempus😆
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Ah! yes, thanks, PMRpro. If I took the thyroxine the night before, I would need to have an empty stomach wouldn't I, so will need to consider gap, possibly twixt lunch and dinner (my habits are rather all over the place, like me, I'm afraid)🙃
The annual infusion is a thought but what if my body didn't like it? At least with a once a week drug, I can stop it, if any repercussions. The thought of a whole years worth being pumped into me sounds a bit worrying. And I guess money might be an issue with the NHS, otherwise everybody would go for a year's supply?
Will check out the links. Thanks again. Good of you to reply on a Saturday soir!
Yes, I can see that could be a slight problem...Btw, PMRpro, if I want to send a general reply to everyone who has kindly responded here, do I have to go into the box that makes it look as though I'm replying to myself at the bottom of the page?
As good a way as any. If it is something important you want them to definitely see, it would be a new thread, Not many follow a thread to see later replies
I am in exactly the same situation. I booked myself in with the pharmacists at my local surgery and asked her to write out a schedule for me.
You are right with your conclusion.
On the one day of the week that I take Alendronic Acid I take that first, as soon as I wake up, on an empty stomach with water, do not lie down afterwards.
Then at least 30 min later I take the Thyroxine again, still empty stomach, with water, no caffeine for 30 mins.
Then at least 30 mins later eat breakfast, then Lansoprazole (gastro-resistant capsules) followed by Prednisolone.
Then at lunch time my first set of Adcal-D3, then at 6pm my second set of Adcal-D3.
I am hopeless at remembering all of these and have alerts set up on my phone also on my watch.
The AA and the Thyroxine sit in a bowl by my bedside with labels on.
I have also bought a fairly large vintage box from eBay that sits in the middle of the kitchen table with my Lansoprosole, Pred and Adcal-D3 meds so I can’t miss it but disguising them so nobody else has to see my pharmacy stockpile.
I hope that helps, good luck with your journey, here’s a keep happy quote..
“What day is it?” “It’s today,” squeaked Piglet. “My favourite day,” said Pooh. A.A.Milne
Thanks a lot, Noffiepawrent, I was thinking of doing exactly the same at either my Medical Centre of Village Phamacy, so will do so this week. As I said to PMRpro above, I've been feeling quite down today, so all the replies have made me feel so much better.
Your keep happy quote helped too. It reminded me of how Pooh got stuck in Rabbit's hole, because he ate too much honey when visiting Rabbit and couldn't get out!! The bit I liked was when Rabbit used Pooh's back legs to hang his towels on🤣😍 Ah! happy days, reading Winnie the Pooh to my little boy - now 46!
I was diagnosed with PMR in June 2023. Like you I have been on Thyroxine for a few years now so I take my Alendronic Acid when I wake up, wait 30 minutes then take my Thyroxine and some other medications I’m on wait 30 minutes before having my first cup of tea and the take Prednisolone after my breakfast. I haven’t encountered any problems and hopefully you won’t either, good luck.
During a medication review by a pharmacist (the GP practice farm it out) I was told thyroxine should be taken first and then wait 30mins before taking anything else. PMRPros suggestion sounds perfect.
It is indeed hard work and the funny thing is my surgery never seems to bother about contra-indications or relevant timings to take drugs. I suppose it's all on the Patients' Information Leaflet or on the medicine bottle itself but there must be hundreds of people out there who get completely muddled up with drugs.
I think your action plan looks good. Thyroxine and Alendronic acid, in tablets, are presented as water soluble salts. In the presence of omeprazole like drugs (if taken), they will remain in solution in the stomach and will be absorbed in the small intestine. In the absence of omeprazole like drugs, depending on the amount of water taken, they will both precipitate in the stomach's hydrochloric acid to produce insoluble forms that might then interfere with each other affecting absorption.
Tvm for your v helpful reply. I say that but it's kinda put me in a quandary again!
To explain: I am a very irregular person, habit-wise. That means that my meal times vary considerably. It's never been a problem, until PMR hit me. So, although the Dr prescribed Lansoprazole for me, I have to admit that I gave up on it, because I continually seemed to forget about it until just about to eat!
I am right in thinking, am I not, that Lansoprazole should be taken 30 minutes before eating? I am going to have to start taking it again, me thinks, in which case I think I'll do so before dinner, otherwise I'll never get round to breakfast on the day I take AA! It's all rather confusing...
It works BETTER if you take it AT LEAST half an hour before eating but I don;t think it stops it working if it isn't, especially when you take it regularly. Since it is for precautionary use, and once you take it regularly the effect lasts longer, it possibly isn't so crucial if you take it not long enough before food. It takes 15-30 mins to work ...
Dear Tempusfugi – I can see your problem. There is a solution.
I take omeprazole for an inherited characteristic of hyperacidity. I have been doing this for at least thirty years. I do not follow the recommended dosing advice though, which is stated in the information leaflet to be one 20mg capsule or tablet in the morning with food or on an empty stomach. This has been tested in Phase III clinical trials and it works. This approach was chosen and tested on the grounds of patient compliance.
No, I take two 10mg capsules per day, the first being swallowed, with around 300ml of water, around one hour before my lunch. Sometimes it might be 90 minutes before my lunch but never much less than 60 minutes before I eat.
I then repeat this procedure around one hour before my evening meal too.
I am still adopting this approach now indeed, taking prednisolone tablets just after breakfast and in the case of alendronic acid, I wait around 45 minutes to allow stomach emptying, before I take my coffee and then breakfast.
I do all this to ensure that I get the best omeprazole pharmacokinetic profile and therefore the best therapeutic effect. I do it this way to minimise the peaks and troughs in the blood level concentration in order to ensure I get the drug concentration in its therapeutic window for as long as possible.
Bye the way, I aim for the 60 minute rather than a 30minute timing to ensure that enough time is available to allow the capsule to pass through and out of the stomach into the small intestine.
I have to say that this approach, for me works perfectly. It has also worked well for my friends and family too.
Moving on, lansoprazole has a very similar pharmacokinetic profile to omeprazole, and if I was taking that proton pump inhibitor, I would adopt exactly the same approach to dosing. I do not know your lansoprazole dose though and therefore I do not know if you could follow my approach to dosing.
Would it be practical for you to consider this two satge dosing procedure?
On a final point, if you do change your dosage regimen, then it is important to tell your doctor and to get his or her agreement. Everybody is different after all. I certainly have told my GPs and I’ve also told my pharmacists.
I have been taking Thyroxine for over 40 years. I am hopeless with a lot of drugs and can feel really ill. The strongest tablet I can tolerate is Ibuprofen but that's off the table now with the pred. I tried AA and by week 3 I was in bed feeling dreadful so stopped. I have had two Zoledronic infusions and no side effects whatsoever. Can't get the third as I am waiting for a referral to a different Rheumy. My 2nd was 2021.
I now take my thyroxine when I go to bed as I understand that is the best time to take it. It takes all the planning out re when to take my pred in the morning now so annoyed I didn't do it years ago.
Hi Sophiestree, I just checked out your Bio. God, you've really been through it. I am so sorry and do hope you are gradually getting a hold on things. I used to live in Essex and, funnily enough, I saw Dr Mani in Chelmsford last year too. He was very kind and pleasant I thought. I am not under his guidance normally.
Seems a lot of us with PMR have the addition of an under-active thyroid. I didn't realise, until I developed PMR that the thyroid problem was an auto-immune disorder too. Thanks for getting back to me and all the best. Tempusfugi
Thank you for posting. I thought i was the only person trying to navigate my way around a medication schedule! I did ask a pharmacist but he was just bemused.
Yes, slightly worrying, isn't it Thirkelly! At the moment, I'm awaiting an op for Carpal Tunnel Syndrome, on my left hand, having had same on my right in November (all down to our friend, PMR, I understand), so have decided to wait until that's over before I start battling with more drugs. V helpful info from everyone on this forum, thank goodness.
Many of us have to develop schedules for taking our medications! Until relatively recently I had a dosette box to deal with 5 different timings of drugs every day since I had one medication that had to be taken 2x daily, 12 hours apart and the capsules give me indigestion (only thing that does!) so had to be at least an hour before bed and that fixed the rest of the day. Another could not be taken until 2 hours after that one but at least only 1x daily and mornings. It needed alarms on my phone - but even so I could still manage to switch off the phone and not take the tablet!
The only thing I keep telling myself is that 100 years ago, I'd probably be dead! All these medications keep us alive, at least they do me😂 I wouldn't be able to function without them...
True, but I was thinking of pre-baby boomers. Plenty of them still around, I think, though as baby boomers we've had the best of it (until now, I guess)!
I suppose we babyboomers grew up with the improvements - but pre-BBs are maybe better able to appreciate the changes/improvements. I was looking at a memory on FB earlier: young woman complaining she couldn't afford to heat the house for the children. But said children were playing in the house in short-sleeved t-shirts, in FEBRUARY. Isn't there is a degree of entitlement at play when someone expects to heat their house to high summer temperatures in the depths of winter? I am not so short I can't afford to heat thank goodness - though to be fair, this flat doesn't need a lot, well built and surrounded on all sides so I benefit from that - but I only heat for a few hours in the morning and in the evening and if I am cold during the day I get a warmer pullover and sit with a blanket over my feet, My bills tumbled after my husband died - he was like his mother "I'm not warm enough, I'll turn up ALL the heating". I'll never forget her turning on both bars of the radiant fire and still complaining it wasn't warm enough - but sitting on the other side of a large coffee table!!!! I grew up in a house with a single open fire in the living room. Later we had a rayburn in the kitchen which did help a bit.
I'm delighted to say that my daughters haven't!! One regularly videocalls me wearing her dressing gown on top of her clothes!!!! And loves her heated throw from her MIL. So do the pets ...
Neither do my kids -but then they grew up in either less than salubrious military accommodation or draughty houses-and then moved into older properties…
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osteoporosis diagnosis 
Alendronic Acid
PMR confusion over drug timings
Update on progress
Ad-Cal & Thyroxine 
