Prednisone, Antibiotics and PPI(proton pump inhibitor)

Bones, joints and muscles
1

I have general questions on those 3 above.  Recently I have experience side effects ( I think) from the above medication and would like to decide if it is worth taking anything in addition to prednisone.  Side effects are mainly with stomach and lately with cramps in the leg muscles. First I had constipation for month or so; lately it is soft stool, and frequent bathroom visits.  I think side effects are caused by complete change in the bacteria culture in the intestines killed by antibiotics. What also does not help is PPI interfering with mineral absorption and ( most likely) causing low potassium and magnesium levels and thus muscle cramps.

So:

- How often are antibiotics and PPI given along with prednisone?

- How necessary is PPI if I take split dose, 5mg each, and with lots of yogurt?

- After taper, at what level of pred one does not need antibiotics and/or PPI?

I have my monthly appointment with rheumatologist this week and would like to prepare for it.

2

I've never had antibiotics but yes to the cramps or trigger finger this I took magnesium which resolved the problem I stopped when my dose got to around 10 mg

3

I have taken all these and they do cause problems. I have tapered and weaned off Prednisolone now for over a month and the stomach problems have eased 80 % I still need to take some antacid from time to time and also an ocasional 10m PPI only if I really need it. If I dont take the ppi the problem with stomach acid spirals out of control. I had been on it daily for ten years and suffered horrible palpitations. That was at 20-40m I stopped taking it and tried many other remedies. The only one that had a long lasting effect was taking betain hydrochloric with pepsin before a meat meal. I no longer eat any high fat foods, however some things do affect me more that others. I still have not completely worked out what they are. I have to take antibiotics because I also have to use catheters. I dont think they affect me too much but the other two definitely did.

4

Nick & others, I have had similar bowel problems the last few months, & it's been 6.5 months since on prednisone. Playing the up & down dosage game with my good doctors. My biggest, most devastating, side effect is so much weight gain, bloat, & swelling. It seems like I was gaining a little weight the 1rst few months, but more recently have blown up.like a huge helium balloon, I hate it. My appetite has gone through the ceiling, can't seem to satisfy my hunger. Anyone else with these problems ? I know there is always much talk on this chat line about weight gain, but anyone else notice it coming on so fast & so much weight, bloat, & tge huge increase in appetite ? Thanks

5

Mr Fred has a lot to answer for.  I really had to put myself in a position were I could 'control' my eating - it was difficult but when you put you mind to it you can 'control' it.  On a more positive note as you reduce further and keep up exercise it does get better!

6

Nick,

I avoid antibiotics and PPI's like the plague. Tried PPI's twice for prescribed 14 days, but didn't help.

Antibiotics are just bad for body (I'm sure if really, really needed I'd take) so even my doctor avoids (when I had a cold).

Magnesium can make stools soft. No one told me that until later and Doctor made me stop all dairy which meant yogurt. So for 6 months I dreaded going to bathroom, but I did of course.

Finally!!! Learned of probiotics in pill form, refrigerated is best, 12 billion active cells or more.  And I take the magnesium every other day.  Now I have beautiful healthy poops!!! There I said it! Funny things we rejoice at when age (I'm 54) wink 

My acid reflux is not as bad now due to switching to Rayos prednisone, taken at night, time released to help not be as stiff and painful in mornings. 

Dang doctors still will NOT agree that Pred causes acid reflux!! Went today to doctor and still will not! Then said we just treat joints and muscles, not the stomach, go back to GI doctor for that. Ugh. 

So, I drink 2 oz. of aloe Vera juice before I eat, that helps some. I asked if that was ok, even though I read not to over do juice if on corticosteroids. 

I'm frustrated over the acid reflux, I avoid fruits, wine (except with steak on occasional weekend!), no acid type foods, no spices (boo boo), ... 

Hope when this is gone I can enjoy food again!

To not gain weight, I did the no flour, no grains, no dairy, no sugar, no legumes...lost 25 lbs, but now I'm losing muscle. 

Hope this his info helps some. Just my experience.

7

There was an item on CBC news this evening (Feb 22nd) about PPIs.  Yes, they have been touted as safe - but only for short term use.  Beyond 2 months there is increasing evidence for serious side effects including kidney disease, increased fracture risk, pneumonia, increased incidence of c. difficile, low magnesium levels. 

8

Thank you all for your comments! At first I did not analyze what doctor prescribed, because I was concern only about PMR and whatever I took was working. In the beginning I did not have any side effects, so it was not an issue. Now I am more skeptical how useful antibiotics and PPI are. I know I have to take prednisone, but I never had any issue with acid reflex before PMR or since I started treatment. I could understand justification for antibiotics to prevent any infection with weaken immune system at high dose of pred.  As I lower the dose, I think the need for antibiotics should go away.  As far as PPIs I think they are a case of overmedication, for sure and I am going to stop using them.  In fact, since I am at 10mg pred, which I take in split dose and always with yogurt + meal I think I am pretty sure that acid reflex should not bother me.  I am also going to suspend further antibiotics use and let my  body recover, especially intestines, from (most likely) unnecessary overmedication.

Thanks again for help to all of  you!

9

...and for the record, I do consume coffee , chocolate and wine, and had/have no issue with acid. I have not changed my diet a bit since the start of PMR; yes my appetite has gone up, so was my activity ( walking + exercise )  that is currently at about 5000 calories/week. My weight has stayed the same, within 2Kg, initially went down 3-4Kg and then recover about half of that. My diet is mostly carbs ( rice), which we eat almost every meal, lots of vegetables and some meat, usually measured in 10s of grams/day... fish, chicken and pork. Almost every dinner is finished with some sort of desert ( with wine). 

As long as calories intake is balanced with activities, there is no worry about gaining weight.

10

Your last statement is very true Nick

11

it is a hard work... I may look like I am bragging, but here are my stats for January:

walked 155Km, biked 20Km ( just started biking) and swim 6.8Km. It took me about 39hrs and I burned total of 14800 calories...

I use a free app on the smart phone, " endomondo" and it tracks all the above for  me, just in case anyone is wondering how to do it.

12

I'm so dang envious of you! My hip bursitis is acting up again because I did some gardening, so I'm back to sluggsville. My goal is this summer to be walk/jog, biking, swimming!!! 

How can you eat all those things not good for acid reflux? Gee, I envy your stomach too.

 

13

and you will Layne!.. In wormer weather it is much easier to train. Except when it gets too hot, then probably swimming and biking is the best...

14

Just came back from the hospital from my monthly checkup. Everything seems OK, and after I explained to rheumatologist my concern about antibiotics and PPI medication he said he was planning to discontinue them anyway... so I am off them! That was easy.

In addition, since my blood test is normal, I am starting taper from 10-->> 9mg tomorrow. 

15

Just to update on this topic... After I stopped taking antibiotics and PPI withing 2 days, all my problems with stomach were gone! I do feel much better and I am not as tired as with constant stomach troubles and lack of sleep.

I will never know if rheumatologists really planned to stop those meds or it was my complaining that prompted it... Either way, I am only taking prednisone now.