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7+ Things To Avoid While Taking Prednisone

7+ Things To Avoid While Taking Prednisone

Are you wondering what to avoid while taking prednisone?

When I took prednisone, I wanted to give it the best chance to work to save my life from bleeding to death.

Watch now!

7+ Things to avoid while on Prednisone

Transcription autogenerated from the video above so some errors are possible

weight: 400;”>Seven things to avoid while taking Prednisone. Hi, I’m Dr. Megan, your prednisone pharmacist. Lots of people ask me, what should I avoid while taking prednisone? Today I’m here to offer seven or more things to avoid while taking prednisone. 

Okay, it’s not really gonna be 7, it’ll be 11, but seven just sounds better, right? The reason I used 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.”

First of all, I’m gonna 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?


The first thing to avoid while taking prednisone is smoking. Since prednisone is causing immunosuppression in 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 and we don’t wanna do that. 

Shot of Alcohol

We want to avoid a shot of alcohol. Alcohol you should avoid while taking prednisone. Alcohol can worsen osteoporosis, and weight gain and it can worsen 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. 


Stimulants like caffeine. This isn’t hard and fast, completely avoid it at all costs guidance. If you are 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 big straight sugar energy drinks while on prednisone. And avoiding caffeine in general is wise. 


Next avoid is shots, except only the live vaccines. There aren’t a lot of vaccines that are live, 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 flu shots that are live may include the MMR shot and chickenpox shot. Most people don’t need to worry about the chickenpox shot.

A related shot to that is for shingles ’cause it’s actually the same virus that’s causing shingles and chicken pox. That’s usually given to 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. 

This is the exact definition from the CDC. They said;

Substantially immunosuppressive steroid dose. So this is the definition of who’s 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.

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.

If somebody is 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 is Zostavax and that’s a live vaccine and you need to avoid that while on prednisone.

But the other one is called Shingrix and it’s a recombinant of the virus and it’s not live. You can get it while on prednisone.

But here’s the deal with all vaccines, the live vaccines you want to avoid and the other ones you can get, but they may not work as well because your immune system is not working like it normally would. You might not have as robust of an immune response as you were hoping for.

You may need to be revaccinated 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-live shots, which is most of them; they are are just fine. 


NSAIDs, which are non-steroidal anti-inflammatory drugs like ibuprofen, which is also known as Motrin or Aleve, which is also known as naproxen. Celecoxib, which is Celebrex.

Those ones you’d want to avoid because it’s actually a drug-drug interaction. They are both affecting similar pathways in your body and it can lead to an increased risk of gastrointestinal bleeding, like bleeding in your gut. So avoid that. 

But it’s not black and white, talk to your doctor about it. And if the benefit of taking both outweighs your risk of having a GI bleed, then that’s something you and your doctor can work out.


Avoid sugar. This is mostly because prednisone is a glucocorticoid. It’s a part of glucose, meaning glucose meaning sugar.

If we are eating simple sugars, candy desserts, all the things you crave while on prednisone, it’s a problem. Because prednisone is interfering with our 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 Which Foods to Avoid While on Prednisone. So check that out if you want to know more.


Another food type to avoid and that’s salt or sodium. Because prednisone is causing us to retain salt. When we’re eating salt, that makes it even harder for our kidneys to get the proper balance of salt and water which can lead to water weight gain. 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. 


Prednisone is mimicking your body’s naturally occurring hormone called cortisol. Cortisol is our stress hormone. It is secreted by your body in times of stress, to get you through those horrible stressful times such as famine or war. When we have extra stress, it’s even more taking a toll on our body. 

Doing what you can to decrease your stress while on 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 sports. I mean extreme sports. Doing normal physical exercise is fine. I’m talking about marathons, Iron Man races, and triathlons. That is very depleting and stressful on your body. 

We want to avoid these because when you take prednisone as a drug, you’re taking 10, 20, or even a hundred 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 causes muscle loss, and issues with the integrity of your skin and bones. You don’t want to put 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 it if you start taking prednisone. And if you 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. Okay? 

Sick People

Avoid sick people while on prednisone. You don’t need to avoid 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 COVID 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.


I’m not saying avoid supplements, I’m saying avoid certain supplements.

What Vitamins Should Not Be Taken With Prednisone?

1. Avoid Aluminum Hydroxide While on Prednisone

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 calcium, but we’re talking about the kind that’s aluminum hydroxide. And that doesn’t mean don’t ever take it totally. 

They did studies and it said some patients have shown as much as a 40% decrease in the prednisone bioavailability when code administered with aluminum magnesium hydroxide. 

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 an ion and it sucks the prednisone in and 40% of it’s just hiding, unavailable to be absorbed and used. The prednisone just goes straight through your gut and you never even get it into your body.

You can take aluminum hydroxide; 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. 

2. Avoid Licorice Root While on Prednisone

Licorice root or the Latin Glycyrrhiza glabra, often an ingredient in adrenal support supplements, should be avoided while on prednisone.

The extract of licorice root 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. Since prednisone is causing 150 or more side effects, you don’t want that. We want the prednisone to fall off normally and not prolong 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. It might even be blocking the prednisone altogether. 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. 

3. St. John’s Wort

St John’s wort is often used for people who have depression and I can totally see that ’cause prednisone often causes depression and anxiety as a side effect. Many other mood changes as well. And so people might be like “I need to know a natural way to help me cope with the mood changes from prednisone.”

The problem is St. John’s war is a, it causes lots of drug interactions and one of those 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 or while on prednisone. 

4. Avoid Calcium Alone While on Prednisone

Avoid calcium alone. Calcium is being depleted by prednisone. When you take prednisone, your body is messing with the calcium system and 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 if you only take the calcium, the calcium isn’t being told where to go. Calcium needs messengers, it needs these signals to tell it to go from the blood into the bone to build bone. 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 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 and the progress of your heart disease. If there’s a lot of calcium deposited here, that’s bad news. We do not want the calcium floating around in the blood. That’s not our goal. 

What needs to be added to Calcium?

Instead, do not take calcium alone. take calcium with vitamin D. They did a study, an analysis of properly conducted trials, concluded that supplementation with vitamin D and calcium was more effective than placebo or calcium alone in protecting against corticosteroid-induced osteoporosis. If you want to protect your bones against osteoporosis, you need at least vitamin D along with calcium.

The doctors who prescribed prednisone the most who are called rheumatologists, came up with a guideline. They recommend a thousand milligrams of calcium and 400 to 800 international units of vitamin D per day in the prevention of osteoporosis. Vitamin D isn’t the only thing you’re gonna need though. You should also have vitamin K2 and magnesium to help drive that calcium into the bone to give those signals.

What’s the best supplement?

And if you’re wondering, what’s the best way to get that? I personally had to take prednisone and I have family members with osteoporosis. I did not want to have those risks. And I felt horrible while I was on prednisone.

All the side effects I was going through, I discovered that if we replenish the nutrients that prednisone depletes, from calcium, vitamin D, and 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. 

Nutranize Zone

I invented a supplement, I call it Nutranize Zone. It’s the first and only supplement for people on prednisone and it gives back all of those nutrients you need. Plus I found other supplement ingredients in here to help counteract other side effects. So just go to Nutranize.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.

  1. Uribe M, Casian C, Rojas S, et al. Decreased bioavailability of prednisone due to antacids in patients with chronic active liver disease and in healthy volunteers. Gastroenterology. 1981;80(4):661-665. [PubMed 7202937]
  2. https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html

Dr. Megan Milne, PharmD, BCACP

Dr. Megan Milne, PharmD, BCACP, is an award-winning clinical pharmacist board certified in the types of conditions people take prednisone for. Dr. Megan had to take prednisone herself for an autoimmune condition so understands what it feels like to suffer prednisone side effects and made it her mission to counteract them as the Prednisone Pharmacist.

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