However, the response to such vaccines cannot be predicted. Immunization procedures may be undertaken in patients who are receiving corticosteroids as replacement therapy, e. Viral Infections Chickenpox and measles can have a more serious or even fatal course in pediatric and adult patients on corticosteroids.
In pediatric and adult patients who have not had these diseases, particular care should be taken to avoid exposure. If exposed to chickenpox, prophylaxis with varicella zoster immune globulin VZIG may be indicated. If exposed to measles, prophylaxis with immune globulin IG may be indicated.
If chickenpox develops, treatment with antiviral agents should be considered. Ophthalmic Use of corticosteroids may produce posterior subcapsular cataracts, glaucoma with possible damage to the optic nerves, and may enhance the establishment of secondary ocular infections due to bacteria, fungi, or viruses. The use of oral corticosteroids is not recommended in the treatment of optic neuritis and may lead to an increase in the risk of new episodes. Corticosteroids should not be used in active ocular herpes simplex.
W hen reduction in dosage is possible, the reduction should be gradual. Discontinuation of corticosteroids may result in clinical improvement. Cardio-Renal As sodium retention with resultant edema and potassium loss may occur in patients receiving corticosteroids, these agents should be used with caution in patients with congestive heart failure, hypertension , or renal insufficiency.
Endocrine Drug-induced secondary adrenocortical insufficiency may be minimized by gradual reduction of dosage. Gastrointestinal Steroids should be used with caution in active or latent peptic ulcers, diverticulitis , fresh intestinal anastomoses, and nonspecific ulcerative colitis , since they may increase the risk of a perforation. Signs of peritoneal irritation following gastrointestinal perforation in patients receiving corticosteroids may be minimal or absent.
There is an enhanced effect due to decreased metabolism of corticosteroids in patients with cirrhosis. Musculoskeletal Corticosteroids decrease bone formation and increase bone resorption both through their effect on calcium regulation i. This, together with a decrease in the protein matrix of the bone secondary to an increase in protein catabolism, and reduced sex hormone production, may lead to inhibition of bone growth in pediatric patients and the development of osteoporosis at any age.
Special consideration should be given to patients at increased risk of osteoporosis e. Dexamethasone is a substrate and moderate inducer of CYP3A and a substrate of the P-glycoprotein P-gp drug transporter. Although induction of dexamethasone through the CYP3A pathway may lead to decreased drug efficacy, the net effect of lumacaftor; ivacaftor on P-gp transport is not clear.
Monitor the patient for decreased corticosteroid efficacy or increased or prolonged therapeutic effects and adverse events. Additionally, ivacaftor exposure could theoretically be further decreased when given with another CYP3A inducer; however, ivacaftor; lumacaftor dosage adjustments are not recommended with concomitant use of a moderate CYP3A inducer such as dexamethasone. Moderate Because lurasidone is primarily metabolized by CYP3A4, decreased plasma concentrations of lurasidone may occur when the drug is co-administered with inducers of CYP3A4.
Decreased plasma concentrations of lurasidone may lead to a decrease in efficacy of lurasidone. If lurasidone is used with a moderate CYP3A4 inducer, it may be necessary to increase the lurasidone dose after chronic treatment 7 days or more.
Moderate Use caution if coadministration of maraviroc with dexamethasone is necessary, due to a possible decrease in maraviroc exposure. Monitor for a decrease in maraviroc efficacy with concomitant use. Moderate Additional monitoring may be required when coadministering systemic or inhaled corticosteroids and mecasermin, recombinant, rh-IGF In animal studies, corticosteroids impair the growth-stimulating effects of growth hormone GH through interference with the physiological stimulation of epiphyseal chondrocyte proliferation exerted by GH and IGF Dexamethasone administration on long bone tissue in vitro resulted in a decrease of local synthesis of IGF Similar counteractive effects are expected in humans.
If systemic or inhaled glucocorticoid therapy is required, the steroid dose should be carefully adjusted and growth rate monitored. Dexamethasone is an inducer of CYP3A4, and may increase the metabolism of mefloquine and reduce mefloquine plasma concentrations if coadministered. Moderate Drugs which may cause hyperglycemia, including corticosteroids, may cause temporary loss of glycemic control.
Minor Anticholinergics, such as mepenzolate, antagonize the effects of antiglaucoma agents. Mepenzolate is contraindicated in patients with glaucoma and therefore should not be coadministered with medications being prescribed for the treatment of glaucoma.
In addition, anticholinergic drugs taken concurrently with corticosteroids in the presence of increased intraocular pressure may be hazardous. Moderate Corticosteroids may increase the risk of hypokalemia if used concurrently with methazolamide. Methenamine; Sodium Acid Phosphate: Severe Medications which affect pituitary or adrenocortical function, including all corticosteroid therapy, should be discontinued prior to and during testing with metyrapone.
Patients taking inadvertent doses of corticosteroids on the test day may exhibit abnormally high basal plasma cortisol levels and a decreased response to the test. Although systemic absorption of ocular, inhaled and topical corticosteroids is minimal, temporary discontinuation of these products should be considered if possible to reduce the potential for interference with the test results.
Moderate Leukopenia, neutropenia, anemia, and thrombocytopenia have been associated with micafungin. Patients who are taking immunosuppressives such as the corticosteroids with micafungin concomitantly may have additive risks for infection or other side effects.
In a pharmacokinetic trial, micafungin had no effect on the pharmacokinetics of prednisolone. Acute intravascular hemolysis and hemoglobinuria was seen in a healthy volunteer during infusion of micafungin mg and oral prednisolone 20 mg. This reaction was transient, and the subject did not develop significant anemia. Major Mifepristone Mifeprex is contraindicated in patients on long-term corticosteroid therapy and Korlym is contraindicated in patients who require concomitant treatment with systemic corticosteroids for serious medical conditions or illnesses e.
Mifepristone, RU Mifeprex and Mifepristone Korlym both exhibit antiglucocorticoid activity that may antagonize corticosteroids.
A mifepristone dose of 4. Major Use caution if mitotane and dexamethasone are used concomitantly, and monitor for decreased efficacy of dexamethasone and a possible change in dosage requirements. Mitotane is a strong CYP3A4 inducer and dexamethasone is a CYP3A4 substrate; coadministration may result in decreased plasma concentrations of dexamethasone. Minor Drugs that exhibit significant induction of the hepatic microsomal CYP3A4 isoenzyme, such as dexamethasone, may potentially increase the metabolism of modafinil.
Decreased serum levels of modafinil could potentially result in decreased efficacy of modafinil. While therapy is designed to take advantage of this effect, patients may be predisposed to over-immunosuppression resulting in an increased risk for the development of severe infections. Close clinical monitoring is advised with concurrent use; in the presence of serious infections, continuation of the corticosteroid or immunosuppressive agent may be necessary but should be accompanied by appropriate antimicrobial therapies as indicated.
Major Ordinarily, patients receiving chronic immunosuppressant therapy should not be treated with natalizumab. Treatment recommendations for combined corticosteroid therapy are dependent on the underlying indication for natalizumab therapy. Corticosteroids should be tapered in those patients with Crohn's disease who are on chronic corticosteroids when they start natalizumab therapy, as soon as a therapeutic benefit has occurred.
If the patient cannot discontinue systemic corticosteroids within 6 months, discontinue natalizumab. The concomitant use of natalizumab and corticosteroids may further increase the risk of serious infections, including progressive multifocal leukoencephalopathy, over the risk observed with use of natalizumab alone. In multiple sclerosis MS clinical trials, an increase in infections was seen in patients concurrently receiving short courses of corticosteroids.
However, the increase in infections in natalizumab-treated patients who received steroids was similar to the increase in placebo-treated patients who received steroids.
Short courses of steroid use during natalizumab, such as when they are needed for MS relapse treatment, appear to be acceptable for use concurrently.
Major Avoid concomitant use of dexamethasone with neratinib due to decreased efficacy of neratinib. Because of the significant impact on neratinib exposure from strong CYP3A4 induction, the potential impact on neratinib efficacy from concomitant use with moderate CYP3A4 inducers should be considered as they may also significantly decrease neratinib exposure.
Moderate Netupitant is a moderate inhibitor of CYP3A4 and should be used with caution in patients receiving concomitant medications that are primarily metabolized through CYP3A4, such as dexamethasone. The plasma concentrations of CYP3A4 substrates can increase when co-administered with netupitant. The inhibitory effect on CYP3A4 can last for multiple days.
A two-fold increase in the systemic exposure of dexamethasone was observed 4 days after single dose of netupitant. The duration of the effect was not studied beyond 4 days. If coadministration is necessary, decrease the dose of dexamethasone. Decreased nilotinib concentrations are likely and increased dexamethasone levels may occur.
Selecting an alternate agent with less potential for CYP3A4 induction is recommended. If use of both of these agents is required, increasing the nilotinib dosage will most likely not account for the loss of exposure based on the nonlinear pharmacokinetics of nilotinib. Coadministration of nintedanib with CYP3A4 inducers such as dexamethasone should be avoided as these drugs may decrease exposure to nintedanib and compromise its efficacy.
Moderate Although some patients may need to be given corticosteroids and NSAIDs concomitantly, which can be done successfully for short periods of time without sequelae, prolonged concomitant administration should be avoided. Corticosteroids can have profound effects on sodium-potassium balance; NSAIDs also can affect sodium and fluid balance.
Monitor serum potassium concentrations; potassium supplementation may be necessary. In addition, NSAIDs may mask fever, pain, swelling and other signs and symptoms of an infection; use NSAIDs with caution in patients receiving immunosuppressant dosages of corticosteroids. The Beers criteria recommends that this drug combination be avoided in older adults; if coadministration cannot be avoided, provide gastrointestinal protection.
Moderate Ocrelizumab has not been studied in combination with other immunosuppressive or immune modulating therapies used for the treatment of multiple sclerosis, including immunosuppressant doses of corticosteroids. Concomitant use of ocrelizumab with any of these therapies may increase the risk of immunosuppression.
Monitor patients carefully for signs and symptoms of infection. Major Avoid the coadministration of olaparib with dexamethasone due to decreased olaparib exposure; if concomitant use is unavoidable, there is a potential for decreased efficacy of olaparib. Plasma concentrations and efficacy of dexamethasone may be reduced if these drugs are administered concurrently. Dosages of dexamethasone may require adjustment if oritavancin is initiated or withdrawn during dexamethasone therapy.
Moderate Concomitant use of oxymetholone with corticosteroids or corticotropin, ACTH may cause increased edema. Major Use caution and monitor patients for decreased palbociclib efficacy if dexamethasone is used concomitantly with palbociclib. Major Avoid administering pazopanib in patients who require chronic treatment with a strong CYP3A4 inducer, such as dexamethasone.
Moderate Concomitant use of pegaspargase with corticosteroids can result in additive hyperglycemia. Moderate Additive myelosuppressive effects may be seen when alpha interferons are given concurrently with other myelosuppressive agents, such as antineoplastic agents or immunosuppressives.
Major Agents such as immunosuppressives have adverse reactions similar to those of penicillamine. Concomitant use of penicillamine with these agents is contraindicated because of the increased risk of developing severe hematologic and renal toxicity. Major Start perampanel at a higher initial dose of 4 mg once daily at bedtime when using concurrently with dexamethasone due to a potential reduction in perampanel plasma concentration. If introduction or withdrawal of dexamethasone occurs during perampanel therapy, closely monitor patient response; a dosage adjustment may be necessary.
Minor Corticosteroids administered systemically prior to or concomitantly with photosensitizing agents may decrease the efficacy of photodynamic therapy. Minor Corticosteroids may interact with cholinesterase inhibitors, occasionally causing severe muscle weakness in patients with myasthenia gravis. Moderate Pimozide is associated with a well-established risk of QT prolongation and torsade de pointes TdP.
Use of pimozide and medications known to cause electrolyte imbalance may increase the risk of QT prolongation. Therefore, caution is advisable during concurrent use of pimozide and corticosteroids. According to the manufacturer, potassium deficiencies should be correctly prior to treatment with pimozide and normalized potassium levels should be maintained during treatment.
Moderate Posaconazole and dexamethasone should be coadministered with caution due to an increased potential for adverse events. Posaconazole is a potent inhibitor of CYP3A4, an isoenzyme partially responsible for the metabolism of dexamethasone. Further, both dexamethasone and posaconazole are substrates of the drug efflux protein, P-glycoprotein, which when administered together may increase the absorption or decrease the clearance of the other drug.
This complex interaction may cause alterations in the plasma concentrations of both posaconazole and dexamethasone, ultimately resulting in an increased risk of adverse events. Potassium Phosphate; Sodium Phosphate: Moderate Corticotropin can cause alterations in serum potassium levels. The use of potassium salts or supplements would be expected to alter the effects of corticotropin on serum potassium levels.
Therefore, magnesium sulfate; potassium sulfate; sodium sulfate should be administered with caution during concurrent use of medications that lower the seizure threshold such as systemic corticosteroids. Minor The manufacturer of spironolactone lists corticosteroids as a potential drug that interacts with spironolactone. Intensified electrolyte depletion, particularly hypokalemia, may occur.
However, potassium-sparing diuretics such as spironolactone do not induce hypokalemia. In fact, hypokalemia is one of the indications for potassium-sparing diuretic therapy. Therefore, drugs that induce potassium loss, such as corticosteroids, could counter the hyperkalemic effects of potassium-sparing diuretics.
Moderate Drugs that induce hepatic metabolism via the microsomal CYP enzyme system decrease the bioavailability of praziquantel.
Minor Concurrent use of purine analogs with other agents which cause bone marrow or immune suppression such as other antineoplastic agents or immunosuppressives may result in additive effects. Major QT prolongation has occurred during concurrent use of quetiapine and medications known to cause electrolyte imbalance.
Therefore, caution is advisable during concurrent use of quetiapine and corticosteroids. Moderate Quinolones have been associated with an increased risk of tendon rupture requiring surgical repair or resulting in prolonged disability; this risk is further increased in those receiving concomitant corticosteroids.
Discontinue quinolone therapy at the first sign of tendon inflammation or tendon pain, as these are symptoms that may precede rupture of the tendon. Moderate Use caution if coadministration of ribociclib with dexamethasone is necessary, as the systemic exposure of dexamethasone may be increased resulting in increase in treatment-related adverse reactions.
Exposure to ribociclib may also decrease, resulting in decreased efficacy. Moderate Patients receiving immunosuppressives along with rilonacept may be at a greater risk of developing an infection. Major Ritodrine has caused maternal pulmonary edema, which appears more often in patients treated concomitantly with corticosteroids. Patients so treated should be closely monitored in the hospital. Moderate Rituximab and corticosteroids are commonly used together; however, monitor the patient for immunosuppression and signs and symptoms of infection during combined chronic therapy.
Minor Coadministration of rivaroxaban and dexamethasone may result in decreased rivaroxaban exposure and may decrease the efficacy of rivaroxaban. If these drugs are administered concurrently, monitor the patient for signs of lack of efficacy of rivaroxaban. Major Coadminister dexamethasone and roflumilast cautiously as this may lead to reduced systemic exposure to roflumilast. In pharmacokinetic study, administration of a single dose of roflumilast in patients receiving another CYP3A4 inducer, rifampin, resulted in decreased roflumilast Cmax and AUC, as well as increased Cmax and decreased AUC of the active metabolite roflumilast N-oxide.
Major The concomitant use of romidepsin, a CYP3A4 substrate, and dexamethasone, a strong CYP3A4 inducer, may result in significantly altered romidepsin plasma exposure. Therefore, avoid using romidepsin with potent CYP3A4 inducers if possible.
Rubella Virus Vaccine Live: When used with drugs that are CYP3A4 inducers such as dexamethasone, a dose adjustment is not necessary, but closely monitor patients and titrate the ruxolitinib dose based on safety and efficacy. Moderate Caution is advised with the concomitant use of sapropterin and dexamethasone as coadministration may result in increased systemic exposure of dexamethasone.
Dexamethasone is a substrate for the drug transporter P-glycoprotein P-gp ; in vitro data show that sapropterin may inhibit P-gp. If these drugs are used together, closely monitor for increased side effects of dexamethasone. Major Avoid concurrent administration of dexamethasone and saquinavir boosted with ritonavir.
Dexamethasone is may induce the CYP3A4 metabolism of saquinavir, resulting in reduced saquinavir plasma concentrations. Decreased saquinavir plasma concentrations could lead to HIV treatment failures or the development of viral-resistance.
If used concomitantly, the patient should be observed for changes in the clinical efficacy and concentrations of the antiretroviral regimen. It can be expected that concomitant administration of sildenafil with CYP3A4 enzyme inducers like dexamethasone will decrease plasma concentrations of sildenafil.
Major Avoid concurrent use of simeprevir and systemic dexamethasone. Induction of CYP3A4 by dexamethasone may reduce the plasma concentrations of simeprevir, resulting in treatment failure.
Major Concomitant use of sipuleucel-T and immunosuppressives should be avoided. Concurrent administration of immunosuppressives with the leukapheresis procedure that occurs prior to sipuleucel-T infusion has not been studied. Sipuleucel-T stimulates the immune system and patients receiving immunosuppressives may have a diminished response to sipuleucel-T. When appropriate, consider discontinuing or reducing the dose of immunosuppressives prior to initiating therapy with sipuleucel-T.
Sirolimus is extensively metabolized by CYP3A4 in the gut and liver. Concurrent use of sirolimus with dexamethasone may decrease patient exposure to sirolimus. Consider alternative steroid therapy. Use sirolimus and dexamethasone with caution, if at all, and monitor patients closely. Smallpox Vaccine, Vaccinia Vaccine: Sodium Benzoate; Sodium Phenylacetate: Moderate Corticosteroids may cause protein breakdown, which could lead to elevated blood ammonia concentrations, especially in patients with an impaired ability to form urea.
Corticosteroids should be used with caution in patients receiving treatment for hyperammonemia. Moderate The concurrent use of corticosteroids with sodium phenylbutyrate may increase plasma ammonia levels hyperammonemia by causing the breakdown of body protein. Patients with urea cycle disorders being treated with sodium phenylbutyrate usually should not receive regular treatment with corticosteroids.
Major Avoid coadministration of velpatasvir with dexamethasone. Taking these drugs together may significantly decrease velpatasvir plasma concentrations, potentially resulting in loss of antiviral efficacy. Additionally, velpatasvir is an inhibitor of the drug transporter P-glycoprotein P-gp.
Coadministration with substrates of this transporter, such as dexamethasone, may increase their exposure. Taking these drugs together may significantly decrease voxilaprevir plasma concentrations, potentially resulting in loss of antiviral efficacy.
In addition, voxilaprevir, a P-glycoprotein P-gp inhibitor, may alter concentrations of dexamethasone, a P-gp substrate. Moderate Corticosteroids can retard bone growth and therefore, can inhibit the growth-promoting effects of somatropin. If corticosteroid therapy is required, the corticosteroid dose should be carefully adjusted. Major Avoid the concomitant use of sonidegib and dexamethasone; sonidegib levels may be significantly decreased and its efficacy reduced.
Avoid the use of sorafenib with a strong CYP3A4 inducer. If a strong CYP3A4 inducer must be coadministered with sorafenib, consider a sorafenib dose increase Succinylcholine: Major Concurrent administration of sunitinib with strong inducers of CYP3A4 such as dexamethasone results in decreased concentrations of sunitinib and its primary active metabolite. Whenever possible selection of an alternative concomitant medication with no or minimal enzyme inhibition potential is recommended.
A dosage increase should be considered when sunitinib must be administered concurrently with strong CYP3A4 inducers. Minor Tadalafil is metabolized principally by cytochrome P 3A4.
Studies have shown that concomitant administration of CYP3A4 enzyme-inducers, such as dexamethasone, will decrease plasma levels of tadalafil. Major Concomitant use of dexamethasone and tamoxifen may result in decreased concentrations of tamoxifen and its active metabolites, which may compromise efficacy. Monitor patients for changes in therapeutic effect of tamoxifen. Plasma concentrations of tamoxifen and its active metabolites have been reduced when coadministered with other CYP3A4 inducers.
Furthermore, there are case reports in which the simultaneous use of amphotericin B and hydrocortisone led to an enlarged heart and heart failure. Carbenoxolone increases the risk of hypokalemia. Chloroquine, hydroxychloroquine and mefloquine: Increased risk of myopathies and cardiomyopathies. Concomitant administration of ACE inhibitors creates an increased risk of blood disorders. The blood pressure-lowering effects of antihypertensive drugs may be affected by corticosteroids.
The dose of the anti-hypertensive treatment may have to be adjusted during the treatment with dexamethasone. Great care should be taken during co-administration with thalidomide, a there have been reported cases of toxic epidermal necrolysis.
The effect of vaccinations may be reduced during treatment with dexamethasone. Vaccination with live vaccines during treatment with large therapeutic doses of dexamethasone and other corticosteroids is contraindicated due to the possibility of viral infection. In this case, vaccination should be postponed for at least 3 months after the completion of treatment with corticosteroids. Other types of immunisation during treatment with large therapeutic doses of corticosteroids are dangerous due to the risk of neurological complications and decreased or absent increase in the antibody titers in comparison with expected values and therefore a smaller protective effect.
However, patients who have received corticosteroids locally parenteral or for a short period of time less than 2 weeks , in smaller doses may be immunised. Concomitant use of cholinesterase inhibitors and corticosteroids may cause serious muscle weakness in patients with myasthenia gravis. If possible, cholinesterase inhibitors should be discontinued at least 24 hours before the start of corticosteroid therapy. The risk of tendinitis and tendon rupture is increased in patients treated concomitantly with glucocorticoids and fluoroquinolones.
Co-treatment with CYP3A inhibitors, including cobicistat-containing products, is expected to increase the risk of systemic side-effects.
The combination should be avoided unless the benefit outweighs the increased risk of systemic corticosteroid side-effects, in which case patients should be monitored for systemic corticosteroid side-effects.
Pharmacokinetic interactions Effects of other medicinal products on dexamethasone: The administration of dexamethasone with inducers of CYP3A4, such as ephedrine, barbiturates, rifabutin, rifampicin, phenytoin, and carbamazepine can lead to reduced plasma concentrations of dexamethasone, so the dose must be increased. Aminoglutethimide can accelerate the reduction of dexamethasone and reduce its efficacy. If necessary, the dexamethasone dosage should be adjusted.
Bile acid resins, such as cholestyramine, may decrease the absorption of dexamethasone. Topically applied gastrointestinal drugs, antacids, activated charcoal: Decreased glucocorticoid resorption has been described during co-administration of prednisolone and dexamethasone. Therefore, the administration of glucocorticoids and topically applied gastrointestinal drugs, antacids, activated charcoal should be postponed with an interval of at least two hours. The administration of dexamethasone with inhibitors of CYP3A4, such as azoleantifungals e.
If required, the dexamethasone dose should be reduced. Ketoconazole may not only increase the plasma concentration of dexamethasone by inhibition of CYP3A4, but also suppress adrenal corticosteroid synthesis and cause adrenal insufficiency upon discontinuation of corticosteroid treatment. Estrogens, including oral contraceptives, may inhibit the metabolism of certain corticosteroids and thus enhance their effect.
The administration of dexamethasone with substances metabolized by CYP3A4 can lead to increased clearance and decreased plasma concentrations of these substances. A reduction of isoniazid plasma concentrations was observed during concurrent use of prednisolone. Patients taking isoniazid should be monitored closely. Concomitant administration of cyclosporine and corticosteroids may lead to an increased effect of both substances.
There is an increased risk of cerebral seizures. Reduced praziquantel plasma concentrations create a risk of treatment failure due to the increased hepatic metabolism of dexamethasone. Concomitant corticosteroid therapy may either potentiate or lead to a weakening of the effect of oral anticoagulants.
In case of high doses or of treatment lasting over 10 days there is a risk of bleeding specific to corticosteroid therapies gastrointestinal mucosa, vascular fragility. Patients who use corticosteroids combined with oral anticoagulants should be closely monitored controls on day 8, then every two weeks during and after treatment.
Atropine and other anticholinergics: Intraocular pressure increases may be noted during co-administration with dexamethasone. Reduced increase in TSH may be noted during administration of protirelin.
Administration of corticosteroids to pregnant animals can cause abnormalities in foetal development, including cleft palate, intrauterine growth retardation and effects on brain growth and development. Long-term or repeated corticosteroid therapy in pregnancy increases the risk of intrauterine growth retardation.
In newborns exposed to corticosteroids in the prenatal period, there is an increased risk of adrenal insufficiency, which under normal circumstances undergoes spontaneous postnatal regression, and is rarely of clinical significance. Dexamethasone should be prescribed during pregnancy, and particularly in the first trimester, only if the benefit outweighs the risks for the mother and child.
Breast-feeding Glucocorticoids are excreted in breast milk. Dexamethasone impairs calcium absorption and new bone formation. Patients on prolonged treatment with dexamethasone and other corticosteroids can develop osteoporosis and an increased risk of bone fractures. Supplemental calcium and vitamin D are encouraged to slow this process of bone thinning. It has been demonstrated in some groups of patients treated with steroids that the loss of bone may be prevented by treatment with biphosphonate drugs , for example, alendronate Fosamax.
In rare individuals, destruction of large joints can occur while undergoing treatment with dexamethasone or other corticosteroids.
Report any unusual weight gain. Prolonged use of corticosteroids may cause posterior subcapsular cataracts, glaucoma with possible damage to the optic nerve and can decadron the risk of secondary ocular infections due to fungi or viruses, decadron 4mg. Your doctor will order certain lab tests to check your response to dexamethasone. Copyright c First Databank, Inc. Healthcare professionals are asked to report any suspected adverse reactions via theYellow Card Scheme at: Signs of peritoneal 4mg following gastrointestinal perforation in patients receiving large doses of corticosteroids may be minimal or absent. If decadron have a history of ulcers or take large doses of aspirin or other arthritis medication, limit your consumption of alcoholic beverages while taking this drug. Psychic derangements may appear when corticosteroids are used, ranging from euphoria, insomnia, mood swings, personality changes, and severe depression to frank psychotic manifestations. Ocular disorders Systemic treatment with glucocorticoids can induce chorioretinopathy which may result in impaired vision including loss of vision. Call your doctor if your blood sugar is high or if sugar is present in your urine; your dose of diabetes medication and your diet may need to be changed. If any of these effects persist or worsen, notify your doctor or pharmacist promptly. Administration of live virus vaccines, including smallpox, is contraindicated in individuals receiving immunosuppressive doses of corticosteroids. If these problems occur, decadron 4mg, call your doctor immediately. Recommended doses 4mg not be exceeded, and the patient should be carefully monitored during therapy. It may also be used for other conditions as determined by your doctor.
This acute myopathy is generalized, decadron 4mg, decadron involve ocular and respiratory muscles, and may result in quadriparesis. If this köpa viagra phuket occurs and the diagnosis decadron sepsis is 4mg, appropriate antimicrobial therapy should be instituted. List Decadron Tablet side effects by likelihood and severity. Major Vigabatrin should not be used with corticosteroids, which 4mg associated with serious ophthalmic effects e. Some products that may interact with this drug include: Coadministration with other drugs that are metabolized by CYP3A4 e. Monitor decadron for breakthrough fungal infections. Monitor patients carefully for signs and symptoms of infection. Acetylsalicylic acid should be used carefully in combination with corticosteroids in hypoprothrombinaemia. Monitor therapeutic response; the dosage requirements 4mg amlodipine may be increased.
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