Also indexed as: Aristocort Oral, Cortef Oral, Decadron Oral,
Delta-Cortef Oral, Deltasone Oral, Dexamethasone Oral, Hydrocortisone Oral, Medrol Oral,
Methylprednisolone Oral, Orasone Oral, Pediapred Oral, Prednisolone Oral, Prednisone Oral,
Prelone Oral, Triamcinolone Oral
About 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.
Try these helpful products which may be beneficial if taken with this medicine
- Low-salt foods
- Try a low-sodium diet, as limiting salt
can improve the results of the medicine
- To avoid depleting potassium, which can lead to muscle cramps, twitches, and an irregular
heart beat, eat more fruits, vegetables, and juices
- Calcium with vitamin D
- To avoid bone loss, try taking 1,000 mg of calcium and 400 IU of vitamin D daily
These recommendations are not comprehensive and are not intended to
replace the advice of your doctor or pharmacist. Continue reading the full article for more
information on interactions with vitamins, herbs, and foods.
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.
Interactions with Vitamins, Herbs, and Foods
In some cases, an herb or supplement may appear in more than one category, which may seem
contradictory. For clarification, read the full article for details about the summarized
| May Be Beneficial: Depletion or
interference—The medication may deplete or interfere with the absorption or
function of the nutrient. Taking these nutrients may help replenish them.
| May Be Beneficial: Side effect
reduction/prevention—Taking these supplements may help reduce the likelihood and/or
severity of a potential side effect caused by the medication.
| May Be Beneficial: Supportive
interaction—Taking these supplements may support or otherwise help your medication
Horny goat weed*
N-acetyl cysteine (NAC)*
Avoid: Reduced drug absorption/bioavailability—Avoid these supplements
when taking this medication since the supplement may decrease the absorption and/or activity
of the medication in the body.
Avoid: Adverse interaction—Avoid these supplements when taking this
medication because taking them together may cause undesirable or dangerous results.
Check: Other—Before taking any of these supplements or eating any of
these foods with your medication, read this article in full for details.
An asterisk (*) next to an item in the summary indicates that the
interaction is supported only by weak, fragmentary, and/or contradictory scientific
Interactions with Dietary Supplements
Corticosteroids may increase the body’s loss of magnesium.1 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.2
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.3
Oral corticosteroids increase the urinary loss of potassium.4 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.
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.5 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
therapy6 —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.7
Corticosteroids may increase the loss of vitamin B6.8 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.9 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 calcium10 and interfere with the
activation and metabolism of the vitamin,11 12 13
14 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.15 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
osteoporosis.16 Most doctors recommend 1,000 mg of calcium and 400–800 IU
vitamin D per day for the prevention of osteoporosis.
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.17 Double-blind trials are needed to confirm these
A controlled trial found that a single dose of the synthetic corticosteroid dexamethasone
suppressed production of melatonin in nine of 11 healthy volunteers.18 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.
Oral corticosteroids cause both sodium and water retention.19 People taking
corticosteroids should talk with their doctor about whether they should restrict salt
Oral corticosteroids have been found to increase urinary loss of vitamin K, vitamin C, selenium, and zinc.20 21 The importance of
these losses is unknown.
Interactions with Herbs
Buckthorn, Alder buckthorn (Rhamnus catartica,
Rhamnus frangula, Frangula alnus)
Use of buckthorn or alder buckthorn 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
According to preliminary human studies, horny goat weed offset some of the side effects of
Licorice (Glycyrrhiza glabra)
Licorice extract was shown to decrease the elimination of prednisone in test tube
studies.24 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.25 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.26 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.
Use of corticosteroids may be associated with loss of certain minerals, called electrolytes.
Herbs with a diuretic action (i.e., they promote fluid loss from the body through an increase
in urine production) may accelerate the electrolyte loss caused by
corticosteroids.27 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.
Like diuretic herbs, herbs with a laxative action could theoretically increase electrolyte
loss associated with corticosteroid use.28 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 and Other Compounds
Corticosteroids can cause stomach upset and should be taken with food.29
Oral corticosteroids can cause loss of body protein. For this reason, medical doctors
sometimes recommend a high-protein diet for people taking these drugs.30 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
Corticosteroids can irritate the stomach, and alcohol can enhance this adverse
Taking methylprednisolone with grapefruit juice has been shown to delay the absorption and
increase the blood concentration of the drug.32 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
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3. Behr J, Maier K, Degenkolb B, et al. Antioxidative and clinical
effects of high-dose N-acetylcysteine in fibrosing alveolitis. Adjunctive therapy to
maintenance immunosuppression. Am J Respir Crit Care Med 1997;156:1897–901.
4. Thelkeld DS, ed. Hormones, Adrenal Cortical Steroids, Glucocorticoids.
In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Apr
5. Hunt TK, Ehrlich HP, Garcia JA, Dunphy JE. Effect of vitamin A on
reversing the inhibitory effect of cortisone on healing of open wounds in animals and man.
Ann Surg 1969;170:633–40.
6. Shenai JP, Mellen BG, Chytil F. Vitamin A status and postnatal
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9. Sur S, Camara M, Buchmeier A, et al. Double-blind trial of pyridoxine
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concentrations in man. J Clin Endocrinol Metab 1981;52:111–5.
11. Trovato A, Nuhlicek DN, Midtling JE. Drug-nutrient interactions.
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12. Chesney RW, Mazess RB, Hamstra AJ, et al. Reduction of
serum-1,25-dihydroxyvitamin-D, in children receiving glucocorticoids. Lancet
13. Nielsen HK, Eriksen EF, Storm T, Mosekilde K. The effects of
short-term, high-dose prednisone on the nuclear uptake of 1,25-dihydroxyvitamin D3 in
monocytes from normal human subjects. Metabolism 1988;37:109–14.
14. Avioli LV. Serum 25-hydroxyvitamin D concentrations in patients
receiving chronic corticosteroid therapy. J Lab Clin Med 1977;23:399–404.
15. 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. A randomized, double-blind, placebo-controlled trial.
Ann Intern Med 1996;125:961–8.
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corticosteroid-induced osteoporosis. Arthritis Rheum 1999;42:1740–51.
17. Ravina A, Slezak L, Mirsky N, et al. Reversal of
corticosteroid-induced diabetes mellitus with supplemental chromium. Diabet Med
18. Demisch L, Demisch K, Nickelsen T. Influence of dexamethasone on
nocturnal melatonin production in healthy adult subjects. J Pineal Res
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22. European Scientific Cooperative on Phytotherapy (ESCOP). Frangulae
cortex, frangula bark. Monographs on the Medicinal Uses of Plant Drugs. Exeter, UK:
University of Exeter, Centre for Complementary Health Studies, 1997.
23. Cai D, Shen S, Chen X. Clinical and experimental research of
Epimedium brevicornum in relieving neuroendocrino-immunological effect inhibited by
exogenous glucocorticoid. Zhongguo Zhong Xi Yi Jie He Za Zhi 1998;18:4–7 [in
24. 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.
25. Chen MF, Shimada F, Kato H, et al. Effect of glycyrrhizin on the
pharmacokinetics of prednisolone following low dosage of prednisolone hemisuccinate.
Endocrinol Jpn 1990;37:331–41.
26. Kumagai A, Nanaboshi M, Asanuma Y, et al. Effects of glycyrrhizin on
thymolytic and immunosuppressive action of cortisone. Endocrinol Jpn
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29. Threlkeld DS, ed. Hormones, Adrenal Cortical Steroids,
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30. Trovato A, Nuhlicek DN, Midtling JE. Drug-nutrient interactions.
Am Fam Physician 1991;44:1651–8 [review].
31. Holt GA. Food & Drug Interactions. Chicago: Precept
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32. Varis T, Kivisto KT, Neuvonen PJ. Grapefruit juice can increase the
plasma concentrations of oral methylprednisolone. Eur J Clin Pharmacol