I have recently been diagnosed with PMR. I am now taking Prednisolone 15mg daily. From the literature given to me by my doctor and from reading posts on this I realise that I must start taking vitamin D and Calcium.
I have just read the North East region support group's summer news letter. I found it extremely helpful, but I have a query.
When discussing vitamin D and Calcium they write:-
Rule is - Early AM - Prednisolone (with food)
Mid AM - 1st PPI (on empty stomach) an hour before food
Could anyone please tell me what "1st PPI" means. (abbreviations are of no help to a newcomer like me.)
Is the 15 mg a day the right dosage?
I seem to be fine with 15mg of Prednisolone daily at the moment. I did reduce too quickly to 12.5 and had a relapse so am back on 15 mg and will now follow the Bristol plan an reduce more slowly.
I started at 15 did not work, went to 20 still nothing then went to 25 and bingo worked fantastic. After a month went down to 20 and the inflamation level went really high. So now we are doing another test to see where we are. I think I need to increase my mg again to 25
Well PPI stands for Proton Pump Inhibitor.
They are taken for acid in the stomach.
Hope this helps
Thank you Marilyn for the information. Yes I understand. I haven't taken any of that yet. Not had stomach problems up to now on the 15mg of Prednisolone but it is early days yet for me. Fingers crossed I can continue without it. Thanks again. I am finding this site so helpful as a newly diagnosed PMR sufferer.
The stomach problem you mentioned has started affecting me. I need to talk to my rheumatologist about that - cannot eat without getting really uncomfy. I've been on 15mg - now down to 5mg for almost 2 years.
Unfortunately I also have osteoporosis which means that my doc will change my medicine soon as prednisone has worsened it substantially.
PMR is really a hard one to deal with.
Lois
Many patients who are given pred are also given "stomach protection" medication. The latest on the market and now most often used by GPs are Proton-Pump-Inhibitors, PPIs, such as omeprazole. Whether they are the best remains disputed - they certainly stop the production of acid very effectively but it is felt by many that it is TOO effective and even gastroenterologists wonder why GPs have given up using the older sort such as Zantac. Many people manage well by taking
Sometimes patients are told to take 2 PPIs a day, one before their first meal, one before going to bed to avoid reflux problems overnight when lying down.
When you are taking calcium and vit D - which, yes, you should have been given a prescription for that as well - take the pred in the early morning, one calcium tablet with lunch and one with afternoon tea or dinner. You shouldn't take pred and calcium tablets close together, allow at least 3 hours between, and calcium/vit D tablets should always be taken with a small amount of fat to transport the vit D (the milk in tea or coffee is enough as long as it isn't skimmed, which you shouldn't be using anyway: it may have lots of calcium, your body doesn't absorb it because of the lack of fat).
Try eating a yoghurt when taking your pred. It has worked for dozens of patients who have been unable to take a PPI because of the side effects.
There is no real alternative to pred for PMR and now you are at 5mg it would be a case of closing the stable door after the horse has bolted!
If you had osteoporosis anyway you should have been given more bone protection medication from the start. Normally they are all too keen to hand out alendronic acid like sweeties and for someone with osteoporosis it is important - I do object to it being used for people with normal bone density but not if there is a need.
Alendronic acid can cause nasty gastric problems so if you already have stomach trouble make sure you emphasise that to your doctor and ask if he will consider denosumab which is given as injections every 6 months and is approved for patients for whom alendronic acid is contraindicated.
I was prescribed Omeprazole because of the various drugs I am taking. I always use the interactions checker on Drugs dot com and discovered the following
methotrexate ↔ omeprazole
Applies to: methotrexate, omeprazole
Talk to your doctor before using methotrexate together with omeprazole. Using these medications together can increase the blood levels and side effects of methotrexate. Your doctor or pharmacist may be able to offer suggestions on safer alternatives if you require treatment for stomach acid or ulcer while you are being treated with methotrexate. However, if your doctor does prescribe these medications together, you may need a dose adjustment or special tests to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.
I told my GP that I would prefer to take Ranitidine [Zantac] if I have to take something, so, that is what I am now taking
As an addendum to mrsmop's post:
Many doctors are unaware of this interaction, others will try to tell you it only applies to the high doses of methotrexate used in cancer chemotherapy. In the studies that flagged it up they say that it is also possible at lower doses.
In addition to this, I forgot to mention that taking omeprazole (or any other PPI) can also cause osteoporosis as it practically stops the absorption of calcium - it changes the conditions in the gut so much that calcium isn't absorbed, so actually it is worse than pred in that context but it seems they don't stop to think of that.
Ranitidine (Zantac) is less of a concern in either case.
A big thank you Eileen again for the info on Vitamin D and Calcium. I see my GP next Friday so I will ask for a prescription then. I don't think you quite finished the first paragraph of your reply - Many people manage well by taking.......
Am I understanding it right then that if at present I am not experiencing problems with my stomach I should keep away from the PPIs. As the saying goes if a thing isn't broken why try and fix it.
I have used skimmed milk now for many years but I will now follow your advise regarding that.
I will be off to the stationery shop tomorrow to buy a notebook. I have collected so much excellent information from yourself and the other good people on this site but I need to get it all down on paper now. I try to keep up with technology but I still like pen and paper.
I will have to work out a medication regime now as I take Metformin, Asprin and Bendroflumethiazide as well. By the way I took my 15mg Prednisolone very early this morning with just one Weetabix and milk and then went back to bed for a couple of hours and then took my Diabetes medication with a second Weetabix a couple of hours later at my normal breakfast time and I have been a lot better today. I just need to carefully slot in the Vitamin D and Calcium now. Can I just ask Eileen I have for many years taken a Garlic tablet, I buy it from the health food shop. Will this have any effect on the Prednisone. Many thanks again.
Sorry for that slip up.
Proton Pump Inhibitors. (PPI's) Tablets for acid reflux mainly. Omnaprozale, Lanszoprozale (check spelling). However, make sure you need this protection and check out the side effects listed on the paper that comes with the tablets.
Personally, Zantac are best, but I used the acid reflux remedy when I was given it by other people who used it and found it worked and it did for me, then no worry about more side effects.
No personal experience but I know that MrsO who posts on here uses garlic. This a quote from a post of hers a few years ago:
"I have found that a strict diet containing anti-inflammatory foods has helped me with relief of pain. Oily fish 3-4 times a week and daily beetroot, pineapple, garlic, olive oil, amongst others."
It is quite a balancing act when you have loads of tablets to take isn't it! A dosette box helps there - you can see what you've forgotten!
Yes, I think one of those boxes will be very helpful now. I will continue with the garlic. Thank you.
Thank you Mrs K. I will certainly keep away from the PPIs as long as I can and if needed in the future I will ask GP for Zantac.
As we are on the subject of Omeprazole Eileen I do hope you don't mind my asking you this question. My son has been taking Omeprazole for many years now for a reflux problem. He also has a condition called Barratts oesophagus. He has never been offered any medication to protect him from osteoporosis. I will certainly tell him all you have mentioned about Omeprazole. My question is, if he was to change to Zantac would he still need osteoporosis protection.
Hi Eileen.As you are such a great fountain of information ,can I give you a rundown of my daily medication routine and ask your advice.
I have PMR and type 2 diabetes.High blood pressure, osteoarthritis in my shoulder and acid reflux.
First thing in the morning I check my glucose levels then take 12 mgs Pred.
With my breakfast I take 500mgs Metformin
With my lunch I take a calcium channel blocker,a beta blocker and an ace inhibitor for my hypertension.
With my evening meal I take another 500mgs Metformin.
On retiring I take a glass of semi-skimmed milk with vitamin D and calcium.
I'm also supposed to talke a statin but I'm not keen on taking it as it has in the past given me muscular pain.
I am also prescribed Lansaprozole twice a day but I only take it if I really need to.
I have found it very difficult to know what I can take with what so have tried to work out a routine as best I can.
My hypertension and diabetes are both under control and my reflux is unpredictable.Some days It can be very bad or not affect me at all.
I have always been affected by stomach problems from time to time and cannot tolerate asprin however low the dosage.
I have taken Zantac in the past with no ill effects.Many thanks in advance for your help.
Hi
I hope you don't mind me putting in my two penuth! Have you had your calcium blood test result? When I was first diagnosed in January, my gp automatically put me on a calcium and vitamin d supplement. Two weeks later I was feeling very unwell. A different doctor checked my blood test results and found that my calcium levels were too high. Apparently this is very worrying! She took me off of them immediately, so it is worth double checking that you actually need everything you are prescribed to save yourself from any extra discomfort. Welcome to the forum (but sorry, of course that you have this horrid condition)! Take care and I hope you have a rapid journey through pmr.