Spacing the medication!!!

I've been reading about not taking Vit D3 and Calcium at the same time as pred, taking it with something fatty..breaking the Adcal tablets in half!! Someone said we needed a spreadsheet for all this medication and I'm thinking that's a good idea!! I'm currently splitting my pred which makes it more complicated!!

I'm also on Levothyroxine and it states on the Adcal patient sheet that 4 hours should be left after taking the thyroxine before taking the Adcal!!

So....currently....Levothyroxine, Omeprazole and Vit K2 on waking!! First dose of pred with breakfast. Adcal about lunchtime. This is where it gets difficult...I was taking my 2nd pred with my evening meal and Adcal at bedtime....but have been going to bed early as I am so tired at the mo (not sleeping well either) so the evening doses are close together.

It's a minefield!!!!

39 Replies

  • Hi Alty. I take my Calcium/D3 at the same time as my Pred - didn't realise I shouldn't be doing that. What with the HRT patches having to be changed twice a week, the Pred every day, the Metho on a Tuesday and the Folate on a Wednesday, the K2, the B12, and the blood tests, I am struggling to keep on track too - brain fog doesn't help!

  • Bit d I take mine in the evening with a plain yogurt it says take one daily So that could mean mor or evening

  • Is it any wonder we forget to put the meat in the oven?!

  • Or walk around looking for my glasses when they are on my head?!

  • I spent half an hour, last week, looking for my phone, whilst listening to a podcast on the same phone. (The phone was in my pocket and I was listening through headphones!)

  • Love it❤️!

  • That's really hilarious.

  • Glad it's not just me. I have even been searching in my bag for my tube ticket as I have approached the exit, then realised I am actually holding it in my teeth!! Arrrggh!

  • :) :)

  • Hi,

    Can you swap the evening Pred and Adcal around? I know it's says Pred best taken with food, but a spoonful of yoghurt or glass of milk would probably suffice.

    Why are you breaking Adcal tablet in half?

  • Hi DL, I'm not breaking them in half...yet!! haha! I read on another post that we only absorb so much calcium at a time so that person was breaking the tablets in half!! I've not gone down that route! I've always taken the pred with food...never tried milk....or the yoghurt...that sounds even better to me. Thank you. :)

  • Depends on the tablet - one version is 1000mg calcium which is more than the body will absorb at one time. No doubt there are doctors who don't know that who think it is cost saving...

    Though some of them say 1500mg calcium carbonate - which is 600mg elemental calcium which is just about OK. Absorption is highest from doses not more than 500mg - so trumpeting your once-a-day tablet improving compliance isn't really very clever is it?

  • Altywhite, The recommended daily allowance (RDA) of calcium for an adult, published by the Food and Nutrition Board (FNB) at the Institute of Medicine of the National Academies, is 1000–1200 mg (1200 mg for age 70 and older) and based on the latest research, it is best to get as much calcium as possible from natural food sources while minimizing supplemental calcium - especially calcium carbonate. Interestingly, the number the RDA is based on, (the number that really matters), is how much calcium you absorb, not how much you eat. The average adult needs 300-400 mg of calcium that can be readily metabolized and used to satisfy the body’s calcium requirements.

    The following is the very short list of high calcium food items that have been tested for bioavailability.

    If you can get your calcium from items on this list and you won't have to worry about supplement timing.

    Food Serving Size Calcium absorbed per serving

    Collard greens 1 cup cooked 173mg

    Canned salmon (6 oz with bones) 1 6-ounce serving 114mg

    Turnip greens 1 cup cooked 102mg

    Milk, Lactaid, yogurt 1 cup 96mg

    Cheese (hard such as cheddar) 1 ½ oz 97mg

    Sardines (with bones) 1 can (3.75oz) 95mg

    Bok choi 1 cup cooked 69mg

    Broccoli 1 cup cooked 57mg

    Kale 1 cup cooked 46mg

    Mineral water 20oz bottle 41mg

    Mustard greens 1 cup cooked 42mg

    Chinese spinach ½ cup 29mg

    Almonds 1/4 cup 22mg

    Beans (white) 4 oz 25mg

    Beans (pinto) 4 oz 15mg

    Beans (red) 4 oz 10mg

    Whole wheat bread 1 slice 17mg

    The following is an example of an easy to follow regimen which provides 1000% of the daily bioavailable calcium requirement from natural foods.

    1 cup of milk or yogurt, (either regular or lactose free) 96mg

    2 ounces of low fat hard cheese 129mg

    1 can of sardines, 1 serving salmon, or a third portion of dairy 95mg

    400mg of calcium citrate (21% elemental calcium) 84mg

    Total 404 mg

  • You are talking about NORMAL HEALTHY people's RDA. The idea of the supplemental calcium alongside corticosteroid therapy is to protect against bone density loss without having to resort to bisphosphonates in the first instance. I can't find the reference - but a study has shown that having extra calcium in the form of supplements does do that with no risk of side effects.

    There is also a trap in your list of foods: it is only appropriate in the USA. Few foods in Europe are fortified with calcium and vit D. I won't get into a discussion as to whether that is a good or bad thing - but it is so.

  • Surely only bread and dairy would be affected by fortification - not vegetables or tinned salmon?

  • True - mea culpa. However, overall they are probably significant.

    Interestingly, until quite recently I was not allowed to eat most of those green veg - they are a no-no if you are on warfarin-type anticoagulants.

    With tinned salmon and sardines you are supposed to eat the bones,.. Tinned salmon is bad enough - the bones too would be the end!

  • I haven't had either tinned salmon or sardines for years. But as a child I particularly liked the bones!

  • I thought you were strange... ;-)

  • 😜

  • You'll think me strange too, but I always eat (and like!) the bones in tinned fish and the little roes in pilchards are scrummy!

    I take a huge amount of dietary calcium - keep meaning to calculate exactly how much. If you do find that reference that might free me / us from the bisphosphonate, please do share it with us.

  • Rugger - Having a dexascan is the best way to approach that. If your bone density is high enough you shouldn't be on AA.

  • Sadly, a DEXAscan in January showed I do have osteoporosis, having been on pred for 9 months, but I'll never know what my bone density was like before diagnosis. I misunderstood your reply and thought that I might get away without the Risedronate and just manage with my dietary and supplemental calcium. I know that HeronNS might say give it a try, with increased walking etc. I am trying to up my activity - walked along the Prom at Scarborough yesterday!

  • It depends on the readings - Heron was wrongly told she had osteoporosis when in fact it was just osteopenia, albeit fairly advanced at -2.1. She got the same reading to -1.6 in a year with a dietary and exercise approach.

    By - bet that was fun - didn't you get blown away? My daughter is a paramedic in Whitby...

  • Yes, my readings are -2.6, -2.8 and -3.1.

    I suppose I was thinking if I could improve my readings by 0.5 by natural means like Heron, that would be a better way than with bisphosphonates, in view of recent news.

    We were lucky with the weather - a still day, with sunshine and clouds, but not a drop of rain until the journey home to West Yorkshire. We like Whitby, but were visiting friends who have moved to Hackness, so Scarborough was nearer to their home.

  • But you can do both - and be able to stop the bisphosphonate once your scan readings are better.

  • Yep - that's my hope / intention!

  • I don't think your scan results are particularly dire. A couple of them are barely over the fairly randomly selected osteoporosis line. If you follow the natural route, plus make sure you learn techniques to protect your spine if your doctor considers you may be vulnerable to compression fractures, you should be able to improve your bone density as quickly with nutrition and exercise as you can with the drugs - and no side effects except generally better health!

    Research has been done showing that micronutrients can improve bone density. You don't have to measure everything out as they did in the experiment, but here's an article to get you started:

  • Thanks Heron - food for thought!

  • I agree....sorry...don't do fish bones of any kind!!

  • Well, altywhite, you do know we are only referring to the little gently crunchy bones in tinned fish which can't possibly do you damage when you swallow them?! Liking or disliking is probably a texture thing. I remember the horror of having to eat tripe when I was a youngster. I used to swallow the pieces whole, unable to bring myself to chew them. 🤢

  • Oh crikey Heron....the dreaded tripe!! My mum used to serve it cold with pepper and vinegar!! She swore blind in later years that she never used to make me eat it!!! But she did!! Haha. And yes....the bone thing is definitely texture!! 😀

  • OMG, hot was bad enough!

  • I'm on rivaroxaban, and I can't find any reference to avoiding greens with this anticoagulant. Should I raise it with my consultant do you think?

  • No - it is one of the new generation anticoagulants which work in a totally different way . It is warfarin and its relatives that are a problem, they work by an effect on the vit K pathway in the clotting cascade. Dark green veg are high in vit K1 - kale and spinach are particularly high. The better things of the new generation ones are not having to worry about what you eat - and no blood tests! Not that the cranberry thing was ever real - the patient in whom they found the massive INR was a cranberry farmer - and literally drank gallons of cranberry juice!

  • None of the items on the list I provided are fortified with calcium, and 350 - 400 mg of bioavailable calcium from foods is the equivalent of taking 1200 mg of supplemental calcium. The reason being that only 13-40 % of supplements can be assimilated by the digestive system and incorporated into the bone. .

    It has also been shown that a calcium rich diet is protective of the heart while calcium supplementation may damage the heart. Additionally, hypercalcemia, (a shift in the body's acid/base balance towards alkaline), calcinosis and nephrocalcinosis, (calcium deposits in the tissues and kidneys), kidney stones, plaque in the arteries, and an increased risk of heart attack, stroke, and kidney disease has been linked to taking milk with calcium supplements in the wrong ratio.

    Furthermore, although taking calcium with vitamin D may offset metabolic problems caused by steroids, no amount of supplementation will prevent fractures. The latest studies also show bisphosphonates are problematic and their value in preventing fractures is in question.

    The following link is just one of many that demonstrated the advantages of a calcium rich diet over supplementation:

  • Hi admiral, thanks for the info. I consider myself to have a pretty good balanced diet and luckily like most of the foods rich in calcium....except fish bones! I will continue with my D3/calcium though as I have been on quite high doses of pred for the last 2years (not so much now...down to 12mg) and I can't/don't want to take bisphosphonates. Maybe I'll get my levels checked at my next blood test.

  • Hi altywhite,

    It is definitely a mission remembering to take all your meds. I have done a table landscape for the month, stuck inside the cupboard door and using a highlighter just cross off each box during the day as I take them so i know I have taken it - it works quite well for me.Regards John

  • I didn't know anything about not taking them at the same time, can anyone tell me what the reason for that is please? I write everything down, including pain symptoms, and find it very useful if a little hyperchondriacal!!! Is that a real word?

  • Prednisone interferes with the absorption of calcium. Prednisone does more, changing the formation of certain bone building cells, but at least by taking calcium at a different time we can maximize calcium intake.

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