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Vitamins for MS: Do supplements make a difference? Whipple's disease Yucca: Can it relieve arthritis pain? Although the FDA-approved product labeling states that corticosteroids are contraindicated in patients with systemic fungal infections, most clinicians believe that systemic corticosteroids can be administered to these patients as long as appropriate therapy is administered simultaneously. Avoid use of prednisone in patients with a fungal infection or bacterial infection that is not adequately controlled with anti-infective agents.

Activation of latent disease or exacerbation of intercurrent infection due to pathogens such as Amoeba, Candida, Cryptococcus, Mycobacterium, Nocardia, Pneumocystis, or Toxoplasma can occur in patients receiving systemic corticosteroids. Rule out infection with latent or active amebiasis before initiating corticosteroid therapy in patients who have spent time in the tropics or who have unexplained diarrhea.

Use corticosteroids with caution in patients with known or suspected Strongyloides threadworm infestation as the immunosuppressive effects may lead to disseminated infection, severe enterocolitis, and sepsis. Reserve systemic corticosteroid therapy in active tuberculosis for patients with fulminating or disseminated disease and only in conjunction with appropriate antituberculosis therapy. Reactivation of tuberculosis may occur in patients with latent tuberculosis or tuberculin reactivity; close observation for disease reactivation is needed if corticosteroids are indicated in such patients.

Furthermore, chemoprophylaxis is advised if prolonged corticosteroid therapy is needed. Advise patients receiving immunosuppressive doses of systemic corticosteroids to avoid exposure to persons with a viral infection i. Instruct patients to get immediate medical advice if exposure occurs. If exposed to chicken pox, prophylaxis with varicella zoster immune globulin may be indicated. If exposed to measles, prophylaxis with pooled intramuscular immunoglobulin may be indicated.

Avoid the use of corticosteroids in active ocular herpes infection due to the risk of corneal perforation. Corticosteroids should not be used in cerebral malaria. As glucocorticoids can produce or aggravate Cushing's syndrome, glucocorticoids, such as prednisone, should be avoided in patients with Cushing's disease. Acute adrenal insufficiency and even death may occur following abrupt discontinuation of systemic therapy. In addition, a withdrawal syndrome unrelated to adrenocortical insufficiency may occur following sudden discontinuation of corticosteroid therapy.

These effects are thought to be due to the sudden change in glucocorticoid concentration rather than to low corticosteroid levels. Withdraw prolonged systemic corticosteroid therapy greater than 2 weeks gradually. HPA suppression can last for up to 12 months following cessation of systemic chronic therapy. Recovery of HPA axis function is generally prompt and complete upon discontinuation of short-term or topical corticosteroid therapy.

Like all corticosteroids, prednisone therapy may impair immune and adrenocortical function. HPA-suppressed patients may need supplemental corticosteroid treatment during periods of physiologic stress, such as surgery, acute blood loss, or infectious conditions, even after the corticosteroid has been discontinued. Patients should advise the attending physician of the corticosteroid they have received within the last 12 months, and the disease for which they were being treated.

Identification cards which include the name of the patient's disease, the currently administered type and dose of corticosteroid, and the patient's physician should be carried with the patient at all times. Corticosteroid therapy, including prednisone therapy, has been associated with left ventricular free-wall rupture in patients with recent myocardial infarction, and should therefore be used cautiously in these patients.

As sodium retention with resultant edema and potassium loss may occur in patients receiving corticosteroids, these agents should be used with caution in patients with congestive heart failure, hypertension, or renal disease or insufficiency. Systemic corticosteroids, such as prednisone, may decrease glucose tolerance, produce hyperglycemia, and aggravate or precipitate diabetes mellitus. Metabolic clearance of corticosteroids is decreased in hypothyroidism and increased in hyperthyroidism.

Changes in thyroid disease status of a patient may necessitate adjustment in dosage. Systemic corticosteroids should be used with caution in patients with active or latent peptic ulcer disease, diverticulitis, fresh intestinal anastomoses, and nonspecific ulcerative colitis, since steroids may increase the risk of a gastrointestinal GI perforation. Signs of peritoneal irritation following GI perforation in patients receiving corticosteroids may be minimal or absent. Corticosteroids should not be used in patients where there is a possibility of impending GI perforation, abscess, or pyogenic infection.

There is an enhanced effect due to decreased metabolism of corticosteroids in patients with severe hepatic disease with cirrhosis. An acute myopathy has been observed with the use of high doses of corticosteroids, most often occurring in patients with neuromuscular disease disorders e. This acute myopathy is generalized, may involve ocular and respiratory muscles, and may result in quadriparesis.

Elevation of creatinine kinase may occur. Clinical improvement or recovery after stopping corticosteroids may require weeks to years. Use with caution in patients with glaucoma; corticosteroids can elevate intraocular pressure with possible damage to the optic nerves. If steroid therapy is continued for more than 6 weeks, intraocular pressure should be monitored.

Use of corticosteroids may produce posterior subcapsular cataracts and may enhance the establishment of secondary ocular infection due to bacteria, fungi or viruses. The use of oral corticosteroids is not recommended in the treatment of optic neuritis and may lead to an increase in the risk of new episodes.

Corticosteroids should not be used in active ocular herpes simplex because of possible corneal perforation. Existing emotional instability or psychosis may be aggravated by corticosteroids. Psychiatric derangements may appear when corticosteroids are used, ranging from euphoria, insomnia, mood swings, personality changes, and severe depression, to frank psychosis. Use prednisone with caution in patients with a seizure disorder; systemic steroids can lower the seizure threshold. Corticosteroids decrease bone formation and increase bone resorption both through their effect on calcium regulation i.

This, together with a decrease in the protein matrix of the bone secondary to an increase in protein catabolism, and reduced sex hormone production, may lead to inhibition of bone growth in pediatric patients and the development of osteopenia or osteoporosis at any age. Growth and development of pediatric patients on prolonged corticosteroid therapy should be carefully observed. Special consideration should be given to patients at increased risk of osteoporosis e. Consider interventions to reduce bone loss or treat glucocorticoid-induced osteoporosis in affected patients.

To minimize the risk of glucocortoicoid-induced bone loss, the smallest possible effective dosage and duration should be used. Current recommendations suggest that all interventions be initiated in any patient in whom glucocorticoid therapy with at least the equivalent of 5 mg of prednisone for at least 3 months is anticipated. Prednisone has been used in infants, children, and adolescents; however, consider pediatric-specific issues before initiating treatment.

Safety and efficacy have not been established for the use of corticosteroids in neonates. Adverse effects in newborns have included complications of treatment such as gastrointestinal bleeding, intestinal perforation, hyperglycemia, and hypertension. The potential for growth inhibition in any pediatric patient should be monitored during prolonged therapy, and the potential for growth effects should be weighed against the clinical benefit obtained and the availability of other treatment alternatives.

Administration of corticosteroids to pediatric patients should be limited to the least amount compatible with an effective therapeutic regimen. Further, children receiving corticosteroids are immunosuppressed, and are therefore more susceptible to infection.

Normally innocuous infections can become fatal in these children, and care should be taken to avoid exposure to these diseases. Published studies provide evidence of efficacy and safety in pediatric patients for the treatment of nephrotic syndrome pediatric patients more than 2 years of age , and aggressive lymphomas and leukemias patients greater than 1 month of age. Other indications for pediatric use of corticosteroids e.

Indicated vaccination procedures may be undertaken in patients receiving nonimmunosuppressive doses of corticosteroids as replacement therapy e. Administration of live or live, attenuated vaccines is contraindicated in patients receiving immunosuppressive doses of corticosteroids.

Killed or inactivated vaccines may be administered. However, the response to such vaccines may be diminished and cannot be predicted. In patients who have received high-dose, systemic corticosteroids for 2 weeks or longer, it is recommended to wait at least 3 months after discontinuation of therapy before administering a live-virus vaccine.

If systemic corticosteroids such as prednisone must be used during pregnancy, the potential risks should be discussed with the patient. Infants born to mothers who have received substantial doses of corticosteroids during pregnancy should be carefully observed for signs of hypoadrenalism. Corticosteroids have been shown to be teratogenic in many species when given in doses equivalent to the human dose.

Animal studies in which corticosteroids have been given to pregnant mice, rats, and rabbits have yielded an increased incidence of cleft palate in the offspring. There are no adequate and well-controlled studies in pregnant women. Corticosteroids distribute into breast milk, and the manufacturer states that because of the potential for serious adverse reactions in nursing babies, a decision should be made whether to discontinue nursing or to discontinue the drug.

However, prednisone concentrations in breast milk are low, and no adverse effects have been reported in the breast-fed infant with maternal use of any corticosteroid during breast-feeding; prednisone is generally considered compatible to use during lactation. Published case reports of systemic prednisone use during pregnancy that indicate little risk to a nursing infant due to lack of reported side effects.

Prednisone is converted to prednisolone in vivo, and peak concentrations in human milk appear in about 1 hour after a dose; the total daily dose reaching the infant is approximately 0. Prednisolone and methylprednisolone have similar data available regarding systemic use during lactation. At higher daily prednisone doses, avoidance of breast-feeding during times of peak milk concentrations can help limit infant exposure; however, such adjustments are rarely necessary.

Consider the benefits of breast-feeding, the risk of potential infant drug exposure, and the risk of an untreated or inadequately treated condition. Use systemic corticosteroids such as prednisone with caution in the geriatric patient; the risks and benefits of therapy should be considered for any individual patient, particularly with chronic use. According to the Beers Criteria, systemic corticosteroids are considered potentially inappropriate medications PIMs for use in geriatric patients with delirium or at high risk for delirium and should be avoided in these patient populations due to the possibility of new-onset delirium or exacerbation of the current condition.

The Beers expert panel notes that oral and parenteral corticosteroids may be required for conditions such as exacerbation of chronic obstructive pulmonary disease COPD but should be prescribed in the lowest effective dose and for the shortest possible duration. According to the OBRA guidelines, the need for continued use of a glucocorticoid, with the exception of topical or inhaled formulations, should be documented, along with monitoring for and management of adverse consequences.

Intermediate or longer-term use may cause hyperglycemia, psychosis, edema, insomnia, hypertension, osteoporosis, mood lability, or depression. Abatacept: Moderate Concomitant use of immunosuppressives, as well as long-term corticosteroids, may potentially increase the risk of serious infection in abatacept treated patients.

Advise patients taking abatacept to seek immediate medical advice if they develop signs and symptoms suggestive of infection. While there is controversy regarding the ulcerogenic potential of corticosteroids alone, concomitant administration of corticosteroids with aspirin may increase the GI toxicity of aspirin and other non-acetylated salicylates.

Withdrawal of corticosteroids can result in increased plasma concentrations of salicylate and possible toxicity. Although some patients may need to be given corticosteroids and NSAIDs concomitantly, which can be done successfully for short periods of time without sequelae, prolonged coadministration should be avoided. Acetaminophen; Butalbital: Moderate Coadministration may result in decreased exposure to prednisone.

Monitor for decreased response to prednisone during concurrent use. Acetaminophen; Butalbital; Caffeine: Moderate Coadministration may result in decreased exposure to prednisone. Acetaminophen; Butalbital; Caffeine; Codeine: Moderate Coadministration may result in decreased exposure to prednisone. Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.

Monitor patients for increased pressor effect if these agents are administered concomitantly. Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.

Acetaminophen; Dextromethorphan; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Acetaminophen; Guaifenesin; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Acetazolamide: Moderate Corticosteroids may increase the risk of hypokalemia if used concurrently with acetazolamide.

Hypokalemia may be especially severe with prolonged use of corticotropin, ACTH. Acetohexamide: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Systemic and inhaled corticosteroids are known to increase blood glucose and worsen glycemic control in patients taking antidiabetic agents.

The main risk factors for impaired glucose tolerance due to corticosteroids are the dose of steroid and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance.

Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. Adalimumab: Moderate Closely monitor for the development of signs and symptoms of infection if coadministration of a corticosteroid with adalimumab is necessary. Adalimumab treatment increases the risk for serious infections that may lead to hospitalization or death. Patients taking concomitant immunosuppressants including corticosteroids may be at greater risk of infection.

Albiglutide: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Alefacept: Severe Patients receiving other immunosuppressives should not receive concurrent therapy with alefacept; there is the possibility of excessive immunosuppression and subsequent risks of infection and other serious side effects.

In clinical efficacy trials, concurrent treatment of alefacept with these types of agents did not occur. The duration of the period following treatment with alefacept that is appropriate before starting other immunosuppressive therapy has not been evaluated. Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids.

Monitoring serum potassium levels and cardiac function is advised, and potassium supplementation may be required. Aliskiren; Hydrochlorothiazide, HCTZ: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids.

Alogliptin; Metformin: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Alpha-glucosidase Inhibitors: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued.

Altretamine: Minor Concurrent use of altretamine with other agents which cause bone marrow or immune suppression such as corticosteroids may result in additive effects. Ambenonium Chloride: Minor Corticosteroids may interact with cholinesterase inhibitors including ambenonium, neostigmine, and pyridostigmine, occasionally causing severe muscle weakness in patients with myasthenia gravis. Glucocorticoids are occasionally used therapeutically, however, in the treatment of some patients with myasthenia gravis.

In such patients, it is recommended that corticosteroid therapy be initiated at low dosages and with close clinical monitoring. The dosage should be increased gradually as tolerated, with continued careful monitoring of the patient's clinical status. Amifampridine: Moderate Carefully consider the need for concomitant treatment with systemic corticosteroids and amifampridine, as coadministration may increase the risk of seizures.

If coadministration occurs, closely monitor patients for seizure activity. Seizures have been observed in patients without a history of seizures taking amifampridine at recommended doses. Systemic corticosteroids may increase the risk of seizures in some patients.

Amiloride; Hydrochlorothiazide, HCTZ: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids. Aminolevulinic Acid: Minor Corticosteroids administered prior to or concomitantly with photosensitizing agents used in photodynamic therapy may decrease the efficacy of the treatment.

Amiodarone: Major Use caution when coadministering amiodarone with drugs which may induce hypokalemia and, or hypomagnesemia, including corticosteroids. Since antiarrhythmic drugs may be ineffective or may be arrhythmogenic in patients with hypokalemia, any potassium or magnesium deficiency should be corrected before instituting and during amiodarone therapy.

Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids. Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids.

Amphotericin B cholesteryl sulfate complex ABCD : Moderate The potassium-wasting effects of corticosteroid therapy can be exacerbated by concomitant administration of other potassium-depleting drugs including amphotericin B. Serum potassium levels should be monitored in patients receiving these drugs concomitantly. Amphotericin B lipid complex ABLC : Moderate The potassium-wasting effects of corticosteroid therapy can be exacerbated by concomitant administration of other potassium-depleting drugs including amphotericin B.

Amphotericin B liposomal LAmB : Moderate The potassium-wasting effects of corticosteroid therapy can be exacerbated by concomitant administration of other potassium-depleting drugs including amphotericin B. Amphotericin B: Moderate The potassium-wasting effects of corticosteroid therapy can be exacerbated by concomitant administration of other potassium-depleting drugs including amphotericin B. Aprepitant, Fosaprepitant: Moderate Use caution if prednisone and aprepitant, fosaprepitant are used concurrently and monitor for an increase in prednisone-related adverse effects for several days after administration of a multi-day aprepitant regimen.

The active metabolite of prednisone, prednisolone, is a CYP3A4 substrate. As a single mg or 40 mg oral dose, the inhibitory effect of aprepitant on CYP3A4 is weak, with the AUC of midazolam increased by 1. After administration, fosaprepitant is rapidly converted to aprepitant and shares many of the same drug interactions.

However, as a single mg intravenous dose, fosaprepitant only weakly inhibits CYP3A4 for a duration of 2 days; there is no evidence of CYP3A4 induction. Fosaprepitant mg IV as a single dose increased the AUC of midazolam given on days 1 and 4 by approximately 1. Less than a 2-fold increase in the midazolam AUC is not considered clinically important. Argatroban: Moderate Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention.

Assess sodium chloride intake from all sources, including intake from sodium-containing intravenous fluids and antibiotic admixtures. Carefully monitor sodium concentrations and fluid status if sodium-containing drugs and corticosteroids must be used together. Arsenic Trioxide: Moderate Caution is advisable during concurrent use of arsenic trioxide and corticosteroids as electrolyte imbalance caused by corticosteroids may increase the risk of QT prolongation with arsenic trioxide.

Asparaginase Erwinia chrysanthemi: Moderate Concomitant use of L-asparaginase with corticosteroids can result in additive hyperglycemia. L-Asparaginase transiently inhibits insulin production contributing to hyperglycemia seen during concurrent corticosteroid therapy. Insulin therapy may be required in some cases. Administration of L-asparaginase after rather than before corticosteroids reportedly has produced fewer hypersensitivity reactions.

Atazanavir: Moderate Coadministration of prednisone with atazanavir may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression. Corticosteroids, such as beclomethasone and prednisolone, whose concentrations are less affected by strong CYP3A4 inhibitors, should be considered, especially for long-term use.

Atazanavir; Cobicistat: Moderate Coadministration of prednisone with atazanavir may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression. Moderate Coadministration of prednisone with cobicistat may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression.

Atenolol; Chlorthalidone: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids. Atracurium: Moderate Caution and close monitoring are advised if corticosteroids and neuromuscular blockers are used together, particularly for long periods, due to enhanced neuromuscular blocking effects.

In such patients, a peripheral nerve stimulator may be of value in monitoring the response. Concurrent use may increase the risk of acute myopathy. Elevation of creatine kinase may occur. Atropine; Hyoscyamine; Phenobarbital; Scopolamine: Moderate Coadministration may result in decreased exposure to prednisone. Azilsartan; Chlorthalidone: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids.

Belladonna Alkaloids; Ergotamine; Phenobarbital: Moderate Coadministration may result in decreased exposure to prednisone. Benazepril; Hydrochlorothiazide, HCTZ: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids.

Bendroflumethiazide; Nadolol: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids. Bepridil: Moderate Hypokalemia-producing agents, including corticosteroids, may increase the risk of bepridil-induced arrhythmias and should therefore be administered cautiously in patients receiving bepridil therapy. Bisoprolol; Hydrochlorothiazide, HCTZ: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids.

Bivalirudin: Moderate Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention. Boceprevir: Major Concurrent administration of systemic corticosteroids, such as prednisone, and boceprevir is not recommended. If prednisone and boceprevir are coadministered, close monitoring for corticosteroid-related adverse events and for decreased boceprevir efficacy is advised.

If prednisone dose adjustments are made, re-adjust the dose upon completion of boceprevir treatment. Predictions about the interaction can be made based on the metabolic pathway of prednisone. Prednisone is metabolized by the hepatic isoenzyme CYP3A4 and the drug efflux transporter P-glycoprotein P-gp ; boceprevir inhibits both the isoenzyme and the drug efflux pump.

Coadministration may result in elevated prednisone plasma concentrations. Bosentan: Minor A dose adjustment of prednisone may be necessary if bosentan is initiated or withdrawn during therapy. Bosentan may increase the metabolism of prednisone resulting in decreased exposure. Brompheniramine; Carbetapentane; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.

Bupropion: Moderate Because bupropion is associated with a dose-related risk of seizures, extreme caution is recommended during concurrent use of other drugs that may lower the seizure threshold such as systemic corticosteroids. Low initial dosing and slow dosage titration of bupropion is recommended if these combinations must be used; the patient should be closely monitored.

Bupropion; Naltrexone: Moderate Because bupropion is associated with a dose-related risk of seizures, extreme caution is recommended during concurrent use of other drugs that may lower the seizure threshold such as systemic corticosteroids. Butabarbital: Moderate Coadministration may result in decreased exposure to prednisone. Cabozantinib: Minor Monitor for an increase in prednisone-related adverse reactions if coadministration with cabozantinib is necessary; a dose adjustment of prednisone may be necessary.

Prednisone is a P-glycoprotein P-gp substrate. Cabozantinib is a P-gp inhibitor and has the potential to increase plasma concentrations of P-gp substrates; however, the clinical relevance of this finding is unknown. Calcium Carbonate: Moderate Calcium absorption is reduced when calcium carbonate is taken concomitantly with systemic corticosteroids.

Systemic corticosteroids induce a negative calcium balance by inhibiting intestinal calcium absorption as well as by increasing renal calcium losses. The mechanism by which these drugs inhibit calcium absorption in the intestine is likely to involve a direct inhibition of absorptive cell function.

Calcium Carbonate; Magnesium Hydroxide: Moderate Calcium absorption is reduced when calcium carbonate is taken concomitantly with systemic corticosteroids. Calcium Carbonate; Risedronate: Moderate Calcium absorption is reduced when calcium carbonate is taken concomitantly with systemic corticosteroids.

Calcium Carbonate; Simethicone: Moderate Calcium absorption is reduced when calcium carbonate is taken concomitantly with systemic corticosteroids. Canagliflozin: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Canagliflozin; Metformin: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued.

Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Candesartan; Hydrochlorothiazide, HCTZ: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids.

Captopril; Hydrochlorothiazide, HCTZ: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids. Carbamazepine: Moderate Hepatic microsomal enzyme inducers, including carbamazepine, can increase the metabolism of prednisone. Carbetapentane; Chlorpheniramine; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.

Carbetapentane; Diphenhydramine; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Carbetapentane; Guaifenesin; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.

Carbetapentane; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Carbetapentane; Phenylephrine; Pyrilamine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Carbinoxamine; Hydrocodone; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.

Carbinoxamine; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Carvedilol: Minor Increased concentrations of prednisone may occur if it is coadministered with carvedilol; exercise caution.

Carvedilol is a P-glycoprotein P-gp inhibitor and prednisone is a P-gp substrate. Ceritinib: Minor Monitor for steroid-related adverse reactions if coadministration of ceritinib with prednisone is necessary, due to increased prednisone exposure. Certolizumab pegol: Moderate The safety and efficacy of certolizumab in patients with immunosuppression have not been evaluated. Patients receiving immunosuppressives along with certolizumab may be at a greater risk of developing an infection.

Many of the serious infections occurred in patients on immunosuppressive therapy who received certolizumab. Chlophedianol; Guaifenesin; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.

Chlorothiazide: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids. Chlorpheniramine; Dextromethorphan; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.

Chlorpheniramine; Dihydrocodeine; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Chlorpheniramine; Hydrocodone; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Chlorpheniramine; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.

Chlorpropamide: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Chlorthalidone: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids.

Chlorthalidone; Clonidine: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids. Cholestyramine: Moderate Cholestyramine may increase the clearance of corticosteroids, such as prednisone.

Cimetidine: Moderate Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention. Cisatracurium: Moderate Caution and close monitoring are advised if corticosteroids and neuromuscular blockers are used together, particularly for long periods, due to enhanced neuromuscular blocking effects.

Citalopram: Moderate Caution is advisable during concurrent use of citalopram and corticosteroids as electrolyte imbalance caused by corticosteroids may increase the risk of QT prolongation with citalopram. Clindamycin: Moderate Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention. Cobicistat: Moderate Coadministration of prednisone with cobicistat may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression.

Codeine; Phenylephrine; Promethazine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Concurrent use may result in elevated prednisone serum concentrations. According to the manufacturer of conivaptan, concomitant use of conivaptan, a strong CYP3A4 inhibitor, and CYP3A substrates, such as prednisone, should be avoided.

Coadministration of conivaptan with other CYP3A substrates midazolam, simvastatin, amlodipine has resulted in increased mean AUC values 2 to 3 times. Theoretically, similar pharmacokinetic effects could be seen with prednisone. Treatment with prednisone may be initiated no sooner than 1 week after completion of conivaptan therapy. In addition, conivaptan has been associated with hypokalemia 9. Although not studied, consider the potential for additive hypokalemic effects if conivaptan is coadministered with drugs known to induce hypokalemia, such as corticosteroids.

Daclatasvir: Moderate Systemic exposure of prednisone, a P-glycoprotein P-gp substrate, may be increased when administered concurrently with daclatasvir, a P-gp inhibitor. Taking these drugs together could increase or prolong the therapeutic effects of prednisone; monitor patients for potential adverse effects. Dapagliflozin: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued.

Dapagliflozin; Metformin: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Dapagliflozin; Saxagliptin: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued.

Darunavir: Moderate Coadministration of prednisone with darunavir may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression. Darunavir; Cobicistat: Moderate Coadministration of prednisone with cobicistat may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression.

Moderate Coadministration of prednisone with darunavir may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression. Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide: Moderate Coadministration of prednisone with cobicistat may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression.

Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir: Moderate Coadministration of prednisone with ritonavir a strong CYP3A4 inhibitor may cause prednisone serum concentrations to increase, potentially resulting in Cushing's syndrome and adrenal suppression.

Consider use of an alternative corticosteroid whose concentrations are less affected by strong CYP3A4 inhibitors, such as beclomethasone and prednisolone, especially during long-term treatment. Deferasirox: Moderate Because gastric ulceration and GI bleeding have been reported in patients taking deferasirox, use caution when coadministering with other drugs known to increase the risk of peptic ulcers or gastric hemorrhage including corticosteroids.

Denosumab: Moderate The safety and efficacy of denosumab use in patients with immunosuppression have not been evaluated. Patients receiving immunosuppressives along with denosumab may be at a greater risk of developing an infection. Desmopressin: Major Desmopressin, when used in the treatment of nocturia is contraindicated with corticosteroids because of the risk of severe hyponatremia. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer.

Dextran: Moderate Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention. Dextromethorphan; Diphenhydramine; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Dextromethorphan; Guaifenesin; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.

Digoxin: Moderate Hypokalemia, hypomagnesemia, or hypercalcemia increase digoxin's effect. Corticosteroids can precipitate digoxin toxicity via their effect on electrolyte balance. It is recommended that serum potassium, magnesium, and calcium be monitored regularly in patients receiving digoxin. Diltiazem: Moderate Prednisone is metabolized by the liver to the active metabolite prednisolone.

Prednisolone is metabolized by CYP3A4 to inactive compounds. As diltiazem is both a substrate and an inhibitor of CYP3A4, monitor patients for corticosteroid-related side effects if prednisone and diltiazem are taken. Dipeptidyl Peptidase-4 Inhibitors: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued.

Diphenhydramine; Hydrocodone; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Diphenhydramine; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Dofetilide: Major Corticosteroids can cause increases in blood pressure, sodium and water retention, and hypokalemia, predisposing patients to interactions with certain other medications.

Corticosteroid-induced hypokalemia could also enhance the proarrhythmic effects of dofetilide. Doxacurium: Moderate Caution and close monitoring are advised if corticosteroids and neuromuscular blockers are used together, particularly for long periods, due to enhanced neuromuscular blocking effects. The concomitant administration of dronedarone with CYP3A4 and P-gp substrates may result in increased exposure of the substrate and should, therefore, be undertaken with caution. Droperidol: Moderate Caution is advised when using droperidol in combination with corticosteroids which may lead to electrolyte abnormalities, especially hypokalemia or hypomagnesemia, as such abnormalities may increase the risk for QT prolongation or cardiac arrhythmias.

Dulaglutide: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Echinacea: Moderate Echinacea possesses immunostimulatory activity and may theoretically reduce the response to immunosuppressant drugs like corticosteroids. For some patients who are using corticosteroids for serious illness, such as cancer or organ transplant, this potential interaction may result in the preferable avoidance of Echinacea.

Although documentation is lacking, coadministration of echinacea with immunosuppressants is not recommended by some resources. Econazole: Minor In vitro studies indicate that corticosteroids inhibit the antifungal activity of econazole against C. When the concentration of the corticosteroid was equal to or greater than that of econazole on a weight basis, the antifungal activity of econazole was substantially inhibited.

When the corticosteroid concentration was one-tenth that of econazole, no inhibition of antifungal activity was observed. Efalizumab: Major Patients receiving immunosuppressives should not receive concurrent therapy with efalizumab because of the possibility of increased infections and malignancies. Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide: Moderate Coadministration of prednisone with cobicistat may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression.

Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate: Moderate Coadministration of prednisone with cobicistat may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression. Empagliflozin: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Empagliflozin; Linagliptin: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued.

Empagliflozin; Metformin: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Enalapril; Hydrochlorothiazide, HCTZ: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids.

Ephedrine: Moderate Ephedrine may enhance the metabolic clearance of corticosteroids. Decreased blood concentrations and lessened physiologic activity may necessitate an increase in corticosteroid dosage. Eprosartan; Hydrochlorothiazide, HCTZ: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids. Erlotinib: Moderate Monitor for symptoms of gastrointestinal GI perforation e.

Permanently discontinue erlotinib in patients who develop GI perforation. The pooled incidence of GI perforation clinical trials of erlotinib ranged from 0. Ertugliflozin: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Ertugliflozin; Metformin: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued.

Ertugliflozin; Sitagliptin: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Estrogens: Moderate Estrogens have been associated with elevated serum concentrations of corticosteroid binding globulin CBG , leading to increased total circulating corticosteroids, although the free concentrations of these hormones may be lower; the clinical significance is not known.

Patients should be monitored for signs of decreased clinical effects of estrogens e. Caution is warranted if these drugs are coadministered. Exenatide: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Fluconazole: Moderate Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention.

Fluoxymesterone: Moderate Coadministration of corticosteroids and fluoxymesterone may increase the risk of edema, especially in patients with underlying cardiac or hepatic disease. Corticosteroids with greater mineralocorticoid activity, such as fludrocortisone, may be more likely to cause edema.

Administer these drugs in combination with caution. Fosamprenavir: Moderate Concomitant use of prednisone and fosamprenavir may result in altered prednisone plasma concentrations. Amprenavir, the active metabolite of fosamprenavir, is an inducer of P-gp and a potent inhibitor and moderate inducer of CYP3A4.

Fosinopril; Hydrochlorothiazide, HCTZ: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids. Gallium Ga 68 Dotatate: Moderate Corticosteroids may accentuate the electrolyte loss associated with diuretic therapy resulting in hypokalemia.

Also, corticotropin may cause calcium loss and sodium and fluid retention. Mannitol itself can cause hypernatremia. Close monitoring of electrolytes should occur in patients receiving these drugs concomitantly. Gemcitabine: Moderate Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention. Gentamicin: Moderate Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention.

Glecaprevir; Pibrentasvir: Moderate Caution is advised with the coadministration of glecaprevir and prednisone as coadministration may increase serum concentrations of prednisone and increase the risk of adverse effects. Prednisone is a substrate of P-glycoprotein P-gp ; glecaprevir is a P-gp inhibitor.

Moderate Caution is advised with the coadministration of pibrentasvir and prednisone as coadministration may increase serum concentrations of prednisone and increase the risk of adverse effects. Prednisone is a substrate of P-glycoprotein P-gp ; pibrentasvir is a P-gp inhibitor. Glimepiride: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued.

Glimepiride; Pioglitazone: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Glimepiride; Rosiglitazone: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued.

Glipizide: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Glipizide; Metformin: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued.

Glyburide: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Glyburide; Metformin: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued.

Glycerol Phenylbutyrate: Moderate Corticosteroids may induce elevated blood ammonia concentrations. Corticosteroids should be used with caution in patients receiving glycerol phenylbutyrate. Monitor ammonia concentrations closely. Golimumab: Moderate The safety and efficacy of golimumab in patients with immunosuppression have not been evaluated.

Patients receiving immunosuppressives along with golimumab may be at a greater risk of developing an infection. Guaifenesin; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Haloperidol: Moderate Caution is advisable during concurrent use of haloperidol and corticosteroids as electrolyte imbalance caused by corticosteroids may increase the risk of QT prolongation with haloperidol.

Hemin: Moderate Hemin works by inhibiting aminolevulinic acid synthetase. Corticosteroids increase the activity of this enzyme should not be used with hemin. Heparin: Moderate Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention. Hetastarch: Moderate Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention. Hydantoins: Moderate Hydantoin anticonvulsants induce hepatic microsomal enzymes and may increase the metabolism of prednisone, leading to reduced efficacy.

Depending on the individual clinical situation and the indication for the interacting medication, enzyme-induction interactions may not always produce reductions in treatment efficacy. Hydralazine; Hydrochlorothiazide, HCTZ: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids. Hydrochlorothiazide, HCTZ: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids.

Hydrochlorothiazide, HCTZ; Irbesartan: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids. Hydrochlorothiazide, HCTZ; Lisinopril: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids.

Hydrochlorothiazide, HCTZ; Losartan: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids.

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July 5, Acetyl-L-carnitine: Can it relieve MS fatigue? Addison's disease Adrenal fatigue: What causes it? Albuterol side effects Alcoholic hepatitis Allergies Allergies and asthma Allergy medications: Know your options Allergy-proof your home Aplastic anemia Arthritis Arthritis pain: Do's and don'ts Aspergillosis Aspirin allergy Asthma Asthma and acid reflux Asthma attack Asthma diet Adult asthma action plan Asthma inhalers: Which one's right for you?

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Base tan? Bad idea Behcet's disease Botox injections: Can they relieve arthritis pain? Explaining multiple sclerosis Bullous pemphigoid Bursitis Can arthritis pain medications be harmful? Can baby eczema be prevented?

Can I exercise if I have atopic dermatitis? Cannabis for MS: Can it help treat symptoms? Infographic: Cardiac sarcoidosis: A heart under attack Carpal tunnel exercises: Can they relieve symptoms? Does stress make rheumatoid arthritis worse? Drug allergy Dust mite allergy Ease rheumatoid arthritis pain when grocery shopping Ease stress to reduce eczema symptoms Eczema bleach bath: Can it improve my symptoms?

Emerging treatments for multiple sclerosis Emphysema Estriol as a potential treatment option for multiple sclerosis MS Exercise and multiple sclerosis Exercising with arthritis Fingolimod during pregnancy: Is it safe? Giant cell arteritis Glomerulonephritis Hip labral tear How do I reduce fatigue from rheumatoid arthritis? How to treat baby eczema Hyperinflated lungs: What does it mean?

Hypopituitarism I have atopic dermatitis. How can I sleep better? Interstitial lung disease Is depression a factor in rheumatoid arthritis? Is there a multiple sclerosis diet? Juvenile idiopathic arthritis Knee bursitis Knee pain LABAs for asthma Living better with atopic dermatitis eczema Living better with rheumatoid arthritis Long-term safety of natalizumab for treating multiple sclerosis Managing anxiety in MS: What works? Mayo Clinic Minute: Prevent migraines with magnetic stimulation Mayo Clinic Minute Weathering migraines Mayo Clinic Minute: What parents need to know about pink eye Medication overuse headaches Migraine Migraine medications and antidepressants Migraine treatment: Can antidepressants help?

Migraines and Vertigo Migraines: Are they triggered by weather changes? Alleviating migraine pain Mindfulness practice: Can it reduce symptoms of MS? Mixed connective tissue disease Mononucleosis Mononucleosis: Can it recur? Mononucleosis and Epstein-Barr: What's the connection? MSM for arthritis pain: Is it safe? Myasthenia gravis Nasal Cleaning Nasal spray addiction: Is it real? Ocular migraine: When to seek help Oil of oregano: Can it treat sinusitis?

Oral lichen planus Osteoporosis and long-term prednisone: What is the risk? Ozone air purifiers Palindromic rheumatism: Precursor to rheumatoid arthritis? Paraneoplastic syndromes of the nervous system Personalized therapy for multiple sclerosis MS Pink eye conjunctivitis Pink eye: How long is it contagious? Pink eye treatment: What if I wear contact lenses?

Plantar fasciitis Pneumonitis Polymyalgia rheumatica Polymyositis Polymyositis: Can it affect my lungs? Prednisone risks, benefits Preeclampsia Preterm labor Protect your joints while housecleaning Pseudoclaudication: Is it related to claudication? Ramsay Hunt syndrome Reactive airway disease: Is it asthma? Rheumatoid arthritis and exercise Rheumatoid arthritis: Vaccines Rheumatoid arthritis diet Rheumatoid arthritis: Can it affect the eyes?

Rheumatoid arthritis: Can it affect the lungs? Rheumatoid arthritis medications: Dangerous during pregnancy? Rheumatoid arthritis pain: Tips for protecting your joints Sacroiliitis Salt craving: A symptom of Addison's disease? Hand exercises for people with arthritis Joint protection Spinal stenosis Stop your next migraine before it starts Stress management for MS Sulfa allergy Sunburn Sunburn treatment: Do I need medical attention? Swollen knee Takayasu's arteritis Tanning: Does a base tan prevent sunburn?

Tendinitis Tendinitis pain: Should I apply ice or heat? Further, children receiving corticosteroids are immunosuppressed, and are therefore more susceptible to infection. Normally innocuous infections can become fatal in these children, and care should be taken to avoid exposure to these diseases.

Published studies provide evidence of efficacy and safety in pediatric patients for the treatment of nephrotic syndrome pediatric patients more than 2 years of age , and aggressive lymphomas and leukemias patients greater than 1 month of age. Other indications for pediatric use of corticosteroids e. Indicated vaccination procedures may be undertaken in patients receiving nonimmunosuppressive doses of corticosteroids as replacement therapy e.

Administration of live or live, attenuated vaccines is contraindicated in patients receiving immunosuppressive doses of corticosteroids. Killed or inactivated vaccines may be administered. However, the response to such vaccines may be diminished and cannot be predicted. In patients who have received high-dose, systemic corticosteroids for 2 weeks or longer, it is recommended to wait at least 3 months after discontinuation of therapy before administering a live-virus vaccine. If systemic corticosteroids such as prednisone must be used during pregnancy, the potential risks should be discussed with the patient.

Infants born to mothers who have received substantial doses of corticosteroids during pregnancy should be carefully observed for signs of hypoadrenalism. Corticosteroids have been shown to be teratogenic in many species when given in doses equivalent to the human dose. Animal studies in which corticosteroids have been given to pregnant mice, rats, and rabbits have yielded an increased incidence of cleft palate in the offspring.

There are no adequate and well-controlled studies in pregnant women. Corticosteroids distribute into breast milk, and the manufacturer states that because of the potential for serious adverse reactions in nursing babies, a decision should be made whether to discontinue nursing or to discontinue the drug.

However, prednisone concentrations in breast milk are low, and no adverse effects have been reported in the breast-fed infant with maternal use of any corticosteroid during breast-feeding; prednisone is generally considered compatible to use during lactation. Published case reports of systemic prednisone use during pregnancy that indicate little risk to a nursing infant due to lack of reported side effects.

Prednisone is converted to prednisolone in vivo, and peak concentrations in human milk appear in about 1 hour after a dose; the total daily dose reaching the infant is approximately 0. Prednisolone and methylprednisolone have similar data available regarding systemic use during lactation.

At higher daily prednisone doses, avoidance of breast-feeding during times of peak milk concentrations can help limit infant exposure; however, such adjustments are rarely necessary. Consider the benefits of breast-feeding, the risk of potential infant drug exposure, and the risk of an untreated or inadequately treated condition. Use systemic corticosteroids such as prednisone with caution in the geriatric patient; the risks and benefits of therapy should be considered for any individual patient, particularly with chronic use.

According to the Beers Criteria, systemic corticosteroids are considered potentially inappropriate medications PIMs for use in geriatric patients with delirium or at high risk for delirium and should be avoided in these patient populations due to the possibility of new-onset delirium or exacerbation of the current condition.

The Beers expert panel notes that oral and parenteral corticosteroids may be required for conditions such as exacerbation of chronic obstructive pulmonary disease COPD but should be prescribed in the lowest effective dose and for the shortest possible duration. According to the OBRA guidelines, the need for continued use of a glucocorticoid, with the exception of topical or inhaled formulations, should be documented, along with monitoring for and management of adverse consequences.

Intermediate or longer-term use may cause hyperglycemia, psychosis, edema, insomnia, hypertension, osteoporosis, mood lability, or depression. Abatacept: Moderate Concomitant use of immunosuppressives, as well as long-term corticosteroids, may potentially increase the risk of serious infection in abatacept treated patients. Advise patients taking abatacept to seek immediate medical advice if they develop signs and symptoms suggestive of infection.

While there is controversy regarding the ulcerogenic potential of corticosteroids alone, concomitant administration of corticosteroids with aspirin may increase the GI toxicity of aspirin and other non-acetylated salicylates. Withdrawal of corticosteroids can result in increased plasma concentrations of salicylate and possible toxicity. Although some patients may need to be given corticosteroids and NSAIDs concomitantly, which can be done successfully for short periods of time without sequelae, prolonged coadministration should be avoided.

Acetaminophen; Butalbital: Moderate Coadministration may result in decreased exposure to prednisone. Monitor for decreased response to prednisone during concurrent use. Acetaminophen; Butalbital; Caffeine: Moderate Coadministration may result in decreased exposure to prednisone. Acetaminophen; Butalbital; Caffeine; Codeine: Moderate Coadministration may result in decreased exposure to prednisone.

Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Monitor patients for increased pressor effect if these agents are administered concomitantly. Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.

Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Acetaminophen; Dextromethorphan; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Acetaminophen; Guaifenesin; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.

Acetazolamide: Moderate Corticosteroids may increase the risk of hypokalemia if used concurrently with acetazolamide. Hypokalemia may be especially severe with prolonged use of corticotropin, ACTH. Acetohexamide: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued.

Systemic and inhaled corticosteroids are known to increase blood glucose and worsen glycemic control in patients taking antidiabetic agents. The main risk factors for impaired glucose tolerance due to corticosteroids are the dose of steroid and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance.

Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. Adalimumab: Moderate Closely monitor for the development of signs and symptoms of infection if coadministration of a corticosteroid with adalimumab is necessary.

Adalimumab treatment increases the risk for serious infections that may lead to hospitalization or death. Patients taking concomitant immunosuppressants including corticosteroids may be at greater risk of infection. Albiglutide: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued.

Alefacept: Severe Patients receiving other immunosuppressives should not receive concurrent therapy with alefacept; there is the possibility of excessive immunosuppression and subsequent risks of infection and other serious side effects. In clinical efficacy trials, concurrent treatment of alefacept with these types of agents did not occur.

The duration of the period following treatment with alefacept that is appropriate before starting other immunosuppressive therapy has not been evaluated. Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids.

Monitoring serum potassium levels and cardiac function is advised, and potassium supplementation may be required. Aliskiren; Hydrochlorothiazide, HCTZ: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids. Alogliptin; Metformin: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued.

Alpha-glucosidase Inhibitors: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Altretamine: Minor Concurrent use of altretamine with other agents which cause bone marrow or immune suppression such as corticosteroids may result in additive effects. Ambenonium Chloride: Minor Corticosteroids may interact with cholinesterase inhibitors including ambenonium, neostigmine, and pyridostigmine, occasionally causing severe muscle weakness in patients with myasthenia gravis.

Glucocorticoids are occasionally used therapeutically, however, in the treatment of some patients with myasthenia gravis. In such patients, it is recommended that corticosteroid therapy be initiated at low dosages and with close clinical monitoring. The dosage should be increased gradually as tolerated, with continued careful monitoring of the patient's clinical status. Amifampridine: Moderate Carefully consider the need for concomitant treatment with systemic corticosteroids and amifampridine, as coadministration may increase the risk of seizures.

If coadministration occurs, closely monitor patients for seizure activity. Seizures have been observed in patients without a history of seizures taking amifampridine at recommended doses. Systemic corticosteroids may increase the risk of seizures in some patients. Amiloride; Hydrochlorothiazide, HCTZ: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids.

Aminolevulinic Acid: Minor Corticosteroids administered prior to or concomitantly with photosensitizing agents used in photodynamic therapy may decrease the efficacy of the treatment. Amiodarone: Major Use caution when coadministering amiodarone with drugs which may induce hypokalemia and, or hypomagnesemia, including corticosteroids.

Since antiarrhythmic drugs may be ineffective or may be arrhythmogenic in patients with hypokalemia, any potassium or magnesium deficiency should be corrected before instituting and during amiodarone therapy. Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids. Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids.

Amphotericin B cholesteryl sulfate complex ABCD : Moderate The potassium-wasting effects of corticosteroid therapy can be exacerbated by concomitant administration of other potassium-depleting drugs including amphotericin B. Serum potassium levels should be monitored in patients receiving these drugs concomitantly. Amphotericin B lipid complex ABLC : Moderate The potassium-wasting effects of corticosteroid therapy can be exacerbated by concomitant administration of other potassium-depleting drugs including amphotericin B.

Amphotericin B liposomal LAmB : Moderate The potassium-wasting effects of corticosteroid therapy can be exacerbated by concomitant administration of other potassium-depleting drugs including amphotericin B. Amphotericin B: Moderate The potassium-wasting effects of corticosteroid therapy can be exacerbated by concomitant administration of other potassium-depleting drugs including amphotericin B.

Aprepitant, Fosaprepitant: Moderate Use caution if prednisone and aprepitant, fosaprepitant are used concurrently and monitor for an increase in prednisone-related adverse effects for several days after administration of a multi-day aprepitant regimen. The active metabolite of prednisone, prednisolone, is a CYP3A4 substrate. As a single mg or 40 mg oral dose, the inhibitory effect of aprepitant on CYP3A4 is weak, with the AUC of midazolam increased by 1. After administration, fosaprepitant is rapidly converted to aprepitant and shares many of the same drug interactions.

However, as a single mg intravenous dose, fosaprepitant only weakly inhibits CYP3A4 for a duration of 2 days; there is no evidence of CYP3A4 induction. Fosaprepitant mg IV as a single dose increased the AUC of midazolam given on days 1 and 4 by approximately 1. Less than a 2-fold increase in the midazolam AUC is not considered clinically important. Argatroban: Moderate Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention.

Assess sodium chloride intake from all sources, including intake from sodium-containing intravenous fluids and antibiotic admixtures. Carefully monitor sodium concentrations and fluid status if sodium-containing drugs and corticosteroids must be used together. Arsenic Trioxide: Moderate Caution is advisable during concurrent use of arsenic trioxide and corticosteroids as electrolyte imbalance caused by corticosteroids may increase the risk of QT prolongation with arsenic trioxide.

Asparaginase Erwinia chrysanthemi: Moderate Concomitant use of L-asparaginase with corticosteroids can result in additive hyperglycemia. L-Asparaginase transiently inhibits insulin production contributing to hyperglycemia seen during concurrent corticosteroid therapy. Insulin therapy may be required in some cases. Administration of L-asparaginase after rather than before corticosteroids reportedly has produced fewer hypersensitivity reactions. Atazanavir: Moderate Coadministration of prednisone with atazanavir may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression.

Corticosteroids, such as beclomethasone and prednisolone, whose concentrations are less affected by strong CYP3A4 inhibitors, should be considered, especially for long-term use. Atazanavir; Cobicistat: Moderate Coadministration of prednisone with atazanavir may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression. Moderate Coadministration of prednisone with cobicistat may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression.

Atenolol; Chlorthalidone: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids. Atracurium: Moderate Caution and close monitoring are advised if corticosteroids and neuromuscular blockers are used together, particularly for long periods, due to enhanced neuromuscular blocking effects. In such patients, a peripheral nerve stimulator may be of value in monitoring the response.

Concurrent use may increase the risk of acute myopathy. Elevation of creatine kinase may occur. Atropine; Hyoscyamine; Phenobarbital; Scopolamine: Moderate Coadministration may result in decreased exposure to prednisone. Azilsartan; Chlorthalidone: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids.

Belladonna Alkaloids; Ergotamine; Phenobarbital: Moderate Coadministration may result in decreased exposure to prednisone. Benazepril; Hydrochlorothiazide, HCTZ: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids. Bendroflumethiazide; Nadolol: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids.

Bepridil: Moderate Hypokalemia-producing agents, including corticosteroids, may increase the risk of bepridil-induced arrhythmias and should therefore be administered cautiously in patients receiving bepridil therapy. Bisoprolol; Hydrochlorothiazide, HCTZ: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids.

Bivalirudin: Moderate Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention. Boceprevir: Major Concurrent administration of systemic corticosteroids, such as prednisone, and boceprevir is not recommended.

If prednisone and boceprevir are coadministered, close monitoring for corticosteroid-related adverse events and for decreased boceprevir efficacy is advised. If prednisone dose adjustments are made, re-adjust the dose upon completion of boceprevir treatment. Predictions about the interaction can be made based on the metabolic pathway of prednisone. Prednisone is metabolized by the hepatic isoenzyme CYP3A4 and the drug efflux transporter P-glycoprotein P-gp ; boceprevir inhibits both the isoenzyme and the drug efflux pump.

Coadministration may result in elevated prednisone plasma concentrations. Bosentan: Minor A dose adjustment of prednisone may be necessary if bosentan is initiated or withdrawn during therapy. Bosentan may increase the metabolism of prednisone resulting in decreased exposure. Brompheniramine; Carbetapentane; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.

Bupropion: Moderate Because bupropion is associated with a dose-related risk of seizures, extreme caution is recommended during concurrent use of other drugs that may lower the seizure threshold such as systemic corticosteroids. Low initial dosing and slow dosage titration of bupropion is recommended if these combinations must be used; the patient should be closely monitored.

Bupropion; Naltrexone: Moderate Because bupropion is associated with a dose-related risk of seizures, extreme caution is recommended during concurrent use of other drugs that may lower the seizure threshold such as systemic corticosteroids. Butabarbital: Moderate Coadministration may result in decreased exposure to prednisone. Cabozantinib: Minor Monitor for an increase in prednisone-related adverse reactions if coadministration with cabozantinib is necessary; a dose adjustment of prednisone may be necessary.

Prednisone is a P-glycoprotein P-gp substrate. Cabozantinib is a P-gp inhibitor and has the potential to increase plasma concentrations of P-gp substrates; however, the clinical relevance of this finding is unknown. Calcium Carbonate: Moderate Calcium absorption is reduced when calcium carbonate is taken concomitantly with systemic corticosteroids. Systemic corticosteroids induce a negative calcium balance by inhibiting intestinal calcium absorption as well as by increasing renal calcium losses.

The mechanism by which these drugs inhibit calcium absorption in the intestine is likely to involve a direct inhibition of absorptive cell function. Calcium Carbonate; Magnesium Hydroxide: Moderate Calcium absorption is reduced when calcium carbonate is taken concomitantly with systemic corticosteroids. Calcium Carbonate; Risedronate: Moderate Calcium absorption is reduced when calcium carbonate is taken concomitantly with systemic corticosteroids.

Calcium Carbonate; Simethicone: Moderate Calcium absorption is reduced when calcium carbonate is taken concomitantly with systemic corticosteroids. Canagliflozin: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued.

Canagliflozin; Metformin: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued.

Candesartan; Hydrochlorothiazide, HCTZ: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids.

Captopril; Hydrochlorothiazide, HCTZ: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids. Carbamazepine: Moderate Hepatic microsomal enzyme inducers, including carbamazepine, can increase the metabolism of prednisone. Carbetapentane; Chlorpheniramine; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.

Carbetapentane; Diphenhydramine; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Carbetapentane; Guaifenesin; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.

Carbetapentane; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Carbetapentane; Phenylephrine; Pyrilamine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.

Carbinoxamine; Hydrocodone; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Carbinoxamine; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Carvedilol: Minor Increased concentrations of prednisone may occur if it is coadministered with carvedilol; exercise caution.

Carvedilol is a P-glycoprotein P-gp inhibitor and prednisone is a P-gp substrate. Ceritinib: Minor Monitor for steroid-related adverse reactions if coadministration of ceritinib with prednisone is necessary, due to increased prednisone exposure. Certolizumab pegol: Moderate The safety and efficacy of certolizumab in patients with immunosuppression have not been evaluated. Patients receiving immunosuppressives along with certolizumab may be at a greater risk of developing an infection.

Many of the serious infections occurred in patients on immunosuppressive therapy who received certolizumab. Chlophedianol; Guaifenesin; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Chlorothiazide: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids.

Chlorpheniramine; Dextromethorphan; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Chlorpheniramine; Dihydrocodeine; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Chlorpheniramine; Hydrocodone; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.

Chlorpheniramine; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Chlorpropamide: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued.

Chlorthalidone: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids. Chlorthalidone; Clonidine: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids.

Cholestyramine: Moderate Cholestyramine may increase the clearance of corticosteroids, such as prednisone. Cimetidine: Moderate Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention.

Cisatracurium: Moderate Caution and close monitoring are advised if corticosteroids and neuromuscular blockers are used together, particularly for long periods, due to enhanced neuromuscular blocking effects. Citalopram: Moderate Caution is advisable during concurrent use of citalopram and corticosteroids as electrolyte imbalance caused by corticosteroids may increase the risk of QT prolongation with citalopram.

Clindamycin: Moderate Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention. Cobicistat: Moderate Coadministration of prednisone with cobicistat may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression. Codeine; Phenylephrine; Promethazine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.

Concurrent use may result in elevated prednisone serum concentrations. According to the manufacturer of conivaptan, concomitant use of conivaptan, a strong CYP3A4 inhibitor, and CYP3A substrates, such as prednisone, should be avoided. Coadministration of conivaptan with other CYP3A substrates midazolam, simvastatin, amlodipine has resulted in increased mean AUC values 2 to 3 times.

Theoretically, similar pharmacokinetic effects could be seen with prednisone. Treatment with prednisone may be initiated no sooner than 1 week after completion of conivaptan therapy. In addition, conivaptan has been associated with hypokalemia 9. Although not studied, consider the potential for additive hypokalemic effects if conivaptan is coadministered with drugs known to induce hypokalemia, such as corticosteroids.

Daclatasvir: Moderate Systemic exposure of prednisone, a P-glycoprotein P-gp substrate, may be increased when administered concurrently with daclatasvir, a P-gp inhibitor. Taking these drugs together could increase or prolong the therapeutic effects of prednisone; monitor patients for potential adverse effects.

Dapagliflozin: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Dapagliflozin; Metformin: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued.

Dapagliflozin; Saxagliptin: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued.

Darunavir: Moderate Coadministration of prednisone with darunavir may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression. Darunavir; Cobicistat: Moderate Coadministration of prednisone with cobicistat may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression. Moderate Coadministration of prednisone with darunavir may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression.

Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide: Moderate Coadministration of prednisone with cobicistat may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression. Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir: Moderate Coadministration of prednisone with ritonavir a strong CYP3A4 inhibitor may cause prednisone serum concentrations to increase, potentially resulting in Cushing's syndrome and adrenal suppression.

Consider use of an alternative corticosteroid whose concentrations are less affected by strong CYP3A4 inhibitors, such as beclomethasone and prednisolone, especially during long-term treatment. Deferasirox: Moderate Because gastric ulceration and GI bleeding have been reported in patients taking deferasirox, use caution when coadministering with other drugs known to increase the risk of peptic ulcers or gastric hemorrhage including corticosteroids.

Denosumab: Moderate The safety and efficacy of denosumab use in patients with immunosuppression have not been evaluated. Patients receiving immunosuppressives along with denosumab may be at a greater risk of developing an infection. Desmopressin: Major Desmopressin, when used in the treatment of nocturia is contraindicated with corticosteroids because of the risk of severe hyponatremia. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer.

Dextran: Moderate Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention. Dextromethorphan; Diphenhydramine; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Dextromethorphan; Guaifenesin; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.

Digoxin: Moderate Hypokalemia, hypomagnesemia, or hypercalcemia increase digoxin's effect. Corticosteroids can precipitate digoxin toxicity via their effect on electrolyte balance. It is recommended that serum potassium, magnesium, and calcium be monitored regularly in patients receiving digoxin. Diltiazem: Moderate Prednisone is metabolized by the liver to the active metabolite prednisolone.

Prednisolone is metabolized by CYP3A4 to inactive compounds. As diltiazem is both a substrate and an inhibitor of CYP3A4, monitor patients for corticosteroid-related side effects if prednisone and diltiazem are taken.

Dipeptidyl Peptidase-4 Inhibitors: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Diphenhydramine; Hydrocodone; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Diphenhydramine; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.

Dofetilide: Major Corticosteroids can cause increases in blood pressure, sodium and water retention, and hypokalemia, predisposing patients to interactions with certain other medications. Corticosteroid-induced hypokalemia could also enhance the proarrhythmic effects of dofetilide. Doxacurium: Moderate Caution and close monitoring are advised if corticosteroids and neuromuscular blockers are used together, particularly for long periods, due to enhanced neuromuscular blocking effects.

The concomitant administration of dronedarone with CYP3A4 and P-gp substrates may result in increased exposure of the substrate and should, therefore, be undertaken with caution. Droperidol: Moderate Caution is advised when using droperidol in combination with corticosteroids which may lead to electrolyte abnormalities, especially hypokalemia or hypomagnesemia, as such abnormalities may increase the risk for QT prolongation or cardiac arrhythmias.

Dulaglutide: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Echinacea: Moderate Echinacea possesses immunostimulatory activity and may theoretically reduce the response to immunosuppressant drugs like corticosteroids.

For some patients who are using corticosteroids for serious illness, such as cancer or organ transplant, this potential interaction may result in the preferable avoidance of Echinacea. Although documentation is lacking, coadministration of echinacea with immunosuppressants is not recommended by some resources. Econazole: Minor In vitro studies indicate that corticosteroids inhibit the antifungal activity of econazole against C. When the concentration of the corticosteroid was equal to or greater than that of econazole on a weight basis, the antifungal activity of econazole was substantially inhibited.

When the corticosteroid concentration was one-tenth that of econazole, no inhibition of antifungal activity was observed. Efalizumab: Major Patients receiving immunosuppressives should not receive concurrent therapy with efalizumab because of the possibility of increased infections and malignancies.

Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide: Moderate Coadministration of prednisone with cobicistat may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression. Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate: Moderate Coadministration of prednisone with cobicistat may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression.

Empagliflozin: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Empagliflozin; Linagliptin: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued.

Empagliflozin; Metformin: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Enalapril; Hydrochlorothiazide, HCTZ: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids.

Ephedrine: Moderate Ephedrine may enhance the metabolic clearance of corticosteroids. Decreased blood concentrations and lessened physiologic activity may necessitate an increase in corticosteroid dosage. Eprosartan; Hydrochlorothiazide, HCTZ: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids.

Erlotinib: Moderate Monitor for symptoms of gastrointestinal GI perforation e. Permanently discontinue erlotinib in patients who develop GI perforation. The pooled incidence of GI perforation clinical trials of erlotinib ranged from 0. Ertugliflozin: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued.

Ertugliflozin; Metformin: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Ertugliflozin; Sitagliptin: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Estrogens: Moderate Estrogens have been associated with elevated serum concentrations of corticosteroid binding globulin CBG , leading to increased total circulating corticosteroids, although the free concentrations of these hormones may be lower; the clinical significance is not known.

Patients should be monitored for signs of decreased clinical effects of estrogens e. Caution is warranted if these drugs are coadministered. Exenatide: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Fluconazole: Moderate Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention.

Fluoxymesterone: Moderate Coadministration of corticosteroids and fluoxymesterone may increase the risk of edema, especially in patients with underlying cardiac or hepatic disease. Corticosteroids with greater mineralocorticoid activity, such as fludrocortisone, may be more likely to cause edema.

Administer these drugs in combination with caution. Fosamprenavir: Moderate Concomitant use of prednisone and fosamprenavir may result in altered prednisone plasma concentrations. Amprenavir, the active metabolite of fosamprenavir, is an inducer of P-gp and a potent inhibitor and moderate inducer of CYP3A4.

Fosinopril; Hydrochlorothiazide, HCTZ: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids. Gallium Ga 68 Dotatate: Moderate Corticosteroids may accentuate the electrolyte loss associated with diuretic therapy resulting in hypokalemia.

Also, corticotropin may cause calcium loss and sodium and fluid retention. Mannitol itself can cause hypernatremia. Close monitoring of electrolytes should occur in patients receiving these drugs concomitantly. Gemcitabine: Moderate Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention. Gentamicin: Moderate Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention.

Glecaprevir; Pibrentasvir: Moderate Caution is advised with the coadministration of glecaprevir and prednisone as coadministration may increase serum concentrations of prednisone and increase the risk of adverse effects. Prednisone is a substrate of P-glycoprotein P-gp ; glecaprevir is a P-gp inhibitor. Moderate Caution is advised with the coadministration of pibrentasvir and prednisone as coadministration may increase serum concentrations of prednisone and increase the risk of adverse effects.

Prednisone is a substrate of P-glycoprotein P-gp ; pibrentasvir is a P-gp inhibitor. Glimepiride: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Glimepiride; Pioglitazone: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued.

Glimepiride; Rosiglitazone: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Glipizide: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued.

Glipizide; Metformin: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Glyburide: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued.

Glyburide; Metformin: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Glycerol Phenylbutyrate: Moderate Corticosteroids may induce elevated blood ammonia concentrations.

Corticosteroids should be used with caution in patients receiving glycerol phenylbutyrate. Monitor ammonia concentrations closely. Golimumab: Moderate The safety and efficacy of golimumab in patients with immunosuppression have not been evaluated. Patients receiving immunosuppressives along with golimumab may be at a greater risk of developing an infection.

Guaifenesin; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Haloperidol: Moderate Caution is advisable during concurrent use of haloperidol and corticosteroids as electrolyte imbalance caused by corticosteroids may increase the risk of QT prolongation with haloperidol. Hemin: Moderate Hemin works by inhibiting aminolevulinic acid synthetase. Corticosteroids increase the activity of this enzyme should not be used with hemin.

Heparin: Moderate Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention. Hetastarch: Moderate Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention.

Hydantoins: Moderate Hydantoin anticonvulsants induce hepatic microsomal enzymes and may increase the metabolism of prednisone, leading to reduced efficacy. Depending on the individual clinical situation and the indication for the interacting medication, enzyme-induction interactions may not always produce reductions in treatment efficacy. Hydralazine; Hydrochlorothiazide, HCTZ: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids.

Hydrochlorothiazide, HCTZ: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids. Hydrochlorothiazide, HCTZ; Irbesartan: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids.

Hydrochlorothiazide, HCTZ; Lisinopril: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids. Hydrochlorothiazide, HCTZ; Losartan: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids.

Hydrochlorothiazide, HCTZ; Methyldopa: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids. Hydrochlorothiazide, HCTZ; Metoprolol: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids.

Hydrochlorothiazide, HCTZ; Moexipril: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids. Hydrochlorothiazide, HCTZ; Olmesartan: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids.

Hydrochlorothiazide, HCTZ; Propranolol: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids. Moderate Patients receiving corticosteroids during propranolol therapy may be at increased risk of hypoglycemia due to the loss of counter-regulatory cortisol response.

This effect may be more pronounced in infants and young children. If concurrent use is necessary, carefully monitor vital signs and blood glucose concentrations as clinically indicated. Hydrochlorothiazide, HCTZ; Quinapril: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids.

Hydrochlorothiazide, HCTZ; Spironolactone: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids. Hydrochlorothiazide, HCTZ; Telmisartan: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids.

Hydrochlorothiazide, HCTZ; Triamterene: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids. Hydrochlorothiazide, HCTZ; Valsartan: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids.

Hydrocodone; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Moderate Use sodium phosphate cautiously with corticosteroids, especially mineralocorticoids or corticotropin, ACTH, as concurrent use can cause hypernatremia. Ibritumomab Tiuxetan: Moderate Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention.

While therapy is designed to take advantage of this effect, patients may be predisposed to over-immunosuppression resulting in an increased risk for the development of severe infections. If coadministration is necessary, close clinical monitoring is advised and therapy should be accompanied by appropriate antimicrobial therapies as indicated.

Incretin Mimetics: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Indapamide: Moderate Additive hypokalemia may occur when indapamide is coadministered with other drugs with a significant risk of hypokalemia such as systemic corticosteroids.

Coadminister with caution and careful monitoring. Infliximab: Moderate Many serious infections during infliximab therapy have occurred in patients who received concurrent immunosuppressives that, in addition to their underlying Crohn's disease or rheumatoid arthritis, predisposed patients to infections. The impact of concurrent infliximab therapy and immunosuppression on the development of malignancies is unknown.

In clinical trials, the use of concomitant immunosuppressant agents appeared to reduce the frequency of antibodies to infliximab and appeared to reduce infusion reactions. Insulin Degludec; Liraglutide: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued.

Insulin Glargine; Lixisenatide: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Insulins: Moderate Monitor patients receiving insulin closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued.

Isavuconazonium: Moderate Concomitant use of isavuconazonium with prednisone may result in increased serum concentrations of prednisone. Prednisolone, the active metabolite of prednisone, is a substrate of the hepatic isoenzyme CYP3A4; additionally prednisone is a substrate of the drug transporter P-glycoprotein P-gp. Caution and close monitoring for adverse effects, such as corticosteroid-related side effects, are advised if these drugs are used together.

Isoniazid, INH; Pyrazinamide, PZA; Rifampin: Moderate A dose adjustment of prednisone may be necessary when administered concurrently with rifamycins, due to the potential for decreased exposure of prednisone. Isoniazid, INH; Rifampin: Moderate A dose adjustment of prednisone may be necessary when administered concurrently with rifamycins, due to the potential for decreased exposure of prednisone. Isoproterenol: Moderate The risk of cardiac toxicity with isoproterenol in asthma patients appears to be increased with the coadministration of corticosteroids.

Intravenous infusions of isoproterenol in refractory asthmatic children at rates of 0. Isotretinoin: Minor Both isotretinoin and corticosteroids can cause osteoporosis during chronic use. Patients receiving systemic corticosteroids should receive isotretinoin therapy with caution. Itraconazole: Moderate Prednisone is metabolized by the liver to the active metabolite prednisolone.

Monitor patients for corticosteroid-related side effects if both prednisone and itraconazole are taken. Ixabepilone: Minor Ixabepilone is a weak inhibitor of P-glycoprotein Pgp. Prednisone is a Pgp substrate, and concomitant use of ixabepilone with a Pgp substrate may cause an increase in prednisone concentrations. Use caution if ixabepilone is coadministered with a Pgp substrate. Ketoconazole: Moderate Ketoconazole can decrease the hepatic clearance of prednisone, resulting in increased plasma concentrations.

The interaction may be due to the inhibition of cytochrome P 3A4 isoenzyme by ketoconazole, and subsequent decreases in corticosteroid metabolism by the same isoenzyme. The dose of corticosteroid should be titrated to avoid steroid toxicity. Prednisolone and prednisone pharmacokinetics appear less susceptible than methylprednisolone to CYP3A4 inhibitory interactions. Ketoconazole also can enhance the adrenal suppressive effects of corticosteroids.

L-Asparaginase Escherichia coli: Moderate Concomitant use of L-asparaginase with corticosteroids can result in additive hyperglycemia. Ledipasvir; Sofosbuvir: Moderate Caution and close monitoring of prednisone-associated adverse reactions is advised with concomitant administration of ledipasvir.

Prednisone is a substrate of the drug transporter P-glycoprotein P-gp ; ledipasvir is a P-gp inhibitor. Taking these drugs together may increase prednisone plasma concentrations. Letermovir: Moderate A clinically relevant increase in the plasma concentration of prednisolone the active metabolite of prednisone may occur if given with letermovir. In patients who are also receiving treatment with cyclosporine, the magnitude of this interaction may be amplified.

Prednisolone is a CYP3A4 substrate. Levetiracetam: Moderate Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention. Levomethadyl: Major Caution is advised when using levomethadyl in combination with other agents, such as corticosteroids, that may lead to electrolyte abnormalities, especially hypokalemia or hypomagnesemia. Linagliptin; Metformin: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued.

Liraglutide: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Live Vaccines: Severe Live vaccines should generally not be administered to an immunosuppressed patient.

Not that steroid withdrawal syndrome rebound effect for

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There is no scientific evidence to support one strategy over another. This is not the only taper strategy. Let me repeat, there is no scientific strategy for tapering. If you have been on prednisone longer than 6 weeks, then you probably need a slower taper. This prednisone taper chart lasts much longer.

You might be okay with the taper above, but maybe not. Like I said, this is very individualized. But that still might be too fast for you. Another strategy is to drop on alternating days. So instead of dropping from 10 mg for a month directly down to 9 mg for a month, you decrease every other day.

For example:. Hold 9 mg for a few weeks. And repeat by dropping down to 8 mg completely, and holding for a few weeks. Then repeating the strategy with the next milligram decrease, and so on. Many people find the biggest triggers are when dropping below 10 mg or below 5 mg… both being a tough hurdle. If so, try this alternate day strategy. You could even go every 3 days instead of every other day if you need it even slower that second week.

Check out this website created just to help plan prednisone tapers! Finally, if you have reached this point, you might need to speak to an endocrinologist, a doctor who can help you with these specific hormone issues. The endocrinologist may switch you from prednisone to hydrocortisone, a sister of prednisone.

It lasts less time than prednisone and has to be taken several times per day. The bottom line: you need to work closely with your doctor and listen to your body. None of these tapering strategies are perfect for everyone, so you need to work together to find what works for you. The taper charts mentioned throughout this article are only useful if you can see them on a calendar. Mark off each day that you take it, then you will know which dose to take. You are being redirected to our trusted and authorized Nutranize product website.

The Nutranize website is designed, constructed and endorsed by Dr. Megan Milne, the Prednisone Pharmacist. Please grant us just a few seconds to get you there. Automated page speed optimizations for fast site performance. Prednisone Taper In this article, I explain who needs to taper prednisone and why tapering prednisone is necessary. Check out this video, a Prednisone Parable about the Prednisone Taper. Find out how tapering prednisone is like escaping from a labyrinth… Who needs to taper?

Anyone taking more than 20 mg prednisone per day for 21 days or more. Anyone with Cushing side effects like Moon Face and belly fat. If you are taking prednisone at bedtime. Using prednisone every other day at 10 mg or below. Why Taper? Prednisone must be tapered for several reasons. First, no one wants to continue taking prednisone because it has so many side effects.

Why Taper Slowly? This study did show that it is possible to put an entire population on the same tapering regimen, but it did not show: That the tapering was effective at disease remission. In some cases, your doctor may temporarily increase the dose and taper more slowly. Some people may have difficulty tapering off steroids despite incremental tapers of only 1 mg.

Another technique is known as an alternate-day taper. For example, instead of tapering from 4 mg to 3 mg of prednisone, a doctor may prescribe taking 4 mg one day and 3 mg the next day, then alternating back and forth for one week. Then, if successful, the doctor may prescribe 4 mg one day, and 2 mg the next, and so on until the patient is taking only 4 mg every other day for example, 4 mg one day and zero the next day. The doctor then continues to try to decrease the dose on that alternate day.

Tapering may not always prevent withdrawal symptoms. In some cases, the physical effects may be enhanced by psychological dependence. There are no tests to predict who will experience withdrawal and to what degree accurately. People on long-term chronic prednisone therapy are at the greatest risk for withdrawal.

However, it can also occur in people who are only taking the steroid for a short period of time. In some cases, the tapering process may take weeks or several months. Some doctors will opt for an alternative corticosteroid than prednisone. These medications can achieve the same therapeutic result with fewer side effects.

A 5 mg dose of prednisone is equal to the following doses of other corticosteroids based on a corticosteroid conversion calculator :. Prednisone is a corticosteroid used to treat inflammation. It mimics the stress hormone cortisol, which is made by the adrenal glands. When taken for extended periods, prednisone interferes with the natural production of cortisol.

As a result, it is not recommended to stop prednisone abruptly. Doing so can cause body aches, fatigue, fever, and other uncomfortable withdrawal symptoms. To minimize or prevent prednisone withdrawal symptoms, your doctor will instruct you how to taper off the steroid slowly. There is no standard tapering method. You may still experience uncomfortable symptoms for a few days when you taper.

If withdrawal symptoms are debilitating or last longer than seven days, call your doctor, who can adjust the dose and slow the taper. The amount of time it takes to taper off prednisone depends on many factors. These include the condition you're being treated for, the dose, and the duration of use.

Eventually, your adrenal glands should return to their normal cortisol production levels, but this can take time. There are many options available for discontinuing prednisone use. When low doses of corticosteroids are used for long periods, tapering can continue for months or years. Work closely with your doctor to find the right taper for you. Dealing with chronic inflammation? An anti-inflammatory diet can help.

Our free recipe guide shows you the best foods to fight inflammation. Get yours today! A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy. Allergy Asthma Clin Immunol. The steroid withdrawal syndrome: a review of the implications, etiology, and treatments. J Pain Symptom Manage. Table of Contents View All. Table of Contents.

Why Taper? How to Taper. What to Expect. Example of Prednisone Tapering Strategy Decrease dose in 5-milligram mg increments if less than 40 mg of prednisone is taken per day. Decrease in 2. Decrease in 1-mg increments once a mg dose is reached.