Stomach pains caused by prednisone? | Arthritis Information

 

I started having mild stomach pains last week. I say "mild" because they are definitely pains but not enough to make me double over or anything near that. They seem to be getting more frequent. I always take my prednisone with a lot of food, so would it be surprising if it caused some disturbance anyway? Also, I started drinking coffee again in February when I had the bad flare and now it's hard cutting it out completely again (I was off coffee for over a year when I relapsed). Could that be the culprit?

I had GERD (acid reflux and hiatal hernia) before I had PMR, and since starting prednisone--which aggravated the GERD--I've been taking Zantac morning and night. 75 mg in the a.m. and 150 mg at night, for 17 months now.  The coffee is not good for the GERD of course.

I don't have my appendix so it's not appendicitis!

Anyone have any ideas? All I needed was another pain! lol I do plan to call the doctor tomorrow.  I dread having another endoscopy or God forbid, colonoscopy...I just had both of those last July!

Thanks!
freesia
Hi freesia,

Hi Nanatjjj,
Thanks so much for your response. I wonder if the coffee has just been "too much". 

Right after I started taking prednisone, I decided that I'd better not drink coffee, mainly because of the bone loss aspect, but maybe I was protecting my stomach without realizing it.  The flare I had in February put me in so much pain I was just looking for a way to feel better--plus, I mistakenly thought if I'm taking less prednisone, it would be okay to drink coffee. WRONG.

I think you may be right about upsetting the lining of my stomach and now it needs to heal. As far as Maalox, are you talking about liquid Maalox? I hate the chalky texture or something about those liquid antacids!  I know that some prescription and otc antacids (like Prevacid, etc) say you shouldn't take other antacids along with them. I'm not sure about Zantac but I'm sure it says on the box.

The pains I am having occur fairly soon after eating, so it's kind of different. I know what you mean about GERD pain sometimes not occurring for an hour or so. I've sometimes eaten dangerously spicy food, thought I was okay, only to be suffering mightily in a few hours.

Thanks so much! It's so reassuring to be able to come to this site and hear from others who have PMR.  I appreciate so much what you had to say!

About new pains: this (stomach pain) is the last thing I would have expected! Isn't that always the way it is??? lol.

Take care and thanks again,
freesia
Hi freesia, Hi Freesia I'm afraid I don't know a lot about stomach problems as I have a cast-iron stomach! Except - the majority of the dose I take is enteric-coated pred which isn't absorbed in the stomach so doesn't have the usual irritant effect on the gastric lining but passes further down the gut where it has a less irritating effect. When I do have to use the white tablets to make up the dose I make sure that I take it with my breakfast and I can cope with up to 2mg but when I was using 4x1mg tabs I did have a bit of discomfort/stabbing pain butit went away once I reduced the amount of white tabs. Hi Mrs E, I didnt recall that they even had Prednisone as enteric coated. Good information in case some of us start having stomach problems too. With my history, I am surprised that I have not had problems since on the Prednisone. I'll just count my blessings for that. Lot's of other things to deal with! Hi Celtic, MrsE and Nanatjjj,

Thanks to all of you for your replies!

Nanatjjj, I take all my prednisone in the morning. It's only around 7 or 6.5 mg right now. My stomach, except for increased GERD, has been fine up until last week. I actually had been "off" coffee the last week or so... even while I wasn't drinking it I had the pains. Over the weekend I felt like I needed it for a boost so I drank some, and I think maybe the pain was more troublesome because of it.

MrsE, The pain is under my bust, and sometimes feels like it's in my esophagus, too. I shouldn't have mentioned my appendix at all--I realize that it's on the lower right of the abdomen (at least that's where my scar is).  But when I had appendicitis the pain didn't seem to be specifically in that area (until the doctor hit it to test me. He promised he would only do that once.) So I just wanted to remove that possibility from the table.

Maybe I do need a PPI instead of the Zantac, which works differently. I sure wish I had the enteric-coated prednisone. Why do they even make any other kind, since it seems to be so universally irritating to the stomach?

The weird thing is, I seem to be more aware of my stomach problem now than I am of the PMR (although I am still stiff and sore). Maybe that's a good thing!

Celtic, I had also heard that GERD can be caused by too much acid in the stomach whereas doctors always assume it's from too much acid. A while back, I tried the lemon juice in water but it seemed to make things worse. I'll try some yogurt. I've been trying not to eat dairy with my prednisone because I understood that it can reduce the prednisone's effect. Maybe it would help, though.

I can't even believe I have GERD --I used to have a cast-iron stomach! I guess things change...

My primary care doctor's office isn't open yet but I will call them as soon as they are, and try to talk to the doctor and/or get an appointment.  I hope she doesn't tell me I should see the rheumy instead...it's further away.

Take care everyone and thanks again, will keep you informed on this.

freesia
freesia2011-05-23 08:27:07

I'm not sure you have enteric coated pred in the USA - do you get prednisone or prednisolone? Here in mainland Europe (as opposed to the UK) it's always the plain white tablets that are offered as far as I know. The difference is (needless to say) PRICE - quite a difference!

 

Eileen

Update: I did get to see my primary care doctor today.  She thinks that possibly the prednisone has thinned or weakened my stomach lining to some extent, and then food or drink (namely coffee, soda) and rough food abraded it a bit. That's the working theory!

Anyway, she prescribed a new antacid type medication called Dexilant. By the way, it's enteric coated. I need to research it--she gave me sample packages that aren't too informative.  Also, I have to baby my stomach and eat soft, bland foods.

I'm kind of scared thinking that the prednisone is doing this, since I probably will be on it for at least another year....
freesia2011-05-23 16:23:56 Hi Freesia,

I've been taking Dexilant for about 4 months now. It's working great for me!  It's a time release formula so one pill in the morning should work for you.  Here's a link to their website:

http://www.dexilant.com/

On the left-hand side there is an add to click on to sign up for a card that pays up to toward your part of the prescription.  It's good for one year from your sign up date.  I've used it several times and it's paid my co-pay portion each time. Not sure where you're located as your profile says, "not given", but hope you can take advantage of this. Hope Dexilant works for you.
RickF2011-05-23 18:05:35

Hi freesia

Freesia Hi Everyone,
RickF, I am glad that Dexilant is working for  you, that is great. I had a bad reaction to it . I took it at 5 p.m. and had throwing up(more like dry heaves) and diarrea during the night.  I had to take a thyroid pill this morning on an empty stomach and so far, doing okay but soon will have to eat some food soon so I can take my prednisone. I will have to contact the doctor in a few minutes to see if she wants me to continue taking Dexilant. I know it was weird to take it at 5 p.m. but since I usually take Zantac in the evening to protect my stomach overnight, I figured I'd better start it right away...but never expected such a violent reaction.  Thanks anyhow for posting the link! I took Aciphex once and they also offer rebates --pretty substantial ones--on that medication.

Nana, you are so right, my doctor is thinking along the same lines as all of you at this site. That is really good. It sure says alot about the quality of thought and experience here (which I never doubted).  I bet that the damage was building up during the few months that I went back to drinking coffee and soda. Thankfully it seems as if I caught it in time.

MrsE, thank you for the further advice on yogurt. Okay--I am going to try that! I guess I could try the lemon and water idea once more, but the first time I tried it, it  had the opposite effect it was supposed to.

Thanks again everyone--will let you know what my doctor says about the antacid or PPI situation.

freesia


freesia2011-05-24 08:37:59Dexilant update: I just talked to my doctor and she thinks that it wasn't the Dexilant that made me so sick, she thinks it might have been what I ate for dinner!  She didn't think it could cause such a violent reaction.  So I guess I'll keep on with the Dexilant.  So that is good news.
Oh, Freesia, poor you - hope to have better news from you tomorrow! Thanks, Celtic!  freesia2011-05-24 10:34:31Just to be clear, Dexilant is not an antacid but a PPI (Proton Pump Inhibitor) which causes your body to produce less acid.

Quote: "Proton pump inhibitors reduce the production of acid by blocking the enzyme in the wall of the stomach that produces acid. The reduction of acid prevents ulcers and allows any ulcers that exist in the esophagus, stomach, and duodenum to heal. PPI drugs are used for the prevention and treatment of acid-related conditions such as ulcers, GERD and Zollinger-Ellison syndrome."

When I have bouts with GERD (or reflux), I also use Gas-X when needed.
Hi RickF, yes, that is so true, Dexilant is a PPI. It works differently than an antacid.

I am doing well this morning, so I am sure I must have had some brief food poisoning episode, and it was just a coincidence that I happened to start the Dexilant the night before.  I hope it will work out--I like the idea that it's time-released, and enteric coated.

freesia

freesia2011-05-25 11:52:40How is the stomach problem? Hi Nanatjjj,
Thank you for asking!

I saw the GI doc --what a frustrating experience--he isn't too good at talking with patients.  He said that prednisone can upset your stomach but it doesn't thin the lining of your stomach. However, I know it does! My primary care doctor told me it does and it can cause ulcers, which was what I was worried about. He didn't even address that! But anyway, he put me on 40 mg Nexium because my insurance won't cover Dexilant, and it's very expensive. Heck--Nexium is expensive enough-- if I didn't have insurance it would be outrageous. I also have to take 150 mgs of Zantac at night. 

Thankfully my stomach has calmed down a lot --no pains to speak of.  However, I wonder if the PPI (Nexium) is overkill. I feel like, if I don't drink the coffee and sodas, and stay on a GERD diet pretty much, avoiding foods that I know cause acid reflux, the Zantac should take care of things.  The other day I must have eaten something that caused reflux because I had the familiar acid in my throat! It doesn't seem like this should be happening. Oh well. The GI doc didn't even tell me how long I had to use the PPI! I had to drag that out of him --and he didn't mention following up or anything like that. ARggggghhhhh. Thank heavens my primary care doc is on top of things.

I wanted to edit this to add: my hemoglobin is low for some reason. It's 10 and it used to be 12 or 13. No wonder I feel tired, although it seems to have gotten worse since I started taking the PPI's (first Dexilant, now Nexium).  It's possible that the antacid I've been taking for 1-1/2 yrs --Zantac-- is reducing iron absorption. My doctor prescribed taking iron supplements and then I'll have blood work and some other tests in a month or so.

freesia
freesia2011-06-14 15:00:32Hi freesia, Hi Nanatjjj,
Thanks for your thoughtful response!!

I'm worried about the low hemoglobin, too. Now that I think about it....shouldn't the GI doc have also been concerned? My primary care doctor always has my blood tests forwarded to him (when they could involve the GI tract) but the reports never seem to be in my chart.  So if he didn't get the report...shouldn't he have ordered that test ? It's also weird that he didn't say, "you're having new symptoms so let's do an endoscopy"--he said "you just had an endoscopy last July" in other words, they just won't do it that soon, no matter what? Oh well, anyway.  I am going to try to switch to a woman doctor at the same practice.

At least I have to say I'm not having the stomach pain I was having before, so that is good. I'm a little less tired after 3 days of iron supplement.

I'm also concerned as to whether low iron going on for a long time could lead to something really devastating, like leukemia? I'm probably completely off-base here.  I have to do some research at Google University. freesia2011-06-15 13:50:39First of all - don't worry about low Hb causing leukaemia (it's the other way round), and they'll have looked at your bloods and seen if there were any abnormal white cells. Long term gastric meds can cause some malabsorption of iron. 12 is quite usual for many women and 10 isn't a lot lower (enough to make you feel tired though) so iron tablets should sort you out - if they'd been really worried you'd have had a transfusion or iron injections. My MIL went down to about 6 at one time - heart was playing up not surprisingly plus dizzy spells and breathless but since her eyes were still pink it didn't occur to her idiot GP. If the patient's eyes are not pink  you're in a pretty bad way! HI MrsE, are you sure you aren't a doctor?  freesia2011-06-18 10:16:56Hi freesia, I think MrsE told us she was a scientist, not a physician. She sure has lots of knowledge!  Why dont they just do the occult blood test now? It's a simple thing that you can do at home testing your stool. And the endoscopy would show whatever ulcer or polyps were in the stomach and I think also the first part of the small intestines. Hi Nanatjjj,
I knew she was a scientist--I am always just stunned by her accuracy in knowing about medical conditions. It seems like she knows enough to be a doctor!

I didn't know there was a stool test to do at home. I'll look for that.

It's sickening (ha--no pun intended) how much power the drug companies have. I keep wondering when the new health care system will kick in so that everyone can get health care without having to rely on ER's?

freesia  Hi freesia,