Pentasa & Omeprazole

[frank4360]

I have had Ulcerative Colitis/Chrohn's Disease (for many years doctors could not agree which it was) for more than 35 years - I am now 64. It is apparently a relatively mild case, and certainly I have heard of much more severe cases, though it never actually felt particularly mild.

For the first few years I was on some sort of Sulfasalazine; which appeared to do nothing but turn my urine yellow, so I gave it up.

When I was about 50 the disease seemed to become more severe, and it certainly caused problems with my work (passing blood, visiting the bathroom ten or fifteen times a day, etc).

I was then prescribed Colifoam enema - which again seemed to have no effect.

After pressure from my wife I tried the doctor again in about 1998 - I was put on steroids
to control the immediate flare-up, and Pentasa as a long-term measure. This has worked well until the last few weeks (August 2011).

I have also been taking Omeprazole 20mg once per day to control Reflux Oesophogitis, which has also worked well for more than 10 years.

Now comes the interesting point - I decided a few weeks ago that, as I do not like taking
medicines unnecessarily, I would cut down the Omeprazole and only take a capsule when I felt the need. This resulted in me taking a 20mg capsule only every second or third day, rather than daily.

I have just had a very severe flare-up of Crohn's - passing blood and mucus, lack of control of bowel movement), which seems to coincide with me stopping daily Omeprazole. This has lasted for about 3 weeks, despite increasing the Pentasa to eight 500mg tablets per day.

So several days ago I started again taking a 20mg capsule of Omeprazole each day. After a day or so my Crohn's flare-up is now under control - no blood or mucus.

This is only anecdotal evidence, and of course there may be no connection with the stop-start of Omeprazole, but has anyone else had a similar experience?

 

[xJillx]

Hi Frank and welcome! I am like you; I am told I have a mild case, though it doesn't always feel that way. But it certainly sounds like you've had a nice long run until recently. I got to say, I have never heard of Omeprazole having such an effect on Crohn's. But, hey, if it works, stick with it and don't ask questions!

Have you had any recent testing with this recent flare such as a colonoscopy? I would be curious to see what results would be when you weren't taking the Omeprazole daily vs. when you are.

 

[frank4360]

Have you had any recent testing with this recent flare such as a colonoscopy? I would be curious to see what results would be when you weren't taking the Omeprazole daily vs. when you are.

I have a regular colonoscopy and endoscopy here in France - the health service here is superb; much better than the UK - but never actually during a flare-up, as this is the first in the ten years I have lived in France.

I will be back to see my specialist when I return from a long trip to New Zealand, but by then I hope everything will be back to what we laughingly call "normal"!

Good luck with your problem - and keep smiling.

 

[tobyjug]

Very interesting as I was never quite sure why I was prescribed omeprazole. Acid reflux was not a problem, but regular nausia (sp?) was, so I presumed it was for this.

I spoke with the doc last week and we agreed that I go down to one 20mg tab a day. So far so good, no sign of a flare or any other symptom

The one medicine they won't muck around with is the pentasa, not allowed to cut that back.

Like you, I'm a 'mild to moderate' case so I'll have to wait and see how things progress, but doing everything I can to stay mild. Don't like some of the stories I read on here.

 

[frank4360]

Very interesting as I was never quite sure why I was prescribed omeprazole. Acid reflux was not a problem, but regular nausia (sp?) was, so I presumed it was for this.

Very strange - my Omeprazole was never prescribed for anything to do with Crohn's, but for acid reflux! It was Pentasa (originally Asacol, I think) for the Crohn's.

Curious.

 

[vickie_x]

Hi
I am on both Pentasa and Omeprazole and would be interested to find out why, if they are linked, the Omeprazole seems to help keep things under control. I found when I decreased from 40mg to 20mg I started getting a few symptoms back but I was also on the dreaded pred at the time so I think any inflammation it may have triggered was sorted without a need to increase the Omeprazole again. But at least I now know I wasn't going crazy! x

 

[frank4360]

Hi
I am on both Pentasa and Omeprazole and would be interested to find out why, if they are linked, the Omeprazole seems to help keep things under control.

I wondered if the Omeprazole reduced acid in the stomach enough to let the Pentasa through to be dissolved in the lower gut where it needs to do its work.

Of course I am in no way qualified to make such a guess, which is why I have asked the question in forums to see if anyone else has noticed a link between Omeprazole and Pentasa.


Frank

 

[David]

That's really interesting. Epocrates actually tells doctors that PPIs and Pentasa shouldn't be prescribed together.

Just thinking with my fingers...

1. Maybe your PPI was allowing the Pentasa to hit just the right spot and once you stopped, because your gastric acid increased, the Pentasa was being released higher in your system.

2. Maybe it is dietary related and when your ability to digest certain foods changed because of the higher gastic acid levels, whatever was being digested was hated by your system and sent you into a flare.

3. Maybe your duodenum is inflamed and isn't producing the necessary bicarbonate to neutralize the acid that enters your intestines so the gastric acid is doing damage there.

4. Maybe Omeprazole has some beneficial affect for CD that isn't known.

5. Just a coincidence

6. A million other possibilities

 

[Crohn's 35]

This is only anecdotal evidence, and of course there may be no connection with the stop-start of Omeprazole, but has anyone else had a similar experience?

I thought the same thing but Omeprazole is a bone eater, and I avoid taking it. I have a Hiatus hernia, thanks to Prednisone on and off 20 years, but mostly off. Just dont want to add any more problems. I do know flares can start up in the 50's age group, hope I can avoid it. :wecome:

 

[CD95]

I had had Crohn's for more than ten years now, with long periods of remission. Recently it has been quite hard to control and I have also been recently prescribed omeprozole. I have a feeling the Pentasa may actually cause the acid reflux. Would anyone agree with this? Although it is very hard to tell since the listed side affects of Pentasa are quite similar to the symptoms of Crohn's!
apparantly the omeprozole takes about 2 weeks to take proper effect so I shall see how it goes.

 

[nitty]

Hi!

This is my first ever post so please forgive any mistakes.

Briefly, after a summer of bleeding I was given a diagnosis of UC, which was then changed to Crohn's after a colonoscopy. My symptoms suggest it is mainly restricted to the colon. Since the scope on 9th November this year I have been on 4g oral Pentasa and 500mg Asacol suppositories per day.

I have also taken Omeprazole 10mg a day for a few years due to a small hiatus hernia which causes acid reflux. I usually take this daily, but can miss a few days before feeling I need it again.

The Pentasa and Asacol worked like magic to begin with and after just under 3 weeks I was told I could stop the suppositories if I wanted. I started bleeding again very quickly, so am back on the Asacol for the foreseeable future. However, even since going back on them, my symptoms have continued to get worse.

In the meantime, whilst reading the leaflet about Pentasa I saw that you should not take indigestion remedies at the same time, as they can affect the coating on the granules. Although Omeprazole has a different method of action to more immediate acting antacids I decided to stop taking it while my friend who is a pharmacist is looking into whether it is a problem or not.

It was just crossing my mind whether stopping the Omeprazole was what had contributed to the worsening symptoms when I stumbled across this thread. I restarted the Omeprazole last night, and so I will be keen to see if this helps and will post the results in a few days, hopefully with a positive outcome!!

I would love to hear whether anyone else has noticed any link between the two drugs.

Nitty X

 

[Sunshine]

Interesting thread! I am on both omeprazole (hiatial hernia) and pentasa...both prescribed by my GI at the same time and he never mentioned interactions between the two. I did find worsening of my symptoms when I briefly went down to one 20mg per day instead of 2 so I went back to 2 per day (am & pm dose) and saw improvement. Maybe there is some kind of connection for pentasa delivery. My crohn's is 'mild' or so the doctor calls it, in the terminal ilium so maybe the omeprazole helps the pentasa get to the right place before the coating is dissolved.

 

[nikimazur]

I've been on omeprazole for the past three years, for what was originally gastritis and now have crohns, and am on 4g on Pentasa a day. I have never taken Pentasa, without a daily dose of omeprazole and wonder how it would be effected. My doctor has never said anything about the two interacting though. very interesting though

 

[Grumbletum]

I'd been on Prednisolone for about 5 months when I went into hospital for a pre- op assessment. They were surprised I wasn't on Omeprozole and immediately put me on 20mg. Told that this was to protect my stomach from the harshness of the steroid, even though I didn't have those kind of issues with it. They told me to stop taking it when I'd weaned off the Pred.

 

[mike316atl]

On Christmas I forgot to take my omeprazole and pentasa all day (Don't know where my mind was at). I felt crappy all day and the next morning I was coughing up little amounts of blood. I will never forget again!

 

[nitty]

Reporting back after resuming regular omeprazole.

Well, my symptoms stopped getting worse, and have slowly got better to the point where I have not had signs of passing any fresh blood for a few days. I can't claim there is any definite link as I am new to Crohn's and could just be having a coincidental fluctuation in symptoms, but I'm certainly not going to stop taking it again to find out!

While I was looking into this I did find a summary of one piece of research that was carried out on the subject (sorry, lost link, but it's by Dr Riley at Northern General Hospital, Sheffield). It says that the mesalazine is activated in pHs above 6-7, and so because omprazole increases pH by reducing stomach acid production it could speed up the release of mesalazine in the gut, thus affecting which part of the gut gets most of the drug. What the study does look into is how much mesalazine is excreted by subjects who take/do not take omeprazole, and found no difference between the two. I didn't fully understand the whole study (a bit technical for me), but from what I saw it didn't say whether the subjects used actually had any form of IBD, and so measurements were purely in amounts of excreted drug and not of any personal experience of symptoms, which could really be pretty significant, especially if omeprazole just affects where mesalazine is released as opposed to how much is excreted.

This leaves me more sceptical about whether it really makes much difference for me because, as far as I know, it's just my colon that is affected, and so an earlier release of the drug would presumably be detrimental for me. I can see that it could be helpful for those affected higher up in their system.

I'm afraid that's my very amateur and probably inaccurate research reading. If anyone out there has a better scientific knowledge than me (not difficult!) and can better interpret the research I would be very grateful.

Nitty

 

[gigirl]

has anyone had headaches when starting Pentasa? I started it about 5 days ago and last night had abdominal bloating and headache. Today, just headache and lethargy. I know headaches are listed on the side effects. Any advice?

 

[JDTM]

I was wondering about this as well, and I just found this thread on the forum. Based on this, the Pentasa sounds like it's designed to release in the small intestine (in an alkaline environment); they wouldn't dissolve in an acidic environment (the stomach). This is interesting -- if you stopped taking Omeprazole, your stomach would be more acidic, and you would think that the extra acid being produced would eat up the Pentasa... but apparently it's not.

SCIENCE!!

Anyways, thought I'd chime in because I'm currently on Pentasa and omeprazole. (Actually, I'm currently on Dexilant at the moment as my PPI, which is designed to release differently over time... but I'm switching back to omeprazole as soon as the Dexilant is done. It's super expensive!)

 

[KellyMom]

I just took my first Pentasa dose today, and I am also talking Prilosec. I will chime in if I see any similarities as above, this is interesting and I was also wondering about the interaction of the two.

 

[csblanton]

Im having all the symptoms of crohns and have been prescribed prilosec. How did your gi doctor come to his diagnosis of crohns for you?

 

[JDTM]

Hey csblanton -- my diagnosis came over time. At first I was having problems with stomach pain, and I got an upper endoscopy which revealed duodenal ulcers. Omeprazole was prescribed for me at first to control the stomach acid and gastritis -- the actual Crohn's diagnosis came later when I had a colonoscopy when I started having problems below the belt, so to speak.

 

[frank4360]

Hello to all

Having started this thread back in September 2011, I thought that an update was in order.

I have never experienced a flare-up of Crohn's symptoms since the time in 2011 that I reduced taking Omeprazole. Since that flare-up I have never missed a 20mg daily dose. Are the two facts connected? - I don`t know but I will never miss a dose again!!!

Interestingly, my Pentasa and Omeprazole prescriptions were originally for completely different (the first for Crohns and the second for reflux oesophigitis/hiatus hernia) problems and given by different doctors. No mention has ever been made of a possible interaction between the two by my original, English, or current, French doctors.

Maybe there is a link, and maybe there isn`t - but even if there is no way of telling, I will stick to what seems to work, even if no-one knows why!!!


Good luck to everyone, and keep smiling.

 

[PVail]

Hi so ive been on Asacol for a few years now in the TI at the end of the small intestine as it enters the large bowel. This works ok as long as i stay consistant with the dose each day . About six months ago i got real sore stomach and bad acid reflux. Turned out to be a H,Pylor i(helicobactor) infection in the stomach ( which can cause stomach ulcers) I took the cocktail of drugs prescribed for the infection and feel that it subsided after a few weeks albiet leaving me with upper stomach pain all the time as well as lower pain.
I went back and asked the doctor about this and I was told to take Omeprazole basically for ever or else it would get worse .
I too stopped or backed off fully medicating each day and within a week had a bad flare up . It looks like you can take both e the Omeprazole and Asacol, well at least I can . I definetly feel much better on both but just last week i fractured two ribs on my right side just getting up out of a chair with no apparent reason. A&E couldnt explain it .
Now this really bothers me as I just read about PPIs and found they can cause rib fractures with prolonged use.
Why did my doctor not tell me this ? Im aware that having IBD impairs my ability to absorb nutrients and this can cause osteoperosis eventually but this is unexpected to say the least.

 

[Philsayce]

Hi all. I came across this post searching for Omeprazole and lower GI bleeds. I’m currently awaiting investigation with rectal bleeding (not piles or polyps) not particularly mucus and no pain. Some nausea but not marked. Anyway, my go (family doctor) has prescribed Omeprazole while awaiting specialist appointment and while thinking she was absolutely bonkers (being a nurse and only ever knowing Omeprazole being used for upper GI issues) I am pretty amazed that the rectal bleeding does seem to be resonsifn to whether I take the drug. Having experimented with in the drug and not on the drug it’s seems to have some (very anecdotal) effect. As I say I’m currently being investigated for a recent development so please take this as just one person’s experience and possibly not related to UC OR CRohns. Just an observation. I wonder whether anyone else has been taking just Omeprazole and noticed effects.

 

[Anna's Bandit]

I appreciate this thread.

I have been taking pantoprazole for years for my acid reflux with great results.
I now take my pantoprazole AND occassional Extra Strength Gaviscon.

I see my GI on Friday and I am going to ask him about the pantoprazole and how it works with Humira.

I am supposed to start Humira soon and 6mp pill.

I get overwhelmed by so much information here