seven things to avoid while taking prednisone hi I'm Dr Megan your Prednisone pharmacist and lots of people ask me what should I avoid while taking prednisone and so today I'm here to offer seven or more things to avoid while taking prednisone okay it's not really going to be seven it'll be 11 but seven just sounds better right the reason I use the number seven is because it starts with the letter S and all of the things I'm going to tell you to avoid today start with the letter s so seven just made a lot more sense first of all I'm going to cover the most important things and then at the end I will cover another common question people have which is what vitamins should not be taken with prednisone so first thing to avoid while taking prednisone is smoking since prednisone is causing immunosuppression of your body smoking is even more harmful than it normally would be so avoid that in addition smoking can worsen the possible osteoporosis caused by prednisone so we just we don't want to do that number two you want to avoid a shot of alcohol alcohol can worsen the osteoporosis it can worsen the weight gain and it can worsen the insomnia those are the three biggest side effects of prednisone and alcohol can make them all worse plus the alcohol makes it harder to recover your adrenal system after prednisone interferes with it number three is stimulants like caffeine this isn't a hard completely like avoid it at all costs if you're using stimulants and you don't absolutely need them to function throughout the day it's best to avoid them prednisone is pretty hard on your heart and caffeine can be hard on your heart too so definitely avoid the really big scary straight sugar energy drinks while on Prednisone definitely avoid that but avoiding caffeine in general is wise but is not a straight next avoid shot uh this kind of shot except only the live vaccines there aren't a lot of vaccines that are alive most of them are killed completely and aren't going to interfere much and so they're okay to get but the live vaccines there are a few to know about that you should be warned first of all the flu mist the nasal spray version of the flu shot you should avoid the injectable version is totally fine so get the flu shot I have a whole video in depth all about the flu shot whether or not to get the flu shot while on prednisone and the best timing other shots that are live may include the MMR shot the chickenpox shot most people don't need to worry about the chickenpox shot related shot to that is for shingles because it's actually the same virus that's causing shingles and chickenpox and that's usually given to a adults who are over 50 who have a stable immune system but if you are on Prednisone you don't have a stable immune system and I want to read this important detail this exact definition from this EDC they said that substantially immunosuppressive steroid dose so this is the definition of whose immunosuppressed is considered to be greater than or equal to two weeks of daily receipt of 20 milligrams or a two milligram per kilogram body weight of Prednisone or equivalent basically what does that mean if you're taking 20 milligrams or more per day for two weeks or longer or the equivalent of that all squished together in like one dose then you're considered immunosuppressed and that's when we need to be careful so if somebody at risk for shingles you have a family history and you've had it in the past then there's two vaccines that could be given for shingles One exhaustive X and that's a live vaccine and you need to avoid that while in prednisone but the other one is called shingrix and it's a recombinant of the virus and it's not live so you can get it while on Prednisone but here's the deal with all vaccines the lives you want to avoid the other ones you can get but they may not work as well because your immune system is not working as well you might not have as robust of immune response as you were hoping for you may need to be re-vaccinated after you stop taking prednisone talk to your doctor about the best way to proceed but it's okay to get shots that are non-life shots which is most of them most of them are just fine the next number five is NSAIDs which are non-steroidal anti-inflammatory drugs like ibuprofen which is also known as Motrin or Aleve which is also known as naproxen those are the two big ones to avoid celecoxib which is Celebrex those ones you'd want to avoid because it's actually a drug interaction they are both affecting similar Pathways in your body and it can lead to an increased risk of GI bleeding like bleeding in your gut avoid that but it's not it's not black and white like talk to your doctor about it if the benefit of taking both outweighs your risk for having a GI bleed then that's something you and your doctor can work out all right number six is avoid sugar and this is mostly because prednisone is a glucocorticoid that's the class of drug it's a part of glucose meaning glucose meaning sugar so if we are eating simple sugars candy desserts all the things you crave while in prednisone it's a problem because prednisone is interfering appropriate metabolism of sugar you're just increasing the risk of weight gain and diabetes while on Prednisone I have a whole long video All About foods to avoid so check that out if you want to know more number seven goes along with that and that is another food type to avoid and that's salt or sodium because prednisone is causing us to retain salt and so when we're eating salt that's making even harder on our kidneys to get the proper balance of salt and water and that can lead to water weight gain so it's just a lot harder for your body to do its job and can increase your risk for high blood pressure and heart complications so you want to keep your sugar and salt to a minimum while on Prednisone number eight is stress so prednisone is mimicking your body's naturally occurring hormone called cortisol and cortisol is our stress hormone it is secreted by your body in times of stress to save you to get you through those horrible stressful times such as famine or war and so when we have extra stress it's just even more picking a toll on our body so doing what you can to decrease your stress while in prednisone is wise take a break like you're taking a life-saving medication it's okay to give yourself a break right so that's one type of stress another type of stress is number nine and that is sports and bike Sports I mean extreme sports doing normal physical exercise is fine I'm talking extreme sports marathons Iron Mans triathlons things that are very depleting and stressful on your body we want to avoid these because prednisone when you take it as a drug you're taking 10 20 or even 100 times your normal cortisol level and when you're throwing on an extreme exertion like extreme sports that's just a lot more toll on your body prednisone is causing muscle loss it's causing issues with the Integrity of your skin and bones you don't want to be putting extra undue stress or exertion on your body while you're taking prednisone especially while you're taking high doses of Prednisone if you need to be continuing your athletic Pursuits definitely talk to your doctor about this but I don't recommend if you start taking prednisone start gaining weight and you think oh I'll just run a marathon don't do that that's not a good idea don't start an extreme sports habit while on Prednisone your body is already going through enough you don't need to put it through that much more now I'm number 10 avoid sick people while on Prednisone you don't need to avoid you know the snotty little kid around the corner you can go to social events but what we are worried about is sicknesses that can lead to pneumonia because heart disease and pneumonia are the biggest leading causes of death in people who take prednisone we don't want to expose you to somebody who has pneumonia so that could be influenza which is why you should get your flu shot and covid which is why you should also have your cupboard shot you want to protect yourself from things that can cause pneumonia-like symptoms because you're less likely to overcome pneumonia while on Prednisone than if you otherwise were to get it when you aren't on Prednisone number 11 is supplements I'm not saying avoid supplements I'm saying avoid certain supplements so the first one to avoid is things containing aluminum hydroxide and magnesium hydroxide these are often called antacids such as Mylanta Rolaids or Tums usually Tums is okay because it's usually a calcium but we're talking about the kind that's aluminum hydroxide this isn't a hard like don't ever take it this is more like they did studies and it said some patients have shown as much as a 40 decrease in the prednisone bioavailability when code menstrued with aluminum magnesium hydroxide so basically if you were to take 10 milligrams you may only absorb six milligrams because 40 of it is being blocked by the aluminum hydroxide what's happening is aluminum hydroxide is this ion thing and it sucks the prednisone in and 40 of it's just hiding and it just goes straight through your gut and you never even get it into your body so you can do it you just need to be aware that you're probably not absorbing almost half of the drug that you're taking definitely talk to your doctor if you have to take aluminum hydroxide containing things the second is licorice so licorice root or the Latin glyceriza collabra the extract of that was shown to decrease the elimination of Prednisone in test tube studies in addition if you actually absorb the licorice it has been shown to prolong prednisone activity which can increase your Prednisone side effects and prednisone is causing 150 or more side effects you don't want that we want the prednisone to fall off normally and not be prolonging how miserable we feel on Prednisone finally if you're taking licorice it might prevent the immune modulating activity of the prednisone from even working so it might even be blocking the prednisone altogether so I do not recommend taking prednisone and licorice root containing supplements sometimes they're called adrenal support supplements you just want to avoid those while on Prednisone maybe after you stop that's a totally different story but not while you're on it we want to let the prednisone do its job the third supplement to avoid is Saint John's Wort so St John's Wort is often used for people who have depression and I can totally see that because prednisone often causes depression and anxiety as a side effect many other mood changes as well and so people might be like oh I need a natural way to help me cope with the mood changes from prednisone problem is St John's Wort is causes lots of drug interactions and one of the is with the way your body breaks down prednisone in your liver we do not want to interfere again with the way prednisone is being broken down in your liver so let's just avoid St John's ore while on Prednisone the fourth vitamin that you should not take while on Prednisone is calcium alone calcium is being depleted by prednisone when you take prednisone your body is messing with the calcium system it's causing all sorts of changes to the way your body uses calcium if you were to take calcium alone it's not really going to help your bones even though that might be why you would take it what it might actually do is increase your risk for heart disease because the if you only take the calcium then the calcium isn't being told where to go it needs Messengers it needs these signals to tell it go from the blood into the bone build bone and if you'd only take the calcium it just floats around in the blood and can be deposited in the blood vessels leading to hardening of the arteries in fact there's a test they can do they can do an ultrasound right here of the Carotid artery to see how much calcium is deposited there that's a great test to see what your risk for heart disease is like how progressed your heart disease is there's a lot of calcium deposited here that's bad news so we do not want the calcium floating around in the blood that's not our goal instead do not take calcium alone take calcium with vitamin data to study an analysis of properly conducted trials concluded that supplementation with vitamin D and calcium was more effective than Placebo or calcium alone and protecting against corticosteroid induced osteoporosis so if you want to protect your bones against osteoporosis you need at least vitamin D along with calcium and the doctors who prescribe prednisone the most who are called rheumatologists came up with a guideline they said it they recommend a thousand milligrams of calcium and 400 to 800 international units of vitamin D per day in the prevention osteoporosis vitamin D isn't the only thing you're going to need though you actually should also have vitamin K2 and magnesium to help drive that calcium into the bone to give those signals and so if you're wondering well what's the best way to get that I personally had to take prednisone I have family members with osteoporosis and I did not want to go there I did not want to have those risks and I felt horrible while I was on prednisone and I thought of all the side effects I was going through and I discovered that if we replenish the nutrients prednisone depletes from calcium to vitamin D to chromium which is causing the weight gain and the sugar issues if we replenish all of those we feel so much better because we're giving our body the nutrients it needs while on Prednisone so I invented a supplement I call it neutronized Zone it's the first and only supplement for people on prednisone and it gives back all those nutrients you need plus I found other supplement ingredients in here to help counteract other side effects so you just go to neutronize.com and you can get it today to help support your body while you're taking prednisone signing off as Dr Megan your Prednisone pharmacist thank you