Precautions
General precautions
Corticosteroids should be used cautiously in patients with ocular herpes simplex for fear of corneal perforation. Psychic derangements may appear when corticosteroids are used, ranging from euphoria, mood swings, personality changes, and severe depression to frank psychotic manifestations. Also, existing emotional instability or psychotic tendencies may be aggravated by corticosteroids.
Steroids should be used with caution in nonspecific ulcerative colitis. If there is a probability of impending perforation, abscess, or other pyogenic infection, also in diverticulitis, fresh intestinal anatomoses, active or latent peptic ulcer, renal insufficiency, hypertension, osteoporosis and myasthenia gravis.
Growth may be suppressed in children receiving long term, daily divided dose glucocorticoid therapy. the use of such regimen should be restricted to the most serious indications.
Kaposi’s sarcoma has been reported to occur in patients receiving corticosteroid therapy. Discontinuation of corticosteroids may result in clinical remission.
An acute myopathy has been observed with the use of high doses of corticosteroids, most often occuring in patients with disorders of neuromusuclar transmission (e.g. myasthenia gravis), or in patients receiving concomitant therapy with neuromuscular blocking drugs (e.g. pancuronium). This acute myopathy is generalized, may involve ocular and respiratory muscles, and may result in quadriparesis. elevations of creatine kinase may occur. Clinical improvement or recovery after stopping corticosteroids may require weeks to years.
Drug Interactions
The pharmacokinetic interactions listed below are potentially clinically important. Drugs that induce hepatic enzymes such as phenobarbital, phenytoin and rifampin may increase the clearance of corticosteroids and may require increases in corticosteroid dose to achieve the desired response. Drugs such as troleandomycin and ketoconazole may inhibit the metabolism of corticosteroids and thus decrease their clearance. Therefore, the dose of corticosteroid should be titrated to avoid steroid toxicity. Corticosteroids may incrase the clearance of chronic high dose aspirin. This could lead to decreased salicylate serum level or increase the risk of salicylate toxicity when corticosteroid is withdrawn. Aspirin should be use cautiously in conjunction with corticosteroids in patients suffering from hypoprothorombinemia. The effect of corticosteroids on oral anticoagulants is variable. There are reports of enhanced as well as diminished effects of anticoagulants when given concurrently with corticosteroids. Therefore, coagulation indices should be monitored to maintain the desired anticoagulant effect.