One of the things my professors drilled into me in pharmacy school is that prednisone MUST be taken with food.

So when I was prescribed prednisone, I made sure I always had a bite to eat with prednisone.

Imagine my surprise when I became the Prednisone Pharmacist and studied the scientific literature and discovered that maybe that tip wasn’t exactly necessary. Maybe it was more of a myth…

Instead of food being the culprit, science has shown that maybe it’s a drug interaction with an over-the-counter (OTC) medication. The study said:

“Persons concurrently receiving corticosteroids [prednisone] and [the OTC drug] had a risk for peptic ulcer disease that was 15 times greater than that of nonusers of either drug.”

Piper, et al. PMID: 2012355

That means your risk of ulcers is 15 times more likely if you’re taking prednisone with this OTC medication.

Watch my new video to find out which over-the-counter medications you need to avoid while on prednisone.

Plus I include a bonus of 3+ over-the-counter meds you might need to take because of side effects of prednisone.

Watch 3+ Over the Counter Meds to Avoid While on Prednisone now!

3+ Over-the-Counter Medications to Avoid while on Prednisone

1. Ibuprofen
2. Naproxen
3. Aspirin

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) such as ibuprofen (Advil, Motrin), and naproxen (Aleve) are commonly used to relieve pain and reduce inflammation. However, when taken with prednisone, these medications can increase the risk of stomach ulcers and gastrointestinal bleeding. Prednisone already has the potential to cause stomach irritation and ulcers, so adding NSAIDs to the mix can further exacerbate these issues.

The combination can increase the risk of peptic ulcers between 4 to 15 times compared to people who never took either prednisone or NSAIDs.

Aspirin can also increase the risk of gastrointestinal bleeding, though it’s not an NSAID; it’s a salicylate.

One study shows that it might be because prednisone delays the healing of ulcers in the gut by how it affects the COX-1 enzyme.

3+ Over the Counter Medications You May Need While on Prednisone

1. Tylenol
2. Antacids like calcium carbonate (Tums)
3. Proton Pump Inhibitors (PPIs) like omeprazole (Prilosec)

Pain while on Prednisone?

If you’re having pain like a headache while on prednisone, you may be wondering what you can take now that you know you can’t take ibuprofen. While some over-the-counter medications are best avoided while taking prednisone, there are still options available for managing pain and other symptoms.

Acetaminophen (Tylenol) is generally considered safe to take with prednisone, as it does not have the same potential for stomach irritation as NSAIDs. You can try acetaminophen (Tylenol) to help with occasional pain and fevers while on prednisone. Be sure to limit it to a maximum of 4000 mg per day.

Stomach upset while on Prednisone?

Antacids like calcium carbonate (similar to Tums) are often used to relieve heartburn and indigestion. Plus it has calcium in it and everyone on prednisone should be taking calcium.

Omeprazole (Prilosec) and other drugs in its class, the proton pump inhibitors, or PPIs, treat heartburn as well. The combination of PPIs and prednisone with the drugs to avoid above may protect the gut lining from the damage. (see Koomanan, et al). So if you take prednisone AND NSAIDs, you also need to take a PPI like omeprazole.

It is crucial to consult with your healthcare provider before taking any over-the-counter medications while on prednisone. Your doctor can provide guidance on which medications are safe to take and which ones should be avoided. Additionally, they can recommend alternative treatments or adjustments to your medication regimen to ensure your health and safety.

If you’re wondering what else you need to avoid while on prednisone, you should download my free list. It includes everything from A-Z of drugs, herbs, shots, and foods you need to avoid while on prednisone. Just fill out the form below to get my FREE list:

Key Takeaways

1. Avoid combining prednisone with ibuprofen, naproxen, Meloxicam, Celebrex, and aspirin to prevent gastrointestinal problems and potential ulcers and bleeding.
2. Acetaminophen, antacids with calcium carbonate, and omeprazole can help counteract prednisone side effects and alleviate stomach upset caused by the combination of prednisone and NSAIDs.
3. Consult with a doctor before combining prednisone with any NSAID to ensure safety and effectiveness.
4. Adhere to the maximum daily dose of 4,000 milligrams of acetaminophen and check for acetaminophen in other medications to avoid exceeding the limit.
5. Download the list of other things to avoid while on prednisone provided by Dr. Megan for comprehensive guidance on safe and effective use of prednisone.

References:

1. Piper JM, Ray WA, Daugherty JR, Griffin MR. Corticosteroid use and peptic ulcer disease: role of nonsteroidal anti-inflammatory drugs. Ann Intern Med. 1991;114(9):735-40. PMID: 2012355.
2. Koomanan N, Ko Y, Yong WP, et al. Clinical Impact of Drug–Drug Interaction Between Aspirin and Prednisolone at a Cancer Center. Clin Thera. 2012;34(12):2259-2267.
3. Luo JC, Shin VY, Liu ESL, et al. Dexamethasone delays ulcer healing by inhibition of angiogenesis in rat stomachs. Eur J Pharmacology; 2004;485(1–3): 275-281. doi.org/10.1016/j.ejphar.2003.11.038.