Interesting article on use of Lansoprazole on Inside Health (Radio 4) this afternoon.

[Chris-Bromsgrove]

I just happened to hear this in the car this afternoon. The link to the programme transcript is attached below. You need to scroll down to the last interview with Anton Emmanuel. It seems Lansoprozole and similar acid inhibiting drugs are very difficult to come off after prolonged use. They can also inhibit digestion of certain vitamins and minerals. None of this is mentioned in the drug information leaflet. Reading the article it is making me wonder whether the side effects outweigh the benefits.

bbc.co.uk/programmes/b03q8z4k

[Ironingqueen20]

I find it so hard to accept that things like this can be prescribed repeatedly for years when it may not be doing you any good at all and nobody checks whether a patient actually needs to even be on it any more.

[HiveMind]

I'd heard of the effects of PPI's but was under the impression that because I take (a very low dose) of steroids, that I should still take them. Could anyone enlighten me?

[Albasain]

Very interesting article! I am seeing my consultant tomorrow (Rheumatology) and I will be reviewing my current medications of which Omeprazole is one. I too am on steroids (Prednisolone.) I will raise this as a question citing the article. I will keep you posted as to the outcome.

[Suzym2u Moderator Vasculitis UK]

Very interesting article indeed. I have shared this with John, too Chris.

Susan

[PMRpro]

It may not be mentioned in the drug info leaflet in the pack - but it is well documented all over the literature that they interfere with calcium absorption - and can themselves be a cause of osteoporosis. The FDA has issued warnings they should not be used for more than short periods at a time.

The stomach is an acid environment for a very good reason - to create the right conditions to absorb various things and if you change that environment as drastically as PPIs do you are setting yourself up for trouble.

On another forum I have been jumping up and down for the last 3 years saying they should not be blanket prescribed as they are for steroid taking patients in the UK. As an aside, it's the same with statins - they cause muscle and joint pain and I was given them briefly - I thought PMR was bad, what they did to me was far worse! I stopped after about 10 days and my cardiologist was perfectly happy and didn't insist I try another.

However - to get back to the subject here. I live in Italy - if you are on pred you get pred and calcium/vitD supplements. That's it. If you have problems they review that of course - you possibly get something if you are also on anticoagulants because there there is a risk of gastric bleeding which was why I was given them whilst in hospital and I was on a raft of medications for other things at the time. But since I would have to pay for my own PPIs even though a doctor has said I need them, I suspect they are more likely to use H2 inhibitors, good old Zantac and co. I have seen complaints from gastroenterologists (not UK ones I hasten to add) that H2 inhibitors have been ignored since PPIs came along and wonder why GPs lean towards the PPIs.

I think there is a distinct naivety amongst doctors. The drug rep comes along and tells them how wonderful this new drug is and it will cure their patients with no side effects or it will prevent something happening and imply it would be negligent not to use it. They start prescribing it instead of the older proven stuff - and then the truth starts to appear once the drug is being used in a large population of poorly people. What the drug companies tell you is an edited version of the truth: they shout about the positive side and bury the negatives from the trials. It is far more likely that a positive report will get to the literature, be published in a journal, than a negative or even "nothing happened" paper. That actually led to an antidepressant being prescribed - when not only was it no better than what was available (that is all a drug has to do by the way, be as good as, not even better than, the current) and as a result the suicides that had also happened during the trials were never mentioned - until they had patients doing it. Drug companies tell what is to their advantage - and it has been identified all over the place.

A lot of ladies on the other forum I do a lot with have had problems with the PPIs their GPs handed out like sweeties - chest pain and upset stomachs amongst other things and some were told NEVER to take a PPI again. They use yoghurt - plain live yoghurt - which adds calcium and does seem to protect their stomachs. I did for a long time to although I had enteric coated pred at first and now am on Lodotra - both absorbed from lower down the gut, removing much of the gastric problem. I won't deny that if you are GCA level pred (over 20mg) perhaps some form of stomach protection is a good idea - but I have never used any on 15mg and down for the last 4 years. So far, so good.

I do wonder if this is emerging now enteric coated pred is discouraged in favour of plain pred plus a PPI (on the ground it is cheaper).

[Katie18]

thanks for that article - i caught part of it myself driving home from work - ill be discussing it with my condultants. i am only in 2mg of steroid a day but have been prescribed lanzoprozole calcichew and the weekly tablet to protect your bones.

[jackrussell]

I have vasculitis and at the moment am in remission, however I have been having trouble with acid reflux for which I have been prescribed Lanzoprazole, I usually only take them " when required " but recently have been taking them more often, the outcome being ( although I wasn,t aware until I read this article mentioned by Chris ) that I am now having trouble with my voice, which sometimes seems very weak and sometimes I lose my voice altogether, My Rhuemy has referred me on to the ENT. consultant to make sure it isn,t Vasculitis related. When I saw the ENT consultant the conversation went very much as the programme says ,acid reflux in my case is the reason and I am now being reffered on to a speech therapist to strengthen my voice. After seeing this report I am now going to stop the Lanzoprazole and try the Zantac ( the ENT consultant did prescribe Gaviscon extra .)and I will certainly not be having Botox injections if suggested.and I am going to give the Gaviscon and Zantac a try because I don,t feel I have a major problem , It,s just with certain foods ,but as the Dr.freely prescribes the Lanzoprazole I thought they would be ok, I am in many ways beginning to think less is more, as sometimes it appears everything is thrown at a problem which in turn creates another. Thanks for passing that on Chris I shall most certainly take a step back on this issue and take note.

[Winter64]

I have been taking Lansoprazole for about a year now, I found for me Ranitadine (Zantac) made my reflux worse, I get bleeding somewhere in my insides that they cant find and cant definitely pin to my vasculitis, my voice went and I got a cough more than my normal asthmatic cough hence the lansoprazole and now I find it very difficult to get off as the acid comes back straight away even with gaviscon and tums instead. ENT camera found my vocal cords ok so thats not a problem. I am interested in this because although I have been taking Ad-Cal twice every day for a couple of years my calcium and magnesium levels have now dropped again and my GP and I were looking at lansoprazole in which her book says it reduces magnesium levels and my med leaflet says can increase fractures, along with my current antidepressant Doxepin which I take for depression and urticarias which can also increase likelihood of fractures, as im 49 and my bone scans arent looking fantastic anyway due to previous bouts on and off pred. Im worried how I am going to be able to get back off lansoprazole without permanent acid reflux which doesnt help my gut bleeds ot hiatus hernia before I turn into a pile of dust !

[Chris-Bromsgrove]

Thanks everyone for sharing your experiences. My dose of pred is fairly low (5 mg). I had an appointment with my clinical nurse today and raised this issue. She is going to speak with my consultant to see if I can try to wean off Lansoprazole.

[Wizzi in reply to Chris-Bromsgrove]

Hi Chis my son takes mmf and 7.5 mg of pred one day and 2.5 mg the other. He's been having every morning 15 mg of Lansoprazolo. I world like to stop lansoprazolo (his doctor says that it could be ok) but I don't know how to do. What's your esperience? My son is 13 years old. He's doing well. He has mpa with renal problems(at first kidnies work at 20 per cent and after 1 year and hall the work at 60 per cent. Can I hope batter?

Thank your in advance for your reply

[Chris-Bromsgrove]

Hi Wizzi, Your son's vasculitis sounds very similar to my own. I was on 30 mg of Lansoprosol (which I guess is the adult does). I was taken off it whilst still on 5 mg Prednisolone every other day and had no adverse effects. These days I'm just on 1000 mg of Mycophenolate. Your son's kidneys seem to have made a good recovery. You can survive quite healthily on one kidney, so if his kidney function is up to 60% that is good. Hope this helps but I'm sure his consultant can provide a better answer. Chris.