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6 Interactions found for:

prednisone and Vitamin D3
Interactions Summary
  • 1 Major
  • 2 Moderate
  • 3 Minor
  • prednisone
  • Vitamin D3

Drug Interactions

Moderate
Prednisone + Vitamin D3

The following applies to the ingredients: Prednisone and Cholecalciferol (found in Vitamin D3)

MONITOR: Use of systemic corticosteroids may reduce the effects of vitamin D and its analogs, though the exact mechanism is likely multifaceted. In general, corticosteroid use leads to increased excretion of calcium, whereas vitamin D promotes calcium absorption and is often administered with calcium to increase the absorption. Another potential mechanism involved is that long-term steroid use can contribute to weight gain and vitamin D is a fat-soluble vitamin; therefore, the bioavailability of vitamin D may be reduced in overweight and/or obese patients. Additionally, some studies have suggested that corticosteroid use increases the breakdown of 25-hydroxyvitamin D (25(OH)D), the active metabolite of vitamin D2 (ergocalciferol) and vitamin D3 (cholecalciferol). However, several studies examining this theory found no significant differences when the levels of 25(OH)D in patients treated with corticosteroids were compared to the levels measured either pretreatment or in control groups. The results may be demonstrating a lack of effect on 25(OH)D or could be related to limitations in the studies themselves. Regardless of the exact mechanism, the 2001-2006 National Health and Nutrition Examination Survey from the United States reported that 25(OH)D deficiency (levels less than 25 nmol/L or 10 ng/mL) was more than twice as common among children and adults who reported oral steroid use (11%) than in nonusers (5%).

MANAGEMENT: Increased monitoring of calcium and vitamin D levels may be advisable in patients on systemic corticosteroids. Depending on the patient's levels, increased vitamin D supplementation may be required during coadministration. The severity of this interaction is likely impacted by the dosage and/or duration of the systemic corticosteroid. Consultation with relevant local and/or national guidelines may be helpful when deciding on vitamin D dosing as well as goal vitamin D levels.

References

  1. "Product Information. Fultium-D3 (colecalciferol)." Internis Pharmaceuticals Ltd (2024):
  2. "Product Information. Ostelin Specialist Range Vitamin D (colecalciferol)." Sanofi-Aventis Healthcare Pty Ltd T/A Sanofi Consumer Healthcare (2024):
  3. "Product Information. Rocaltrol (calcitriol)." Atnahs Pharma UK Ltd (2021):
  4. "Product Information. Calcitriol (calcitriol)." Strides Pharma Inc. (2019):
  5. "Product Information. Calcitriol (GenRx) (calcitriol)." Apotex Pty Ltd (2024):
  6. Skversky AL, Kumar J, Abramowitz MK, Kaskel FJ, Melamed ML "Association of glucocorticoid use and low 25-hydroxyvitamin D levels: results from the National Health and Nutrition Examination Survey (NHANES): 2001-2006." J Clin Endocrinol Metab 96 (2011): 3838-45
  7. Efird JT, Anderson EJ, Jindal C, et al. "The interaction of vitamin d and corticosteroids: a mortality analysis of 26,508 veterans who tested positive for SARS-CoV-2. https://www.mdpi.com/1660-4601/19/1/447" (2024):
  8. Wakeman M "A literature review of the potential impact of medication on vitamin D status. https://www.dovepress.com/a-literature-review-of-the-potential-impact-of-medication-on-vitamin-d-peer-reviewed-fulltext-article-RMHP" (2024):
  9. Davidson ZE, Walker KZ, Truby H "Clinical review: do glucocorticosteroids alter vitamin D status? A systematic review with meta-analyses of observations studies." J Clin Endocrinol Metab 97 (2012): 738-44
  10. Alzohily B, AlMenhali A, Gariballa S, Munawar N, Yasin J, Shah I "Unraveling the complex interplay between obesity and vitamin D metabolism. https://www.nature.com/articles/s41598-024-58154-z" (2024):

Drug and Food Interactions

Moderate
Vitamin D3 + Food

The following applies to the ingredients: Cholecalciferol (found in Vitamin D3)

MONITOR: Additive effects and possible toxicity (e.g., hypercalcemia, hypercalciuria, and/or hyperphosphatemia) may occur when patients using vitamin D and/or vitamin D analogs ingest a diet high in vitamin D, calcium, and/or phosphorus. The biologically active forms of vitamin D stimulate intestinal absorption of calcium and phosphorus. This may be helpful in patients with hypocalcemia and/or hypophosphatemia. However, sudden increases in calcium or phosphorus consumption due to dietary changes could precipitate hypercalcemia and/or hyperphosphatemia. Patients with certain disease states, such as impaired renal function, may be more susceptible to toxic side effects like ectopic calcification. On the other hand, if dietary calcium is inadequate for the body's needs, the active form of vitamin D will stimulate osteoclasts to pull calcium from the bones. This may be detrimental in a patient with reduced bone density.

MANAGEMENT: Given the narrow therapeutic index of vitamin D and vitamin D analogs, the amounts of calcium, phosphorus, and vitamin D present in the patient's diet may need to be taken into consideration. Specific dietary guidance should be discussed with the patient and regular lab work should be monitored as indicated. Calcium, phosphorus, and vitamin D levels should be kept within the desired ranges, which may differ depending on the patient's condition. Patients should also be counseled on the signs and symptoms of hypervitaminosis D, hypercalcemia, and/or hyperphosphatemia.

References

  1. "Product Information. Drisdol (ergocalciferol)." Validus Pharmaceuticals LLC (2023):
  2. "Product Information. Fultium-D3 (colecalciferol)." Internis Pharmaceuticals Ltd (2024):
  3. "Product Information. Ostelin Specialist Range Vitamin D (colecalciferol)." Sanofi-Aventis Healthcare Pty Ltd T/A Sanofi Consumer Healthcare (2024):
  4. "Product Information. Rocaltrol (calcitriol)." Atnahs Pharma UK Ltd (2021):
  5. "Product Information. Calcitriol (calcitriol)." Strides Pharma Inc. (2019):
  6. "Product Information. Calcitriol (GenRx) (calcitriol)." Apotex Pty Ltd (2024):
  7. "Product Information. Ergocalciferol (ergocalciferol)." RPH Pharmaceuticals AB (2022):
  8. "Product Information. Sandoz D (cholecalciferol)." Sandoz Canada Incorporated (2020):
  9. Fischer V, Haffner-Luntzer M, Prystaz K, et al. "Calcium and vitamin-D deficiency marginally impairs fracture healing but aggravates posttraumatic bone loss in osteoporotic mice. https://www.nature.com/articles/s41598-017-07511-2" (2024):
  10. National Institutes of Health Office of Dietary Supplements "Vitamin D https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/#h37" (2024):

Drug and Pregnancy Interactions

The following applies to the ingredients: Prednisone

This drug should only be used during pregnancy if the benefit outweighs the potential risk to the fetus

AU TGA pregnancy category: A
US FDA pregnancy category: C
US FDA pregnancy category: D (delayed-release tablets)

Comments:
-Observe for signs and symptoms of hypoadrenalism in infants exposed to this drug in utero.
-Women who become pregnant while using this drug should be apprised of the potential fetal risks.
-The short-term use of corticosteroids antepartum for the prevention of respiratory distress syndrome does not seem to pose a risk to the fetus or newborn infant.

Teratogenicity including increased incidence of cleft palate have occurred in animal studies. A number of cohort and case controlled studies in humans suggest maternal corticosteroid use in the first trimester produces a slight increased risk of cleft lip with or without cleft palate (increased from 1 out of 1000 to 3 to 5 out of 1000 infants). Reduced placental and birth weight have been recorded in animals and humans after long term treatment. There is the possibility of adrenal cortex suppression in the newborn with long term use in the mother; however the short term use of corticosteroids antepartum for the prevention of respiratory distress syndrome does not seem to pose a risk to the fetus or the newborn infant. Maternal pulmonary edema has been reported with inhibition of uterine contractions and fluid overload. There are no adequate and well controlled studies in pregnant women.

Use of prednisolone (active metabolite) at high doses for an extended period of time (30 mg/day for a minimum of 4 weeks) has caused reversible disturbances of spermatogenesis that persisted for several months after discontinuation.

AU TGA pregnancy category A: Drugs which have been taken by a large number of pregnant women and women of childbearing age without any proven increase in the frequency of malformations or other direct or indirect harmful effects on the fetus having been observed.

US FDA pregnancy category C: Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.

US FDA pregnancy category D: There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.

References

  1. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn PROD (2001):
  2. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  3. Cerner Multum, Inc. "Australian Product Information." O 0
  4. "Product Information. Rayos (prednisone)." Horizon Therapeutics USA Inc (2016):
  5. "Product Information. PredniSONE (prednisone)." Watson Pharmaceuticals (2016):

The following applies to the ingredients: Cholecalciferol (found in Vitamin D3)

Use is not recommended unless there is a deficiency.

AU TGA pregnancy category: Exempt
US FDA pregnancy category: Not assigned

Comments:
-Vitamin D supplementation should begin a few months prior to pregnancy.

Animal studies at high doses have shown teratogenicity. There are no controlled data in human pregnancy. Because vitamin D raises calcium levels, it is suspect in the pathogenesis of supravalvular aortic stenosis syndrome, which is often associated with idiopathic hypercalcemia of infancy, but excessive vitamin D intake or retention has not been found consistently in these mothers. A study of 15 patients with maternal hypoparathyroidism, treated with high dose vitamin D during pregnancy (average 107,000 international units per day) to maintain normal calcium levels, produced all normal children. Vitamin D deficiency is associated with reduced fetal growth, neonatal hypocalcemia (with and without convulsions), rickets, and defective tooth enamel.

AU TGA pregnancy category Exempt: Medicines exempted from pregnancy classification are not absolutely safe for use in pregnancy in all circumstances. Some exempted medicines, for example the complementary medicine, St John's Wort, may interact with other medicines and induce unexpected adverse effects in the mother and/or fetus.

US FDA pregnancy category Not Assigned: The US FDA has amended the pregnancy labeling rule for prescription drug products to require labeling that includes a summary of risk, a discussion of the data supporting that summary, and relevant information to help health care providers make prescribing decision and counsel women about the use of drugs during pregnancy. Pregnancy categories A, B, C, D and X are being phased out.

References

  1. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  2. Cerner Multum, Inc. "Australian Product Information." O 0
  3. TGA. Therapeutic Goods Administration. Australian Drug Evaluation Committee "Prescribing medicines in pregnancy: an Australian categorisation of risk of drug use in pregnancy. http://www.tga.gov.au/docs/html/medpreg.htm" (2010):
  4. Briggs GG, Freeman RK. "Drugs in Pregnancy and Lactation." Philadelphia, PA: Wolters Kluwer Health (2015):

Drug and Breastfeeding Interactions

The following applies to the ingredients: Prednisone

This drug should be used only if clearly needed

Excreted into human milk: Yes

Comments:
-If this drug is necessary, the lowest dose should be prescribed; theoretically, if high maternal doses are necessary, the dose the infant receives may be minimized by avoiding breastfeeding for 4 hours following dosing and using prednisolone instead of prednisone.

Amounts of glucocorticoids excreted into breast milk are low with a total infant daily dose calculated to be up to 0.23% of the maternal daily dose. For doses up to 10 mg/day, the amount of drug an infant receives via breast milk is undetectable; however the milk/plasma ratio increases with doses above 10 mg/day (e.g., 25% of the serum concentration is found in breast milk when dose is 80 mg/day). If this drug is necessary, the lowest dose should be prescribed as high doses of corticosteroids for long periods could produce infant growth and development problems and interfere with endogenous corticosteroid production. High doses might occasionally cause temporary loss of milk supply.

References

  1. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn PROD (2001):
  2. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  3. Cerner Multum, Inc. "Australian Product Information." O 0
  4. United States National Library of Medicine "Toxnet. Toxicology Data Network. http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT" (2013):
  5. "Product Information. Rayos (prednisone)." Horizon Therapeutics USA Inc (2016):
  6. "Product Information. PredniSONE (prednisone)." Watson Pharmaceuticals (2016):

The following applies to the ingredients: Cholecalciferol (found in Vitamin D3)

Use is not recommended unless the clinical condition of the woman requires treatment.

Excreted into human milk: Yes

Comments:
-Make allowance for any maternal dose if prescribing this product to a breast fed infant.
-Consider monitoring the infant's serum calcium if the mother is receiving pharmacologic doses of vitamin D.
-Vitamin D supplementation is recommended in exclusively breast fed infants.

The required dose of vitamin D during lactation has not been adequately studied; doses similar to those for pregnant women have been suggested.

Chronic ingestion of large doses of vitamin D by the mother may lead to hypercalcemia in the breastfed infant.

References

  1. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  2. Cerner Multum, Inc. "Australian Product Information." O 0
  3. Briggs GG, Freeman RK. "Drugs in Pregnancy and Lactation." Philadelphia, PA: Wolters Kluwer Health (2015):
  4. IOM (Institute of Medicine). "Dietary Reference Intakes for Calcium and Vitamin D." Washington, DC: The National Academies Press (2011):

Therapeutic Duplication Warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

Switch to: Consumer Interactions

Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

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