Methylprednisolone Acetate interactions

Food & lifestyle

• grapefruit juice

  Moderate

  Metabolism

  Grapefruit juice may increase the plasma concentrations of orally administered drugs that are substrates of the CYP450 3A4 isoenzyme. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruit. Because grapefruit juice inhibits primarily intestinal rather than hepatic CYP450 3A4, the magnitude of interaction is greatest for those drugs that undergo significant presystemic metabolism by CYP450 3A4 (i.e., drugs with low oral bioavailability). In general, the effect of grapefruit juice is concentration-, dose- and preparation-dependent, and can vary widely among brands. Certain preparations of grapefruit juice (e.g., high dose, double strength) have sometimes demonstrated potent inhibition of CYP450 3A4, while other preparations (e.g., low dose, single strength) have typically demonstrated moderate inhibition. Pharmacokinetic interactions involving grapefruit juice are also subject to a high degree of interpatient variability, thus the extent to which a given patient may be affected is difficult to predict.

  What to do: Patients who regularly consume grapefruit or grapefruit juice should be monitored for adverse effects and altered plasma concentrations of drugs that undergo significant presystemic metabolism by CYP450 3A4. Grapefruit and grapefruit juice should be avoided if an interaction is suspected. Orange juice is not expected to interact with these drugs.

  32 sources

  1. Edgar B, Bailey D, Bergstrand R, et al. "Acute effects of drinking grapefruit juice on the pharmacokinetics and dynamics on felodipine and its potential clinical relevance." Eur J Clin Pharmacol 42 (1992): 313-7
  2. Jonkman JH, Sollie FA, Sauter R, Steinijans VW "The influence of caffeine on the steady-state pharmacokinetics of theophylline." Clin Pharmacol Ther 49 (1991): 248-55
  3. Bailey DG, Arnold JM, Munoz C, Spence JD "Grapefruit juice--felodipine interaction: mechanism, predictability, and effect of naringin." Clin Pharmacol Ther 53 (1993): 637-42
  4. Bailey DG, Arnold JMO, Spence JD "Grapefruit juice and drugs - how significant is the interaction." Clin Pharmacokinet 26 (1994): 91-8
  5. Sigusch H, Hippius M, Henschel L, Kaufmann K, Hoffmann A "Influence of grapefruit juice on the pharmacokinetics of a slow release nifedipine formulation." Pharmazie 49 (1994): 522-4
  6. Bailey DG, Arnold JM, Strong HA, Munoz C, Spence JD "Effect of grapefruit juice and naringin on nisoldipine pharmacokinetics." Clin Pharmacol Ther 54 (1993): 589-94
  7. Yamreudeewong W, Henann NE, Fazio A, Lower DL, Cassidy TG "Drug-food interactions in clinical practice." J Fam Pract 40 (1995): 376-84
  8. "Grapefruit juice interactions with drugs." Med Lett Drugs Ther 37 (1995): 73-4

  Show all 32 sourcesShow fewer sources

  9. Hukkinen SK, Varhe A, Olkkola KT, Neuvonen PJ "Plasma concentrations of triazolam are increased by concomitant ingestion of grapefruit juice." Clin Pharmacol Ther 58 (1995): 127-31
  10. Min DI, Ku YM, Geraets DR, Lee HC "Effect of grapefruit juice on the pharmacokinetics and pharmacodynamics of quinidine in healthy volunteers." J Clin Pharmacol 36 (1996): 469-76
  11. Majeed A, Kareem A "Effect of grapefruit juice on cyclosporine pharmacokinetics." Pediatr Nephrol 10 (1996): 395
  12. Clifford CP, Adams DA, Murray S, Taylor GW, Wilkins MR, Boobis AR, Davies DS "Pharmacokinetic and cardiac effects of terfenadine after inhibition of its metabolism by grapefruit juice." Br J Clin Pharmacol 42 (1996): p662
  13. Josefsson M, Zackrisson AL, Ahlner J "Effect of grapefruit juice on the pharmacokinetics of amlodipine in healthy volunteers." Eur J Clin Pharmacol 51 (1996): 189-93
  14. Kantola T, Kivisto KT, Neuvonen PJ "Grapefruit juice greatly increases serum concentrations of lovastatin and lovastatin acid." Clin Pharmacol Ther 63 (1998): 397-402
  15. Ozdemir M, Aktan Y, Boydag BS, Cingi MI, Musmul A "Interaction between grapefruit juice and diazepam in humans." Eur J Drug Metab Pharmacokinet 23 (1998): 55-9
  16. Bailey DG, Malcolm J, Arnold O, Spence JD "Grapefruit juice-drug interactions." Br J Clin Pharmacol 46 (1998): 101-10
  17. Bailey DG, Kreeft JH, Munoz C, Freeman DJ, Bend JR "Grapefruit juice felodipine interaction: Effect of naringin and 6',7'-dihydroxybergamottin in humans." Clin Pharmacol Ther 64 (1998): 248-56
  18. Garg SK, Kumar N, Bhargava VK, Prabhakar SK "Effect of grapefruit juice on carbamazepine bioavailability in patients with epilepsy." Clin Pharmacol Ther 64 (1998): 286-8
  19. Lilja JJ, Kivisto KT, Neuvonen PJ "Grapefruit juice-simvastatin interaction: Effect on serum concentrations of simvastatin, simvastatin acid, and HMG-CoA reductase inhibitors." Clin Pharmacol Ther 64 (1998): 477-83
  20. Fuhr U, Maier-Bruggemann A, Blume H, et al. "Grapefruit juice increases oral nimodipine bioavailability." Int J Clin Pharmacol Ther 36 (1998): 126-32
  21. Lilja JJ, Kivisto KT, Neuvonen PJ "Grapefruit juice increases serum concentrations of atorvastatin and has no effect on pravastatin." Clin Pharmacol Ther 66 (1999): 118-27
  22. Eagling VA, Profit L, Back DJ "Inhibition of the CYP3A4-mediated metabolism and P-glycoprotein-mediated transport of the HIV-I protease inhibitor saquinavir by grapefruit juice components." Br J Clin Pharmacol 48 (1999): 543-52
  23. Damkier P, Hansen LL, Brosen K "Effect of diclofenac, disulfiram, itraconazole, grapefruit juice and erythromycin on the pharmacokinetics of quinidine." Br J Clin Pharmacol 48 (1999): 829-38
  24. Lee AJ, Chan WK, Harralson AF, Buffum J, Bui BCC "The effects of grapefruit juice on sertraline metabolism: An in vitro and in vivo study." Clin Ther 21 (1999): 1890-9
  25. Dresser GK, Spence JD, Bailey DG "Pharmacokinetic-pharmacodynamic consequences and clinical relevance of cytochrome P450 3A4 inhibition." Clin Pharmacokinet 38 (2000): 41-57
  26. Gunston GD, Mehta U "Potentially serious drug interactions with grapefruit juice." S Afr Med J 90 (2000): 41
  27. Takanaga H, Ohnishi A, Maatsuo H, et al. "Pharmacokinetic analysis of felodipine-grapefruit juice interaction based on an irreversible enzyme inhibition model." Br J Clin Pharmacol 49 (2000): 49-58
  28. Libersa CC, Brique SA, Motte KB, et al. "Dramatic inhibition of amiodarone metabolism induced by grapefruit juice." Br J Clin Pharmacol 49 (2000): 373-8
  29. Bailey DG, Dresser GR, Kreeft JH, Munoz C, Freeman DJ, Bend JR "Grapefruit-felodipine interaction: Effect of unprocessed fruit and probable active ingredients." Clin Pharmacol Ther 68 (2000): 468-77
  30. Zaidenstein R, Soback S, Gips M, Avni B, Dishi V, Weissgarten Y, Golik A, Scapa E "Effect of grapefruit juice on the pharmacokinetics of losartan and its active metabolite E3174 in healthy volunteers." Ther Drug Monit 23 (2001): 369-73
  31. Sato J, Nakata H, Owada E, Kikuta T, Umetsu M, Ito K "Influence of usual intake of dietary caffeine on single-dose kinetics of theophylline in healthy human subjects." Eur J Clin Pharmacol 44 (1993): 295-8
  32. Flanagan D "Understanding the grapefruit-drug interaction." Gen Dent 53 (2005): 282-5; quiz 286

Conditions

Conditions in which Methylprednisolone Acetate needs care, as documented in this source.

• 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

  9. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):

• 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

  9. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
  10. ""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

• 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

  9. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
  10. "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

  9. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
  10. "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

  9. "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

  9. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):
  10. "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

  9. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
  10. "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

  9. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
  10. "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

  9. "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

  9. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):
  10. "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

  9. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
  10. "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

  9. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
  10. "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

  9. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
  10. "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

  9. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
  10. "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

  9. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
  10. "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

  9. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
  10. "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

  9. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
  10. 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

  9. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
  10. "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

  9. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
  10. "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

  9. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
  10. "Product Information. Emflaza (deflazacort)." PTC Therapeutics, Inc. (2021):

• 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

  9. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
  10. "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

  9. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
  10. "Product Information. Emflaza (deflazacort)." PTC Therapeutics, Inc. (2021):

Therapeutic duplication

Drug classes that overlap with Methylprednisolone Acetate, 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