Drugs that activate liver enzymes such as phenobarbital, phenytoin and rifampin may increase the clearance of corticosteroids, which may require increasing doses of the drug to get the desired effect.
Such drugs as troleandomycin and equipoise definition ketoconazole may inhibit the metabolism of corticosteroids and to reduce its clearance. In this case the dose of corticosteroids to be reduced to avoid overdose phenomena.
Corticosteroids may enhance clearance of acetylsalicylic acid in the received high doses for long periods, which can lead to reduced serum salicylate or salicylates increase the risk of toxicity when canceling corticosteroids. Patients with gipoprotrombinemiey appoint acetylsalicylic acid in combination with corticosteroids should be cautious.
exert diverse effects on the action of oral anticoagulants. It is reported as an enhancement, and to reduce the effect of anticoagulants, taken in conjunction with hydrocortisone. To maintain the desired anticoagulant effect needs constant determination of coagulation parameters.
- When high doses of hydrocortisone for a period longer than 48 – 72 hours, may develop hypernatremia. In this case it is recommended to replace another example methylprednisolone sodium succinate, which causes minor or no causes sodium retention.
- Patients who may be exposed to stress on the background of Sequipoise definition therapy showed an increase in the dose before, during and after the stressful situation. These patients should be under strict medical supervision because of the possible development of adrenal insufficiency.
- The therapy GCS some infections can occur in the form of worn, moreover, may develop a new infection. In the application of corticosteroids may be reduced resistance to infection, and also reduced the body’s ability to localize the infection process. The development of infections caused by various pathogens, such as viruses, bacteria, fungi, protozoa or helminths which are localized in different systems the human body, can be associated with the use of corticosteroids, both as monotherapy and in combination with other immunosuppressive agents acting on cellular immunity, humoral immunity, or neutrophil function. These infections can occur not heavy, but in some cases it is possible for severe and even fatal. The higher doses of corticosteroids are used, the higher the probability of infectious complications.
- The use of hydrocortisone sodium succinate in active tuberculosis should be restricted to cases of fulminant and disseminated tuberculosis when corticosteroids are used to treat the disease in conjunction with appropriate antituberculous chemotherapy. If corticosteroids administered to patients with latent tuberculosis or positive tuberculin skin test, treatment should be under strict medical supervision, because the possible reactivation of the disease. During prolonged therapy with these patients should receive appropriate prophylactic treatment.
- Patients receiving treatment with corticosteroids at the doses that have an immunosuppressive effect, is contraindicated the introduction of live or live equipoise definition attenuated vaccines, but it is possible to introduce killed or inactivated vaccines, but the reaction to the introduction of such vaccines may be reduced. Patients receiving treatment with corticosteroids at doses that do not produce an immunosuppressive action, immunization can be carried out by the appropriate indications.
- Introduction of hydrocortisone can lead to increased blood pressure, water retention and to the salts in the body and an increased excretion of potassium. You may need to limit salt intake from food and supplemental assignment potassium preparations. All corticosteroids increase calcium excretion.
- Since patients receiving parenteral therapy with corticosteroids, in rare cases may develop anaphylactoid reactions (eg, bronchospasm), should take appropriate preventive measures, especially if this patient have a history of allergic reactions to any drugs prior to administration of the drug.
- At long daily therapy corticosteroids in children may be a delay of growth, so this dosing regimen should be administered to children only when there are serious indications. Acute myopathy most often develops in the application of high doses of corticosteroids in patients with impaired neuromuscular transmission (eg, myasthenia gravis with), or in patients while receiving treatment by peripheral muscle relaxants (eg, pancuronium). This acute myopathy is generalized, may affect the eye muscles and the respiratory system, lead to the development tetraparesis. Perhaps the increase in creatine kinase.This improvement or recovery after the abolition of the equipoise definitioncan only occur through a number of weeks or even a few years.