I know that it is a no-no to take Adcal, Accrete etc within 2 hours of pred because the resultant 'soup' impedes the pred from being absorbed. But is this the case with gastric-coated pred?
I notice that on the PIL it says it should be taken within 1 1/2 hours of a meal. Gets tricky when you have to fit in 2 doses a day! Thanks.
Take what within 1 1/2 hours of a meal? Adcal? When do you take your e/c pred?
Our usual mantra is pred for breakfast, calcium with lunch and tea/dinner. Or you can take e/c pred before bed - in the system and acting by early morning which is when the inflammatory substances are shed in the body so they never get to do their damage and you get a really good morning.
Yes, that's roughly what I was doing, but realised that I wasn't leaving 6 hours between the two doses, so started taking the calcium at 9, along with yogurt, particularly as Heron said calcium helped with sleeping. That also dealt with eating spinach at dinner, which in turn meant not having to eat so many danged bananas. It's only now that I discover this about within 1 1/2 hours of a meal. Maybe the yogurt is good enough?
Calcium and vit D both are absorbed better with some fat present and some people find that taking calcium supplements with food reduces any unpleasant effects of the calcium.
I didn’t know any of this , just taking it all in the morning 😱 no wonder I am so tired all the time .
I take vitamin D and calcium separately and vit D with the pred in the morning and calcium later on as I understood it is only the calcium that interferes with the absorption of the steroid. Is that right?
Yes - vit D doesn't have any effect. The calcium is thought to form a sort of sludge around the pred tablets and impair the absorption in the stomach. Further down the gut, pred probably impairs absorption of the calcium! SO keeping them apart can only help.
this is all news to me too. I think I’ll try Pred before bed and have calcium in the morning. Thank you.
The trouble is, the calcium with lunch and dinner doesn’t work if those meals include oxalic acid, phosphate or phytic acid … and I’m quite fond of many things that include spinach, and whole grain cereals … and I don’t normally have breakfast early enough to have a four hour gap to lunch …
I had been tempted to just take it all in one go two hours after dinner, but I now see (below) why the recommendation to split the dose, so mid-afternoon and mid-evening it will continue. Is there a recommendation anywhere for how long to leave between Adcal doses?
That's reasonable - but do take a bit of fat in the mid afternoon and evening!
Between calcium doses? Not sure ...
Interested in the idea of taking my e/c pred in the evening. I am currently halfway through slow drop from 6.5mg to 6mg and having a rotten time of it. Yesterday and today I was completely zombied with some relief by early evening.Any suggestions on how to move to an evening dose please?
I have ditched Adcal as not doing me any favours. My diet gives me enough daily calcium and I have purchased a combined vit C/ vit D supplement I about to start taking.
Appreciate any help on this. Thanks.
e/c pred takes about 4 to 5 hours to get into the system. So if you take it just before bed, it is in the system and working in the early morning when the inflammatory substances are shed in the body. It might also wake you up earlier - you are now on the cusp on adrenal insufficiency until the body catches up
Good. Thanks PMRpro. Would it be ok to take my pred at say 11pm tonight even tho' I had it at 7am this morning? Then continue taking it at 11pm.Or should I take half tonight and half in morning then full dose tomorrow night?
"Cusp of adrenal...till body catches up." You mean this could start getting better soon? Great.
No, you're fine just taking it tonight. You may have a bit better day tomorrow - but don't go mad 
Don't hold your breath - it doesn't happen overnight but it should get better
you are now on the cusp on adrenal insufficiency .. Can you please explain what this means please or direct me to an explanation. Thanks
Always have a look at FAQs - usually something about a question there!
Above about 7mg the pred suppresses the production of cortisol, the natural corticosteroid which is essential to life and produced by the adrenal glands. As you reduce your pred dose, the production of cortisol to top it up the amount the body needs must restart. It doesn't start suddenly like flicking a light switch, it is more like a dimmer switch that can get stuck. If it doesn't catch up quickly enough and you keep reducing you may suffer adrenal insufficiency symptoms.
This is in FAQs-
healthunlocked.com/pmrgcauk...
Thank you. I thought I had it taped. I think I 'll have to remember to take it shortly after dinner. I was just hoping that maybe it wouldn't matter so much with e/c pred.
No sure about that, never been on e/c …but it becomes a real juggling act at times….. 🤹♀️
On my vit d/calcium box the pharmacist has put a sticker saying to allow two hours and I have coated steroids.
Thanks, that settles it!
I have taken Calci-D at the same time as enteric coated Pred in the morning. No doctor/pharmacist told me to take them at different times. Quite annoying. Thank you DL for clarifying. I’ll amend my timings tomorrow. I never forget to take the steroids first thing with breakfast but will need a reminder to myself re the calci-D. Wonder if I should adjust timings for enteric coated pred to be taken in the evening? Or split the dose? Finding life hard on these drugs but know they are vital to keeping GCA inflammation in check. I now wonder if taking the Calci-D has has limited the effect of the steroid dose.
It is likely you did not absorb your steroids so well because of the Calci-D. You would find you needed more steroids, but you probably would not be aware of it.
I've never been told about separating the Adcal and prednisolone? I will now, thank you.
I had no knowledge of this! I've always taken my Pred and Cal/VitD at the same time.
Me too - this is all a revelation to me!! Thank you wonderful people 👏
I've always taken all my tablets (including Omeprazole)at the same time, in the morning.
Not sure what else you are on but Omeprazole should be taken at least 30minutes before the others. Others been covered in post above and I think there is probably other info in faq's.
Thank you for the information. I have not been told any of this by GP or pharmacist so I was taking all my tablets at the same time as well. I will have to alter my routine, I didn't realise I shouldn't take Calcichew with wholegrains either, as breakfast is a wholegrain cereal and I usually have a wholegrain sandwich for lunch.
and you should take magnesium too if you take calcium. I have calcium for lunch and magnesium for dinner.
Thanks for bringing this to our attention. I didn’t know about this either. As it happens I haven’t been taking Adcal within 2 hours of Prednisolone because I take Pred with my breakfast of branflakes so knew not to take within 2 hours of bran.
Something I only recently discovered is that I should not eat my favourite licorice all sorts whilst on Prednisolone. None of this is brought to my attention at the beginning of my journey on Pred.
I must admit to eating a sneaky one or two from my OH Licorice Allsorts occasionally 😱
Oh no, what's the problem with licorice allsorts?
As far as I have read, licorice stops Pred working properly.
No - other way round: it inhibits the metabolism of cortisol and pred so it remains in the body for longer and the level may rise. So it potentiates the effect of pred - but that also means the adverse effects are potentiated as well.
Thanks for explaining that. It is a bit complicated for me to understand but suffice to know I shouldn’t eat licorice while on Pred.
Simple version: liquorice stops your body getting rid of cortisol and pred. So the level in the body gets higher. More pred = more effects, both good and bad.
Thank you.
Oh my goodness what a nightmare, I did read on the forum about leaving a gap, so have been having Pred for breakfast, Adcal D3 for lunch and tea, but then I end up eating something I don't need so as to have food with my BP tablets. The only thing my dr said when asked was to not have a milky drink with Adcal D3. No other rules, so had just been going by what they said on the leaflets or prescription, which is about nothing, till I found out there was rules! I have come across mention of the grains, but I have porridge oats or cornflakes for breakfast with my pred. I also have granary bread quite a lot, which would mean for lunch with my Adcal. so I may not be absorbing much!!!!! However I do eat quite a lot of dairy. And had a long spell on AA so hopefully it will pan out.
The only thing my dr said when asked was to not have a milky drink with Adcal D3.
Oh-oh. did he give a reason for that?
Really don't see why not - unless he thinks it might have too much calcium when put together with a supplement, But the body knows what it is doing, it only absorbs about 500mg calcium at a time ...
livestrong.com/article/5248...
Thanks for that, it might make things in my life better, sometimesI go out and would love a cappuccino but think it is too close to my lunch/Adcal and water does get tedious. I often wonder if eating fruit having just had Omoprazole and then a bit later pred is worth it , will there be anything left other than some fibre after they have had their go.
Also be careful of supplements like slippery elm that coat the stomach nd prevent absorption. Also stool softeners. Jane
I didn’t know that either, been taking everything in the morning. Would it be better to continue to take adcal and vit D with my breakfast which is full fat yoghurt and berries and take my pred at lunchtime? Wow learn so much from this site thank you so much
If it works for you taking it in the morning, you probably shouldn't change it, particularly if you have sleep problems, as you want to have as little pred as possible left in you when you want to sleep. As far as I know, that is more important than whether you take pred with a bit of wholemeal.
thank you Sharitone
It won't kick in until very late in the day if you do and the later in the day you take pred the more likely it is to disturb sleep. It doesn't need lots of fat - a cup of tea with milk is probably enough.
thank you Pro I’ve took everything first thing in morning for the last 3 years didn’t know about this
I'm totally confused! Started Pred 4 wks ago. Told best to take with or after breakfast. Also on Adcal-D3 take one twice a day so pre breakfast and early evening. Lanzoprazole 30/60 minutes pre food again pre breakfast.Once a week take alendronic acid on empty stomach on getting up.
Read should not take calcium tabs for at last 4 hrs after taking Alendronic so take Lanz. And Adcal 4 hrs later as both contain calcium! Am I doing this right or should I take Adcal after Pred?? To add to all this waiting for methotrexate prescription goodness knows how I'll fit that in once a week with all the other tabs!!
I was told not to take calcium on the same day as the alendronic acid. But having read all this I think I need a chat with the pharmacist! I’ve swapped my pred to bed but now it’s swallowed with BP tabs and no food. As someone else said you can end up eating unnecessary food to take tabs and I’m trying to keep weight down! Also important.
Newly diagnosed ? timing of pred
A couple of questions please
Timing of taking prednisolone 
Actemra and reducing prednisone
