Prilosec and antibiotics

[Anonymous]

I am wondering when is best to take Prilosec as I wonder if it interacts with antibiotics?

[Maz]

@Moogle wrote:

I am wondering when is best to take Prilosec as I wonder if it interacts with antibiotics?

Hi Donna,

Yes, I think some abx are acid-labile and rely on stomach acid for absorption, such as ketoconazole (an anti-fungal), while with some classes of abx there may be potentiated action with reduced stomach acidity, such as with erythromycin. See following link – Interactions:

http://en.wikipedia.org/wiki/Prilosec#Interactions

That said, there are SDers here who need to take a PPI due to severe GERD and it is used in combo with a tetracycline. Drugs.com is a great site to check for drug interactions, but you can also call your pharmacist to ask specific questions, such as timing doses, for the specific preparation you are using (immediate release or time release?):

http://www.drugs.com/interactions-check.php?drug_list=1636-0,1750-1709

It is also worth reading up on the drug, itself:

http://www.drugs.com/prilosec.html

I do this for every medication I take.

It’s worth noting that Prilosec has been tied to osteoporosis, which I think you mentioned may already be a concern for you (re: calcium and parathyroid), and a greater risk of C. Diff, which may not be such a great thing while on abx therapy. Do you work with an ND, at all? There may be some more naturopathic means to help with GERD that could be suggested.

http://en.wikipedia.org/wiki/Prilosec#Adverse_effects

“Proton pump inhibitors may be associated with a greater risk of osteoporosis related fractures[6][7] and Clostridium difficile-associated diarrhea.”

It’s been discussed here in the past that PPIs can be dependence-forming, so it’s important not to stop them suddenly because there is a possibility of rebound reflux.

None of this is to worry you…these things can all be discussed with your LLMD who should be well-versed in what you can safely use while you are healing. Your best bet for a quick answer would be to put a call through to you local pharmacist – they usually don’t mind answering these types of questions – although someone like Richie can probably fill you in on this, too, as he’s used PPIs and mino, I seem to recall.

[richie]

Hi–good memory Maz –I still take a PPI and minocin daily —I take prescription strngth prilosec in the afternoon along with my probiotics —its about 5 hours away from the doses of minocin { mid-day}
richie

[Maz]

Thanks for chiming in, Richie!

Donna, I have been looking at an AP doc’s website in NYC, Dr. L. G., who has a specialty in gut issues, including leaky gut, which is a hot topic of conversation around here right now. He was interviewed on the Today Show about acid reflux and your might find some of his commentary interesting:

http://www.today.com/id/19352872/site/todayshow/ns/today-today_health/t/have-acid-reflux-soothe-it-naturally/#.USa6zqWUQRA

Of course, in the case of SD, one of the issues is not too much acid, but an inadequate stomach sphincter that is allowing acid to reflux, so some of this may be moot, although it’s never a bad idea to research all this stuff. Interesting that stomach acid is actually needed in order to absorb calcium, which is likely why long-term use of PPIs may lead to osteoporosis.

Here is Dr. L. G.’s website, if you’re interested in reading more:

http://mdheal.org/

And a power point presentation of this doctor’s:

http://www.mdheal.org/articles/gastrointestinaldisorders_files/frame.htm

One of the bugs that has been tied to SD is helicobacter pylori, which can cause severe reflux, gastritis, and other gut-related issues. It’s a spirochete, similar to Lyme disease. If I had SD, I’d probably get screened for H. Pylori…but that’s just me. 😉

http://www.ncbi.nlm.nih.gov/pubmed/18797112

http://www.ncbi.nlm.nih.gov/pubmed/21145276

http://www.ncbi.nlm.nih.gov/pubmed/10852299

http://www.ncbi.nlm.nih.gov/pubmed/20711592

http://www.ncbi.nlm.nih.gov/pubmed/20498013

http://www.ncbi.nlm.nih.gov/pubmed/19952485

http://www.ncbi.nlm.nih.gov/pubmed/15994110

http://www.ncbi.nlm.nih.gov/pubmed/7817672

At Sclero.org, you may also find the following page of research articles interesting to flip through:

http://www.sclero.org/medical/symptoms/gi/esophagus.html

Inadequate stomach sphincter? Does one need SD in order to have this? Nope, it can be the result of Helicobacter Pylori, too….so this may be an interesting connection for SDers with GERD.

http://www.ncbi.nlm.nih.gov/pubmed/12676113

[Anonymous]

Thanks all of you. I have a lot of reading to do. All the best. Donna

[Anonymous]

Maz,
It looks like Helicobacter pylori is treated with Flagyl. I recall this is used in the treatment of lyme. Does it make sense to just assume that I should take a flagyl as part of my treatment. I don’t think Helicobacter pylori would be an issue as I don’t have hallmark signs in the stomach, such as bloating after eating, but I am not sure. I will talk to my doctor about it.

Best,
Donna

[Maz]

@Moogle wrote:

It looks like Helicobacter pylori is treated with Flagyl. I recall this is used in the treatment of lyme. Does it make sense to just assume that I should take a flagyl as part of my treatment. I don’t think Helicobacter pylori would be an issue as I don’t have hallmark signs in the stomach, such as bloating after eating, but I am not sure. I will talk to my doctor about it.

Hi Donna,

Discussing the addition of other anti-microbials with your LLMD will be a good idea. Most will take a pretty comprehensive approach with a combination oral therapy and sometimes adding IVs….e.g. a tetra, a macrolide and an azole. This type of combo is so comprehensive that it will hit a number of sins at once, so to speak. For those with gastro issues, like GERD, however, there may need to be additional supports.

Some of these infections are sub-clinical…we don’t know we have them and they persist in low-levels, which in most folks don’t cause any issues and can actually be helpful in digestion and keeping other colonies of bugs in the gut in check. Interestingly, when they treated RA patients with clarithromycin in a long-term study for helicobacter pylori, the results were pretty amazing. In rheumatics, however, for whatever reason, some bugs suddenly seem to cause this “bacterial allergy” that Brown talked about even when pathogen levels are low and difficult to identify on testing (e.g. intracellular bugs and bugs with reduced outer surface proteins). It may be that some of their proteins mimic our own and our immune system gets confused (molecular mimicry), attacking our own tissues, or it may be that some bugs are pleomorphic and shape-shift into dormancy (like Lyme cysts), producing no or few symptoms for long latency periods and then exploding into existence when the opportunity arises. My first Lyme doc once mentioned that it’s not inconceivable that bugs of similar type – e.g. borrelia, oral spirochetes and h. pylori, all spirochetes, recognize extended family members and gang together. So, it’s all a really muddy picture, which is why LLMDs will do a good deal of therapeutic probing, trialing different anti-microbials to see what works.

You’re right…flagyl is a Lyme abx that is both a cyst-buster and targets parasites, like protozoans. It’s used in the treatment of H. pylori, too (though usually in shorter courses) and so the best type of doc to treat it would likely be a LLMD, as Lyme txs would kill two birds with one stone. When flagyl packs too much of a punch, herx-wise, sometimes folks will swop out to tinidazole, which in some is better tolerated.

The following link is an article written by a Lyme Literate doc who wrote an article on Bell’s Palsy of the Gut, which talks about a lot of this stuff that you may find interesting:

“Bell’s Palsy of the Gut” and other GI Manifestations of Lyme and Associated Diseases”

http://www.ilads.org/lyme_research/lyme_publications14.html

But, yes, even if you never test for HP or test negative, then a comprehensive approach that an LLMD can offer should be a great way to go. 😉

[JeffN]

I will defer to Maz on the technical aspects but I too take 20mg of Prilosec daily. I take my mino at 9:30 AM or so and when I was on two doses a day I would take my Prilosec with lunch. I figured that gave me the most time between the Prilosec and my PM mino. I can say that both the mino and the Prilosec did what they were supposed to do.

[Author]

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