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.
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. Articaine; Epinephrine: Moderate Corticosteroids may potentiate the hypokalemic effects of epinephrine. 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 ciclesonide with atazanavir may cause elevated ciclesonide 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 ciclesonide with atazanavir may cause elevated ciclesonide serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression.
Moderate Coadministration of ciclesonide with cobicistat may cause elevated ciclesonide 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 Limit the period of use of neuromuscular blockers and corticosteroids and only use when the specific advantages of the drugs outweigh the risks for acute myopathy. An acute myopathy has been observed with the use of high doses of corticosteroids in patients receiving concomitant long-term therapy with neuromuscular blockers. Clinical improvement or recovery after stopping therapy may require weeks to years.
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.
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. Brompheniramine; Carbetapentane; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Brompheniramine; Dextromethorphan; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.
Brompheniramine; 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.
Caffeine; Sodium Benzoate: Moderate Corticosteroids may cause protein breakdown, which could lead to elevated blood ammonia concentrations, especially in patients with an impaired ability to form urea.
Corticosteroids should be used with caution in patients receiving treatment for hyperammonemia. 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.
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.
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.
Cimetidine: Moderate Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention. Cisatracurium: Moderate Limit the period of use of neuromuscular blockers and corticosteroids and only use when the specific advantages of the drugs outweigh the risks for acute myopathy.
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 ciclesonide with cobicistat may cause elevated ciclesonide 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.
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 ciclesonide with darunavir may cause elevated ciclesonide serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression. Darunavir; Cobicistat: Moderate Coadministration of ciclesonide with cobicistat may cause elevated ciclesonide serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression.
Moderate Coadministration of ciclesonide with darunavir may cause elevated ciclesonide serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression. Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide: Moderate Coadministration of ciclesonide with cobicistat may cause elevated ciclesonide serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression.
Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir: Moderate Coadministration of ciclesonide with ritonavir may cause elevated ciclesonide serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression.
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. 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 Limit the period of use of neuromuscular blockers and corticosteroids and only use when the specific advantages of the drugs outweigh the risks for acute myopathy. 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.
Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide: Moderate Coadministration of ciclesonide with cobicistat may cause elevated ciclesonide serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression. Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate: Moderate Coadministration of ciclesonide with cobicistat may cause elevated ciclesonide 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; 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.
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.
Ephedrine; Guaifenesin: Moderate Ephedrine may enhance the metabolic clearance of corticosteroids. Epinephrine: Moderate Corticosteroids may potentiate the hypokalemic effects of epinephrine. 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.
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. 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. 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. 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; 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. 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. 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; 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; 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.
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.
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. Inebilizumab: Moderate Concomitant usage of inebilizumab with immunosuppressant drugs, including systemic corticosteroids, may increase the risk of infection. Consider the risk of additive immune system effects when coadministering therapies that cause immunosuppression with inebilizumab. 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.
Irbesartan; 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.
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 Monitor for steroid-related adverse effects if coadministration of ciclesonide and itraconazole is necessary. Coadministration of another strong CYP3A4 inhibitor increased the AUC of the active metabolite of ciclesonide, des-ciclesonide, by approximately 3. Ketoconazole: Minor Potent inhibitors of CYP3A4 may increase serum concentrations of ciclesonide and its active metabolite des-ciclesonide.
In a drug interaction study, orally inhaled ciclesonide coadministered with oral ketoconazole increased the AUC of des-ciclesonide by approximately 3. Labetalol: Moderate Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention. L-Asparaginase Escherichia coli: Moderate Concomitant use of L-asparaginase with corticosteroids can result in additive hyperglycemia.
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.
Lisinopril; 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. 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.
Lonapegsomatropin: Moderate Corticosteroids can retard bone growth and therefore, can inhibit the growth-promoting effects of somatropin. If corticosteroid therapy is required, the corticosteroid dose should be carefully adjusted. While glucocorticoids with mineralocorticoid activity e. Lopinavir; Ritonavir: Moderate Coadministration of ciclesonide with ritonavir may cause elevated ciclesonide serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression.
Losartan; 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. Macimorelin: Major Avoid use of macimorelin with drugs that directly affect pituitary growth hormone secretion, such as corticosteroids.
Healthcare providers are advised to discontinue corticosteroid therapy and observe a sufficient washout period before administering macimorelin. Use of these medications together may impact the accuracy of the macimorelin growth hormone test.
Mannitol: Moderate Corticosteroids may accentuate the electrolyte loss associated with diuretic therapy resulting in hypokalemia. Mecasermin rinfabate: Moderate Additional monitoring may be required when coadministering systemic or inhaled corticosteroids and mecasermin, recombinant, rh-IGF In animal studies, corticosteroids impair the growth-stimulating effects of growth hormone GH through interference with the physiological stimulation of epiphyseal chondrocyte proliferation exerted by GH and IGF Dexamethasone administration on long bone tissue in vitro resulted in a decrease of local synthesis of IGF The following lists contain some of the key side effects that may occur while taking Alvesco.
These lists do not include all possible side effects. For more information about the possible side effects of Alvesco, talk with your doctor or pharmacist. They can give you tips on how to deal with any side effects that may be bothersome. Most of these side effects may go away within a few days or a couple of weeks.
Call your doctor right away if you have serious side effects. In clinical studies , children taking inhaled corticosteroids such as Alvesco grew about 0.
Children taking higher doses of inhaled corticosteroids over longer periods had the largest change in growth. This should help decrease any side effects your child has. You may wonder how often certain side effects occur with this drug or whether certain side effects pertain to it. As with most drugs, some people can have an allergic reaction after taking Alvesco. Allergic reactions involving swelling of the mouth, lips, or tongue have been reported in people taking Alvesco.
A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include:. Call your doctor right away if you have an allergic reaction to Alvesco, as the reaction could become severe. During Alvesco treatment, oral thrush may occur in adults and children. This is a type of fungal infection in the mouth caused by a fungus called Candida albicans.
A placebo is a treatment with no active drug in it. If you develop symptoms of oral thrush while taking Alvesco, talk with your doctor. They can recommend a medication for it. But sometimes, your doctor may have you stop your treatment with Alvesco until the oral thrush has gone away.
After using your Alvesco inhaler, gargle and rinse out your mouth with water, then spit the water out. This helps decrease your risk of developing oral thrush. In clinical trials , eye conditions were reported in people using either Alvesco or other inhaled corticosteroids. Alvesco is a type of corticosteroid. They will probably recommend a vision test. If you do develop changes in your vision, your doctor may monitor your eyes more often than usual.
Or they may switch you to a different medication to treat your asthma. Bronchodilators open up your airways to allow more air into your lungs. However, corticosteroid medications that are taken orally by mouth may cause weight gain. In some cases, you may take these drugs with Alvesco. If you notice an unexpected weight gain while using Alvesco, talk with your doctor. Your doctor may also be able to recommend ways for you to manage your weight.
You may wonder how Alvesco compares with other medications that are prescribed for similar uses. Here we look at how Alvesco and Qvar Redihaler are alike and different. The active drug ingredient in Alvesco is ciclesonide. The active drug ingredient in Qvar Redihaler is beclomethasone. Both Alvesco and Qvar Redihaler are inhaled corticosteroids.
You should not use Alvesco or Qvar Redihaler to treat asthma attacks or sudden trouble breathing. These drugs are not rescue inhalers. Alvesco and Qvar decrease swelling in airways over time, which may lead to fewer and less severe asthma attacks. Both Alvesco and Qvar Redihaler come as aerosol inhalers. This type of inhaler releases a fine spray of medication into your lungs when you take a dose.
Alvesco and Qvar Redihaler are both inhaled corticosteroids. Therefore, these medications can cause very similar side effects, but some different ones as well. Below are examples of these side effects. These lists contain up to 10 of the most common mild side effects that can occur with either Alvesco or Qvar Redihaler, as well as mild side effects that both drugs may share. This list contains examples of serious side effects that can occur with either Alvesco or Qvar Redihaler:.
But studies have found both Alvesco and Qvar Redihaler to be effective for helping prevent asthma symptoms. According to estimates on GoodRx. Alvesco and Qvar Redihaler are both brand-name drugs. There are currently no generic forms of either drug. Brand-name medications usually cost more than generics. Other drugs are available that can treat your condition. Some may be a better fit for you than others. They can tell you about other medications that may work well for you. There are many different types of medications that may be used to treat your asthma.
In some cases, a combination of drugs may be used. Below are examples of other inhaled medications that your doctor may recommend to treat your asthma:. Like Qvar Redihaler above , the drug Advair has similar uses to Alvesco. The active drug ingredient in Alvesco is ciclesonide, which is an inhaled corticosteroid. Advair HFA contains two active drug ingredients: fluticasone and salmeterol. Fluticasone is a type of drug called an inhaled corticosteroid. Salmeterol is a kind of drug known as a long-acting beta-agonist.
Alvesco and Advair HFA decrease swelling in airways over time, which may lead to fewer and less severe asthma attacks. Note: Advair comes in another form called Advair Diskus. This form of the drug is approved to help prevent asthma symptoms in adults as well as children ages 4 years and older.
Alvesco and Advair HFA both contain inhaled corticosteroids. Therefore, these medications can cause very similar side effects. However, Advair HFA also contains another type of drug called a bronchodilator , which is used to treat asthma. Therefore, Advair HFA can cause some different side effects as well. Below are examples of the side effects of each drug. These lists contain up to 10 of the most common mild side effects that can occur with either Alvesco or Advair HFA, as well as mild side effects that both drugs may share.
These lists contain examples of serious side effects that can occur with either Alvesco or Advair HFA, as well as serious side effects that both drugs may share. But studies have found both Alvesco and Advair HFA to be effective for helping prevent asthma symptoms. Alvesco and Advair HFA are both brand-name drugs. Typically, your doctor will start you on a low dosage.
Your doctor will ultimately prescribe the smallest dosage that provides the desired effect. The following information describes dosages that are commonly used or recommended.
However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to fit your needs. Each inhaler contains 60 inhalations puffs. The mcg inhaler releases 80 mcg of Alvesco into your lungs. But pushing down on the inhaler valve releases mcg of the drug. Pushing down on the inhaler valve of the mcg inhaler releases mcg of Alvesco.
This is because the actual amount of medication that reaches your lungs depends on other factors, such as how you breathe in after taking your dose. The drug works by helping prevent asthma symptoms from occurring in adults as well as children ages 12 years and older. This is one inhalation puff of the microgram mcg inhaler twice per day. The maximum recommended dosage is mcg twice daily.
This is one puff of the mcg inhaler twice per day. The maximum recommended dosage is mcg of Alvesco twice daily. This is two puffs of the mcg inhaler twice per day. After using Alvesco for about 1 week, your doctor may slowly start to decrease your dosage of oral steroids. Alvesco is approved to be used in children ages 12 years and older with asthma.
The dosages for children pediatric dosages are the same as for adults. If you forget to take a dose of Alvesco, talk with your doctor or pharmacist. Depending on how long it has been since your missed dose, they may recommend either:. This can include setting an alarm on your phone or downloading a reminder app. A kitchen timer can work, too. Alvesco is meant to be used as a long-term treatment.
As with all medications, the cost of Alvesco can vary. To find current prices for Alvesco in your area, check out GoodRx. The cost you find on GoodRx. Keep in mind that you may be able to get a day supply of Alvesco. If approved by your insurance company, getting a day supply of the drug could reduce your number of trips to the pharmacy and help lower the cost.
Before approving coverage for Alvesco, your insurance company may require you to get prior authorization. This means that your doctor and insurance company will need to communicate about your prescription before the insurance company will cover the drug.
Ciclesonide nasal spray is only for use in the nose. Do not swallow the nasal spray and be careful not to spray it in your eyes or directly onto the nasal septum the wall between the two nostrils. Ciclesonide controls the symptoms of rhinitis but does not cure it. Your symptoms probably will not begin to improve for at least hours after your first dose and it may be longer before you feel the full benefit of ciclesonide.
Continue to use ciclesonide even if you feel well. Do not stop taking ciclesonide without talking to your doctor. Each bottle of ciclesonide nasal spray is designed to provide sprays after the bottle is primed initially. The bottle must be disposed of after 4 months of use. You should count 4 months from the date that the bottle is removed from the foil pouch and write it on the sticker that is provided in the carton.
Place the sticker in the space provided on the bottle to remind you of this date. It is also important to keep track of the number of sprays you have used and dispose of the bottle after you have used sprays, even if the bottle still contains some liquid and it is before the 4 months have passed.
This medication may be prescribed for other uses; ask your doctor or pharmacist for more information. Use the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not use a double dose to make up for a missed one. Ciclesonide may cause children to grow more slowly.
It is not known whether using ciclesonide decreases the final adult height that children will reach. Talk to your doctor about the risks of giving this medication to your child.
Ciclesonide may cause other side effects. Call your doctor if you have any unusual problems while taking this medication. Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture not in the bathroom.
Do not freeze. Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them.
However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program.
It is important to keep all medication out of sight and reach of children as many containers such as weekly pill minders and those for eye drops, creams, patches, and inhalers are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location — one that is up and away and out of their sight and reach. If someone swallows ciclesonide, call your local poison control center at If the victim has collapsed or is not breathing, call local emergency services at If your applicator becomes clogged, remove the dust cap and gently pull upwards to free the nasal applicator.
Wash the dust cap and applicator with warm water. Dry and replace the applicator and press down and release the pump one time or until you see a fine spray.
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