Lansoprazole & Prednisolone

[Bayleaf1]

My question may have been asked before but here goes…….. When diagnosed with PMR eighteen months ago I was prescribed pred plus Lansoprazole as a “stomach liner”. My pred tablets are gastroresistant apart from the 1mg ones and my understanding was this was to make sure the drug was not attacked by stomach acid and reached where it needed to go intact. I’m now down to taking 2.5mg of pred a day and wonder if I still need to take the Lansoprazole. I’m reading about long term use of it as possibly causing all sorts of horrible things. I would welcome opinions from others please.

[Noni71]

I can’t advise you on your question but can only tell you of my experience. As I began tapering to 5mg of Prednisolone, I also began to take just one Omeprazole instead of two thinking that it would be ok. Unfortunately I had to go back up to two after a few days as I felt nauseous and not good at all digestion wise. Try it, I’m sure nothing serious will happen and you can always go back to them if necessary.

[Bayleaf1 in reply to Noni71]

Were your 5mg pred tablets gastro resistant I wonder? I’m actually only taking one 15mg capsule of Lansoprazole so from what I read when the time comes to taper it will be taken every other day for a while. I suppose I will cross that bridge when I come to it.

[Noni71 in reply to Bayleaf1]

No my tabs were non gastro resistant. I did taper the PPI but still felt sick. Will have another go again when I start my next taper.

[DorsetLady PMRGCAuk volunteer]

Actually when you are on EC Pred you don’t need to be on a PPI, but as you say your 1mg Pred are plain ones, and you will be continuing to take just them as you get lower then you may need to stay on the Lansoprazole.

Discuss with your GP, and if you decide to come off the PPI, you do need to taper off it slowly otherwise you may suffer from acid reflux…

[Bayleaf1 in reply to DorsetLady]

That is my understanding so thank you for confirming it and as you say the lower my dose now means that I will be taking the non gastro resistant tablets.

[PMRpro Ambassador]

Your understanding of the use of enteric coated pred isn't quite correct - the enteric coating is purely to protect the stomach from the potential irritant effect of the pred itself. There was a study on enteric coated pred to see if it would work better in gastrointestinal disorders by there being a topical effect when it was released in the part of the gut affected. It didn't! In our case you need the pred systemically - in the bloodstream to allow the antiinflammatory effect to reach the entire body.

On that basis - if you have been on e/c pred the whole time, unless you have gastric problems you didn't really require the lansoprazole. Now, having been on it so long, you can't just stop taking it, you will have to taper it to reduce the risk of developing rebound acid production that can be very unpleasant. The usual process is to halve the dose first but you seem already to be on the lowest dose, Using one of the slowed tapers on here is also a good way to go about it and some people use gaviscon in the interim to deal with any acid problems.

At the very low doses of pred many doctors feel there is no need for a PPI - and some experts say it is the blood level of pred that causes the problems, not the physical presence of the pred in the stomach. Taken with food of some sort, especially yoghurt, many people find no need for a PPI. I have never taken one because of pred, only if there is another need such as surgery.

[Bayleaf1 in reply to PMRpro]

Thank you for your detailed response PMRpro. Very reassuring to know the whys and wherefores of these things. I suppose when I started on 15mg of pred on the standard tapering regime it was a “belt and braces” thing to automatically prescribe the PPI as for some of the time I would be taking the 1mg non coated tablets. I will probably continue the Lansoprazole as I taper lower with the pred. I forgot to take the Lansoprazole yesterday morning………well I didn’t forget but took another similar looking capsule in error and didn’t realise until the evening. I then started reading up on it. Back to as I was I think.

[PMRpro Ambassador in reply to Bayleaf1]

But there have been 1mg enteric coated tablets for several years - no need for plain to be used.

[DorsetLady PMRGCAuk volunteer in reply to PMRpro]

No there isn’t, but EC 1mg are silly prices in UK

[PMRpro Ambassador in reply to DorsetLady]

They are, that is true. so they won't be available much longer if there is no market.

[DorsetLady PMRGCAuk volunteer in reply to PMRpro]

There seem to have been issues with supplies for long time -as often discussed on here - so probably will be fazed out..

[Bayleaf1 in reply to DorsetLady]

Ah, that explains it then.

[Bayleaf1 in reply to PMRpro]

I know but my GP and pharmacy say that they are very hard to source so I have to accept these otherwise my medications would be held up and I can’t have that as I have to have them delivered as I don’t drive.

[piglette]

As the others say if you are taking gastro resistant tablets you don’t need Lansoprazole. I am not sure all doctors know this though!!