Hydrocortisone + Lidocaine interactions

Checked as Hydrocortisone + Lidocaine in this data source.

Full monograph for Hydrocortisone + Lidocaine Check it against another medicine

Medicines

751 documented

Severity

Mechanism

Medicines documented to interact with Hydrocortisone + Lidocaine, worst severity first.
Medicine	Severity	Mechanism	Effect	Sources
Adalimumabvia Lidocaine, Hydrocortisone	Major	Metabolism · Synergy	The use of tumor necrosis factor (TNF) blockers with other immunosuppressive or myelosuppressive agents may increase the risk of infections. Serious infections…2 documented mechanisms	25 sources — open the full entry
Amiodarone Hydrochloridevia Lidocaine, Hydrocortisone	Major	Metabolism · Synergy	Amiodarone can cause dose-related prolongation of the QT interval. Theoretically, coadministration with agents that can produce hypokalemia and/or…2 documented mechanisms	12 sources — open the full entry
Arsenic Trioxidevia Hydrocortisone	Major	Synergy	Arsenic trioxide can cause QT interval prolongation and complete atrioventricular block. Since hypokalemia and hypomagnesemia are known risk factors for…	2 sources — open the full entry
Baricitinibvia Hydrocortisone	Major	Others	Coadministration of baricitinib or tofacitinib with other immuno- or myelosuppressive agents may potentiate the risk of infections as well as lymphoma and…	6 sources — open the full entry
Bempedoic acidvia Hydrocortisone	Major	Synergy	Concomitant administration of bempedoic acid may potentiate the risk of tendon rupture or injury associated with fluoroquinolones and corticosteroids. The…	2 sources — open the full entry
Bempedoic acid + Ezetimibevia Lidocaine, Hydrocortisone	Major	Synergy · Unknown	Concomitant administration of bempedoic acid may potentiate the risk of tendon rupture or injury associated with fluoroquinolones and corticosteroids. The…3 documented mechanisms	2 sources — open the full entry
Bupivacaine Hydrochloridevia Lidocaine, Hydrocortisone	Major	Synergy · Unknown	Additive toxicities may occur when bupivacaine is coadministered with other local anesthetics. The potential for increased risk of systemic toxicities such as…2 documented mechanisms	3 sources — open the full entry
Bupivacaine Hydrochloride + Dextrosevia Lidocaine, Hydrocortisone	Major	Synergy · Unknown	Additive toxicities may occur when bupivacaine is coadministered with other local anesthetics. The potential for increased risk of systemic toxicities such as…2 documented mechanisms	3 sources — open the full entry
Bupropion Hydrochloridevia Lidocaine, Hydrocortisone	Major	Synergy	The use of bupropion is associated with a dose-related risk of seizures. The risk may be further increased when coadministered with selective serotonin…2 documented mechanisms	19 sources — open the full entry
Chloroquine Phosphatevia Lidocaine	Major	Synergy	Coadministration of local anesthetics with other oxidizing agents that can also induce methemoglobinemia such as antimalarials (e.g., chloroquine, primaquine…	5 sources — open the full entry
Ciprofloxacinbase Ophthalmicvia Hydrocortisone, Lidocaine	Major	Synergy · Unknown	Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism…2 documented mechanisms	7 sources — open the full entry
Ciprofloxacin + Dexamethasonevia Hydrocortisone, Lidocaine	Major	Metabolism · Synergy · Unknown	Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism…4 documented mechanisms	11 sources — open the full entry
Ciprofloxacin + Hydrocortisone Acetatevia Hydrocortisone, Lidocaine	Major	Synergy · Unknown	Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism…2 documented mechanisms	7 sources — open the full entry
Clobetasol Propionate + Ofloxacin + Ornidazole + Terbinafinevia Lidocaine, Hydrocortisone	Major	Synergy · Unknown	Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism…6 documented mechanisms	7 sources — open the full entry
Dapsonevia Lidocaine, Hydrocortisone	Major	Synergy · Unknown	Coadministration of local anesthetics with other oxidizing agents that can also induce methemoglobinemia such as antimalarials (e.g., chloroquine, primaquine…2 documented mechanisms	5 sources — open the full entry
Deferasiroxvia Lidocaine, Hydrocortisone	Major	Metabolism · Synergy	Coadministration with drugs that have known ulcerogenic or hemorrhagic potential may increase the risk of gastrointestinal bleeding associated with the use of…2 documented mechanisms	7 sources — open the full entry
Delafloxacinvia Hydrocortisone	Major	Synergy	Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism…	7 sources — open the full entry
Desmopressin Acetatevia Hydrocortisone	Major	Synergy	Coadministration of desmopressin with loop diuretics or systemic or inhaled corticosteroids may increase the risk of severe hyponatremia. Loop diuretics and…	9 sources — open the full entry
Dexamethasone + Levofloxacinvia Lidocaine, Hydrocortisone	Major	Metabolism · Synergy · Unknown	Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism…3 documented mechanisms	11 sources — open the full entry
Dextromethorphan + Bupropionvia Lidocaine, Hydrocortisone	Major	Synergy	The use of bupropion is associated with a dose-related risk of seizures. The risk may be further increased when coadministered with selective serotonin…2 documented mechanisms	19 sources — open the full entry
Etanerceptvia Lidocaine, Hydrocortisone	Major	Metabolism · Synergy	The use of tumor necrosis factor (TNF) blockers with other immunosuppressive or myelosuppressive agents may increase the risk of infections. Serious infections…2 documented mechanisms	25 sources — open the full entry
Flutamidevia Lidocaine	Major	Synergy	Coadministration of local anesthetics with other oxidizing agents that can also induce methemoglobinemia such as antimalarials (e.g., chloroquine, primaquine…	5 sources — open the full entry
Gatifloxacinvia Lidocaine, Hydrocortisone	Major	Synergy · Unknown	Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism…2 documented mechanisms	7 sources — open the full entry
Gatifloxacin + Dexamethasonevia Lidocaine, Hydrocortisone	Major	Metabolism · Synergy · Unknown	Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism…4 documented mechanisms	11 sources — open the full entry
Gemifloxacinvia Hydrocortisone	Major	Synergy	Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism…	7 sources — open the full entry
Golimumabvia Lidocaine, Hydrocortisone	Major	Metabolism · Synergy	The use of tumor necrosis factor (TNF) blockers with other immunosuppressive or myelosuppressive agents may increase the risk of infections. Serious infections…2 documented mechanisms	25 sources — open the full entry
Hydroxyureavia Lidocaine, Hydrocortisone	Major	Synergy · Unknown	Coadministration of local anesthetics with other oxidizing agents that can also induce methemoglobinemia such as antimalarials (e.g., chloroquine, primaquine…2 documented mechanisms	5 sources — open the full entry
Ifosfamidevia Lidocaine, Hydrocortisone	Major	Synergy · Unknown	Coadministration of local anesthetics with other oxidizing agents that can also induce methemoglobinemia such as antimalarials (e.g., chloroquine, primaquine…2 documented mechanisms	5 sources — open the full entry
Infliximabvia Lidocaine, Hydrocortisone	Major	Metabolism · Synergy	The use of tumor necrosis factor (TNF) blockers with other immunosuppressive or myelosuppressive agents may increase the risk of infections. Serious infections…2 documented mechanisms	25 sources — open the full entry
Iohexolvia Lidocaine, Hydrocortisone	Major	Others · Synergy	Intrathecal administration of iodinated contrast media may induce seizures. Although clinical data are generally lacking, there may be a theoretical risk of…2 documented mechanisms	10 sources — open the full entry
Iopamidolvia Lidocaine, Hydrocortisone	Major	Others · Synergy	Intrathecal administration of iodinated contrast media may induce seizures. Although clinical data are generally lacking, there may be a theoretical risk of…2 documented mechanisms	10 sources — open the full entry
Isosorbide Dinitrate + Hydralazine Hydrochloridevia Lidocaine, Hydrocortisone	Major	Antagonism · Metabolism · Synergy · Unknown	Coadministration of local anesthetics with other oxidizing agents that can also induce methemoglobinemia such as antimalarials (e.g., chloroquine, primaquine…3 documented mechanisms	7 sources — open the full entry
Isosorbide Mononitratevia Lidocaine, Hydrocortisone	Major	Synergy · Unknown	Coadministration of local anesthetics with other oxidizing agents that can also induce methemoglobinemia such as antimalarials (e.g., chloroquine, primaquine…2 documented mechanisms	5 sources — open the full entry
Leflunomidevia Lidocaine, Hydrocortisone	Major	Synergy · Unknown	The use of leflunomide with other immunosuppressive or myelosuppressive agents may increase the risk of infections. The risk is thought to extend to…2 documented mechanisms	2 sources — open the full entry
Levofloxacin (Eye/Ear)via Hydrocortisone	Major	Synergy	Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism…	7 sources — open the full entry
Levofloxacin Hemihydratevia Hydrocortisone	Major	Synergy	Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism…	7 sources — open the full entry
Lidocaine + Prilocainevia Lidocaine	Major	Synergy	Prilocaine can cause dose-related methemoglobin formation via its ortho-toluidine metabolite. Coadministration with other oxidizing agents that can also induce…2 documented mechanisms	13 sources — open the full entry
Lomefloxacinvia Hydrocortisone	Major	Synergy	Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism…	7 sources — open the full entry
Loteprednol Etabonate + Gatifloxacinvia Lidocaine, Hydrocortisone	Major	Synergy · Unknown	Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism…2 documented mechanisms	7 sources — open the full entry
Metoclopramide Hydrochloridevia Lidocaine, Hydrocortisone	Major	Synergy · Unknown	Coadministration of local anesthetics with other oxidizing agents that can also induce methemoglobinemia such as antimalarials (e.g., chloroquine, primaquine…2 documented mechanisms	5 sources — open the full entry
Mifepristonevia Lidocaine, Hydrocortisone	Major	Antagonism · Metabolism	Mifepristone is a potent antiglucocorticoid and may antagonize the effects of corticosteroids. Pharmacokinetically, mifepristone may increase the plasma…2 documented mechanisms	14 sources — open the full entry
Mifepristone + Misoprostolvia Lidocaine, Hydrocortisone	Major	Antagonism · Metabolism · Unknown	Mifepristone is a potent antiglucocorticoid and may antagonize the effects of corticosteroids. Pharmacokinetically, mifepristone may increase the plasma…3 documented mechanisms	14 sources — open the full entry
Moxifloxacin HydrochlorideInjection Ophthalmic Tabletvia Lidocaine, Hydrocortisone	Major	Synergy · Unknown	Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism…2 documented mechanisms	7 sources — open the full entry
Moxifloxacin Hydrochloride + Dexamethasonevia Lidocaine, Hydrocortisone	Major	Metabolism · Synergy · Unknown	Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism…4 documented mechanisms	11 sources — open the full entry
Moxifloxacin Hydrochloride + Xanthan Gumvia Lidocaine, Hydrocortisone	Major	Synergy · Unknown	Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism…2 documented mechanisms	7 sources — open the full entry
Nalidixic Acidvia Hydrocortisone	Major	Synergy	Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism…	7 sources — open the full entry
Nitrofurantoinvia Hydrocortisone, Lidocaine	Major	Synergy · Unknown	Coadministration of local anesthetics with other oxidizing agents that can also induce methemoglobinemia such as antimalarials (e.g., chloroquine, primaquine…2 documented mechanisms	5 sources — open the full entry
Nitrofurantoin + Nitrofurantoin Microcrystalsvia Hydrocortisone, Lidocaine	Major	Synergy · Unknown	Coadministration of local anesthetics with other oxidizing agents that can also induce methemoglobinemia such as antimalarials (e.g., chloroquine, primaquine…2 documented mechanisms	5 sources — open the full entry
Nitroglycerinbase IV Infusion Ointmentvia Hydrocortisone, Lidocaine	Major	Synergy · Unknown	Coadministration of local anesthetics with other oxidizing agents that can also induce methemoglobinemia such as antimalarials (e.g., chloroquine, primaquine…2 documented mechanisms	5 sources — open the full entry
Ofloxacinvia Lidocaine, Hydrocortisone	Major	Synergy · Unknown	Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism…2 documented mechanisms	7 sources — open the full entry

Conditions

Conditions in which Hydrocortisone + Lidocaine needs care, as documented in this source.

Arrhythmias, Cardiac
Major
Antiarrhythmic agents can induce or worsen ventricular arrhythmias. Ventricular tachycardia, ventricular fibrillation, and torsades de pointes have occurred in some patients. Patients with underlying cardiac dysfunction, bradycardia, hypokalemia, hypomagnesemia, or high antiarrhythmic serum concentrations are at increased risk for drug-induced arrhythmias. Therapy with antiarrhythmics should be used with extreme caution in patients with or predisposed to arrhythmias. Evidence of improved survival is lacking for use of antiarrhythmic therapy in asymptomatic, non-life-threatening arrhythmias. Therapy with antiarrhythmic agents should be reserved for patients with life-threatening arrhythmias.
62 sources
1. Anderson JL, Popat KD "Paradoxical ventricular tachycardia and fibrillation after intravenous bretylium therapy." Arch Intern Med 141 (1981): 801-2
2. Sclarovsky S, Lewin RF, Kracoff O, Strasberg B, Arditti A, Agmon J "Amiodarone-induced polymorphous ventricular tachycardia." Am Heart J 105 (1983): 6-12
3. Strasberg B, Sclarovsky S, Erdberg A, et al. "Procainamide-induced polymorphous ventricular tachycardia." Am J Cardiol 47 (1981): 1309-14
4. Stratmann H, Walter K, Kennedy H "Torsade de pointes associated with elevated N-acetylprocainamide levels." Am Heart J 109 (1985): 375-6
5. Lo KS, Gantz KB, Stetson PL, et al. "Disopyramide-induced ventricular tachycardia." Arch Intern Med 140 (1980): 413-4
6. Kinney EL, Field EH, Salmon MP, Zelis R "Cardiac arrhythmias associated with disopyramide." N Engl J Med May (1990): 1146
7. Chia BL "Disopyramide induced atypical ventricular tachycardia." Aust N Z J Med 10 (1980): 665-8
8. Tzivoni D, Keren A, Stern S, Gottlieb S "Disopyramide-induced Torsade de pointes." Arch Intern Med 141 (1981): 946-7
Show all 62 sourcesShow fewer sources
1. Schweitzer P, Mark H "Torsade de pointes caused by disopyramide and hypokalemia." Mt Sinai J Med 49 (1982): 110-4
2. Riccioni N, Castiglioni M, Bartolomei C "Disopyramide-induced QT prolongation and ventricular tachyarrhythmias." Am Heart J 105 (1983): 870-1
3. Andrivet P, Beaslay V, Canh VD "Torsades de pointe with flecainide-amiodarone therapy." Intensive Care Med 16 (1990): 342-3
4. Cocco G, Strozzi C, Chu D, Pansini R "Torsades de pointes as a manifestation of mexiletine toxicity." Am Heart J 100 (1980): 878-80
5. Nora MO, Chandrasekaran K, Hammill SC, Reeder GS "Prolongation of ventricular depolarization: ECG manifestation of mexiletine toxicity." Chest 95 (1989): 925-8
6. Morganroth J, Pratt CM "Prevalence and characteristics of proarrhythmia from moricizine (themozine)." Am J Cardiol 63 (1989): 172-6
7. Damle R, Levine J, Matos J, et al. "Efficacy and risks of moricizine in inducible sustained ventricular tachycardia." Ann Intern Med 116 (1992): 375-81
8. Nathan AW, Hellestrand KJ, Bexton RS, Camm AJ "Fatal ventricular tachycardia in association with propafenone, a new class IC antiarrhythmic agent." Postgrad Med J 60 (1984): 155-6
9. Stavens CS, McGovern B, Garan H, Ruskin JN "Aggravation of electrically provoked ventricular tachycardia during treatment with propafenone." Am Heart J 110 (1985): 24-9
10. Hii JT, Wyse DG, Gillis AM, et al. "Propafenone-induced torsade de pointes: cross-reactivity with quinidine." Pacing Clin Electrophysiol 14 (1991): 1568-70
11. Cheesman M, Ward DE "Exacerbation of ventricular tachycardia by tocainide." Clin Cardiol 8 (1985): 47-50
12. Bauman JL, Bauernfeind RA, Hoff JV, et al. "Torsade de pointes due to quinidine: observations in 31 patients." Am Heart J 107 (1984): 425-30
13. Koenig W, Schinz AM "Spontaneous ventricular flutter and fibrillation during quinidine medication." Am Heart J 105 (1983): 863-5
14. Morganroth J, Horowitz LN "Incidence of proarrhythmic effects from quinidine in the outpatient treatment of benign or potentially lethal ventricular arrhythmias." Am J Cardiol 56 (1985): 585-7
15. Au PK, Bhandari AK, Bream R, et al. "Proarrhythmic effects of antiarrhythmic drugs during programmed ventricular stimulation in patients without ventricular tachycardia." J Am Coll Cardiol 9 (1987): 389-97
16. Engler RL, LeWinter M "Tocainide-induced ventricular fibrillation." Am Heart J 101 (1981): 494-6
17. Wesley RC Jr, Turnquest P "Torsades de pointe after intravenous adenosine in the presence of prolonged QT syndrome." Am Heart J 123 (1992): 794-6
18. Orebaugh SL, Handy M "Intravenous adenosine therapy accelerating rate of paroxysmal supraventricular tachycardia." Am J Emerg Med 10 (1992): 326-30
19. Reed R, Falk JL, O'Brien J "Untoward reaction to adenosine therapy for supraventricular tachycardia." Am J Emerg Med 9 (1991): 566-70
20. Meurer MK "A 21-year-old woman with rapid atrial fibrillation after adenosine administration." J Emerg Nurs 17 (1991): 135-6
21. Dougherty AH, Gilman JK, Wiggins S, Jalal S, Naccarelli GV "Provocation of atrioventricular reentry tachycardia: a paradoxical effect of adenosine." Pacing Clin Electrophysiol 16 (1993): 8-12
22. "Product Information. Tonocard (tocainide)." Merck & Co., Inc (2002):
23. "Product Information. Ethmozine (moricizine)." DuPont Pharmaceuticals (2002):
24. "Product Information. Cordarone (amiodarone)." Wyeth-Ayerst Laboratories (2002):
25. "Product Information. Bretylol (bretylium)." DuPont Pharmaceuticals (2002):
26. "Product Information. Xylocaine (lidocaine)." Astra-Zeneca Pharmaceuticals (2002):
27. "Product Information. Procan SR (procainamide)." Parke-Davis (2001):
28. "Product Information. Pronestyl (procainamide)." Apothecon Inc (2001):
29. Raehl CL, Patel AK, LeRoy M "Drug-induced torsade de pointes." Clin Pharm 4 (1985): 675-90
30. Buss J, Neuss H, Bilgin Y, Schlepper M "Malignant ventricular tachyarrhythmias in association with propafenone treatment." Eur Heart J 6 (1985): 424-8
31. Sulke AN, Holt P, Sowton GE "Acceleration of conduction within an accessory pathway with propafenone." Int J Cardiol 28 (1990): 105-7
32. "Product Information. Adenocard (adenosine)." Fujisawa (2001):
33. "Product Information. Tambocor (flecainide)." 3M Pharmaceuticals (2001):
34. "Product Information. Mexitil (mexiletine)." Boehringer-Ingelheim (2001):
35. "Product Information. Rythmol (propafenone)." Knoll Pharmaceutical Company
36. Ben-Sorek ES, Wiesel J "Ventricular fibrillation following adenosine administration. A case report." Arch Intern Med 153 (1993): 2701-2
37. Said SAM, Somer ST, Luttikhuis HAO "Flecainide-induced JT prolongation, t wave inversion and ventricular tachycardia during treatment for symptomatic atrial fibrillation." Int J Cardiol 44 (1994): 285-7
38. Makkar RR, Fromm BS, Steinman RT, Meissner MD, Lehmann MH "Female gender as a risk factor for torsades de pointes associated with cardiovascular drugs." JAMA 270 (1993): 2590-7
39. "Product Information. Norpace (disopyramide)." Searle (2001):
40. Oberg KC, Otoole MF, Gallastegui JL, Bauman JL "''late'' proarrhythmia due to quinidine." Am J Cardiol 74 (1994): 192-4
41. Romer M, Candinas R "Adenosine-induced non-sustained polymorphic ventricular tachycardia." Eur Heart J 15 (1994): 281-2
42. Hohnloser SH, Klingenheben T, Singh BN "Amiodarone-associated proarrhythmic effects - a review with special reference to torsade de pointes tachycardia." Ann Intern Med 121 (1994): 529-35
43. Celiker A, Tokel K, Cil E, Ozkutlu S, Ozme S "Adenosine induced torsades de pointes in a child with congenital long QT syndrome." Pacing Clin Electrophysiol 17 (1994): 1814-7
44. Exner DV, Muzyka T, Gillis AM "Proarrhythmia in patients with the Wolff-Parkinson-White Syndrome after standard doses of intravenous adenosine." Ann Intern Med 122 (1995): 351-2
45. Williamson BD, Hummel J, Niebauer M, Man C, Strickberger SA, Daoud E, Morady F "Bradycardia-facilitated polymorphic ventricular tachycardia caused by amiodarone after radiofrequency modification of atrioventricular conduction." Am Heart J 130 (1995): 399-401
46. Dhein S, Schott M, Gottwald E, Klaus W "Electrocardiological profile and proarrhythmic effects of quinidine, verapamil and their combination: a mapping study." Naunyn Schmiedebergs Arch Pharmacol 352 (1995): 94-101
47. "Product Information. Cordarone (amiodarone)." Apothecon Inc (2022):
48. Hohnloser SH, Vandeloo A, Baedeker F "Efficacy and proarrhythmic hazards of pharmacologic cardioversion of atrial fibrillation: prospective comparison of sotalol versus quinidine." J Am Coll Cardiol 26 (1995): 852-8
49. "Product Information. Corvert (ibutilide)." Pharmacia and Upjohn (2001):
50. Silverman AJ, Machado C, Baga JJ, Meissner MD, Lehmann MH, Steinman RT "Adenosine-induced atrial fibrillation." Am J Emerg Med 14 (1996): 300-1
51. Boriani G, Biffi M, Frabetti L, Azzolini U, Sabbatani P, Bronzetti G, Capucci A, Magnani B "Ventricular fibrillation after intravenous amiodarone in wolff-parkinson-white syndrome with atrial fibrillation." Am Heart J 131 (1996): 1214-6
52. Faggiano P, Gardini A, Daloia A, Benedini G, Giordano A "Torsade de pointes occurring early during oral amiodarone treatment." Int J Cardiol 55 (1996): 205-8
53. Heisler BE, Ferrier GR "Proarrhythmic actions of flecainide in an isolated tissue model of ischemia and reperfusion." J Pharmacol Exp Ther 279 (1996): 317-24
54. Strickberger SA, Man KC, Daoud EG, et al. "Adenosine-induced atrial arrhythmia: a prospective analysis." Ann Intern Med 127 (1997): 417-22
Cardiomyopathies
Major
Antiarrhythmic agents can induce severe hypotension (particularly with IV administration) or induce or worsen congestive heart failure (CHF). Patients with primary cardiomyopathy or inadequately compensated CHF are at increased risk. Antiarrhythmic agents should be administered cautiously and dosage and/or frequency of administration modified in patients with hypotension or adequately compensated CHF. Alternative therapy should be considered unless these conditions are secondary to cardiac arrhythmia.
17 sources
1. Halkin H, Meffin P, Melmon KL, Rowland M "Influence of congestive heart failure on blood levels of lidocaine and its active monodeethylated metabolite." Clin Pharmacol Ther 17 (1975): 669-76
2. Crouthamel WG "The effect of congestive heart failure on quinidine pharmacokinetics." Am Heart J 90 (1975): 335-9
3. Ravid S, Podrid PJ, Lampert S, Lown B "Congestive heart failure induced by six of the newer antiarrhythmic drugs." J Am Coll Cardiol 14 (1989): 1326-30
4. Swiryn S, Kim SS "Quinidine-induced syncope." Arch Intern Med 143 (1983): 314-6
5. Gottlieb SS, Packer M "Deleterious hemodynamic effects of lidocaine in severe congestive heart failure." Am Heart J 118 (1989): 611-2
6. Ochs HR, Grube E, Greenblatt DJ, Arendt R "Intravenous quinidine in congestive cardiomyopathy." Eur J Clin Pharmacol 19 (1981): 173-6
7. Prescott LF, Adjepon-Yamoah KK, Talbot RG "Impaired lignocaine metabolism in patients with myocardial infarction and cardiac failure." Br Med J 1 (1976): 939-41
8. "Product Information. Cordarone (amiodarone)." Wyeth-Ayerst Laboratories (2002):
Show all 17 sourcesShow fewer sources
1. "Product Information. Xylocaine (lidocaine)." Astra-Zeneca Pharmaceuticals (2002):
2. "Product Information. Quinidex Extentabs (quiNIDine)." Wyeth-Ayerst Laboratories
3. "Product Information. Quiniglute (quinidine)." Berlex, Richmond, CA.
4. "Product Information. Adenocard (adenosine)." Fujisawa (2001):
5. "Product Information. Mexitil (mexiletine)." Boehringer-Ingelheim (2001):
6. Thomson P, Melmon K, Richardson J, Cohn K Steinbrunn W, Cudihee R, Rowland M "Lidocaine pharmacokinetics in advanced heart failure, liver disease, and renal failure in humans." Ann Intern Med 78 (1973): 499-508
7. Singh SN, Fletcher RD, Fisher SG, et al. "Amiodarone in patients with congestive heart failure and asymptomatic ventricular arrhythmia." N Engl J Med 333 (1995): 77-82
8. "Product Information. Cordarone (amiodarone)." Apothecon Inc (2022):
9. "Product Information. Corvert (ibutilide)." Pharmacia and Upjohn (2001):
Infections
Major
The immunosuppressant and anti-inflammatory effects of corticosteroids, particularly in higher dosages, may decrease host resistance to infectious agents, decrease the ability to localize infections, and mask the symptoms of infection. Secondary infections may be more likely to develop. In general, corticosteroids should not be used in patients with active infections, especially systemic fungal infections, unless they are medically necessary and effective antimicrobial therapy or other appropriate treatment has been instituted. However, for corticosteroid-dependent patients who develop a severe or life-threatening infection, continuation of corticosteroid therapy with at least physiologic replacement dosages should be considered, since these patients may have secondary adrenocortical insufficiency. Removal of external steroid during periods of stress may be detrimental to these patients.
9 sources
1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):
Show all 9 sourcesShow fewer sources
1. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
Kidney Diseases
Major
Lidocaine is primarily eliminated by the kidney. Less than 10% is eliminated unchanged in the urine. Two active metabolites (MEGX and GX) have been identified that exhibit antiarrhythmic and convulsant properties. GX accumulates during prolonged intravenous lidocaine infusion. Serum concentrations of lidocaine and the active metabolites are increased and the half-life prolonged in patients with renal impairment. Therapy with lidocaine should be administered cautiously and dosing modified for repeated or maintenance doses in patients with compromised renal function. Clinical monitoring of cardiac function (continual ECG) is required and serum metabolite concentrations and monitoring renal function are recommended.
8 sources
1. Eriksson E, Granberg P-O, Ortengren B "Study of renal excretion of prilocaine and lidocaine." Acta Chem Scand 358 (1966): 55-69
2. Thomson PD, Rowland M, Melmon KL "The influence of heart failure, liver disease, and renal failure on the disposition of lidocaine in man." Am Heart J 82 (1971): 417-21
3. Collinsworth KA, Strong JM, Atkinson AJ Jr, et al. "Pharmacokinetics and metabolism of lidocaine in patients with renal failure." Clin Pharmacol Ther 18 (1975): 59-64
4. Jacobi J, McGory RW, McCoy H, Matzke GR "Hemodialysis clearance of total and unbound lidocaine." Clin Pharm 2 (1983): 54-7
5. Vaziri ND, Saiki JK, Hughes W "Clearance of lidocaine by hemodialysis." South Med J 72 (1979): 1567-8
6. "Product Information. Xylocaine (lidocaine)." Astra-Zeneca Pharmaceuticals (2002):
7. Grossman S, Davis D, Kitchell B, Shand D, Routledge P "Diazepam and lidocaine plasma protein binding in renal disease." Clin Pharmacol Ther 31 (1982): 350-7
8. Thomson P, Melmon K, Richardson J, Cohn K Steinbrunn W, Cudihee R, Rowland M "Lidocaine pharmacokinetics in advanced heart failure, liver disease, and renal failure in humans." Ann Intern Med 78 (1973): 499-508
Liver Diseases
Major
Lidocaine is rapidly and extensively metabolized by the liver. Less than 10% is eliminated unchanged in the urine. Several inactive and two active forms (MEGX and GX) have been identified. MEGX and GX exhibit antiarrhythmic and convulsant properties. GX accumulates during prolonged intravenous lidocaine infusion. The pharmacokinetic disposition of lidocaine is altered by changes in hepatic function, including hepatic blood flow. Therapy with lidocaine should be administered cautiously and dosing modifications for repeated or loading and maintenance doses may be necessary. Clinical monitoring of cardiac (continuous ECG) is required and serum metabolite concentrations and monitoring hepatic function are recommended.
13 sources
1. Williams RL, Blaschke TF, Meffin PJ, et al. "Influence of viral hepatitis on the disposition of two compounds with high hepatic clearance: lidocaine and indocyanine green." Clin Pharmacol Ther 20 (1976): 290-9
2. Huet P-M, LeLorier J "Effects of smoking and chronic hepatitis B on lidocaine and indocyanine green kinetics." Clin Pharmacol Ther 28 (1980): 208-15
3. Bauer LA, Brown T, Gibaldi M, et al. "Influence of long-term infusions on lidocaine kinetics." Clin Pharmacol Ther 31 (1982): 433-7
4. Barry M, Keeling PW, Weir D, Feely J "Severity of cirrhosis and the relationship of a1-acid glycoprotein concentration to plasma protein binding of lidocaine." Clin Pharmacol Ther 47 (1990): 366-70
5. Thomson AH, Elliott HL, Kelman AW, et al. "The pharmacokinetics and pharmacodynamics of lignocaine and MEGX in healthy subjects." J Pharmacokinet Biopharm 15 (1987): 101-15
6. Forrest JA, Finlayson ND, Adjepon-Yamoah KK, Prescott LF "Antipyrine, paracetamol, and lignocaine elimination in chronic liver disease." Br Med J 1 (1977): 1384-7
7. Colli A, Buccino G, Cocciolo M, et al. "Disposition of a flow-limited drug (lidocaine) and a metabolic capacity-limited drug (theophylline) in liver cirrhosis." Clin Pharmacol Ther 44 (1988): 642-9
8. Villeneuve JP, Thibeault MJ, Ampelas M, et al. "Drug disposition in patients with HBsAg-positive chronic liver disease." Dig Dis Sci 32 (1987): 710-4
Show all 13 sourcesShow fewer sources
1. Huet PM, Villeneuve JP "Determinants of drug disposition in patients with cirrhosis." Hepatology 3 (1983): 913-8
2. "Product Information. Xylocaine (lidocaine)." Astra-Zeneca Pharmaceuticals (2002):
3. Huang YS, Lee SD, Deng JF, Wu JC, Lu RH, Lin YF, Wang YJ, Lo KJ "Measuring lidocaine metabolite - monoethylglycinexylidide as a quantitative index of hepatic function in adults with chronic hepatitis and cirrhosis." J Hepatol 19 (1993): 140-7
4. Thomson P, Melmon K, Richardson J, Cohn K Steinbrunn W, Cudihee R, Rowland M "Lidocaine pharmacokinetics in advanced heart failure, liver disease, and renal failure in humans." Ann Intern Med 78 (1973): 499-508
5. Shiffman ML, Luketic VA, Sanyal AJ, Duckworth PF, Purdum PP, Contos MJ, Mills AS, Edinboro LE, Poklis A "Hepatic lidocaine metabolism and liver histology in patients with chronic hepatitis and cirrhosis." Hepatology 19 (1994): 933-40
Premature Birth
Major
The use of certain parenteral formulations of dexamethasone, hydrocortisone, methylprednisolone, prednisolone and triamcinolone is considered by the drug manufacturers to be contraindicated in neonates, particularly premature infants and infants of low birth weight. Some formulations of these drugs contain benzyl alcohol which, when used in bacteriostatic saline intravascular flush and endotracheal tube lavage solutions, has been associated with fatalities and severe respiratory and metabolic complications in low-birth-weight premature infants. However, many experts feel that, in the absence of benzyl alcohol-free equivalents, the amount of the preservative present in these formulations should not necessarily preclude their use if they are clearly indicated. The American Academy of Pediatrics considers benzyl alcohol in low doses (such as when used as a preservative in some medications) to be safe for newborns. Continuous infusions of high dosages of medications containing benzyl alcohol may, however, cause toxicity and should be avoided if possible.
10 sources
1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):
Show all 10 sourcesShow fewer sources
1. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
2. ""Inactive" ingredients in pharmaceutical products: update (subject review). American Academy of Pediatrics Committee on Drugs. Available from: URL: http://www.aap.org/policy/re9706.html." Pediatrics 99 (1997): 268-78
Seizures
Major
Seizures have occurred during lidocaine therapy and have been associated with the rapid administration of a large intravenous doses or accumulation of active metabolites with maintenance therapy. Therapy with lidocaine should be administered cautiously to patients with or predisposed to seizure disorders. Clinical monitoring of cardiac (continuous ECG) is required, and serum metabolite concentrations are recommended.
7 sources
1. Crampton RS, Oriscello RG "Petit and grand mal convulsions during lidocaine hydrochloride treatment of ventricular tachycardia." JAMA 204 (1968): 109-12
2. Sundaram MB "Seizures after intraurethral instillation of lidocaine." Can Med Assoc J 137 (1987): 219-20
3. Pelter MA, Vollmer TA, Blum RL "Seizure-like reaction associated with subcutaneous lidocaine injection ." Clin Pharm 8 (1989): 767-8
4. "Product Information. Xylocaine (lidocaine)." Astra-Zeneca Pharmaceuticals (2002):
5. Fortuna A, Fortuna AO "Convulsion during lignocaine infiltration." Anaesth Intensive Care 21 (1993): 483
6. Ryan CA, Robertson M, Coe JY "Seizures due to lidocaine toxicity in a child during cardiac catheterization." Pediatr Cardiol 14 (1993): 116-8
7. Wu FL, Razzaghi A, Souney PF "Seizure after lidocaine for bronchoscopy: case report and review of the use of lidocaine in airway anesthesia." Pharmacotherapy 13 (1993): 72-8
Sick Sinus Syndrome
Major
The use of lidocaine is contraindicated in patients with Stokes-Adam syndrome, Wolff-Parkinson White syndrome, or second- or third-degree AV block in the absence of a functional artificial pacemaker, or congenital QT prolongation.
4 sources
1. Tagliente TM, Jayagopal S "Transient left bundle branch block following lidocaine." Anesth Analg 69 (1989): 545-7
2. Hilleman DE, Mohiuddin SM, Destache CJ "Lidocaine-induced second-degree mobitz type II heart block." Drug Intell Clin Pharm 19 (1985): 669-73
3. Keidar S, Grenadier E, Palant A "Sinoatrial arrest due to lidocaine injection in sick sinus syndrome during amiodarone administration." Am Heart J 104 (1982): 1384-5
4. "Product Information. Xylocaine (lidocaine)." Astra-Zeneca Pharmaceuticals (2002):
Cushing Syndrome
Moderate
Corticosteroids mimic the effects of endogenous cortisol and aldosterone. Use of these agents may aggravate conditions of hyperadrenocorticalism in a dose-dependent manner.
10 sources
1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):
Show all 10 sourcesShow fewer sources
1. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
2. "Product Information. Emflaza (deflazacort)." PTC Therapeutics, Inc. (2021):
Diabetes Mellitus
Moderate
Corticosteroids can raise blood glucose level by antagonizing the action and suppressing the secretion of insulin, which results in inhibition of peripheral glucose uptake and increased gluconeogenesis. Therapy with corticosteroids should be administered cautiously in patients with diabetes mellitus, glucose intolerance, or a predisposition to hyperglycemia. Patients with diabetes mellitus should be monitored more closely during corticosteroid therapy, and their antidiabetic regimen adjusted accordingly.
10 sources
1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):
Show all 10 sourcesShow fewer sources
1. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
2. "Product Information. Emflaza (deflazacort)." PTC Therapeutics, Inc. (2021):
Fibrosis
Moderate
Corticosteroids may have enhanced effects on patients with cirrhosis due to decreased metabolism of these agents. Patients with cirrhosis should be monitored more closely for excessive cortisol effects. Dosage adjustments may be required in these patients.
9 sources
1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):
Show all 9 sourcesShow fewer sources
1. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
Hyperlipidemias
Moderate
Corticosteroids may elevate serum triglyceride and LDL cholesterol levels if used for longer than brief periods. Patients with preexisting hyperlipidemia may require closer monitoring during prolonged corticosteroid therapy, and adjustments made accordingly in their lipid-lowering regimen.
10 sources
1. Seale JP, Compton MR "Side-effects of corticosteroid agents." Med J Aust 144 (1986): 139-42
2. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
3. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
4. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
5. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
6. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
7. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
8. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
Show all 10 sourcesShow fewer sources
1. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):
2. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
Hypothyroidism
Moderate
Corticosteroids may have enhanced effects in hypothyroidism due to decreased metabolism of these agents. Patients with hypothyroidism should be monitored more closely for excessive cortisol effects. Dosage adjustments may be required secondary to changes in their thyroid condition.
10 sources
1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):
Show all 10 sourcesShow fewer sources
1. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
2. "Product Information. Emflaza (deflazacort)." PTC Therapeutics, Inc. (2021):
Keratitis, Herpetic
Moderate
Pharmacologic dosages of corticosteroids should be used cautiously in patients with ocular herpes simplex because of the risk of corneal perforation. Corticosteroids are not recommended for patients with active ocular herpes simplex.
10 sources
1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):
Show all 10 sourcesShow fewer sources
1. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
2. "Product Information. Emflaza (deflazacort)." PTC Therapeutics, Inc. (2021):
Latent Tuberculosis
Moderate
In patients with latent tuberculosis or tuberculin reactivity, the use of pharmacologic dosages of corticosteroids may cause a reactivation of the disease. Close monitoring for signs and symptoms of tuberculosis is recommended if corticosteroid therapy is administered to patients with a history of tuberculosis or tuberculin reactivity. During prolonged corticosteroid therapy, tuberculosis chemoprophylaxis may be considered.
9 sources
1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):
Show all 9 sourcesShow fewer sources
1. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
Liver Diseases
Moderate
Corticosteroids are primarily metabolized by the liver and may have enhanced effects in patients with liver disease. Dosage adjustments may be necessary in these patients.
10 sources
1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
2. Cunliffe WJ, Burton JL, Holti G, Wright V "Hazards of steroid therapy in hepatic failure." Br J Dermatol 93 (1975): 183-5
3. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
4. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
5. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
6. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
7. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
8. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
Show all 10 sourcesShow fewer sources
1. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):
2. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
Muscular Diseases
Moderate
Toxic myopathy has been observed with the chronic use or the administration of large doses of corticosteroids, often in patients with disorders of neuromuscular transmission such as myasthenia gravis or in patients receiving neuromuscular blocking agents. Fluorinated corticosteroids such as betamethasone, dexamethasone, and triamcinolone appear to cause more severe muscle atrophy and weakness than the nonfluorinated agents. Moreover, multiple-daily doses are more toxic than once-daily or, preferably, alternate-day morning doses. Steroid myopathy is generalized and sometimes accompanied by respiratory weakness and dyspnea. In some cases, it has resulted in quadriparesis. Elevations of creatine kinase (CK) may also occur, albeit infrequently. After withdrawal of corticosteroid therapy, recovery may be slow and incomplete. Therapy with corticosteroids should be administered cautiously in patients with preexisting myopathy or myoneural disorders since these conditions may confound the diagnosis of steroid-induced myopathy. The presence of a normal serum CK level, minimal/no changes of myopathy on electromyography, and type 2 muscle fiber atrophy on biopsy are helpful in suggesting steroid-induced weakness. If steroid myopathy is suspected, a dosage reduction or discontinuation of the steroid should be considered.
10 sources
1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):
Show all 10 sourcesShow fewer sources
1. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
2. "Product Information. Emflaza (deflazacort)." PTC Therapeutics, Inc. (2021):
Myasthenia Gravis
Moderate
Although corticosteroids are commonly used in the treatment of myasthenia gravis to increase muscle strength, these agents should nevertheless be administered with caution in such setting. Patients should be treated in an intensive care unit and receive respiratory support, since muscle strength may markedly decrease initially, particularly with high dosages. Preferably, therapy should begin with relatively low dosages (15 to 25 mg/day of prednisone or equivalent) and be increased stepwise as tolerated (approximately 5 mg/day of prednisone or equivalent at 2- to 3-day intervals until marked clinical improvement or a dosage of 50 mg/day is reached). Improvement may be delayed and gradual. Thus, it is important not to discontinue therapy prematurely.
1 source
1. Braunwald E, Hauser SL, Kasper DL, Fauci AS, Isselbacher KJ, Longo DL, Martin JB, eds., Wilson JD "Harrison's Principles of Internal Medicine." New York, NY: McGraw-Hill Health Professionals Division (1998):
Myocardial Infarction
Moderate
The use of corticosteroids may be associated with left ventricular free-wall rupture in patients who have had a recent myocardial infarction. Pharmacologic dosages of corticosteroids should be administered with great caution in such patients.
10 sources
1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):
Show all 10 sourcesShow fewer sources
1. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
2. "Product Information. Emflaza (deflazacort)." PTC Therapeutics, Inc. (2021):
Osteoporosis
Moderate
Corticosteroids reduce osteoblastic function and inhibit the absorption of intestinal calcium, which can result in bone resorption and bone loss during prolonged therapy. In addition, bone matrix may be affected by the protein-catabolic effects of corticosteroids, especially when given in high dosages or for prolonged periods, leading to aseptic necrosis and fractures. Long-term or high-dose corticosteroid therapy should be administered cautiously and only if necessary in patients with or at risk for osteoporosis. Adverse skeletal effects may be minimized by alternate-day or intermittent administration. Any patient receiving prolonged therapy with the equivalent of 7.5 mg prednisone/day or more are at risk for glucocorticoid-induced osteoporosis and should be managed according to The American College of Rheumatology (ACR) guidelines.
10 sources
1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):
Show all 10 sourcesShow fewer sources
1. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
2. "Product Information. Emflaza (deflazacort)." PTC Therapeutics, Inc. (2021):
Peptic Ulcer
Moderate
Corticosteroids may cause peptic ulcer disease and gastrointestinal (GI) hemorrhage, usually when given in high dosages or for prolonged periods. However, even conventional dosages may aggravate symptoms in patients with a history of peptic ulcers. Delayed healing of ulcers has also been reported. Therapy with corticosteroids should be avoided or administered cautiously in patients with active or latent peptic ulcers or other risk factors for GI bleeding. Some clinicians recommend the use of prophylactic antacids or H2-antagonists between meals when large doses of corticosteroids are necessary.
10 sources
1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):
Show all 10 sourcesShow fewer sources
1. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
2. "Product Information. Emflaza (deflazacort)." PTC Therapeutics, Inc. (2021):
Peptic Ulcer Perforation
Moderate
Corticosteroids may cause gastrointestinal perforation and hemorrhage, usually when given in high dosages or for prolonged periods. They may also mask symptoms of complications such as peritonitis or intraabdominal sepsis. Therapy with corticosteroids should be avoided or administered cautiously in patients with diverticulitis, nonspecific ulcerative colitis (if there is a probability of impending perforation, abscess, or other pyogenic infection), or recent intestinal anastomoses.
10 sources
1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):
Show all 10 sourcesShow fewer sources
1. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
2. "Product Information. Emflaza (deflazacort)." PTC Therapeutics, Inc. (2021):
Psychotic Disorders
Moderate
Corticosteroids may aggravate the symptoms of psychosis and emotional instability. Patients with these conditions should be monitored for increased or worsened symptoms during corticosteroid therapy.
10 sources
1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):
Show all 10 sourcesShow fewer sources
1. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
2. "Product Information. Emflaza (deflazacort)." PTC Therapeutics, Inc. (2021):
Scleroderma, Localized
Moderate
In patients with scleroderma, corticosteroids may precipitate renal crisis with malignant hypertension, possibly via steroid-induced increases in renin substrate and angiotensin II levels and decreases in vasodilator prostaglandin production. Renal failure may ensue. Therapy with corticosteroids should be administered cautiously in patients with scleroderma. In addition, they should be limited to short-term use.
10 sources
1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):
Show all 10 sourcesShow fewer sources
1. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
2. Braunwald E, Hauser SL, Kasper DL, Fauci AS, Isselbacher KJ, Longo DL, Martin JB, eds., Wilson JD "Harrison's Principles of Internal Medicine." New York, NY: McGraw-Hill Health Professionals Division (1998):
Strongyloidiasis
Moderate
Unlike most helminths, Strongyloides stercoralis has the ability to replicate in the human host. In patients with strongyloidiasis, the use of pharmacologic or immunosuppressive dosages of corticosteroids may result in Strongyloides hyperinfection and dissemination with widespread larval migration, often accompanied by severe enterocolitis and potentially fatal gram-negative septicemia. Therapy with corticosteroids should be administered with extreme caution, if at all, in these patients. For patients on corticosteroids who develop known or suspected Strongyloides infestation, withdrawal of corticosteroids or reduction of the dose of corticosteroids is recommended.
10 sources
1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):
Show all 10 sourcesShow fewer sources
1. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
2. "Product Information. Emflaza (deflazacort)." PTC Therapeutics, Inc. (2021):
Thromboembolism
Moderate
Corticosteroids may increase blood coagulability and have rarely been associated with the development of intravascular thrombosis, thromboembolism, and thrombophlebitis. Therapy with corticosteroids should be administered cautiously in patients who have or may be predisposed to thrombotic or thromboembolic disorders.
10 sources
1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):
Show all 10 sourcesShow fewer sources
1. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
2. "Product Information. Emflaza (deflazacort)." PTC Therapeutics, Inc. (2021):
Toxic Optic Neuropathy
Moderate
Prolonged use of corticosteroids may cause posterior subcapsular cataracts and elevated intraocular pressure, the latter of which may lead to glaucoma and/or damage to the optic nerves. Long-term therapy with corticosteroids should be administered cautiously in patients with a history of cataracts, glaucoma, or increased intraocular pressure.
10 sources
1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):
Show all 10 sourcesShow fewer sources
1. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
2. "Product Information. Emflaza (deflazacort)." PTC Therapeutics, Inc. (2021):
Water-Electrolyte Imbalance
Moderate
Electrolyte imbalance can alter the therapeutic effectiveness of antiarrhythmic agents. Hypokalemia and hypomagnesemia can reduce the effectiveness of antiarrhythmic agents. In some cases, these disorders can exaggerate the degree of QTc prolongation and increase the potential for torsade de pointes. Hyperkalemia can potentiate the toxic effects of antiarrhythmic agents. Electrolyte imbalance should be corrected prior to initiating antiarrhythmic therapy. Clinical monitoring of cardiac function and electrolyte concentrations is recommended.
13 sources
1. "Product Information. Tonocard (tocainide)." Merck & Co., Inc (2002):
2. "Product Information. Ethmozine (moricizine)." DuPont Pharmaceuticals (2002):
3. "Product Information. Cordarone (amiodarone)." Wyeth-Ayerst Laboratories (2002):
4. "Product Information. Xylocaine (lidocaine)." Astra-Zeneca Pharmaceuticals (2002):
5. "Product Information. Procan SR (procainamide)." Parke-Davis (2001):
6. "Product Information. Pronestyl (procainamide)." Apothecon Inc (2001):
7. "Product Information. Quinidex Extentabs (quiNIDine)." Wyeth-Ayerst Laboratories
8. "Product Information. Tambocor (flecainide)." 3M Pharmaceuticals (2001):
Show all 13 sourcesShow fewer sources
1. "Product Information. Mexitil (mexiletine)." Boehringer-Ingelheim (2001):
2. "Product Information. Rythmol (propafenone)." Knoll Pharmaceutical Company
3. "Product Information. Norpace (disopyramide)." Searle (2001):
4. "Product Information. Cordarone (amiodarone)." Apothecon Inc (2022):
5. "Product Information. Corvert (ibutilide)." Pharmacia and Upjohn (2001):
Water-Electrolyte Imbalance
Moderate
Corticosteroids can cause hypernatremia, hypokalemia, and fluid retention. These mineralocorticoid effects are most significant with fludrocortisone, followed by hydrocortisone and cortisone, then by prednisone and prednisolone. The remaining corticosteroids, betamethasone, dexamethasone, methylprednisolone, and triamcinolone, have little mineralocorticoid activities. However, large doses of any corticosteroid can demonstrate these effects, particularly if given for longer than brief periods. All corticosteroids also increase excretion of calcium and can cause hypocalcemia. Therapy with corticosteroids should be administered cautiously in patients with preexisting electrolyte disturbances. Caution is also advised when treating patients with seizure disorders, since electrolyte disturbances may trigger seizure activity.
10 sources
1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):
Show all 10 sourcesShow fewer sources
1. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
2. "Product Information. Emflaza (deflazacort)." PTC Therapeutics, Inc. (2021):
Water-Electrolyte Imbalance
Moderate
Corticosteroids may cause hypernatremia, hypokalemia, fluid retention, and elevation in blood pressure. These mineralocorticoid effects are most significant with fludrocortisone, followed by hydrocortisone and cortisone, then by prednisone and prednisolone. The remaining corticosteroids, betamethasone, dexamethasone, methylprednisolone, and triamcinolone, have little mineralocorticoid activities. However, large doses of any corticosteroid can demonstrate these effects, particularly if given for longer than brief periods. Therapy with corticosteroids should be administered cautiously in patients with preexisting fluid retention, hypertension, congestive heart failure, and/or renal dysfunction. Dietary sodium restriction and potassium supplementation may be advisable.
10 sources
1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):
Show all 10 sourcesShow fewer sources
1. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
2. "Product Information. Emflaza (deflazacort)." PTC Therapeutics, Inc. (2021):

Therapeutic duplication

Drug classes that overlap with Hydrocortisone + Lidocaine, so taking both doubles up the same effect. This source publishes no per-row citations for duplication.

cortisones
The recommended maximum number of medicines in the 'cortisones' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'cortisones' category.
Example product in the source data (US market): Wixela inhub
cortisones
The recommended maximum number of medicines in the 'cortisones' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'cortisones' category.
Example product in the source data (US market): Formoterol/mometasone
cortisones
The recommended maximum number of medicines in the 'cortisones' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'cortisones' category.
Example product in the source data (US market): Trelegy ellipta
cortisones
The recommended maximum number of medicines in the 'cortisones' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'cortisones' category.
Example product in the source data (US market): Fluticasone/vilanterol
cortisones
The recommended maximum number of medicines in the 'cortisones' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'cortisones' category.
Example product in the source data (US market): Symbicort
cortisones
The recommended maximum number of medicines in the 'cortisones' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'cortisones' category.
Example product in the source data (US market): Budesonide/formoterol/glycopyrrolate
cortisones
The recommended maximum number of medicines in the 'cortisones' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'cortisones' category.
Example product in the source data (US market): Albuterol/budesonide
local injectable anesthetics
The recommended maximum number of medicines in the 'local injectable anesthetics' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'local injectable anesthetics' category.
Example product in the source data (US market): Epinephrine/prilocaine
local injectable anesthetics
The recommended maximum number of medicines in the 'local injectable anesthetics' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'local injectable anesthetics' category.
Example product in the source data (US market): Vivacaine
local injectable anesthetics
The recommended maximum number of medicines in the 'local injectable anesthetics' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'local injectable anesthetics' category.
Example product in the source data (US market): Zynrelef

Medicines

Conditions

Arrhythmias, Cardiac

Cardiomyopathies

Infections

Kidney Diseases

Liver Diseases

Premature Birth

Seizures

Sick Sinus Syndrome

Cushing Syndrome

Diabetes Mellitus

Fibrosis

Hyperlipidemias

Hypothyroidism

Keratitis, Herpetic

Latent Tuberculosis

Liver Diseases

Muscular Diseases

Myasthenia Gravis

Myocardial Infarction

Osteoporosis

Peptic Ulcer

Peptic Ulcer Perforation

Psychotic Disorders

Scleroderma, Localized

Strongyloidiasis

Thromboembolism

Toxic Optic Neuropathy

Water-Electrolyte Imbalance

Water-Electrolyte Imbalance

Water-Electrolyte Imbalance

Therapeutic duplication

cortisones

cortisones

cortisones

cortisones

cortisones

cortisones

cortisones

local injectable anesthetics

local injectable anesthetics

local injectable anesthetics