From the Guidelines
Prednisone can be taken while fasting, but it is recommended to take it with food to minimize stomach irritation and gastrointestinal side effects. When considering the administration of prednisone, it's essential to weigh the benefits and risks, particularly in terms of morbidity, mortality, and quality of life. According to the most recent and highest quality study, 1, taking prednisone with food, such as a low-fat breakfast, can be beneficial. This study suggests that food impacts absorption unpredictably, and side effects should be monitored, with standard dosing (on an empty stomach) used if excess toxicity is observed on modified dosing (with food). Some key points to consider when taking prednisone include:
- Taking it with a small snack or meal, particularly in the morning with breakfast, to align with the body's natural cortisol rhythm
- Monitoring for side effects, such as stomach discomfort, nausea, or heartburn, especially when taking it on an empty stomach
- Consulting a healthcare provider about the optimal timing for prednisone dose if on a specific fasting regimen for medical or religious reasons
- Being aware that food creates a buffer in the stomach, protecting the stomach lining from the irritating effects of prednisone, which can increase stomach acid production and reduce the protective mucus layer in the digestive tract. Overall, while prednisone can be taken while fasting, taking it with food is generally recommended to reduce the risk of gastrointestinal side effects and improve quality of life, as supported by the study 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Gastric irritation may be reduced if taken before, during, or immediately after meals or with food or milk. The answer is no, it is not recommended to take prednisone fasted, as gastric irritation may be reduced if taken with food or milk. 2
From the Research
Administration of Prednisone
- There is no direct evidence to suggest that prednisone should be taken with food or on an empty stomach 3, 4, 5, 6.
- However, studies have shown that taking antacids with prednisone can help reduce digestive disturbances, such as indigestion and heartburn 4.
- One study found that taking prednisone with antacids reduced the incidence of digestive complaints from 38% to 17% 4.
- Another study found that prednisone increased esophageal acid contact times in patients with stable asthma, which could potentially lead to gastrointestinal side effects 6.
Gastrointestinal Side Effects
- Gastrointestinal side effects, such as peptic ulcer disease and gastrointestinal bleeding, are potential risks associated with corticosteroid use, including prednisone 3.
- A study found that the incidence of active peptic ulcers was lower in patients taking prednisone with antacids compared to those taking prednisone without antacids 4.
- However, the exact mechanism by which prednisone increases esophageal acid contact times is unclear 6.
Management of Side Effects
- Management of gastrointestinal side effects associated with prednisone use may involve the use of antacids or other medications to reduce symptoms 4.
- In some cases, patients may experience nausea and vomiting while taking prednisone, and management of these symptoms may involve the use of antiemetic medications or other therapies 7.