Stop taking lansoprazole

[Clarbeston]

I'm now down to 2.5mg prednisolone. My latest prescription delivered coated tablets which I've been taking without issues. My question is do I need to continue with the lansoprazole I was prescribed at the beginning of the PMR journey or can I just stop taking it now I'm down to such a low dose and (for now anyway) on coated tablets? Should I gradually reduce and, if so, how? I could open the capsules and ditch some of the contents.

[SheffieldJane]

It is best to reduce Lansoprazole gradually as it can bring about a nasty return of symptoms if done suddenly. Ask for your GPs help in reducing your dose over time.

[Clarbeston]

Thank you for your quick response. I will do as you suggest.

[PMRpro Ambassador]

It is said you shouldn't use a PPI together with enteric coated medication - it is designed to resist acid and break down in the less acid environment after the stomach. I'm not sure how much difference the PPI makes to stomach pH but it will be much less acid.

You must taper the dose to avoid rebound acid production - what dose are you on? There may be a lower dose of lansoprazole or you can, as you suggest, open the capsule and use half of it by mixing with yoghurt or apple sauce is often used. Do that for a couple of weeks and then start missing odd doses a bit like DL/s simple taper with no PPI as the new dose.

[Clarbeston in reply to PMRpro]

Ok, thanks for your thoughts.

[Clarbeston in reply to Clarbeston]

Good idea, thank you.

[piglette]

Perhaos you should talk to your doctor about it or even ask the pharmacist first. Most are very knowledgable about medecines.

[Sharitone]

I was on 20mg of another PPI - Omeprazole - and slowly managed to reduce to 10mg. It had to be slow, though, with alternating doses. I had to use Gaviscon at night until my stomach got accustomed to the lower level of PPI.

[Clarbeston in reply to Sharitone]

Was that doctor's orders or your own system?

[Sharitone in reply to Clarbeston]

I asked to reduce once before, but GP said No. Then I had a gastroscopy which showed benign polyps, so that consultant advised taking as low a dose of omeprazole as possible to manage symptoms. So this time the GP did prescribe 10mg tablets ( I think for lansoprazole ot would be 15mg instead of 30) but I was not told how to reduce I found that on Google, where it said to alternate the higher dose with the lower for a couple of weeks. I did find that after that, a dose of Gaviscon at night tided me over till my stomach was really used to it.

However, I recently tried dropping the PPI altogether every fourth day, and that was not successful.

[Suffererc in reply to Sharitone]

I have been taking Gaviscon as well. Still take it . Calms things down in the night. Stopped the Lanzaprole when on 2mg Pred.

[Hidden]

Dear Clarbeston.

If you wish to stop taking lansoprazole, could I suggest that, providing this does not cause prednisolone induced stomach irritation issues, you do not take enteric coated prednisolone. Your prednisolone blood level profile will be completely changed, and this could well affect your therapy. Please let me explain.

An enteric coated prednisolone tablet, in the presence of lansoprazole, as far as oral absorption is concerned, behaves like a quick release form of prednisolone.

In the absence of lansoprazole, the enteric coated formulation will behave like a delayed release product.

So, the time it would take your ingested prednisolone to reach a peak blood level concentration of around one to two hours, would change significantly to a more variable and extended timing of around four to six hours.

This large change may not be good for your prednisolone therapy.

So, if you have no history of gastric hyperacidity, then it would seem reasonable to work with the quick release form of prednisolone, as I think you have done in the past, and to gradually wean off lanzoprazole.

Good luck.

[Purplegloss]

I am currently on 15mg Lansoprazole, and when I got to a lower dose of Prednisolone my GP took me off the 30mg I was taking, and put me straight on 15mg with no issue. Might be different stopping altogether though.

[PMRpro Ambassador in reply to Purplegloss]

Halving the dose is the first step to stopping it - and there shouldn't be a problem. But you are right, stopping altogether is a different matter,

[Clarbeston in reply to PMRpro]

Lansoprazole update...as suggested I consulted the pharmacist who seemed rather gung ho about stopping. He suggested trying no lansoprazole for a few days and seeing if I had any problems. I think I'll follow your advice as usual and reduce slowly from the 15 mg I'm taking now. You always make so much sense 🙏

[PMRpro Ambassador in reply to Clarbeston]

Hum - not impressed by that, really not!!!

[worrier62]

Can i just check, if we take the coated ones we shouldnt be taking Lanzoprazole? Ive been given both

[PMRpro Ambassador in reply to worrier62]

The lansoprazole shouldn't be needed. But lots do take both fine so don't worry about it.

[worrier62 in reply to PMRpro]

OK thank you, do more people have the coated type of pred more than the ordinary ones. Dont know why they dont give the ordinary ones, they are easier use for changing doses arent they, so must be easier for docs

[PMRpro Ambassador in reply to worrier62]

No, it is mostly the plain sort they use. Do you mean you have been given both sorts of pred? The most common reason for that is that doctors think they are helping patients by giving them 2.5mg tablets - and the 2.5mg coated tablets are cheaper than the 2.5mg plain ones. It is all to do with economies of scale. We say get a pill cutter and cut 5mg plain tablets to get 2.5mg doses.

[DorsetLady PMRGCAuk volunteer in reply to worrier62]

Think more have plain tablets - but they can be harsh on stomach for some people which is why the PPI (Lansoprazole) is also prescribed.

Plain ones are usually cheaper than coated ones, but once you add in the PPI there isn’t much difference in all honesty. May well be down to individual doctors choice (unless patient states a preference) - who knows 😳