Does excessive fluid intake reduce the effectiveness of Prednisone ?
Posted , 12 users are following.
I’m sure this has been discussed before, but I can’t find it.
I believe Prednisone has a fairly short lifespan in the body - half-life of around 3 to 4 hours.
My question is - if the drug is being absorbed by the system during that period, does drinking large quantities of water, coffee, etc. have any effect on the quantity of pred that is absorbed versus the amount that is “flushed” out ?
I drink a load of coffee and water in the morning and throughout the day (no alcohol ‘cos I take methotrexate !) and living in a warm to hot climate (Southern California), drink water all the time when outside working or walking so as not to dehydrate.
Any medical news on this topic ?
Thanks, Dave
0 likes, 92 replies
ptolemy Dave-California
Posted
dan38655 ptolemy
Posted
I have often wondered how caffeine might affect production of "steroid sparing" cortisol by the adrenals, knowing that caffeine stresses the adrenals.
maid_mariane Dave-California
Posted
I have posted i belive on the usa site quoting an article that stated exactly what you said that prednisone is only in the system about 4 hours. I firmly belive that is why pain comes back later afternoon/evening.
My Rumi has me splitting my dose and until i leveled i split it 3x day to pull me through the night. I know split morning with the majority of the dose with a smaller dose supper and i wake up pain free.
As for coffee i too am a hound and i know it says cut back but would really like to know why. Giving up coffee for me is harder than carbs and booze. Lol
EileenH maid_mariane
Posted
The longer you can have in a day without any pred present in the body, the more your own adrenal glands have to do and the less likely it is they will go into hibernation. The side effects, especially the Cushingoid ones, are due to the prescence of excess pred in the body - so 4 hours of exces balanced by 44 hours of none is better is the theory.
However - since the point of pred is to manage the symptoms there isn't a lot of point not managing them as well as it is possible to do is it?
Dave-California maid_mariane
Posted
Yes - I'm Dave the moderator for the "PMR in the USA" group.
It is appreciated that you are very active providing us all in the new PMR Group with your PMR life findings.
Like you, my rheumatologist has suggested that due to continuous misery that I try dose splitting and I did - but after many attempts, single dose still works best for me.
I originaly thought that the increase in pain may be due to my absorption rate not being quite normal and the distribution effect of the corticosteroid needed to be modified.
My rheumatologist and I thought that the Rayos (Lodotra in Europe) may be appropriate due to the time-release factor of the pill and taking it at night instead of in the morning. Knowing that the normal maximum activity of the adrenal cortex is between 2 am and 8 am and is minimal between 4 pm and midnight, corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity.But the Rayos didn't work for me and I went back to normal prednisone. So my thoughts are that the closer the maximum dose activity can be between 2am and 8am, the more control the prednisone will have. I usully get up at around 6am, somedays at 4:30am to play racquetball, and I find the days of most relief are those when I take the pred early.
Following this with 4-5 cups of strong black coffee during the morning - I seem to be doing fine - 4.5mg with 0.5mg tapers over 2-3 month increments.
No Booze - I'm also on methotrexate.
That's my story - Dave
ptolemy Dave-California
Posted
maid_mariane Dave-California
Posted
Nice to see we are both monitoring both sites. Great info, and for me it's comforting we're not alone.
Sorry splitting didn't work for you but don't you think racketball maybe to hard on your jounts and muscles. From what Eileen and everyone says this is a no no.
If not you give me hope.
Mariane
Dave-California ptolemy
Posted
Anyway, I'm sticking with those little "cheap" white tablets that can be cut into tiny pieces to let me continue with my very slow taper.
Dave
Dave-California maid_mariane
Posted
I go to the club at 4:30am and sit in the hot tub and exercise in the tub for about 15 minutes - do a bit of stretching in the gym before I play and it doesn't seem to have had any bad effects on me for the last two years - so I'm going to keep at it - mentally it is very good.
Dave
EileenH maid_mariane
Posted
Mrs.Mac-Canada Dave-California
Posted
I'm at 8mg reducing to 7.5 very slowly because the little darlings at the orphanage I volunteer at gave me their colds😷.
hugs, Diana🌸
EileenH Dave-California
Posted
EileenH
Posted
"The interactions of diuretics with other drugs is mainly due to the Na-K dynamics which are altered, not only in the nephron, but also in the body. So, hypokalemia (decreased potassium in the body) due to diuretics causes enhanced toxicity of drugs like digitalis. Or for example, aminoglycoside anibiotics(streptomycin, amikacin) should not be used with diuretics because they potentiate their toxic effects on the kidney.
What it basically means is that diuretics have no effect on drugs being excreted by the kidney, unless that excretion is dependant on Na-K dynamics in the kidney (which is very very rare). Or in other words, the half life of the drug is not affected. The half life of the drug reflects the dosage to be given so that a therapuetic concentration is acheived in the body. And the half life changes only if there is some problem with the kidneys in ulrafiltration - say renal failure, where half life changes and so drug dosages change. Even doses of diuretics change."
I've sent you the link - will keep reading though.
EileenH
Posted
And it is a fallacy that you can become dehydrated from drinking coffee - you pee the excess fluid out faster but not to excess. Yes, preferably drink water because it has no stimulants or calories but you CAN include the fluids you drink that are in the form of tea and coffee in your daily fluid count.
Dave-California EileenH
Posted
Thanks for the reference.
What I don’t get is what it is that is acting as the diuretic ? From what I understand a diuretic is any medicine causing increased urination.
So any medicine identified as a diuretic causes the kidney to secrete excess fluid by blocking the re-absorption of either water or electrolytes ?
Does this mean that diuresis is a common side effect of Prednisone ? Not that it is a true diuretic, but many PMR patients do seem to have an increase in urination. I do !
But from what you reference, intake of excess fluids does not seem to have any effect on the half-life of the drug (pred) unless there is a problem with the kidneys in ultrafiltration.
Based on this information, do think that there is any issue taking other drugs such as Valsartan (hydrochlorothiazide) for treating high blood pressure – this is a diuretic.
The ‘world of pills’ is so complicated and it seems that medical professionals don’t go into enough to find out what might be happening or going to happen with this long term pred medication intake.
SO - based on all this - it seems like it doesn't matter how much fluid intake one has, providing the kidneys are functioning correctly, and there shouldn't be any influence on the half-life of the prednisone intake dose - RIGHT !
Dave
EileenH Dave-California
Posted
All diuretic means is "a substance that encourages removal of water from the body" - and in that sense even water causes diuresis! It even says that on bottles of mineral water here in central Europe!
If you drink a lot then your system notices that you are getting "diluted" so to speak and the amount of urine produced increases - simply because the amount you need in the body is carefully regulated by the kidneys. The rest is discarded.