Prenisolone and calcium tablets

Really early on in my PMR journey I read something which indicates pred and calcium adversely affect each other. 

Only really when taken at the same time - having a few hours between solves the problem and is why we say pred for breakfast, calcium for lunch and dinner (or whatever variation fits your regimen) 

Eileen, I have a question related to calcium that I have not seen on here.  On a blood test a couple of months ago, my blood calcium level was 10.1 and was labeled as "high."  Someone, I do not rememver for sure told me to take K2 to help with this.  I stopped taking calcium and D altogether.  I began taking the K2.  My blood work just came back with a blood calcium reading of 11.4.  This can mean a tumor of the parathyroid, or a myriad of other things that are worrisome.  My rheumatologist had insisted that I take 40 mg twice a day of Famotidine (Pepcid) to counter the harsh side effects on the stomach of prednisone.  I have done this dutifully.  My primary told me, and I have confirmed with a Google search, that this can raise the blood calcium level.  He asked me to stop taking it imediately.  I have done this.  I am to have blood work in a month to see if the level has gone down.  I had told the rheumatologist that I always too the prednisone iwth plenty of food, but he still insisted that I take the famotidine.  I am trying to relax, but this is of concern to me.  I have just found out that my heart is enlarged, so don't need anymore "fun" news right now.  Thanks, I appreciate any help you can give me, or anyone else if you have expertise in this area.  Donna

 That's what I meant.  Didn't know this at first.  Don't know why the doctors or pharmacists don't tell us.  Having to take iron twice a day, which also can't be taken with calcium, makes things even more complicated.  Magnesium supplements also shouldn't be taken with calcium.  In fact, it looks like for medications calcium is the bad guy.  I guess it goes back to our evolution from some kind of bony worm, where calcium was what we were built on (still are, if you think about it) and therefore the most important mineral.... 

I'm afraid you will just have to be patient until the various measures have had time to show if they are doing the trick - and that will be apparent from the next blood test I would think. They are monitoring it and have done appropriate measures: stopped the calcium supplement, stopped the medications that can also contribute. If those are ruled out as the cause, the next thing will be to check your parathyroid hormone levels. The most common cause of high calcium (over 99% of cases) is a tumour on the parathyroid glands - but it is very very rarely cancer, they are benign and just produce too much PTH. Tumour does NOT mean cancerous, especially here. It is minor operation. The myriad other things you mention are very unlikely.

This is the reason that blood tests should be carried out regularly on all patients - they are cheap and easy and catch many things early. Do you happen to know what your blood vit D level is? Low vit D and high calcium is almost always due to a parathyroid tumour - nothing else.

So in a month's time do make sure your doctor checks calcium, vit D and parathyroid hormone - he might as well when blood is being taken anyway. 

Have they said why you have an enlarged heart? What treatment are you on? It isn't usually a death sentence these days - and most of us on the forum have something extra. Whether that is anything to do with the PMR is variable - my atrial fibrillation probably is due to damage done to the electrical cells in the heart by the autoimmune disorder. 

But we live in the 21st century - lots of things can be managed well now. I know it is easy for me to say don't worry - but, don't worry for now. YOu can worry if they find something nasty - but that is not very likely!

💕

Hi Eileen,  Thank you so much.  The vitamin D was high a couple of months ago, that was why I stopped it along with the calcium.  I knew that the possibility of a tumor was there, but that they are rarely cancer, so that's okay.  On the enlarged heart, I went to the cardiologist as the rheumatologist was concerned about my murmur which was diagnosed about 7 years ago.  I had Afib in 2003, that has been well regulated with meds.  So, the cardiologist did an EKG on Wednesday.  He looked at that and said, "Your heart is enlarged."  No comment of anythign else, other than making appointmens for me to wear a Holter next week, then an echocardiogram the folloiwng week and an appointment to go over the findings on the 2nd of September.  I looked up enlarged heart and saw "Heart Failure" and decided that I did not need to be reading that right now.  I am relaxing and feeling weel with the PMR.  I am staying active, walking everyday, before the heat hits each day.  LOL  Tomorrow I am going to "play" at Disneyland for two days.  That should get my mind off of things.  I will relax and just take it as it comes.  Thanks so much.  Donna

Thanks!!!

the way I understand is that prednisone causes acid in the stomach and that environment inhibits normal absorption of calcium and other minerals.

I think it is a bit more complicated than that - the stomach environment is ALWAYS acid and in fact the use of PPIs to reduce gastric acid production in any patient also reduces the absorption of calcium and puts patients at risk of osteoporosis - with or without pred. 

It's particularly annoying not to know at the beginning - because that's the time we're on our highest dose of pred, and the time our bones are going to suffer most.  Still, never too late to pick up the pieces!  

Pred at breakfast, Calcium at Lunch - we call it a Golden Rule.

Normally time between B & L is roundabout 3 to 4 hours in my world.

But sometimes it is Brunch, so Calcium gets taken later.

I think two hours is enough, but not sure.  I run into same problem with iron and calcium and would not have enough waking hours in the day to manage three doses of calcium and two of iron (one with pred) with four hours between each....

I leave a couple of hours that is a minimum, ideally it should be three hours.