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Hepatic microsomal enzyme inducers: Drug e.g., barbiturates, phenytoin and rifampicin which induce hepatic enzymes may increase glucocorticoid metabolism and may require dosage adjustment or the drugs not given concomitantly.
Non-steroidal anti-inflammatory drugs (NSAIDs): Concomitant administration with ulcerogenic drugs e.g., indomethacin may increase risk of gastrointestinal tract ulceration. Concomitant use with NSAIDs or other anti-rheumatics may result in gastrointestinal risk, gastrointestinal bleeding. Aspirin should be given cautiously to patients with hypoprothrombinaemia. Although concomitant administration with salicylate does not appear to increase the incidence of gastrointestinal ulceration, the possibility of this effect should be considered.
Potassium-depleting drugs: Potassium-depleting diuretics (e.g., thiazides, furosemide, ethacrynic acid) and other drugs that deplete potassium.
Anti-cholinesterase agents: Interaction between glucocorticoid and anti-cholinesterase agents e.g., ambenonium, neostigmine or pyridostigmine can produce weakness in patients with myasthenia gravis. If possible, anticholinesterase treatment should be discontinued at least 24 hours before initiation of glucocorticoid therapy.
Vaccines and toxoids: Because glucocorticoids may inhibit antibody response, this drug may cause reduction responses to toxoids and live or inactivated vaccines. Patients should not receive small-pox vaccination or other immune vaccines especially in large doses while on corticosteroid therapy.
