Prednisolone/Vitamin D3 timing

[Dorothy61]

I’ve been suffering symptoms of PMR since June 2020 and started treatment in October 2020. Started on 15mg Pred and now down to 11mg - reducing by 1mg every 6 weeks. So far so good!

Following original advice from GP I take all medication at 8am with breakfast - this includes Pred, Vitamin D3, Omeprazole and (weekly) Alendronic Acid. However, a recent post suggests that timing is important and it might be better to take the Vitamin D3 at lunchtime as taking the two together may affect the effectiveness of the Pred?

I’m keen to maximise the benefit of the Pred, particularly as I taper further, so any advice would be appreciated.

[PMRpro Ambassador]

It isn't the vit D that causes the problem - it is the calcium carbonate in combined calcium/vit D supplements. Calcium and pred can both interact with each other - calcium cabronate can coat the pred tablets in the stomach and reduce the amount absorbed and further down the gut pred can increase the amount of calcium lost via the urine, Taking them separated by 2-4 hours is advised. If you take the vit D as a separate single supplement it doesn't really matter when you take it. If you take your pred in the morning, as is most common, take the calcium for lunch and dinner - because taking it with food is better for absorbing it.

[Dorothy61 in reply to PMRpro]

Thank you for explaining. I take Accrete D3 which I understand is a calcium-vitamin D3 supplement so it sounds like I’d be better holding off and taking it at lunchtime.

[PMRpro Ambassador in reply to Dorothy61]

Yes - got it in one!!!

[Dorothy61 in reply to PMRpro]

Perfect, thanks again 😊

[PMRpro Ambassador in reply to Dorothy61]

Ooooh - forgot to say, the total dose of calcium needs to be split so you don't take more than 600mg calcium at a time. So if it is 2 tablets a day, one at a time at lunch and sometime later.

[Dorothy61 in reply to PMRpro]

It’s one tablet a day and they are described as 1000mg/880 IU. It also states that each tablet contains 2500mg of calcium carbonate equivalent to 1000mg of calcium.Therefore, I’ll break in half and take the 2 halves at different times.

[PMRpro Ambassador in reply to Dorothy61]

Excellent - just what I'd have said to do!!

[Maudie19 in reply to PMRpro]

Now that I didn't know!

[Bobbury in reply to PMRpro]

I never knew that. My GP just said take twice a day and I've been doing that for years.I've learnt something today, I will now take at different times. I have to say I've had more advice from you PMR pro than I have ever received from my GP, Many thanks

[SnazzyD in reply to PMRpro]

I was also told not to take Pred near Omeprazole and the like.

[Dorothy61 in reply to SnazzyD]

Thanks for your input. Interesting. Perhaps I need to take Pred in the morning and everything else at lunchtime.

[SnazzyD in reply to Dorothy61]

My Pred always had it’s own golden hour.. or two.

[Dorothy61 in reply to SnazzyD]

I like that 😊

[PMRrunner in reply to Dorothy61]

I was told to take my lansoprosil(similar to omeprazole I think) 30 mins before taking the prednisolone

[Dorothy61 in reply to PMRrunner]

That’s interesting, thank you.

[PMRpro Ambassador in reply to SnazzyD]

The silly thing being one is supposed to take the PPI half an hour before breakfast and pred with food ...

[PMRrunner in reply to PMRpro]

Yes that's the reason I was told for taking the prednisolone 30mins after the lansoprosil. On the day I took alendronic acid that was 30mins before lansoprosil and so an hour before prednisolone and breakfast.

[PMRpro Ambassador in reply to PMRrunner]

Mmmm - but Snazzy mentions not taking pred and omeprazole close together ...

[Dorothy61 in reply to PMRpro]

Thank you to everyone who has responded. Seems to be a bit of a minefield but I’ll work out a plan starting from tomorrow - omeprazole first, Pred at least 30 minutes later with breakfast and half calcium 4 hours later and the other half even later......oh what fun we have! 😊

[Bobbury in reply to SnazzyD]

whoops, Ive always taken my pred and omperazole together and Ive been doing that since I developed PMR and that's years...... My GP never said don't take together. But I would rather take your advice than my GP as I don't have a lot of faith in my GP whatsoever. Would it be ok to take omperazole at night? Thanks

[Crochetty in reply to Bobbury]

I always take my ppi at night as more likely to have reflux when lying down

[bluebeam in reply to Crochetty]

Me too and it seems to work well for me!

[PMRpro Ambassador in reply to Bobbury]

It really depends what you need it for. The effect lasts for many hours but is greatest soon after taking it so if like Crochetty you have night time problems, at night is better.

[Hidden]

All the advice seems very sensible. My observation is on your taper regime. So far so good. BUT in my personal experience you may need to slow down once you reach 8 mgs. I am fairly certain that the adrenal function allied to pred withdrawal cause aches and pains which are often described as flare's in my case I endured them continued SLOWLY to taper and used ibuprofen for20 weeks post pred. I am now med free 14 months after diagnosis. Good luck

[Dorothy61 in reply to Hidden]

Yes I accept that the most difficult part of the journey is still ahead and have gleaned from this forum that once you get below 10mgs it can get tricky. I will discuss this with my Rheumy and perhaps reduce by only 0.5 at a time.Thanks for your advice. It sounds like you have done incredibly well.

[Bling123]

Omg I would be in all day if I had to wait around with my tablets 🤣🤣🤣xx

[Dorothy61 in reply to Bling123]

Yes, it can get a bit all consuming but I will try and have a life as well! 😃

[Pawscat11]

Just to throw a spanner in the works I have started taking my pred at 4am ( after reading about it in here) as I usually wake then. Personally its made a massive difference with the pain and stiffness on getting up in the morning. I run a guest house and do breakfast so cant afford a slow getting going. I take the Lanzoperazole before bed. All other supplements with breakfast. I am on 12.5mg and 2 years in to the PMR diagnosis.

[Dorothy61 in reply to Pawscat11]

Yes, like you, I’ve learnt that a lot of people take their Pred in the early hours and it clearly works for you which is great. I think I will now adjust the timing and see what difference that makes first. Thanks for the advice, much appreciated.

[pmrgcavictim in reply to Dorothy61]

Hello Dorothy61, I changed my Pred time from breakfast time, 8:00 to 8:30am. It used to take till around 1:00pm for stiffness and aches to ease. I now take my PRED around 2:00am, before the onslaught of the inflammatory stuff at 4:am ish. I now have my mornings back, which I haven't had for 3 years. I can now do things in the mornings, even my still only, short walks. It works for me, and I really hope it works for you. It's worth giving it a try, nothing to lose, hopefully a lot to gain. All the best. Trevor.

[Dorothy61 in reply to pmrgcavictim]

Thanks for the suggestion. At the moment I can function well enough in the morning before the Pred kicks in. However if this changes as I continue to taper, I’ll definitely consider it.Reluctant to lose even more sleep as insomnia is definitely one of my side effects!

[Maudie19 in reply to Pawscat11]

Yes I did that for a while but was so tired next morning. I now have gastric resistant preds and take as I go to bed with a yoghurt beforehand. Seems to be working OK. Been doing for quite a few months now.

[Pr0jection]

Hi Dorothy61, I had the same dilemma and got excellent advice from this site. I take a 2000IU Vit D3 supplement after a tall glass of hot water as soon as I get up, along with magnesium, cod liver oil and a probiotic. I take my pred around 8.30 a.m. and my calcium and Vit D3 combined supplement + biotin supplement after a late lunch around 3.00 p.m.

[Dorothy61 in reply to Pr0jection]

It’s interesting that there are a number of supplements included in your regime as I’ve been a little nervous about taking additional supplements whilst on Pred. At the moment I only take Aloe Vera in addition to the prescribed drugs. Otherwise, the timing is not dissimilar to my plan.

Thanks for your response, much appreciated.

[Sophiestree]

You should take the omeprazole half an hour before, then pred (with food).

[Dorothy61 in reply to Sophiestree]

Thank you. I’ve started doing that from today so it will be interesting to see if it makes a difference!

[Sophiestree in reply to Dorothy61]

The theory is the omeprazole protects your stomach before the pred. Will be interesting if you have not been doing that and it's fine!!! I stopped the omeprazole after a few days and have been ok, but always make sure I eat before the pred. Something reasonable to line your stomach. It's all a minefield isn't it. And we are all different in what we do.

[Dorothy61 in reply to Sophiestree]

That does make sense.I always take the Pred after most of breakfast which has no doubt helped. I always leave some breakfast for afterwards to take the nasty taste away!

[Sharitone]

This is all very illuminating! Thank you. Why don't we get told these things when everything is first prescribed?! I thought the 2 doses of calcium/vit D had to be evenly spaced, hence morning and evening

[Dorothy61 in reply to Sharitone]

I know! I wish I’d known all this a year ago but better late than never.Another example of just how valuable this forum is.

[Littlefish30]

I don’t take omeprazole anymore because my rheumatologist prescribed me gastric resistance steroids after I requested it because don’t need to be taking unnecessary medication So I take my steroids with vitamin 3 in the morning and calcium tabs lunch x evening

I have had no stomach problems been on steroids for 6 yrs and the gastric resistance steroids for 2 yrs

Hope this helps

[Dorothy61 in reply to Littlefish30]

Thanks. I’d prefer to reduce the number of drugs too so will ask if I can change to gastro resistant Pred at next appointment.

[bonio]

wow, thanks for all of this i've learnt something here too and thanks very much to PMRpro again for such words of wisdom. I will now separate my Accrete from my Pred. Was taking both at breakfast time with an additional D3 later in the day but no extra calcium as calculate in my diet I get way enough of that with one Accrete tab. I have opted not to take AA though as gave me such tum probs. Will see how DEXA goes next time. Good luck Dorothy, and thanks PMRpro.

[Dorothy61 in reply to bonio]

Thank you 🤞

[cycli]

ditto on calcium. Spend more time worrying about this than the condition now. Thanks for the heads up

[Kulots]

Ever since I found out from Dr. Berg and his explanation of the importance of Vitamin K2 to Vitamin D3, I stop taking calcium. I eat enough in food rich in calcium.. Vitamin K2 (in conjunction with Vitamin D3) drives the calcium to the bone and not to other body organs such as the heart and joint. Search on Youtube Dr. Eric Berg .. on the topics of Vitamin D3 and Vitamin K2.. Vitamin D3 and Vitamin K2 would prevent coronary artery and joint calcification.

[Dorothy61 in reply to Kulots]

I’ll definitely look into that, thank you.