Oral Corticosteroids

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Oral Corticosteroids

Corticosteroids are a family of compounds that include the adrenal steroid hormone cortisol (hydrocortisone) and related synthetic drugs, such as prednisone. Both the natural and synthetic compounds are powerful anti-inflammatory agents. Oral corticosteroids are used to treat autoimmune and inflammatory diseases, including asthma, bursitis, Crohn’s disease, tendinitis, ulcerative colitis, rheumatoid arthritis, and lupus, and skin conditions, such as eczema and psoriasis. They are also used to reduce inflammation associated with severe allergic reactions and to prevent organ rejection following transplant surgery.

The information in this article pertains to oral corticosteroids in general. The interactions reported here may not apply to all the Also Indexed As terms. Talk to your doctor or pharmacist if you are taking any of these drugs.

At the time of writing, this product had no well-known interactions with food, supplements, or other compounds. Follow manufacturer instructions for safe use.
Also indexed as:
  • Aristocort,
  • Cortef,
  • cortisol,
  • decadron oral,
  • Delta-Cortef,
  • Deltasone,
  • dexamethasone,
  • hydrocortisone,
  • Medrol oral,
  • methylprednisolone,
  • methylprednisone,
  • oral corticosteroids,
  • oral decadron,
  • oral Medrol,
  • Orasone,
  • Pediapred,
  • prednisolone,
  • prednisone,
  • Prelone,
  • triamcinolone
Alternative Treatments

About this treatment

Interactions with Vitamins

Magnesium

Corticosteroids may increase the body’s loss of magnesium. Some doctors recommend that people taking corticosteroids for more than two weeks supplement with 300–400 mg of magnesium per day. Magnesium has also been reported to interfere with the absorption of dexamethasone.

N-acetyl cysteine (NAC)

One preliminary study found that in people with fibrosing alveolitis (a rare lung disease), supplementation with 600 mg N-acetyl cysteine three times per day increased the effectiveness of prednisone therapy.

Potassium

Oral corticosteroids increase the urinary loss of potassium. This may not cause a significant problem for most people. Individuals who wish to increase potassium intake should eat more fruits, vegetables, and juices rather than taking over-the-counter potassium supplements, which do not contain significant amounts of potassium.

Vitamin A

In some people, treatment with corticosteroids can impair wound healing. In one study, topical or internal vitamin A improved wound healing in eight of ten patients on corticosteroid therapy. In theory, vitamin A might also reverse some of the beneficial effects of corticosteroids, but this idea has not been investigated and no reports exist of such an interaction in people taking both vitamin A and corticosteroids. People using oral corticosteroids should consult with a doctor to determine whether improved wound healing might outweigh the theoretical risk associated with concomitant vitamin A use.

Although blood levels of vitamin A appear to increase during dexamethasone therapy—most likely due to mobilization of the vitamin from its stores in the liver—evidence from animal studies has also indicated that corticosteroids can deplete vitamin A from tissues.

Vitamin B6

Corticosteroids may increase the loss of vitamin B6. One double-blind study of people with asthma failed to show any added benefit from taking 300 mg per day of vitamin B6 along with inhaled steroids. Therefore, while small amounts of vitamin B6 may be needed to prevent deficiency, large amounts may not provide added benefit. Some doctors recommend that people taking corticosteroids for longer than two weeks supplement with at least 2 mg of vitamin B6 per day.

Calcium and vitamin D

Oral corticosteroids reduce absorption of calcium and interfere with the activation and metabolism of the vitamin, increasing the risk of bone loss. Doctors can measure levels of activated vitamin D (called 1,25 dihydroxycholecalciferol) to determine whether a deficiency exists; if so, activated vitamin D is only available by prescription. A study of rheumatoid arthritis patients treated with low amounts of prednisone found that those who received 1,000 mg of calcium per day plus 500 IU of vitamin D per day for two years experienced no bone loss during that time period. An analysis of properly conducted trials concluded that supplementation with vitamin D and calcium was more effective than placebo or calcium alone in protecting against corticosteroid-induced osteoporosis. Most doctors recommend 1,000 mg of calcium and 400–800 IU vitamin D per day for the prevention of osteoporosis.

Chromium

Preliminary data suggest that corticosteroid treatment increases chromium loss and that supplementation with chromium (600 mcg per day in the form of chromium picolinate) can prevent corticosteroid-induced diabetes. Double-blind trials are needed to confirm these observations.

Melatonin

A controlled trial found that a single dose of the synthetic corticosteroid dexamethasone suppressed production of melatonin in nine of 11 healthy volunteers. Further research is needed to determine if long-term use of corticosteroids interferes in a meaningful way with melatonin production, and whether supplemental melatonin would be advisable for people taking corticosteroids.

Sodium

Oral corticosteroids cause both sodium and water retention. People taking corticosteroids should talk with their doctor about whether they should restrict salt intake.

Other nutrients

Oral corticosteroids have been found to increase urinary loss of vitamin K, vitamin C, selenium, and zinc. The importance of these losses is unknown.

Interactions with Herbs

Buckthorn, alder buckthorn

Use of buckthorn or alder buckthorn (Rhamnus catartica, Rhamnus frangula), for more than ten days consecutively may cause a loss of electrolytes (especially the mineral potassium). Because corticosteroids also cause potassium loss, buckthorn or alder buckthorn should be used with caution if corticosteroids are being taken.

Horny goat weed

According to preliminary human studies, horny goat weed offset some of the side effects of corticosteroids.

Licorice

Licorice (Glycyrrhiza glabra) extract was shown to decrease the elimination of prednisone in test tube studies. If this action happens in people, it might prolong prednisone activity and possibly increase prednisone-related side effects. A small, controlled study found that intravenous (iv) glycyrrhizin (an active constituent in licorice) given with iv prednisolone prolonged prednisolone action in healthy men. Whether this effect would occur with oral corticosteroids and licorice supplements is unknown.

An animal study has shown that glycyrrhizin prevents the immune-suppressing actions of cortisone—the natural corticosteroid hormone produced by the body. More research is necessary to determine if this action is significant in humans taking oral corticosteroids. Until more is known, people should not take licorice with corticosteroids without first consulting a doctor.

Diuretic herbs

Use of corticosteroids may be associated with loss of certain minerals, called electrolytes. Herbs with a diuretic action (in other words, they promote fluid loss from the body through an increase in urine production) may accelerate the electrolyte loss caused by corticosteroids. Such herbs include asparagus root, butcher’s broom, cleavers, corn silk, juniper, mate, and parsley. This interaction is theoretical and has not been reported in the medical literature.

Laxative herbs

Like diuretic herbs, herbs with a laxative action could theoretically increase electrolyte loss associated with corticosteroid use. Such herbs include aloe, buckthorn, cascara sagrada, rhubarb, and senna. This interaction is theoretical and has not been reported in the medical literature.

Interactions with Foods & Other Compounds

Food

Corticosteroids can cause stomach upset and should be taken with food.

Protein

Oral corticosteroids can cause loss of body protein. For this reason, medical doctors sometimes recommend a high-protein diet for people taking these drugs. However, people with diseases that cause kidney damage should not consume too much protein, as this could worsen their condition. A high-protein diet should be used only after consulting a doctor.

Alcohol

Corticosteroids can irritate the stomach, and alcohol can enhance this adverse reaction.

Grapefruit juice

Taking the oral corticosteroid methylprednisolone with grapefruit juice has been shown to delay the absorption and increase the blood concentration of the drug. The mechanism by which grapefruit juice increases the concentration of methylpredniolone in the blood is not known, but it is suspected that it may interfere with enzymes in the liver responsible for clearing the drug from the body. In certain people, grapefruit juice may, therefore, enhance the effects of methylprednisolone. The combination should be avoided unless approved by the prescribing doctor.

Pomegranate juice

Pomegranate juice has been shown to inhibit the same enzyme that is inhibited by grapefruit juice. The degree of inhibition is about the same for each of these juices. Therefore, it would be reasonable to expect that pomegranate juice might interact with oral corticosteroids in the same way that grapefruit juice does.

Last Review: 05-11-2011

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Copyright © 2011 Aisle7. All rights reserved. www.Aisle7.net

Please read the disclaimer about the limitations of the information provided here. Do NOT rely solely on the information in this article. The Aisle7 knowledgebase does not contain every possible interaction.

Learn more about Aisle7, the company.

The information presented in Aisle7 is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over-the-counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires June 2011.

© 1995-2011 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated. This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.

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