Greetings all, my first post here after recently discovering this excellent resource. A question about omeprazole please. I have been on a typical taper from 15mg prednisolone for PMR since July of last year. Twice failed to stay at 4mg and reverted to 5, but after 3 months on mainly 5 had a crippling flare last week. I requested 6mg for next month, and a new doctor there granted that without question but added omeprazole, which I've never had before. Would this have been added because of the flare?
My view on the flare is that the 5mg was not enough, it was always bearable but uncomfortable and allowed inflammation to build up and culminate in the flare. Is this likely to be more correct than that a new drug was needed? I really don't want to take another med (on top of avorstatin and bisoprolol prescribed for what was thought to be angina but is now a mystery). I'm very tempted to ignore it, but wonder if I'm just being perverse rather than sensible.
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BlueKiwi
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If you have managed without omeprazole to date, and had no adverse stomach issues… then don’t see the point in adding it in now.
Would say however, that you have reduce quite quickly which is probably why you have flared a couple of times… and TBH there is little point in staying on a dose that is ‘bearable but uncomfortable’ … it inevitably doesn’t end well - as you have discovered. You need to treat a flare with more than just a 1mg increase.
This link contains usual advice for dealing with a flare - if you have enough Pred then try it…and back down to 6mg or 5.5mg as 5mg is just a tad too low.
Many thanks DorsetLady. So far I've only flared once - the two times I failed to stay on 4 it was just too painful all round in my legs (or does that count as a flare?), but the flare attacked my hip as well and left me crawling along the walls. I treated it by boosting the pred to 10mg plus 5g paracetamol for 7 or 8 days, and only yesterday reduced to 6 of pred and 3 of the other. My plan is, as you say, to go from 6 to 5.5 and be very cautious on the taper.
A flare is any increase of symptoms -just shows dose is too low m. It may start in one part of body -but invariably expands to other parts as the inflammation is allowed to build up.
The art is to catch it quick -or preferably not let it happen in the first place!
Omeprazole is for stomach protection - pred can cause gastric irritation and the omeprazole is a standard issue by some doctors for anyone on pred. DId they have a look at your gullet when investigating the angina? Acid reflux can cause similar symptoms at times - did they do an endoscopy to rule that out?
Like DL, I think your problems are related to a precipitous speed of taper and I would also reiterate that there is nothing noble about "putting up with a bit of pain" just to be at a lower dose. The dripping tap of inflammation will fill the bucket and overflow and you can end up back where you started,
Hi BlueKiwi,Along with many others on here my doctor also prescribed omprazole. This is to protect your stomach should the steroids cause you any problem.As I had hardly ever had any problems with indigestion I declined the offer as I am not a believer in taking something I don’t need.I have never had any issues and I stress that was my choice.As you are near to being on treatment for 12 months without any issues it is for you to weigh up the pros and cons.
Many thanks to all. On balance, I will put the omeprazole aside - perhaps raise the issue of not taking it if I see them face-to-face but not through the portal. And yes, I have now learnt to not "put up with pain" when it's PMR.
About omeprazole and chest pain mimicking angina, an endoscopy would rule out gastric distress from pred., but prior to swallowing a camera you might give the omep a three week trial and if the chest pain goes away, then a probable diagnosis could be chest pain from the pred., unless you drink a lot of caffeine, coffee is twice the amount of earl grey, even if Picard didnt have any complaints about it, and around three times green or white tea. Omep doesn't have much in the ay of side effects except decreased absorption of vitamins, in the short run, but long run studies are suggestive of earlier cognitive decline, at least i think tha'ts right , but then i have taken it for twenty years off and on.
Thanks. The chest pain started a couple of years before the PMR and I originally dismissed it as long covid/age/decreptitude. It is proven to not be cardio related, but when I was sent to respiratory people for a possible thymoma they swore that the cause would be the muscles between the ribs. It is only partly similar to costochondritis, not "malarkey" as my GP reckonned, and I have now proved them right: several minutes of ribcage expansion / loosening prior to a brisk walk will reduce the pain to a mere discomfort, while forgetting to do that will always result in bad to extreme pain. These results are repeatedly consistent and have been for three months, excepting a single incident of pain after exercise which was followed within hours by a crippling PMR flare. I am dismissing that incident as an outlier and concentrating on reducing lard, especially around the ribs. I have put the omeprazole away and am taking more care to eat either solid food or yoghurt with the pred. And as you've reminded me, I really should cut the coffee right back.
"Omep doesn't have much in the ay of side effects except decreased absorption of vitamins, in the short run"
You may have had no adverse effects from omeprazole but many patients find it causes gastric effects - ironic given it is taken as "stomach protection"! Bloating and the like, all the way to problematic diarrhoea has been experienced.
I’m not on pred and don’t have PMR but another long term rheumatoid condition that is largely under control. I have however been prescribed omeprazole after strange gastric symptoms appeared last year. The dreadful headaches I experienced whilst taking omeprazole are listed on the PIL as likely and became worse each day. I weaned off after 8 months or so but keep a small supply in case the gastric issue becomes unbearable again. My GP said it’s ok for me to take it as and when but then I’m not on pred.
I also ignored the omeprazole when it was initially prescribed with pred. However after having my gallbladder removed last year it was prescribed by the GI consultant. I now have all sorts of gastric gymnastics going on in my abdomen, and so i can recommend omeprazole if you do need it. I haven’t noticed any side effects and it really does reduce the popping, fizzing and pain in your gastric tract.
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