Corticosteroids Glucocorticoid Effects (Systemic)

Before Using This Medicine

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For corticosteroids, the following should be considered:

Allergies - Tell your doctor if you have ever had any unusual or allergic reaction to corticosteroids. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

Diet - If you will be using this medicine for a long time, your doctor may want you to:

• Follow a low-salt diet and/or a potassium-rich diet.
• Watch your calories to prevent weight gain.
• Add extra protein to your diet.

Pregnancy - Studies on birth defects with corticosteroids have not been done in humans. However, studies in animals have shown that corticosteroids cause birth defects.

Breast-feeding - Corticosteroids pass into breast milk and may cause problems with growth or other unwanted effects in nursing babies. Depending on the amount of medicine you are taking every day, it may be necessary for you to take another medicine or to stop breast-feeding during treatment.

Children - Corticosteroids may cause infections such as chickenpox or measles to be more serious in children who catch them. These medicines can also slow or stop growth in children and in growing teenagers, especially when they are used for a long time. Before this medicine is given to children or teenagers, you should discuss its use with your child's doctor and then carefully follow the doctor's instructions.

Older adults - Older patients may be more likely to develop high blood pressure or osteoporosis (bone disease) from corticosteroids. Women are especially at risk of developing bone disease.

Other medicines - Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking corticosteroids, it is especially important that your health care professional know if you are taking any of the following:

• Aminoglutethimide (e.g., Cytadren) or
• Antacids (in large amounts) or
• Barbiturates, except butalbital, or
• Carbamazepine (e.g., Tegretol) or
• Griseofulvin (e.g., Fulvicin) or
• Mitotane (e.g., Lysodren) or
• Phenylbutazone (e.g., Butazolidin) or
• Phenytoin (e.g., Dilantin) or
• Primidone (e.g., Mysoline) or
• Rifampin (e.g., Rifadin) - Use of these medicines may make certain corticosteroids less effective

• Amphotericin B by injection (e.g., Fungizone) - Using corticosteroids with this medicine may decrease the amount of potassium in the blood. Serious side effects could occur if the level of potassium gets too low

• Antidiabetic agents, oral (diabetes medicine taken by mouth) or
• Insulin - Corticosteroids may increase blood glucose (sugar) levels

• Cyclosporine (e.g., Sandimmune) - Use of this medicine with high doses of methylprednisolone may cause convulsions (seizures)

• Digitalis glycosides (heart medicine) - Corticosteroids decrease the amount of potassium in the blood. Digitalis can increase the risk of having an irregular heartbeat or other problems if the amount of potassium in the blood gets too low

• Diuretics (water pills) or
• Medicine containing potassium - Using corticosteroids with diuretics may cause the diuretic to be less effective. Also, corticosteroids may increase the risk of low blood potassium, which is also a problem with certain diuretics. Potassium supplements or a different type of diuretic is used in treating high blood pressure in those people who have problems keeping their blood potassium at a normal level. Corticosteroids may make these medicines less able to do this

• Immunizations (vaccinations) - While you are being treated with this medicine, and even after you stop taking it, do not have any immunizations without your doctor's approval. Also, other people living in your home should not receive the oral polio vaccine, since there is a chance they could pass the polio virus on to you. In addition, you should avoid close contact with other people at school or work who have recently taken the oral polio vaccine

• Ritodrine (e.g., Yutopar) - Serious side effects could occur

• Skin test injections - Corticosteroids may cause false results in skin tests

• Sodium-containing medicine - Corticosteroids cause the body to retain (keep) more sodium (salt) and water. Too much sodium may cause high blood sodium, high blood pressure, and excess body water

• Somatrem (e.g., Protropin) or
• Somatropin (e.g., Humatrope) - Corticosteroids can interfere with the effects of these medicines

Other medical problems - The presence of other medical problems may affect the use of corticosteroids. Make sure you tell your doctor if you have any other medical problems, especially:

• Acquired immunodeficiency syndrome (AIDS) or
• Fungus infection or
• Herpes simplex infection of the eye or
• Human immunodeficiency virus (HIV) infection or
• Infection at the place of treatment or
• Other infection or
• Recent surgery or serious injury or
• Strongyloides (worm) infestation or
• Tuberculosis (active TB, nonactive TB, or past history of) - Corticosteroids can cause slower healing, worsen existing infections, or cause new infections

• Chickenpox (including recent exposure) or
• Measles (including recent exposure) - Risk of severe disease affecting other parts of the body

• Diabetes mellitus (sugar diabetes) - Corticosteroids may cause a loss of control of diabetes by increasing blood glucose (sugar)

• Diverticulitis or
• Stomach ulcer or other stomach or intestine problems or
• Ulcerative colitis, severe - Corticosteroids may cover up symptoms of a worsening stomach or intestinal condition. A patient would not know if his or her condition was getting worse and would not get medical help when needed

• Glaucoma - Corticosteroids may cause the pressure within the eye to increase

• Heart disease or
• High blood pressure or
• Kidney disease (especially if you are receiving dialysis) or
• Kidney stones - Corticosteroids cause the body to retain (keep) more salt and water. These conditions may be made worse by this extra body water

• High cholesterol levels - Corticosteroids may increase blood cholesterol levels

• Liver disease or
• Overactive thyroid or
• Underactive thyroid - With these conditions, the body may not eliminate the corticosteroid at the usual rate, which may change the medicine's effect

• Myasthenia gravis - When you first start taking corticosteroids, muscle weakness may occur. Your doctor may want to take special precautions because this could cause problems with breathing

• Osteoporosis (bone disease) - Corticosteroids may worsen bone disease because they cause the body to lose more calcium

• Psychosis - This condition may be made worse

• Systemic lupus erythematosus (SLE) - This condition may cause certain side effects of corticosteroids to occur more easily