Glucocorticoids

ACE inhibitors, glucocorticoids

Increased risk of changes in blood counts

Acetazolamide, glucocorticoids

Hypokalaemic effects of acetazolamide are enhanced by corticosteroids.

Aldesleukin [1], glucocorticoids ---> SmPC of [1] of eMC

The co-administration can decrease the efficacy of aldesleukin and should be avoided

Algeldrate/magnesium hydroxide, glucocorticoids

The co-administration of aluminium-containing antacids with other drugs may decrease the absorption of these drugs. It is recommended to separate the times of administration by at least 2 hours

Alogliptin/metformin [1], glucocorticoids ---> SmPC of [1] of EMA

Glucocorticoids have intrinsic hyperglycaemic activity. Should be more frequent blood glucose monitoring performed

Aluminium hydroxide, glucocorticoids

The co-administration of aluminium-containing antacids with other drugs may decrease the absorption of these drugs. It is recommended to separate the times of administration by at least 2 hours

Aluminium oxide/magnesium hydroxide, glucocorticoids

The co-administration of aluminium-containing antacids with other drugs may decrease the absorption of these drugs. It is recommended to separate the times of administration by at least 2 hours

Amiodarone [1], glucocorticoids ---> SmPC of [1] of eMC

Caution should be exercised over combined therapy with drugs which may also cause hypokalaemia and/or hypomagnesaemia

Amisulpride, glucocorticoids

Concomitant use of amisulpride with drugs inducing hypokaliemia is not recommended

Antacids, glucocorticoids

Antacids may reduce bioavailability of glucocorticoid; leave at least 2 hours between administrations

Antibiotics, glucocorticoids

It is important to ensure that any anti-infective therapy is effective and it is recommended to monitor patients closely.

Anticholinergics, glucocorticoids

An acute myopathy has been reported with the concomitant use of high doses of corticosteroids and anticholinergics, such as neuromuscular blocking drugs.

Anticholinesterase, glucocorticoids ---> SmPC of [deflazacort] of eMC

Anticholinesterase drugs may interact with glucocorticoids and cause severe muscle weakness in patients with myasthenia gravis

Antidiabetics, glucocorticoids ---> SmPC of [methylprednisolone] of eMC

The desired effects of hypoglycaemic agents (including insulin) are antagonized by corticosteroids

Antihypertensives, glucocorticoids

The mineralocorticoid effect of glucocorticoid antagonizes the antihypertensive effect, what can cause hypertension

Asparaginase [1], glucocorticoids ---> SmPC of [1] of EMA

Concomitant use of glucocorticoids and/ or anticoagulants with asparaginase may increase the risk of a change in coagulation parameters (see section 4.4). This can promote tendency to bleeding (anticoagulants) or thrombosis (glucocorticoids).

Atazanavir/cobicistat [1], glucocorticoids metabolized by CYP3A4 ---> SmPC of [1] of EMA

Concomitant use of EVOTAZ and fluticasone or other glucocorticoids that are metabolized by CYP3A4 is not recommended unless the potential benefit of treatment outweighs the risk of systemic corticosteroid effects, including Cushing's syndrome and adrenal suppression

Atazanavir/ritonavir, glucocorticoids metabolized by CYP3A4 ---> SmPC of [atazanavir] of EMA

Concomitant use of atazanavir/ritonavir and glucocorticoids that are metabolized by CYP3A4 is not recommended unless the potential benefit of treatment outweighs the risk of systemic corticosteroid effects

Atenolol/chlortalidone, glucocorticoids

Increased loss of potassium and/or magnesium.

Atropine, glucocorticoids

Additional increase in the intraocular pressure

Bamethane, glucocorticoids

Possible enhancement of sympathomimetic effect

Bemiparin, glucocorticoids

The concomitant administration of bemiparin and systemic glucocorticoids is not advisable. Increased risk of bleeding.

Bendroflumethiazide, glucocorticoids

Increased potassium elimination

Bisacodyl [1], glucocorticoids ---> SmPC of [1] of eMC

The concomitant use of diuretics or adreno-corticosteroids may increase the risk of electrolyte imbalance if excessive doses of bisacodyl are taken.

Breast-feeding, glucocorticoids

Glucocorticoids are excreted in breast milk. Strict indication

Calcium, glucocorticoids

Glucocorticoid inhibits the calcium absorption

Canagliflozin/metformin [1], glucocorticoids ---> SmPC of [1] of EMA

Glucocorticoids have intrinsic hyperglycaemic activity. Should be more frequent blood glucose monitoring performed

Carbamazepine, glucocorticoids

Carbamazepine enhances the corticosteroid metabolism and its therapeutic effects may be reduced. Therefore it may be necessary to adjust the dose of prednisolone accordingly

Cardiac glycosides, glucocorticoids

Increased cardiac glycoside effect by hypokaliemia

Chloroquine, glucocorticoids

Increased risk of myopathies and cardiomyopathies

Cholecalciferol [1], glucocorticoids ---> SmPC of [1] of eMC

Concomitant use of glucocorticoids can decrease the effect of vitamin D.

Clopamide, glucocorticoids

Increased potassium elimination

Colchicine, glucocorticoids

The co-administration of colchicine and glucocorticoids may increase the risk of myopathies

Coumarin anticoagulants, glucocorticoids

Decreased anticoagulant effect

Cyclosporine, glucocorticoids

Increased plasma concentration of cyclosporine and the risk of cerebral seizures

Dapagliflozin/metformin [1], glucocorticoids ---> SmPC of [1] of EMA

Glucocorticoids have intrinsic hyperglycaemic activity. Should be more frequent blood glucose monitoring performed

Dibotermin alfa [1], glucocorticoids ---> SmPC of [1] of EMA

In non-clinical studies, concurrent administration of glucocorticoids depressed bone repair (measured as a % change from control), but the effects of InductOs were not altered.

Distigmine, glucocorticoids

Decreased distigmine effect

Diuretics, glucocorticoids

The effects of diuretics are antagonised by glucocorticoids

Droperidol [1], glucocorticoids ---> SmPC of [1] of eMC

To prevent QT prolongation, caution is necessary when patients are taking medicinal products likely to induce electrolyte imbalance

Empagliflozin/metformin [1], glucocorticoids ---> SmPC of [1] of EMA

Glucocorticoids (given by systemic and local routes), beta-2-agonists, and diuretics have intrinsic hyperglycaemic activity. The patient should be informed and more frequent blood glucose monitoring performed

Enoxaparin sodium [1], systemic glucocorticoids ---> SmPC of [1] of EMA

It is recommended that agents which affect haemostasis should be discontinued prior to enoxaparin therapy unless their use is essential.

Enoxaparin, glucocorticoids

The co-administration may enhance the pharmacologic effect and increase the bleeding risk. A close clinical and laboratory monitoring is recommended

Enzyme inductors, glucocorticoids

The enzymatic induction may increase the metabolism and decrease the plasma concentrations of glucocorticoid

Enzyme inhibitors, glucocorticoids

The enzymatic inhibition may increase the plasma concentrations of glucocorticoid

Ephedrine, glucocorticoids

Increased glucocorticoid metabolism and decreased effect

Eplerenone [1], glucocorticoids ---> SmPC of [1] of eMC

Co-administration of glucocorticoids with eplerenone may potentially decrease antihypertensive effects (sodium and fluid retention).

Fosamprenavir/ritonavir, glucocorticoids metabolized by CYP3A4 ---> SmPC of [fosamprenavir] of EMA

Concomitant use of fosamprenavir with ritonavir and glucocorticoids that are metabolised by CYP3A4 is not recommended unless the potential benefit of treatment outweighs the risk of systemic corticosteroid effects

Furosemide [1], glucocorticoids ---> SmPC of [1] of eMC

The co-administration may increase the risk of hypokalaemia.

Glibenclamide, glucocorticoids

The co-administration may weaken the hypoglycemic effect

Gliclazide [1], glucocorticoids ---> SmPC of [1] of eMC

Glucocorticoids (systemic and local route) increase in blood glucose levels with possible ketosis (reduced tolerance to carbohydrates due to glucocorticoids).

Glimepiride [1], glucocorticoids ---> SmPC of [1] of eMC

Weakening of the blood-glucose-lowering effect and possible hyperglycaemia

Glucocorticoids metabolized by CYP3A4, lopinavir/ritonavir [2] ---> SmPC of [2] of EMA

Concomitant use of Kaletra and fluticasone or other glucocorticoids that are metabolised by CYP3A4, such as budesonide, is not recommended unless the potential benefit of treatment outweighs the risk of systemic corticosteroid effects

Glucocorticoids metabolized by CYP3A4, ombitasvir/paritaprevir/ritonavir [2] ---> SmPC of [2] of EMA

Caution should be used when administering ombitasvir/paritaprevir/ritonavir with fluticasone or other glucocorticoids that are metabolised by CYP3A4. Concomitant use can increase systemic exposures of the glucocorticoids

Glucocorticoids metabolized by CYP3A4, ritonavir [2] ---> SmPC of [2] of EMA

Concomitant use of ritonavir and glucocorticoids that are metabolised by CYP3A4 is not recommended unless the potential benefit of treatment outweighs the risk of systemic corticosteroid effects

Glucocorticoids metabolized by CYP3A4, saquinavir/ritonavir ---> SmPC of [saquinavir] of EMA

Concomitant use of saquinavir/ritonavir and budesonide or other glucocorticoids that are metabolised by CYP3A4. Risk of systemic corticosteroid effects.

Glucocorticoids metabolized by CYP3A4, tipranavir/ritonavir ---> SmPC of [tipranavir] of EMA

Concomitant use of tipranavir, co-administered with low dose ritonavir and glucocorticoids that are metabolised by CYP3A4 is not recommended

Glucocorticoids, glycopyrronium

Additional increase in the intraocular pressure

Glucocorticoids, glycyrrhiza

Inhibition of the metabolism of glucocorticoids is possible.

Glucocorticoids, growth hormone

The growth-promoting effect may be inhibited

Glucocorticoids, heparin ---> SmPC of [sodium heparin] of eMC

The anticoagulant effect of heparin may be enhanced by concomitant medication with other drugs affecting platelet function or the coagulation system

Glucocorticoids, hydantoins

Decrease of the plasma concentrations of glucocorticoid

Glucocorticoids, hydroquinidine

Concomitant use of hydroquinidine and hypokalaemic agents increases the risk of heart rhythm disorders (torsades de pointes)

Glucocorticoids, hypokalemia

Hypokalaemic effects are enhanced by corticosteroids.

Glucocorticoids, indapamide [2] ---> SmPC of [2] of eMC

Increased risk of hypokalaemia (additive effect). Decreased antihypertensive effect (water/sodium retention due to corticosteroids).

Glucocorticoids, insulin

Decreased antidiabetic effect. Possible increase of the insulin requirements

Glucocorticoids, insulin aspart [2] ---> SmPC of [2] of EMA

Possible increase of the insulin requirements

Glucocorticoids, insulin degludec [2] ---> SmPC of [2] of EMA

Possible increase of the insulin requirements

Glucocorticoids, insulin degludec/insulin aspart [2] ---> SmPC of [2] of EMA

Possible increase of the insulin requirements

Glucocorticoids, insulin degludec/liraglutide [2] ---> SmPC of [2] of EMA

Possible increase of the Xultophy requirements

Glucocorticoids, insulin detemir [2] ---> SmPC of [2] of EMA

Possible increase of the insulin requirements

Glucocorticoids, interleukin-2 [2] ---> SmPC of [2] of eMC

The co-administration can decrease the efficacy of aldesleukin and should be avoided

Glucocorticoids, isoniazid

Increased hepatic metabolism of isoniazid and decreased metabolism of glucocorticoid

Glucocorticoids, kebuzone

The co-administration may enhance the effects and increase the risk of gastrointestinal bleeding and ulcer formation

Glucocorticoids, ketoconazole

The enzymatic inhibition may increase the plasma concentrations of glucocorticoid

Glucocorticoids, lactitol

The co-administration of hypokaliemia-inducer drugs may enhance the potassium loss

Glucocorticoids, laxatives

Increased potassium elimination

Glucocorticoids, levothyroxine

Inhibition of peripheral conversion of T4 to T3

Glucocorticoids, linagliptin/metformin [2] ---> SmPC of [2] of EMA

Glucocorticoids have intrinsic hyperglycaemic activity. Should be more frequent blood glucose monitoring performed

Glucocorticoids, lomitapide [2] ---> SmPC of [2] of EMA

Medicines that induce CYP3A4 would be expected to increase the rate and extent of metabolism of lomitapide. Consequently, this would reduce the effect of lomitapide. Any impact on efficacy is likely to be variable.

Glucocorticoids, loop diuretics ---> SmPC of [deflazacort] of eMC

Hypokalaemic effects of loop diuretics are enhanced by corticosteroids.

Glucocorticoids, lutetium (177Lu) oxodotreotide [2] ---> SmPC of [2] of EMA

There is some evidence that corticosteroids can induce down-regulation of SST2 receptors. Therefore, as a matter of cautiousness, repeated administration of high-doses of glucocorticosteroids should be avoided during Lutathera treatment.

Glucocorticoids, macimorelin [2] ---> SmPC of [2] of EMA

The combination may impact the accuracy of the diagnostic test. Concomitant use with macimorelin is to be avoided

Glucocorticoids, magnesium

Decreased absorption of glucocorticoid

Glucocorticoids, magnesium hydroxide

The magnesium hydroxide may decrease the absorption of glucocorticoid. Separate administration by at least 2 hours

Glucocorticoids, mefloquine

Increased risk of myopathies and cardiomyopathies

Glucocorticoids, mefruside

Increased potassium elimination

Glucocorticoids, mesalazine

Increased risk of gastrointestinal haemorrhage and ulceration.

Glucocorticoids, metformin [2] ---> SmPC of [2] of eMC

Glucocorticoids (systemic and local routes), beta-2-agonists, and diuretics have intrinsic hyperglycaemic activity. Inform the patient and perform more frequent blood glucose monitoring, especially at the beginning of treatment.

Glucocorticoids, metformin/saxagliptin/dapagliflozin [2] ---> SmPC of [2] of EMA

Glucocorticoids (given by systemic and local routes), beta-2 agonists, and diuretics have intrinsic hyperglycaemic activity. The patient should be informed and more frequent blood glucose monitoring performed

Glucocorticoids, metolazone

The co-administration may increase the risk of hypokaliemia and fluid retention

Glucocorticoids, muscle relaxants (non-depolarizing)

The combination can cause prolonged muscle relaxation and acute myopathy.

Glucocorticoids, nadroparin

Nadroparin should be used with caution by patients treated with systemic glucocorticoids

Glucocorticoids, natriuretic agents

Increased potassium elimination

Glucocorticoids, nimesulide

Increased risk of gastrointestinal haemorrhage and ulceration. Caution is recommended

Glucocorticoids, NSAID ---> SmPC of [methylprednisolone] of eMC

There may be increased incidence of gastrointestinal bleeding and ulceration when corticosteroids are given with NSAIDs.

Glucocorticoids, olsalazine

Increased risk of gastrointestinal haemorrhage and ulceration. Caution is recommended

Glucocorticoids, oral contraceptives

The co-administration may increase the plasma levels of glucocorticoid

Glucocorticoids, parnaparin

The co-administration may cause a mutual enhancement of the anticoagulant effect

Glucocorticoids, pegaspargase [2] ---> SmPC of [2] of EMA

When glucocorticoids (e.g. prednisone) and Oncaspar are given at the same time, alterations in coagulation parameters (e.g. fall in fibrinogen and Antithrombin III deficiency, ATIII) can be more pronounced.

Glucocorticoids, phenindione [2] ---> SmPC of [2] of eMC

Corticosteroids potentiate the effect of phenindione

Glucocorticoids, phenothiazines

The phenothiazine may enhance the absorption of glucocorticoid

Glucocorticoids, phenytoin ---> SmPC of [deflazacort] of eMC

Phenytoin enhances the corticosteroid metabolism and its therapeutic effects may be reduced. Therefore it may be necessary to adjust the dose of corticosteroid accordingly

Glucocorticoids, pindolol/clopamide

Concomitant use of pindolol/clopamide and glucocorticoids may increase the loss of potassium

Glucocorticoids, pioglitazone/glimepiride [2] ---> SmPC of [2] of EMA

Weakening of the blood-glucose-lowering effect and, thus raised blood glucose levels may occur

Glucocorticoids, pioglitazone/metformin [2] ---> SmPC of [2] of EMA

Glucocorticoids have intrinsic hyperglycaemic activity. Should be more frequent blood glucose monitoring performed

Glucocorticoids, piretanide

The co-administration of piretanide with glucocorticoids may cause a great loss of potassium with the risk of hypokaliemia

Glucocorticoids, pixantrone [2] ---> SmPC of [2] of EMA

Caution should be taken when pixantrone is continuously co-administered with efflux transport inducers, as pixantrone excretion might be increased with a consequent decrease of systemic exposure.

Glucocorticoids, potassium chloride

Possible decrease in effects of potassium supplement

Glucocorticoids, praziquantel ---> SmPC of [deflazacort] of eMC

Glucocorticoids may lower the praziquantel concentrations in the blood.

Glucocorticoids, pregnancy

Should only be used during pregnancy if the potential benefit to the mother justifies the potential risk to the fetus.

Glucocorticoids, primidone

Primidone therapy may lead to altered pharmacokinetics in concomitantly administered drugs, whose metabolism may be increased and lead to lowered plasma levels and/or a shorter half-life.

Glucocorticoids, proglumetacine

Increased risk of gastrointestinal haemorrhage and ulceration. Caution is recommended

Glucocorticoids, protirelin

Reduction of TSH-increase

Glucocorticoids, reviparin

The co-administration of reviparin with systemic glucocorticoid may increase the risk of bleeding

Glucocorticoids, salicylates ---> SmPC of [deflazacort] of eMC

The renal clearance of salicylates is increased by corticosteroids and steroid withdrawal may result in salicylate intoxication.

Glucocorticoids, saxagliptin/metformin [2] ---> SmPC of [2] of EMA

Glucocorticoids have intrinsic hyperglycaemic activity. Should be more frequent blood glucose monitoring performed

Glucocorticoids, sitagliptin/metformin [2] ---> SmPC of [2] of EMA

Glucocorticoids (given by systemic and local routes) beta-2-agonists, and diuretics have intrinsic hyperglycaemic activity. The patient should be informed and more frequent blood glucose monitoring performed

Glucocorticoids, sodium chloride

The co-administration may increase the sodium and chloride retention

Glucocorticoids, sodium heparin [2] ---> SmPC of [2] of eMC

The anticoagulant effect of heparin may be enhanced by concomitant medication with other drugs affecting platelet function or the coagulation system

Glucocorticoids, somapacitan [2] ---> SmPC of [2] of EMA

Growth hormone decreases the conversion of cortisone to cortisol and may unmask previously undiscovered central hypoadrenalism or render low glucocorticoid replacement doses ineffective

Glucocorticoids, somatorelin [2] ---> SmPC of [2] of eMC

High levels of glucocorticoids as well as somatostatin or its analogues may inhibit the growth hormone release.

Glucocorticoids, somatropin [2] ---> SmPC of [2] of EMA

Excessive glucocorticoid therapy can inhibit the actions of hGH. Patients receiving concomitant glucocorticoid therapy should have their dose carefully adjusted. Growth hormone decreases the conversion of cortisone to cortisol

Glucocorticoids, sulfonylureas

Weakening of the blood-glucose-lowering effect and, thus raised blood glucose levels may occur

Glucocorticoids, sulpiride [2] ---> SmPC of [2] of eMC

The combination of sulpiride with hypokaliemia-inducing medications is not recommended

Glucocorticoids, thiazides ---> SmPC of [deflazacort] of eMC

Corticosteroids may exacerbate the hypokalaemia associated with thiazide use.

Glucocorticoids, tiapride

Hypokaliemia-inducing medicinal products increase the risk of ventricular arrhythmias, particularly torsades de pointes. The combination is not recommended

Glucocorticoids, tiaprofenic acid

Caution must be exercised when tiaprofenic acid is administered with corticosteroids due to increased risk of gastrointestinal ulceration or bleeding.

Glucocorticoids, tipranavir

Increased plasma levels of glucocorticoid metabolized by CYP3A4 with risk of systemic corticosteroid effects. Concomitant use not recommended

Glucocorticoids, torasemid [2] ---> SmPC of [2] of eMC

The kaliuretic effect of glucocorticoids may be increased by torasemide

Glucocorticoids, vaccinations with live organism vaccines ---> SmPC of [deflazacort] of eMC

Increased toxicity of vaccine due to the immunosuppressive effect of corticosteroid

Glucocorticoids, vildagliptin/metformin [2] ---> SmPC of [2] of EMA

Glucocorticoids have intrinsic hyperglycaemic activity. Should be more frequent blood glucose monitoring performed

Glucocorticoids, vitamin D

Functional antagonism. The D vitamin analog promotes the calcium absorption and the glucocorticoid inhibits it.