Corticosteroids (Systemic, Oral and Injectable) (cont.)
Omudhome Ogbru, PharmD
Omudhome Ogbru, PharmD
Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Medical and Pharmacy Editor:
In this Article
Shrinking (atrophy) of the adrenal glands can be caused by the long term use of corticosteroids resulting in the body's inability to produce cortisol, the body's natural corticosteroid, when the systemic corticosteroids are discontinued.
Another condition which can result from the long term use of corticosteroids is adrenal necrosis of the hip joints, a very painful and serious condition that may require surgery. Any symptoms of hip or knee pain in people taking corticosteroids require prompt medical attention.
Corticosteroids should not be stopped suddenly after prolonged use as this can result in adrenal crisis because of the body's inability to secrete enough cortisol to make up for the withdrawal. Nausea, vomiting, and shock are the reported side effects of adrenal crisis.
With which drugs do systemic (oral and injectable) corticosteroids interact?
Certain drugs such as troleandomycin (TAO), erythromycin (Ery-Tab, EryPed 200), and clarithromycin (Biaxin) and ketoconazole (Nizoral) can reduce the ability of the liver to metabolize (breakdown) corticosteroids and this may lead to an increase in the levels and side effects of corticosteroids in the body. On the other hand, phenobarbital, ephedrine, phenytoin (Dilantin), and rifampin (Rifadin, Rimactane) may reduce the blood levels of corticosteroids by increasing the breakdown of corticosteroids by the liver. This may necessitate an increase of corticosteroid dose when they are used in combination with these drugs.
Estrogens have been shown to increase the effects of corticosteroids possibly by decreasing their breakdown by the liver.
Corticosteroid effects on warfarin (Coumadin) can vary; therefore when taking warfarin (Coumadin) along with corticosteroids, there may be increased need for monitoring coagulation levels more closely.
Low blood potassium (hypokalemia) and a higher chance of heart failure can result from combining corticosteroids with drugs that reduce potassium in the blood (for example, diuretics, amphotericin B).
Anticholinesterase drugs (for example, physostigmine) may cause severe weakness in some patients with myasthenia gravis when prescribed with corticosteroids.
Corticosteroids can increase blood glucose, so close monitoring of blood sugar and higher doses of diabetes medications may be needed.
Cholestyramine (Questran, Questran Light) can decrease the absorption of oral corticosteroids from the stomach and this could reduce the blood levels of corticosteroids.
REFERENCE: FDA Prescribing Information.
Last Editorial Review: 4/15/2014
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