Table 6 Major drug interactions with systemic GCs[1, 8]
Interacting drug class | Effect | Recommendation/comment |
|---|---|---|
Anticonvulsants (e.g., carbamazepine, phenobarbital, phenytoin) | • ↓ GC exposure and efficacy; may persist for weeks following discontinuation of anticonvulsant | • Closely monitor outcomes of concomitant use |
• GC dose alterations may be required | ||
Anticoagulants (e.g., warfarin) | • May ↑ anticoagulant effects of warfarin and ↑ risk of GI bleeding | • Monitor INR closely |
• Significant alteration in warfarin dose will likely be required within 3–7 days of GC initiation | ||
Antifungals (e.g., itraconazole, ketoconazole) | • ↑ GC exposure and toxicity | • Monitor concurrent use for signs of GC overdose (fluid retention, hypertension, hyperglycemia) |
• Dose alteration of methylprednisolone and dexamethasone may be needed (prednisone and prednisolone not affected to a clinically relevant degree by this interaction) | ||
Antidiabetic agents | • GC initiation can lead to glucose dysregulation, thereby counteracting the effects of antidiabetic drugs | • ↑ frequency of BG monitoring when initiating GC therapy |
• Adjust antidiabetic therapy based on BG results | ||
Antibiotics (macrolides) (e.g., clarithromycin) | • ↑ GC exposure and toxicity | • Monitor concurrent use for signs of GC overdose (fluid retention, hypertension, hyperglycemia) |
• Dose alteration of methylprednisolone and dexamethasone may be needed (prednisone and prednisolone not affected to a clinically relevant degree by this interaction) | ||
Antivirals (e.g., atazanavir, indinavir, ritonavir, saquinavir) | • ↑ GC exposure and toxicity | • Monitor concurrent use for signs of GC overdose (fluid retention, hypertension, hyperglycemia) |
• Dexamethasone may ↑ levels of indinavir and saquinavir | • Dose alteration of methylprednisolone and dexamethasone may be needed (prednisone and prednisolone not affected to a clinically relevant degree by this interaction) | |
|  | • Monitor antiviral efficacy of indinavir and saquinavir if patient is taking dexamethasone | |
Anti-infectives (e.g., efavirenz, nevirapine, rifampin) | • ↓ GC exposure and efficacy; may persist for weeks following discontinuation of anti-infective | • Closely monitor outcomes, especially in transplant recipients |
• ↑ GC dose accordingly | ||
Diuretics, potassium wasting (e.g., furosemide, HCTZ) | • GCs may ↑ kaliuretic effects of these diuretics | • Monitor potassium levels to determine whether alteration of diuretic therapy and/or potassium supplementation is needed |
Live vaccines | • Immunization with live vaccines while taking immunosuppressive GC doses (40 mg/day of prednisolone [or equivalent] for > 7 days) may increase risk of both generalized and life-threatening infections | • Postpone live vaccines for at least 3 months after high-dose GC therapy is discontinued |
NSAIDS | • May ↑ risk of GI ulcers when given concomitantly with corticosteroids | • Consider use of PPI if person is at risk of GI ulcers |