Drug or other interactions with corticosteroids Clients who seek your advice should instead be urged to consult their physician before taking any additional prescriptions, over-the-counter medications, nutritional supplements, herbal medications or certain foods. Of particular concern to individuals taking corticosteroids: ● Diuretics (water pills) : Can cause the diuretic to be less effective and may increase the loss of potassium. ● Heart medications : Can increase the risk of having an irregular heartbeat or other problems by decreasing the amount of potassium in the blood. ● Cyclosporine (used for autoimmune disorders, in addition to preventing transplanted organ rejection): Can cause seizures when taken with some corticosteroids. ● Antidiabetic agents or insulin (used to treat diabetes) : Can increase glucose (blood sugar) levels when taken with corticosteroids. ● Medicines containing potassium (used to treat high blood pressure) : Can interfere with potassium levels in the blood. ● Medicines containing sodium : Can cause the body to retain excess sodium and water, which can cause high blood sodium, high blood pressure and excess body water. ● Licorice (candy made from the licorice plant’s root) : Can increase the effects of corticosteroid medications. benefits of treatment are not realized for as long as 17 weeks for IBD. Therapeutic mechanisms of purine analogs are not understood, but appear to result in inhibition of cell reproduction. Both azathioprine and 6-mercaptopurine are used to treat ulcerative colitis and Crohn’s disease. More than one-half of all patients with active disease achieve remission within six months of treatment, and maintain remission in most cases. Individuals who rely on long-term glucocorticoid use to manage their disease may find they are able to take lower dosages of glucocoriticoid with the same effects when it is combined with purine analogs. Symptoms of dose-related toxicities of azathioprine and 6-mercaptopurine include nausea and vomiting, hepatic toxicity, and bone marrow depression. Individuals treated with either drug require routine laboratory monitoring with complete blood counts and liver function testing. Elevated liver levels typically respond to a reduction in dosage, but can lead to leukopenia, macrocytosis, anemia, or throbocytopenia if not addressed. Hypersensitivity occurs in 5 percent of users, with symptoms of fever, rash, diarrhea, hepatitis, and/or pancreatitis. Metabolism of purine analogs is significantly altered in the presence of allopurinol. Dosage of the purine analog should be reduced if allopurinol is taken. Methotrexate is another antimetabolite that is helpful in Crohn’s disease. It works by inhibiting enzyme production, but also may interfere with inflammatory actions and stimulating the release of the anti-inflammatory adenosine. While methotrexate is used successfully to induce and maintain remission in Crohn’s disease, its benefits are not as clear as in the case of ulcerative colitis. At higher dosages, methotrexate may cause a variety of serious adverse effects, but at low doses is typically well tolerated. Individuals with renal insufficiency have an increased risk of hepatic toxicity. Infliximab binds to TNF-a receptors, preventing cytokine from binding it. It has been used to treat moderately severe Crohn’s disease, leading to remission and relief from symptoms in about one-third to two-thirds of users. The median clinical response time is about two weeks. The most significant adverse effects of ifliximab treatment is infection including pneumonia, sepsis, pneumocytosis, and listeriosis due to its suppression of inflammatory response. About 10 percent of
● Antacids (counteracts stomach acidity) : Can decrease the effectiveness of some corticosteroids. ● Anticonvulsants (used to treat seizures) : Can decrease the effectiveness of some corticosteroids. ● Phenylbutazone (used to treat fever and pain) : Can reduce the effectiveness of corticosteroids. ● Aminoglutethimide (used to treat some kinds of tumors) : Can reduce the effectiveness of corticosteroids. ● Griseofulvin (used to treat skin infections) : Can reduce the effectiveness of corticosteroids. ● Ephedrine : May decrease the effectiveness of nasal corticosteroids. ● Ritodrine (used to stop premature labor) : Can cause serious side effects when taken with corticosteroids. ● Rifampin (antibacterial drug used to treat tuberculosis) : May decrease the effectiveness of nasal corticosteroids. ● Barbiturates (group of drugs used as sedatives) : Can decrease the effectiveness of some corticosteroids. ● Mitotane (used to treat cancers that affect the adrenal cortex) : Can decrease the effectiveness of some corticosteroids. ● Amphotericin B by injection (used to treat fungal infections) : Can decrease the amount of potassium in the blood. users have acute adverse infusion reactions including fever, chills, pruritus, urticaria, or cardiopulmonary symptoms. In most cases, however, discontinuation is not necessary. Preventive administration of acetaminophen and diphenhydramine may be useful. A delayed infusion reaction may also occur 1-2 weeks after infusion in about 5 percent of individuals retreated with infliximab; reactions include myalgia, fever, rash, and edema of the face or hand. Digestive enzymes Pancrelipase (Cotazym, Pancrease, Viokase); oral formula contains lipase, protease, and amylase activity. Pancreatic dysfunction may be caused by cystic fibrosis, chronic pancreatitis, or pancreatic surgery. When pancreatic enzymes do not function normally, fats and proteins are not properly digested, leading to a variety of deficiencies and weight loss. Supplements containing a mixture of amylase, lipase, and proteases are the primary form of treatments for pancreatic enzyme deficiency. The two main preparations are pancreatin, with low concentrations of lipase and proteolytic enzymes, and pancrelipase, a much stronger preparation which is no longer in clinical use. Pancrelipase is available in two coated forms, necessary for oral administration, as gastric acids render pancrelipase enzymes inactive. Nonenteric coated preparations (Cotazym, Viokase) should be taken with acid suppression therapy, such as proton pump inhibitor or H2 agonist, to reduce acid in the stomach. Encapsulated formulations such as Creon and Pancrease or Ultrase contain acid-resistant properties and do not require concomitant acid suppression therapy. Pancrelipase is usually administered along with food in a range of formulations that have varying amounts of lipase, amylase, and protease. Most pancreatic enzyme supplements are well tolerated when swallowed (not chewed, due to risk of oropharyngeal mucositis). High doses may cause abdominal pain and diarrhea. Side effects may include increased levels of uric acid and renal stones. Drugs that dissolve gallstones Monoctanoin (Moctanin); Ursodiol (Actigall) Ursudio, or ursodeoxycholic acid, is a bile acid used to dissolve cholesterol gallstones and reduce hepatic cholesterol secretion. Side effects include diarrhea.
Purine analogs: Purine anti-metabolites with immunosuppressive properties Azathioprine and 6-mercaptopurine are anti-metabolites with immunosuppressive properties and long half-lives. Therapeutic
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