Vitamin D and Calcium

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. 

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.

Glad to help.  Anytime !!

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.

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.  

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.

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.

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. 

He certainly should ask to have a dexascan to check his bone density. And if the GP (or consultant) says it isn't necessary for a man - they are wrong. More and more men are being found to have osteoporosis and anyone on long term omeprazole is at risk. It is something that has been under the radar I think but is now being realised. 

In some areas there is a long waiting list for dexascans and some doctors will wriggle like mad to get out of doing one. I have no idea if there are private schemes available - but it is certainly worth looking around if the GP is difficult. If he has Barretts oesophagus he MUST NOT TAKE ALENDRONIC ACID OR ANY OTHER BISPHOSPHONATE. The option would probably be denosumab. 

After so many years on omeprazole he needs to know his bone density status to know what is required - he may be fine but you can't tell by looking at him or even an ordinary x-ray. One problem with long term omeprazole is that you can't just stop it, that can cause something called rebound acid production where the stomach produces even more than before, and I don't know how simply switching to Zantac would work for him. He needs to discuss it with his gastroenterologist. 

Thank you very much Eileen for your prompt reply. I will certainly pass on all you say to my son. I think his next step has to be to discuss all of that as you say with his gastroenterologis, fortunately he has a very good relationship with her. He certainly must have a Dexa Scan. He is 46 now and I know he has been taking Omeprazole since before his 40th birthday. I am beginning to realise that we should all discuss our prescribed drugs with our pharmacists before we start to take them. Many, many thanks again Eileen.