DRUG INTERACTIONS
Drug Interactions
Aminoglutethimide: Aminoglutethimide may lead
to a loss of corticosteroid-induced adrenal suppression.
Amphotericin B injection and potassium-depleting agents: When
corticosteroids are administered concomitantly with potassium-depleting agents
(ie, amphotericin B, diuretics), patients should be observed closely for development
of hypokalemia. There have been cases reported in which concomitant use of
amphotericin B and hydrocortisone was followed by cardiac enlargement and
congestive heart failure.
Antibiotics: Macrolide antibiotics have been reported
to cause a significant decrease in corticosteroid clearance.
Anticholinesterases: Concomitant use of anticholinesterase
agents and corticosteroids may produce severe weakness in patients with myasthenia
gravis. If possible, anticholinesterase agents should be withdrawn at least
24 hours before initiating corticosteroid therapy.
Anticoagulants, oral: Coadministration of corticosteroids
and warfarin usually results in inhibition of response to warfarin, although
there have been some conflicting reports. Therefore, coagulation indices should
be monitored frequently to maintain the desired anticoagulant effect.
Antidiabetics: Because corticosteroids may increase
blood glucose concentrations, dosage adjustments of antidiabetic agents may
be required.
Antitubercular drugs: Serum concentrations of
isoniazid may be decreased.
Cholestyramine: Cholestyramine may increase the
clearance of corticosteroids.
Cyclosporine: Increased activity of both cyclosporine
and corticosteroids may occur when the two are used concurrently. Convulsions
have been reported with this concurrent use.
Digitalis glycosides: Patients on digitalis glycosides
may be at increased risk of arrhythmias due to hypokalemia.
Estrogens, including oral contraceptives: Estrogens
may decrease the hepatic metabolism of certain corticosteroids, thereby increasing
their effect.
Hepatic enzyme inducers (eg, barbiturates, phenytoin, carbamazepine,
rifampin): Drugs which induce hepatic microsomal drug metabolizing
enzyme activity may enhance the metabolism of corticosteroids and require
that the dosage of the corticosteroid be increased.
Ketoconazole: Ketoconazole has been reported to
decrease the metabolism of certain corticosteroids by up to 60%, leading to
an increased risk of corticosteroid side effects.
Nonsteroidal anti-inflammatory drugs (NSAIDs): Concomitant
use of aspirin (or other nonsteroidal anti-inflammatory drugs) and corticosteroids
increases the risk of gastrointestinal side effects. Aspirin should be used
cautiously in conjunction with corticosteroids in hypoprothrombinemia. The
clearance of salicylates may be increased with concurrent use of corticosteroids.
Skin tests: Corticosteroids may suppress reactions
to skin tests.
Vaccines: Patients on prolonged corticosteroid
therapy may exhibit a diminished response to toxoids and live or inactivated
vaccines due to inhibition of antibody response. Corticosteroids may also
potentiate the replication of some organisms contained in live attenuated
vaccines. Routine administration of vaccines or toxoids should be deferred
until corticosteroid therapy is discontinued if possible (see
WARNINGS: Infections: Vaccination).
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