Antiinflammatory/Arthritic Medications
Glucocorticoids
Dexamethasone (Decadron)
Prednisone (Deltasone)
Hydrocortisone (Cortef)
Nonsteroidal Antiinflammatory Drugs (NSAIDs)
Acetyl Salicylic Acid (Aspirin, Ascriptin, Bufferin)
Diclofenac (Voltaren, Voltaren SR, Voltaren XR)
Etodolac (Lodine, Lodine XL)
Ibuprofen (Advil, Motrin, Nuprin, Midol IB, Haltran)
Indomethacin (Indocin, Indocin SR)
Ketorolac tromethamine (Toradol)
Nabumetone (Relafen)
Naproxen (Aleve, Anaprox, Naprosyn)
Oxaprozin (Daypro)
Piroxicam (Feldene)
Rofecoxib (Vioxx)
Diclofenac sodium/Misoprostol (Arthrotec)
Nutritional Considerations:
Avoid alcohol. (Graedon 1995) (Holt 1998).
Avoid large doses of Vitamin E and Aspirin together, there may be an increased risk of bleeding. (Steiner 1995)
Aspirin increases urinary excretion of vitamin C. Discuss supplementation with your pharmacist. (Basu 1982) (Coffey 1975) (Das 1992)
Folic acid intake may be beneficial with the use of NSAID's. Consult your pharmacist regarding possible supplementation. (Baggot 1992)
A 400-mg dose of ibuprofen may also reduce nighttime melatonin secretion, thereby affecting the quality of sleep and rest. (Griffith 1983)
Electrolyte imbalances are possible with dexamethasone, hydrocortisone, and prednisone due to sodium and fluid retention, with long-term use of these drugs, electrolyte levels should be periodically monitored. (Facts and Comparisons 1999)
Glucocorticoids may also affect the immune system and lower levels of several important nutrients. Discuss supplementation of the following nutrients with your pharmacist: vitamins A, C, D, E, selenium, calcium, magnesium, phosphorus, and zinc. (Atkinson 1998) (Gennari 1993) (Gol'berg 1993) (Holt 1998) (Peretz 1987) (Pronsky 1999) (Sambrook 1996) (Yunice 1981)
Herbal Considerations:
Garlic, Ginger or Onion in large doses may increase the risk of bleeding if used together with salicylates (aspirin, for example). (Newall 1996)
Licorice might protect the stomach against NSAID damage, consult your pharmacist before taking the herb with NSAID's. (Brinker 1998) (Rees 1979)
Licorice may decrease the clearance of glucocorticoid drugs, possibly intensifying the duration of their activity and side effects. Thus, avoid Licorice with glucocorticoids. (Chen 1990).
Avoid Aspirin with ginkgo, meadowsweet, and European poplar, it may lead to an increased incidence of bleeding. (Rosenblatt 1997) (Kudriashov 1990)
These herbs have salicylate properties and may have additive effects or side effects with NSAID's: anise, capsicum, celery, chamomile, clove, fenugreek, feverfew, ginseng (Panax), prickly ash, papain, passionflower, red clover, turmeric, wild carrot, wild lettuce, and willow. Consult your pharmacist before using these herbs with any NSAID's. (Brinker 1998) (Blumenthal 1998) (Newall 1996)
There may also be interaction with Aloe, Buckthorn, and Senna. Do not take these herbs and glucocorticoids simultaneously. (Blumenthal 1998)
Ephedra (Ma huang) may increase the clearance of dexamethasone, thereby decreasing its effectiveness. Avoid while taking this drug. (Brinker 1998)
References:
Atkinson SA, Halton JM, Bradley C, et al: Bone and mineral abnormalities in childhood acute lymphoblastic leukemia - influence of disease, drugs, and nutrition, Int J Cancer Suppl, 1998, 11:35-9
Baggott JE, Morgan SL, Ha T, et al: Inhibition of folate-dependent enzymes by nonsteroidal anti-inflammatory drugs, Biochem J, 1992, 282(pt 1):197-202
Basu TK. Vitamin C-aspirin interactions. Int J Vitam Nutr Res Suppl. 1982; 23: 83-90
Blumenthal, M (Ed.): The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. American Botanical Council. Austin, TX. 1998.
Brinker, F Herb Contraindications and Drug Interactions, Eclectic Medical Publications, 1998.
Chen MF, Shimada F, Kato H, et al. Effect of glycyrrhizin on the pharmacokinetics of prednisolone following low dosage of prednisolone hemisuccinate. Endocrinol Japon 1990;37:331-41.
Coffey G and Wilson CWM."Ascorbic Acid Deficiency and Aspirin Induced Haematemesis." BMJ 1:208, 1975.
Das N and Nebioglu S. Vitamin C-aspirin interactions in laboratory animals. J Clin Pharm Ther 17: 343-346, 1992.
Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer Company, 2000.
Gennari C, Differential effect of glucocorticoids on calcium absorption and bone mass, Br J Rheumatol, 1993, 32 (suppl 2):11-4.
Gol'berg ED, Eshchenko VA, Bovt VD, et al: The effect of immunosuppressive substances on the zinc content in cells, Biull Eksp Biol Med, 1993, 116(10):412-3.
Graedon J, Graedon, T: The People's Guide to Deadly Drug Interactions, 1995, p149
Griffith, H. W. 1983. Complete Guide to Prescription and Non-Prescription. Fisher Publishing, Inc., Tucson.
Holt GA. Food & Drug Interactions. Chicago, Precept Press, 1998, 137-38.
Kudriashov BA, Liapina LA, Azieva LD. The content of a heparin-like anticoagulant in the flowers of the meadowsweet. Farmakol Toksikol. 1990 Jul-Aug;53(4):39-41. Russian.
Newall CA, Anderson LA, Phillipson JD. Herbal Medicines: A Guide for Health-care Professionals. London: The Pharmaceutical Press, 1996
Peretz A, Neve J, Vertongen F, et al: Selenium status in relation to clinical variables and corticosteroid treatment in rheumatoid arthritis, J Rheumatol, 1987, 14(6):1104-7.
Pronsky, ZM, et al: Food-Medication Interactions, Pottstown, PA, 1999.
Rees WDW, Rhodes J, Wright JE, et al, "Effect of deglycyrrhizinated liquorice on Gastric Mucosal Damage by Aspirin." Scand J Gastroenterol. 14:605-607, 1979.
Rosenblatt, M and Mindel J. "Spontaneous Hyphema Associated with Ingestion of Gingko biloba Extract." N Engl J Med 336(15):1108. 1997
Sambrook PN: Calcium and vitamin D therapy in corticosteroid bone loss: what is the evidence? J Rheumatol 1996; 23:963-964.
Steiner M, Glantz M, and Lekos A. "Vitamin E Plus Aspirin Compared with Aspirin Alone in Patients with Transient Ischemic Attacks." Am J Clin Nutr 62(Suppl): 1381S-1384S, 1995.
Yunice AA, Czerwinski AW, Lindeman RD: Influence of synthetic corticosteroids on plasma zinc and copper levels in humans, Am J Med Sci, 1981, 282(2):68-74.
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