Stomach upset - link to Omeprazole?

[TillyBrown]

Hi lovely forum people,I have had an upset/gripey tummy for 5 days. Otherwise feeling ok and eating normally. Stomach has been fine since I started Pred/Omeprazole 4 months ago. Dropped from 11mg to 10mg a fortnight ago, which has gone well so far. I know it could be a bug, but was also interested to know if this could this be caused by 4 months of taking Omeprazole. At a recent gp review, I asked about the need for Omeprazole and the gp said I should take it to protect my stomach. I have read on older posts about long term use of it causing damage. Unsure how to approach things.

Any advice welcomed! Thanks

P.s. update to last post - my bone scan showed I have "pretty good bone density" so looks like I don't need to take AA for now, Rheumatologist seems quite flexible on this. Glad I requested the scan!

[DorsetLady PMRGCAuk volunteer]

Good news on the scan and AA.

Not sure on the PPI some get on with it, some don’t, It’s not really supposed to be used long term -but it’s seems to become that. Many manage to protect stomach adequately with yougurt -but if you do decide to come off Omeprazole-then you need to taper it - do discuss with doctor.

[TillyBrown in reply to DorsetLady]

Thanks DL, would much prefer the yoghurt option! Will discuss the taper idea with gp if tummy problems continue. As a side note, my mum and 2 brothers have been on PPIs for years for reflux/indigestion issues (some hereditary thing?), as far as I know they have been ok.

[DorsetLady PMRGCAuk volunteer in reply to TillyBrown]

Indigestion issues -hereditary-think so going by my late hubby, his mother and our children and grandson …, 🤦🏻‍♀️. Fortunately not me!!

[TillyBrown in reply to DorsetLady]

Have you some advice on how best to slowly taper off Omeprazole? My upset tummy continues daily (10 days now), I had a sample tested and it came back negative for nasties. So now planning to discuss with GP whether I could come off Omeprazole for now in case that's the culprit. Thanks.

[DorsetLady PMRGCAuk volunteer in reply to TillyBrown]

Depending on dose - either halve it initially [if there are smaller doses] - think it comes in 10mg, 20mg or 40mg.. or just miss every other day for a week or so and see if there are any issues.. If not, then just increase the days you don't take it until you are off completely.

I didn't have an issue [just stopped it under GP supervision, but that's frowned upon by many], but some get acid reflux or rebound... so wise to have Gaviscon or similar just in case required.

[PMRpro Ambassador in reply to TillyBrown]

Or you can use an H2 antagonist (cimetidine or the like) instead to help reduce the omeprazole first - much easier to taper of them for some reason,

[TillyBrown in reply to PMRpro]

PMRpro DorsetLady Wondering what is the best time of day to take Famotodine when on Pred? The leaflet is confusing. To update I have tapered off Omeprazole for a week (by taking it every other day). Tummy still not right after over 3 weeks (!) but not as bad. GP has prescribed Famotodine at my request (after discussion at my Rheumatology appointment last week). Should I take both while still reducing Omeprazole or stop taking Omeprazole now? The Famotodine dose is 40mg, this seems quite high to me. Omeprazole was 20mg daily. Any advice welcomed, hope you don't mind all the questions!

[PMRpro Ambassador in reply to TillyBrown]

You can't compare numbers - except within the range for the medication concerned.

Oh yes - take famotidine to help get off the PPI, it will sort out the acid rebound that is the problem when stopping a PPI. When do you have acid problems? Do you have night time reflux? Or is the PPI "just in case"? If it is a just in case scenario, take it in the morning, on an empty stomach about half an hour before whatever comes next. Once you have taken it for a few days, the effect lasts the full 24 hours to all intents and purposes. If you have a night time problem - take it before bed to calm down the effect of reflux.

[TillyBrown in reply to PMRpro]

I haven't had any acid or reflux at all since diagnosis in January. It's definitely precautionary to 'protect stomach from potential erosion due to steroids' (currently on 9mg). I mentioned Greek yoghurt but funnily enough the medical profession aren't so keen to prescribe it 😉 . Though my gp did at least say it's good for the gut! Right so, I will start introducing famotodine first thing on the days when not taking Omeprazole and gradually swap them out. Many thanks!

[DorsetLady PMRGCAuk volunteer in reply to TillyBrown]

PMRpro has replied -nothing to add

[CaraDee]

Hello T

I was put on Lansoprazole 30mg when I started on 15mg Pred. My diarrhea started maybe a few weeks later, and was at its truly worst when I was camping at a festival. Disaster! Had to leave early.

I asked to be changed to 15mg Lansoprazole and this has been fine.

Good luck!

[orangemax in reply to CaraDee]

Okay, first of all I live in the US, so things could be different for you if you don't. I have tried almost all of the "zoles", until I figured out that almost all versions of them contain magnesium in small amounts. I cannot take magnesium orally in ANY amount unless I want to have diarrhea, so after doing some searching I found out that omeprazole OTC does not contain magnesium, but oddly Prilosec (for which omeprazole is the generic version) DOES have a small amount. Now different brands could differ, I suppose, so I recommend paying attention to the contents of anything you try.

[TillyBrown in reply to orangemax]

What you say about magnesium is very interesting. I was taking it as a supplement pre diagnosis and early on when starting pred (no problems as I recall). I ran out a month or so ago, and just started taking a capsule daily since last weekend. Could this be causing the upset tummy?! Guess the way to find out is to stop taking it for now. Thanks.

[PMRpro Ambassador in reply to TillyBrown]

What is the dose? And what salt of magnesium?

[TillyBrown in reply to PMRpro]

It's Together Health Magnesium from mineral salts, it says each capsule provides average (NRV): Magnesium 188mg (50%), whatever that means.

[PMRpro Ambassador in reply to TillyBrown]

That means that although the tablet weighs more, it contains 188mg of magnesium the rest is the salt part (carbonate, citrate or whatever) and that is half of the daily recommended amount you need for health. It may be that you eat a lot of fruit and veg with lots of magnesium, or maybe the capsule or something else in the fillers (to make the bulk up) doesn't agree with you.

[TillyBrown in reply to PMRpro]

I just checked online for the most magnesium rich foods, and yes it turns out I do eat a lot of them (bananas, nuts, seeds, green leafy veg...) so maybe have been having too much. I think I will leave off the capsules for a week and see what happens. Thank you PMRpro and everyone else for the great advice. I can't tell you how much it helps to know I'm not alone in the daily struggle that is PMR. 😊

[PMRpro Ambassador in reply to TillyBrown]

The odd one or two out here along with you!

[TillyBrown in reply to CaraDee]

Festival tummy upset- not good! My Omeprazole is 20mg daily, perhaps a lower dose would cover all bases.

[PMRpro Ambassador]

The adverse gut effects of PPIs can take a while to manifest or they may start immediately. Only way to find if they are to blame is to either just stop - tapering over a few weeks - or switch to an H2 antagonist like cimetidine which is a different mechanism to get the same end effect so has different adverse effects.

Good news on the other fronts though.

[TillyBrown in reply to PMRpro]

Thanks PMRpro.

[Heron82]

I’ve been on omp for 6.5 yrs since PMR. Been wanting to come off it as it can reduce bone density and possibly affect kidneys, though data not clear cut. My gp thinks I may have gastritis as pain in stomach. Has advised that I double the dose as gastro-resistant pred does not protect the stomach. Not enthused to do this, so waiting to see if things improve. However in your case I would take it as a damaged stomach lining is not something one wants.

Good luck

[TillyBrown in reply to Heron82]

Thanks. Definitely don't want to damage my stomach. Sounds like there are other options if Omeprazole turns out to be causing tummy upset issue.

[Sharitone]

I think the PIL states 4 years before you need to worry. I asked the GP, and she said it was just back-covering. Who knows! However, there are so many potential causes for an upset stomach, that if yours doesn't settle, you should probably go back to GP. MIne has miserable for months, and it turns out possibly to be due to low levels of ferritin - not something you could guess at!

[Karendeena]

Hi there, yes, lansoprazole did that to me after 4 months so I had to change to a H2 receptor - famotidine.my GI never got back to how it was before.

[TillyBrown in reply to Karendeena]

I hadn't heard of H2 before now, interesting to have this info ahead of contacting gp.

[PMRpro Ambassador in reply to TillyBrown]

Doctors were told in the marketing that PPIs are far superior to old-fashioned H2 antagonists - and they can be very gullible. So they are rarely mentioned ...

[Karendeena in reply to TillyBrown]

Worked for me

[Purplegloss]

I changed from Omeprazole to Lansoprazole, which was much better for me with no side effects. After a while I went from 30mg to 15mg Lansoprazole with no issue. Still on it 6.5 years down the road, but now down to 3.25mg Prednisolone, so pretty pleased with how it is going.

[MaritimeMags]

Omeprazole - ‘damned if you do; damned if you don’t’.

I took a low dose of this for six years, prescribed with Pred at the time I was diagnosed with PMR. Recent reports about longterm use of Omeprazole worried me. I had an endoscopy before Christmas which revealed I had some Fundic polyps (nothing major apparently). Consultant recommended increasing Omeprazole for any stomach discomfort. BUT on researching these polyps, a major cause for their growth can be PPIs like Omeprazole. I only take Omeprazole now every two or three days and, with gastric-coated Pred, so far no discomfort.

[TillyBrown in reply to MaritimeMags]

Thanks MM, that's very interesting. It's so tricky working out the best options out there, they all seem fraught with problems! Wonder why they don't just prescribe everyone with gastric coated Pred if that's better for your stomach, is it purely because of cost?

[DorsetLady PMRGCAuk volunteer in reply to TillyBrown]

The excuse sometimes is cost - but as we’ve looked at many times -coated Pred versus plain Pred + a PPI is not that different.

And sometimes it’s not the individual doctor - it’s an edict from the NHS trust who employ them and claim coated Pred aren’t as effective.

[PMRpro Ambassador in reply to TillyBrown]

Because there is a lot of dispute about whether it is better or not, It was used in one study for lower gut inflammation - someone had a theory it would be deposited closer to the site of the inflammation and that might have a good effect, haven't a clue WHY they should think that myself but hey-ho. It didn't work as well. Also unsurprisingly (to me at least) it wasn't absorbed as well - the gut lining was damaged by the illness, what else would you expect? But that is what is heard rather than the many patients who do so much better with it in PMR.