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.
Helpful Products
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
Potassium
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.
Summary of
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
interactions.
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.
Calcium
Chromium
Magnesium
Melatonin
Potassium
Selenium
Vitamin B6
Vitamin D
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.
Chromium
Vitamin A
May Be Beneficial:Supportive
interaction—Taking these supplements may support or otherwise help your medication
work better.
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.
Magnesium
Avoid:Adverse interaction—Avoid these supplements when taking this
medication because taking them together may cause undesirable or dangerous results.
Alcohol
Sodium
Check:Other—Before taking any of these supplements or eating any of
these foods with your medication, read this article in full for details.
Alder buckthorn*
Buckthorn*
Diuretic herbs*
Grapefruit juice
Laxative herbs*
Licorice
Pomegranate juice*
Protein
Vitamin A*
Vitamin C*
Vitamin K*
Zinc*
An asterisk (*) next to an item in the summary indicates that the
interaction is supported only by weak, fragmentary, and/or contradictory scientific
evidence.
Interactions with Dietary Supplements
Magnesium
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
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.3
Potassium
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.
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.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
Vitamin
B6
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,111213
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
corticosteroid-induced
osteoporosis.16 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.17 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.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.
Sodium
Oral corticosteroids cause both sodium and water retention.19 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.2021 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.22
Horny goat
weed
According to preliminary human studies, horny goat weed offset some of the side effects of
corticosteroids.23
Licorice
Licorice (Glycyrrhiza glabra) 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.
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.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.
Laxative herbs
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
Food
Corticosteroids can cause stomach upset and should be taken with food.29
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.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
doctor.
Alcohol
Corticosteroids can irritate the stomach, and alcohol can enhance this adverse
reaction.31
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.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 doctor.
Pomegranate
juice
Pomegranate juice has been shown to inhibit the same enzyme that is inhibited by grapefruit juice.3334 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.
References (To view, roll mouse over the "References" heading; to hide, click on the heading)
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of magnesium trisilicate on GI absorption of dexamethasone in humans. J Pharm Sci
1978;67:1029–30.
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
1991, 128b.
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
dexamethasone treatment in bronchopulmonary dysplasia. Pediatrics
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7. Georgieff MK, Radmer WJ, Sowell AL. The effect of glucocorticosteroids
on serum, liver, and lung vitamin A and retinyl ester concentrations. J Pediatr
Gastroenterol Nutr 1991;13:376–82.
9. Sur S, Camara M, Buchmeier A, et al. Double-blind trial of pyridoxine
(vitamin B6) in the treatment of steroid-dependent asthma. Ann Allergy
1993;70:147–52.
10. Hahn TJ, Halstead LR, Baran DT. Effects off short term glucocorticoid
administration on intestinal calcium absorption and circulating vitamin D metabolite
concentrations in man. J Clin Endocrinol Metab 1981;52:111–5.
11. Trovato A, Nuhlicek DN, Midtling JE. Drug-nutrient interactions.
Am Fam Physician 1991;44:1651–8 [review].
12. Chesney RW, Mazess RB, Hamstra AJ, et al. Reduction of
serum-1,25-dihydroxyvitamin-D, in children receiving glucocorticoids. Lancet
1978;ii:1123–5.
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
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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.
16. Amin S, LaValley PM, Simms RW, Felson DT. The role of vitamin D in
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
1999;16:164–7.
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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21. Peretz AM, Neve JD, Famaey JP. Selenium in rheumatic diseases.
Semin Arthritis Rheum 1991;20:305–16 [review].
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
Chinese].
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.
Arzneimittelforschung 1979;29:647–9.
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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27. Wallace J. A model for drug/nutrient synergies: focus on cortisone
drugs. Int J Integrative Med 2000;2:33–9.
28. Blumenthal M (ed.). The Complete German Commission E
Monographs. Boston: American Botanical Council, 1998, pp.475–7.
29. Threlkeld DS, ed. Hormones, Adrenal Cortical Steroids,
Glucocorticoids. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and
Comparisons, Apr 1991, 128b.
30. Trovato A, Nuhlicek DN, Midtling JE. Drug-nutrient interactions.
Am Fam Physician 1991;44:1651–8 [review].
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.
