Prednisone/Prednisolone

Prednisone and prednisolone are steroidal antiinflammatory drugs, used to treat a wide variety of conditions such as autoimmune diseases, ulcerative colitis, asthma, dermatological disorders, Crohn’s disease, tendinitis, bursitis, to prevent organ transplant rejection, and in many chemotherapeutic regimens.

Sodium
Steroidal anti-inflammatory drugs cause sodium retention. People taking one of these drugs should talk with their doctor to see if they need to restrict salt intake.

Potassium
Steroidal anti-inflammatory drugs increase the loss of potassium in urine.1 For most people, this may not cause a significant problem. When potassium is to be increased, it is often best achieved by eating more fruit rather than taking potassium supplements. (Fruit contains higher levels of potassium than that found in the legally mandated supplemental level of a maximum 99 mg per pill).

Vitamin D and Calcium
Steroidal anti-inflammatory drugs reduce the body’s ability to activate vitamin D.2 3 Doctors can measure levels of activated vitamin D (called 1,25 dihydroxycholecalciferol) to determine whether a deficiency exists. If so, activated vitamin D is available by prescription. Regular vitamin D supplements in health food stores are unlikely to have the same effect, although supplementation with 1 gram of calcium per day combined with 500 IU of vitamin D has been reported in one trial to help prevent osteoporosis induced by steroid drugs.4

Protein
Steroidal anti-inflammatory drugs cause protein wasting. For this reason, medical doctors sometimes recommend a high-protein diet for people taking these drugs.5 Considering the kidney damage associated with systemic lupus erythematosus—one of the conditions steroids are used to treat—and the link between kidney damage and high-protein diets, it remains unclear if such advice is appropriate for all patients.

Nutrient Depletion
Steroidal anti-inflammatory drugs have been found to increase urinary loss of zinc, vitamin K, and vitamin C, although the clinical importance of these losses remains unclear.6

Licorice (Glycyrrhiza glabra)
Licorice decreases the liver’s ability to clear prednisone from the body,7 thus allowing the drug to act for longer periods of time. Human studies have shown that injections of glycyrrhizin from licorice along with prednisolone, a close relative of prednisone, prolongs the duration of time it is active in the body.8 Combining licorice and prednisone demands expert guidance, to ensure that prednisone does not build up to excessive levels.

An animal study has shown that glycyrrhizin prevents the immunosuppressive effects of cortisone—the natural hormone most like prednisone.9 Further human research will be necessary to see if this effect is significant in humans.

Topical application of glycyrrhetinic acid (a component of licorice) along with various steroids has potentiated the anti-inflammatory effects of these drugs in both humans and animals.10

Aloe (Aloe vera)
Applying aloe gel topically along with a form of cortisone has enhanced the hormone’s anti-inflammatory activity in the skin.11

References:

1. Csaky TZ. Cutting’s Handbook of Pharmacology, 6th ed. New York: Appleton-Century-Crofts, 1979, 351.
2. Trovato A et al. Drug-nutrient interactions. Am Family Phys 1991;44:1651–58 (review).
3. Chesney RW et al. Reduction of serum-1,25-dihydroxyvitamin-D, in children receiving glucocorticoids. Lancet 1978;ii:1123–25.
4. Buckley LM, Leib ES, Cartularo KS, et al. Calcium and vitamin D3 supplementation prevents bone loss in the spine secondary to low-dose corticosteroids in patients with rheumatoid arthritis. Ann Intern Med 1996;125:961–68.
5. Trovato A et al. Drug-nutrient interactions. Am Family Phys 1991;44:1651–58 (review).
6. Buist RA. Drug-nutrient interactions—an overview. Intl Clin Nutr Rev 1984;4(3):114 (review).
7. Tamura Y, Nishikawa T, Yamada K, et al. Effects of glycyrrhetinic acid and its derivatives on delta-4-5-alpha- and 5-beta-reductase in rat liver. Arzneim Forsch 1979;29:647–49.
8. Chen MF, Shimada F, Kato H, et al. Effect of glycyrrhizin on the pharmacokinetics of prednisolone following low dosage of prednisolone hemisuccinate. Endocrinol Japon 1990;37:331–41.
9. Kumagai A, Nanaboshi M, Asanuma Y, et al. Effects of glycyrrhizin on thymolytic and immunosupressive action of cortisone. Endocrinol Japon 1967;14:39–42.
10. Teelucksingh S, Mackie ADR, Burt D, et al. Potentiation of hydrocortisone activity in skin by glycyrrhetinic acid. Lancet 1990;335:1060–63.
11. Davis RH, Parker WL, Murdoch DP. Aloe vera as a biologically active vehicle for hydrocortisone acetate. J Am Podiatric Med Assoc 1991;81:1–9.

Please read the disclaimer about the limitations of the information provided here. Do NOT rely solely on the information in this article. Those wanting to insure they have complete information about possible interactions between a prescription or over-the-counter medication and specific nutrients, herbs, or other medications should talk with the prescribing physician, a pharmacist, or both.

Copyright © 1998 Virtual Health, LLC

The information presented in HealthNotes Online 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 physician, nutritionally-oriented health care practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.