Omeprazole/cramps/headaches and bones

[Fatsiajaponica]

3.5 weeks in to treatment with prednisalone and omeprazole. Reduced after 3 weeks from 20 to 17.5mgs of pred. I am experiencing cramps in my hands, feet and hamstrings. On researching the side effects of omeprazole it seems that it could be the culprit. I also noted that long term use can impact bone health which seems like a bad idea given the effect of prednisalone on bones? Could it be the pred reduction as this surfaced soon after reducing.? I am thinking of ditching the omeprazole and just ensuring that I eat well before taking the steroids. Any advice/experience?

[DorsetLady PMRGCAuk volunteer]

Your cramps may be due to Pred -it can deplete the magnesium in your body rather than the PMR itself.

Some take magnesium supplements - but there are different ones, some upsetting stomach. So gave a look through this -

medicalnewstoday.com/articl...

Or try spray or lotion.

Many manage without a PPI just make sure you always take Pred with/after food.

Do monitor to make sure you don’t get any typical PMR type pains as you have just reduced, Some can manage a 2.5mg drop, but some cannot .

This link explains difference between steroid withdrawal and flare (too low a dose) -

healthunlocked.com/pmrgcauk...

[Fatsiajaponica in reply to DorsetLady]

Thank you, I think I will drop by 1.75 next time rather than 2.5. I have noted all the comments on here about tapering, rheumatoligist had me coming down at 2.5 drops every 2 weeks until I reached 10 and hold. I have learned from this forum that this is not the best idea so will manage it slower. I'll have to persuade GP to prescribe more meds to see me through so fingers crossed. Really I am sure that you , PMRpro and others have saved many from flares and dispiriting yo-yoing with your helpful advice.

[tangocharlie in reply to Fatsiajaponica]

Tell your GP you're been reading advice from the PMRGCA uk charity and their online forum including tapering plans recommended by rheumatologists. In fact give them details of the website so they can spread the word to other patients and health care professionals such as your rheumatologist by the sounds of it. pmrgca.org.uk

[PMRpro Ambassador]

Try taking magnesium supplements - or footbaths with Epsom salts or sprays or creams.

Pred can deplete magnesium levels and so can a PPI - taking both makes it even more likely.

[Fatsiajaponica in reply to PMRpro]

Thank you. I saw something about this on another thread but then couldn't find it so apologies for making you repeat.

[tangocharlie in reply to PMRpro]

Magnesium took away my leg cramps when I was on the steroid injections a few years ago.. Not had the problem with Pred tablets but then they're a much lower dose. I sometimes find rehydration sachets such as you'd take after diahorrea give me a bit of a zing, no idea why but presumably something to do with the way Pred affects the potassium/magnesium balance?

[Charlie1boy]

I too suffered from cramps. Didn’t go for magnesium tablets, but the magnesium spray has certainly helped to alleviate symptoms - not 100%, but over 80%.

Good luck.

[Fatsiajaponica in reply to Charlie1boy]

Thanks Charlie1boy

[bussell]

omeprazole was prescribed for me soon after I started on pred because I had awful acid reflux on going to bed. I was not keen to get into the omep habit so I had a look at what I was eating and when. I gave up my nightly 2 squares of chocolate ate earlier and asked to be prescribed enteric coated pred. And bingo. Problem solved. I now eat chocolate and evening mealbefore 7pm and take pred at 5pm. It takes about 10 hours for me to absorb the coated pred (longer than most people - it’s trial and error to get it right). Cramp in hands and feet has diminished as the pred dose has gone down and omeprazole is out of the picture. Belonging to this group has taught me many things and one of them is that we are all individuals and we can adjust our lives and medication within reason to get our best lifestyle. Wishing you lots of luck

[Fatsiajaponica in reply to bussell]

Thank you for your reply. I'm at the stage where I am reducing carefully and need to halve the tablets atm so unable to use the coated ones yet. So far so good with eating before taking the pred, fingers crossed and cramps gone without the omeprazole!

[DorsetLady PMRGCAuk volunteer in reply to Fatsiajaponica]

EC tablets come in various sizes - 1mg, 2.5mg and 5mg…. so you can mix and match to obtain what dose you require.. so ask for them. However the 1mg dose are very expensive compare to other doses. But if you don’t ask you don’t get!

[Fatsiajaponica in reply to DorsetLady]

Thank you, was unaware and saw this too late for the discussion I had with GP the other day. This was the second GP, first was dismissive and unhelpful, this one listened to my plans for slow taper, referred for the dexa scan and asked me what meds I needed and what dose! It is such an anxious time when diagnosed, I was worried by the transfer of care to GP from private rheumatologist, never know what you are going to get. Now much relieved. This forum is so helpful in reducing that anxiety and giving you the information to confidently challenge the medics.

[DorsetLady PMRGCAuk volunteer in reply to Fatsiajaponica]

You’re welcome, so maybe ask for EC ones - in various strengths - in future…

[tangocharlie]

I put my Pred in gastro-resistant capsules so I don't have to take any stomach protection medicine. Omeprazoles and other 'zoles really upset my stomach and trigger reflux. You can get the capsules from Capsuline UK

[PMRnewbie2017]

Initially, nearly 7 years ago, i started Omeprazole but it didn't suit me either and gave me leg cramps. Pred has never given me any significant digestive issues save for a bit of heartburn when i was on higher doses. I should point out that i have always dosed at 2am so learned to take my tablets with a good draught of water, but didn't lie flat afterwards. I fell asleep half propped up. It's amazing what you get used to! After all these years i seem to be on auto pilot at 2am and don't remember waking to take my tablets.

[Fatsiajaponica in reply to PMRnewbie2017]

😂 I have seen that many take their pred at 2am, glad that you aren't too sleep disturbed by that.

[PMR2011]

I was on Pred for nearly 9 years (for PMR then subsequently GCA) and never took a stomach protector such as omeprazole and never had a problem. I was religious about taking Pred with a meal.

[Fatsiajaponica in reply to PMR2011]

I think it would be helpful for medics to explain that patients may not need to take this other drug, which could have side effects long term, and short term for me. I have also been prescribed the Aledronic Acid which I'm swerving atm until result of dexa scan. I may not need it if I increase calcium, continue with Vit D+K2 and do weight bearing exercise...lets hope anyway!

[PMR2011 in reply to Fatsiajaponica]

Agreed. But some guidelines somewhere tell them it should be a package deal with Pred so it’s automatic. It would seem we need to be the educated consumer much of the time!