Question: I am on cortisol replacement medication and just had a large ulceration in my stomach. Can cortisol replacement cause this? For those on replacement, what is the best pain medication for arthritis that will avoid stomach problems?
 
Answer: One of the potential side effects of cortisol replacement (using prednisone or hydrocortisone, most commonly) is stomach upset, which can include gastritis and peptic ulcers. We usually counsel patients to contact us if they feel an upset stomach, and we can consider dose changes (sometimes lowering the dose), taking the medication with food, and/or prescribing a medication which blocks acid production, such as omeprazole or randitidine. Often times such medications can improve or prevent gastric upset. If someone needs to take a pain medication while receiving steroid replacement, acetaminophen would be optimal as it does not cause gastric upset. If nonsteroidal anti-inflammatory agents are necessary, then concomitant use of medicines that block acid production, along with taking the steroid pills with food, may be necessary.