Pred and calcium tablets timing

[Roltuba]

I’ve recently changed the time of my Pred evening split dose to help with mornings. Have now been seeing remarks about separating time of Adcal from the Pred. Having Googled and re-read the leaflets on both I can find no mention of this. Dr hasn’t said anything (but then no Dr has said anything useful) either. Can anyone enlighten me as to why, and the evidence? I have always made sure to follow the instruction to leave 2 hours after some foods (rhubarb, spinach, whole grains etc) before Adcal, so take it at 11am and bedtime, but now bedtime is Pred time.

Male, aged 71, PMR nearly 4 1/2 years, on 8mg Pred after various flares, never below 6mg. Men “usually have easier time” doesn’t apply!

[Hidden]

A much debated topic & evidence is not that readily available however, my very first Consultant told me not to take them together so l’ve always had a Reminder in my phone to take them later in the day ie Lunchtime & Dinnertime.

From what l’ve read Calcium interferes with the absorption of the Prednisolone, so l always keep them apart as it can’t do any harm & it may well be beneficial.

MrsN

[Roltuba in reply to Hidden]

Thanks for prompt reply. Can’t find that to read anywhere, and as we usually have wholegrain something at lunchtime (wholemeal bread, or more usually Ryvita or oatcakes etc) it’s a question of which to go with! Lunchtime and dinner time a no-no because of that, a definite one in the Adcal leaflet. Yet another irritation... 😬

[Hidden in reply to Roltuba]

I know it’s a pain, I’m having my elevenses & only have my phone to hand, so when l go upstairs l’ll find you one of the previous Posts/Discussions & send you the link.

[Hidden in reply to Roltuba]

There are foods that shouldnt be eaten within 2 hours and other drugs e.g. levothyroxine that require 4 hours. Pred leeches calcium so it seems sensible to separate adcal and pred. It would be like having a hole halfway up your petrol tank, losing half your petrol but always filling it to the top anyway. I am sure this idea came from somewhere and I have read it myself but I can't find anything so far.

[Hidden]

"The calcium carbonate in Adcal D3 tablets may reduce the absorption of many other medicines from the gut, which could make the other medicines less effective. Adcal D3 should preferably not be taken in the two hours before and after taking any other medicine, but for some medicines a longer separation is recommended."

netdoctor.co.uk/medicines/d...

[Hidden]

Roltuba, l haven’t forgot about you, it’s my Moderating Day & it’s been a bit busy! I will try & find that link but safer to say tomorrow!

MrsN

[Hidden]

Just reread your last paragraph, take the Adcal in a morning & after lunch then it’s well away from the Pred!

As l’ve said before, we got the info from somewhere so as it’s not a problem just don’t take them together.

Regards

MrsN

[piglette]

It tells me to leave at least two hours between the two on the label stuck to the medication.

[Hidden]

Thanks Piglette

[PMRpro Ambassador]

I'd just shunt the bedtime calcium to dinner or with a cup of tea in the afternoon. I have to say, I have never really bothers and everything is fine re bone density!

[3daysinjuly in reply to PMRpro]

If I am taking Rayos at 10 pm, when do you suggest I take my calcium tablets?

[PMRpro Ambassador in reply to 3daysinjuly]

I often take 1 of mine at the same time working on the assumption that the Rayos does not break down for 4 hours when taken properly, the calcium will have been absorbed before midnight, the Rayos releases at 2am. Otherwise I take it with my evening meal, a few hours earlier. The other tablet I take in the morning or at lunchtime.

[3daysinjuly]

Ok, thank you.

[nickm001]

It is my understanding that prednisone changes ph of the stomach to more acid and that is not ideal for Calcium or any other mineral absorption.

[PMRpro Ambassador in reply to nickm001]

academic.oup.com/jn/article...

"The absorption of calcium is influenced by conditions within the lumen of the small intestine. The acid secretion from the stomach converts the calcium to a salt, which is absorbed primarily in the duodenum. Unabsorbed calcium is precipitated in the ileum and is excreted in the feces. Lactose, the sugar of milk, aids calcium absorption, whereas excess fatty acid and high concentrations of magnesium and oxalates interfere with it."

Calcium absorption is actually lower down the gut - the acid in the stomach converts the calcium in food to a salt and in fact LOW acid in the stomach reduces absorption of calcium, the reason PPIs are associated with the development of low bone density. Supplements present the calcium in the form of a salt.

ncbi.nlm.nih.gov/pmc/articl...

[nickm001 in reply to PMRpro]

quick search on prednisone impact on bones shows that pred actually changes/inhibits metabolic process of bone rebuilding and calcium replenishing in the bones.

Question is if calcium absorption is not impacted by prednisone, then I don't understand why I have seen many times on this site and others that we should take calcium and vit D at different times then prednisone?

[PMRpro Ambassador in reply to nickm001]

healthunlocked.com/pmrgcauk...

Roltuba has addressed it in this post. It is a purely physical barrier.

[nickm001 in reply to PMRpro]

so in the stomach calcium inhibits prednisone absorption; and in the body prednosone inhibits calcium metabolic process of rebuilding bones. Simple. Thank you!