Calcium and Vitamin D —Helpful Interactions | Aloe and Licorice (Topical) —Possible Supportive Interactions With Topical Steroids | Creatine —Possible Helpful Interaction | DHEA (Dehydroepiandrosterone) —Possible Helpful Interaction | Chromium —Supplementation Possibly Helpful | Ipriflavone —Possible Harmful Interaction | Licorice (Internal) —Possible Harmful Interaction
Corticosteroid drugs (also known as glucocorticoids) act like the naturally occurring adrenal hormone cortisone in the body. They are strong anti-inflammatory and immune-suppressant medications used in many inflammatory and autoimmune conditions, such as rheumatoid arthritis, asthma, inflammatory bowel disease, and systemic lupus erythematosus. Corticosteroids are also prescribed to suppress transplant rejection.
Drugs in this family include:
One of the most serious side effects of long-term corticosteroid use is accelerated osteoporosis. Although we don't fully understand how this works, corticosteroid interference with calcium and vitamin D is known to play a major role.
Calcium and vitamin D supplements are definitely beneficial for fighting ordinary osteoporosis; in addition, there is good evidence that they also protect against osteoporosis brought on by corticosteroids.1 A review of 5 trials enrolling a total of 274 participants found that calcium and vitamin D supplementation significantly prevented bone loss at the lumbar spine and forearm in corticosteroid-treated individuals.2 For example, in a 2-year double-blind placebo-controlled study of 130 individuals, supplementation with 1,000 mg of calcium and 500 IU of vitamin D daily actually reversed steroid-induced bone loss, causing a net bone gain.3
Possible Supportive Interactions with Topical Corticosteroids
Possible Helpful Interaction
There are theoretical reasons (but little direct evidence) to believe that individuals taking corticosteroids, such as prednisone, might be protected from some side effects by taking DHEA at the same time.9,10
Supplementation Possibly Helpful
Long-term, high-dose corticosteroid treatment can cause diabetes. This may be at least partly caused by chromium deficiency. A very preliminary study found treatment with corticosteroids caused increased loss of chromium in the urine.11 Another preliminary study found that individuals with corticosteroid-induced diabetes could improve blood sugar control by taking chromium supplements.12
Possible Helpful Interaction
Long-term use of corticosteroids, whether orally, or possibly, by inhalation, can slow a child’s growth. One animal study suggests that use of the supplement creatine may help prevent this side effect.15
Possible Harmful Interaction
The supplement ipriflavone is used to treat osteoporosis. A 3-year, double-blind trial of almost 500 women, as well as a small study, found worrisome evidence that ipriflavone can reduce white blood cell count in some people.13,14 For this reason, anyone taking medications that suppress the immune system should avoid using ipriflavone except under physician supervision.
Possible Harmful Interaction
When taken by mouth, the herb licorice appears to enhance some actions of oral corticosteroids, but interfere with others.6-8 Because of the unpredictable nature of this interaction, individuals using oral corticosteroids should avoid licorice.
1. Reid IR and Ibbertson HK. Calcium supplements in the prevention of steroid-induced osteoporosis. Am J Clin Nutr. 1986;44:287-290.
2. Homik J, Suarez-Almazor ME, Shea B, et al. Calcium and vitamin D for corticosteroid-induced osteoporosis. Cochrane Database Syst Rev. 1998;(1). DOI: 10.1002/14651858.CD000952.
3. Buckley LM, Leib ES, Cartularo KS, et al. Calcium and vitamin D 3 supplementation prevents bone loss in the spine secondary to low-dose corticosteroids in patients with rheumatoid arthritis. A randomized, double-blind, placebo-controlled trial. Ann Intern Med. 125: 961-968, 1996.
4. Davis RH, Parker WL, and Murdoch DP. Aloe vera as a biologically active vehicle for hydrocortisone acetate. J Am Podiatric Med Assoc. 1991;81:1-9.
5. Teelucksingh S, Mackie ADR, Burt D, et al. Potentiation of hydrocortisone activity in skin by glycyrrhetinic acid. Lancet. 1990;335:1060-1063.
6. Tamura Y, Nishikawa T, Yamada K, et al. Effects of glycyrrhetinic acid and its derivatives on delta-4-5-alpha- and 5-beta-reductase in rat liver. Arzneimittelforschung. 1979;29:647-649.
7. Chen MF, Shimada F, Kato H, et al. Effect of glycyrrhizin on the pharmacokinetics of prednisolone following low dosage of prednisolone hemisuccinate. Endocrinol Jpn. 1190;37:331-341.
8. Kumagai A, Nanaboshi M, Asanuma Y, et al. Effects of glycyrrhizin on thymolytic and immunosuppressive action of cortisone. Endocrinol Jpn. 1967;14:39-42.
9. Robinzon B and Cutulo M. Should dehydroepiandrosterone replacement therapy be provided with glucocorticoids? Rheumatology. 1999;38:488-495.
10. van Vollenhoven RF, Park JL, Genovese MC, et al. A double-blind, placebo-controlled, clinical trial of dehydroepianodrosterone in severe systemic lupus erythematosus. Lupus. 1999;8:181-187.
11. Ravina A, Slezak L, Mirsky N, et al. Reversal of corticosteroid-induced diabetes mellitis with supplemental chromium. Diabet Med. 1999;16:164-167.
12. Ravina A, Slezak L, Mirsky N, et al. Control of steroid-induced diabetes with supplemental chromium. J Trace Elem Exp Med. 1999;12:375-378.
13. Agnusdei D and Bufalino L. Efficacy of ipriflavone in established osteoporosis and long-term safety. Calcif Tissue Int. 1997;61(suppl 1):S23-S27.
14. Alexandersen P, Toussaint A, Christiansen C, et al. Ipriflavone in the treatment of postmenopausal osteoporosis: a randomized controlled trial. JAMA. 2001;285:1482-1488.
15. Roy BD, Bourgeois JM, Mahoney DJ, et al. Dietary supplementation with creatine monohydrate prevents corticosteroid-induced attenuation of growth in young rats. Can J Physiol Pharmacol. 2002;80:1008-1014.
Last reviewed December 2015 by EBSCO CAM Review Board
Last Updated: 12/15/2015
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