Prednisone Antacids

In five healthy volunteers and 12 patients with chronic active liver disease, antacids containing aluminium hydroxide and magnesium hydroxide significantly reduced the and AUC of prednisone when administered with antacids. The systemic availability was reduced by up to 43% (93). 

Uribe M, Casian C, Rojas S, Sierra JG, Go VL. Decreased bioavailability of prednisone due to antacids in patients with chronic active liver disease and in healthy volunteers. Gastroenterology 1981 80(4) 661-5. 

Clinically important, potentially hazardous interactions with alfuzosin, alprazolam, amphotericin B, anisindione, antacids, aprepitant, astemizole, atorvastatin, bosentan, ciclesonide, cimetidine, clorazepate, conivaptan, cyproterone, dasatinib, dexamethasone, dicumarol, didanosine, eplerenone, erythromycin, ethotoin, fentanyl, fesoterodine, fosamprenavir, fosphenytoin, grapefruit juice, HMG-CoA reductase inhibitors, imatinib, ixabepilone, lapatinib, lopinavir, lovastatin, mephenytoin, methylprednisolone, micafungin, midazolam, nilotinib, pimozide, prednisolone, prednisone, quinidine, rifampin, rimonabant, rivaroxaban, sildenafil, silodosin, simvastatin, sirolimus, solifenacin, temsirolimus, terfenadine, tolvaptan, triazolam, vardenafil, vinblastine, vincristine, warfarin... 

Clinically important, potentially hazardous interactions with amiodarone, amprenavir, anisindione, antacids, anticoagulants, aprepitant, atazanavir, atovaquone, beclomethasone, buprenorphine, corticosteroids, cortisone, cyclosporine, cyproterone, dabigatran, dapsone, darunavir, delavirdine, dexamethasone, dicumarol, digoxin, eszopiclone, flunisolide, fosamprenavir, gadoxetate, gestrinone, halothane, imatinib, isoniazid, itraconazole, ketoconazole, lapatinib, lorcainide, methylprednisolone, midazolam, nelfinavir, nifedipine, oral contraceptives, phenylbutazone, prednisone, protease inhibitors, pyrazinamide, ramelteon, ritonavir, saquinavir, solifenacin, sunitinib, tacrolimus, telithromycin, temsirolimus, tipranavir, tolvaptan, trabectedin, triamcinolone, triazolam, voriconazole, warfarin, zaleplon... 

It seems desirable to administer prednisone and prednisolone in conjunction with nonabsorbable antacids. This affords improvement of long-term therapy. It appears that the therapeutic indices of these two analogues, especially when used in conjunction with nonabsorbable antacids, are higher than those for the naturally occurring glucocorticoids. 

The absorption of prednisone, and probably prednisolone, can be reduced by lai e but not small doses of aluminium/magnesium hydroxide antacids. Dexamethasone absorption is reduced by magnesium trisilicate. 

Tanner AR, Caffm JA, Halliday JW, Powell LW. Concurrent administration of antacids and prednisone effect on serum levels of prednisolone. BrJ Clin Pharmacol (1979) 7,397-400. 

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