Prednisone/Prednisolone -- Steroidal Anti-Inflammatory Drugs
Steroidal drugs are often abused and lead to dangerous health conditions.
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.
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