Pharmacort Drug Interactions

Barbiturates phenytoin, carbamazepine, rifampicin and other drugs that stimulate hepatic metabolism. These drugs may enhance hydrocortisone metabolism, shorten its plasma half-life and lead to decreased effect of hydrocortisone. Increased hydrocortisone dosage may be required.
CYP 3A4 inhibitors such as troleandomycin, ketoconazole and macrolide antibiotics: May increase plasma concentrations of corticosteroids. Ketoconazole decreases the metabolism of certain corticosteroid by up to 60% leading to an increased risk of corticosteroids side effects.
Oral contraceptives and estrogen: Can cause alterations in plasma protein binding and metabolism of corticosteroids which can result in exposure of women to increased levels of the unbound corticosteroids for long periods of time.
Aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs): Concomitant use results in increased risk of gastrointestinal adverse effects. Use aspirin cautiously in conjugation with corticosteroid. The clearance of salicylates may be increased with concomitant use of corticosteroids.
Warfarin: Coadministration of corticosteroids and warfarin usually results in decreased response to warfarin, although there have been conflicting results. Monitor coagulation indices frequently to maintain the desired anticoagulant effect.
Potassium-depleting agents such as diuretics and amphotericin-B: Observe patient closely for the development of hypokalemia. In addition, there have been cases reported in which concomitant use of amphotericin B and hydrocortisone was followed by cardiac enlargement and congestive heart failure.
Anticholinesterase agents: Concomitant use of anticholinesterase agents and corticosteroids may produce severe weakness in patients with myasthenia gravis. If possible, withdraw anticholinesterase agents at least 2 hours before initiating corticosteroids therapy.
Insulin and Oral antidiabetic Agents: Concomitant administration of dexamethasone and insulin generally requires higher doses or insulin. Dosage adjustment of antidiabetic agents may be required because corticosteroids may increase blood glucose concentrations.
Aminoglutethimide: May diminish adrenal suppression of hydrocortisone.
lsoniazid: Serum concentrations of isoniazid may be decreased when used concomitantly.
Cholestyramine: May increase the clearance of hydrocortisone.
Ciclosporin: Increased activity of both ciclosporin and corticosteroids may occur when the two are used concomitantly. Convulsions have been reported with concomitant use.
Digitalis Glycosides: Patients may be at increased risk of arrhythmias due to hypokalemia.
Other interactions: Toxoids and five or inactivated vaccines: Patients on prolonged corticosteroid therapy may exhibit 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. If possible, postpone routine administration of vaccines or toxoids until corticosteroids therapy is discontinued.
Skin tests: Corticosteroids may suppress reactions to skin tests.