Betamethasone + Clotrimazole + Gentamicin interactions

Checked as Betamethasone + Clotrimazole + Gentamicin in this data source.

Full monograph for Betamethasone + Clotrimazole + Gentamicin Check it against another medicine

Medicines

752 documented

Severity

Mechanism

Medicines documented to interact with Betamethasone + Clotrimazole + Gentamicin, worst severity first.
Medicine	Severity	Mechanism	Effect	Sources
Adalimumabvia Betamethasone	Major	Synergy	The use of tumor necrosis factor (TNF) blockers with other immunosuppressive or myelosuppressive agents may increase the risk of infections. Serious infections…	6 sources — open the full entry
Adefovir Dipivoxilvia Gentamicin	Major	Excretion	Coadministration of adefovir dipivoxil with other nephrotoxic agents may increase the risk and severity of renal impairment due to additive effects on the…	1 sources — open the full entry
Amiodarone Hydrochloridevia Clotrimazole, Gentamicin	Major	Metabolism · Unknown	Coadministration with azole antifungal agents may significantly increase the plasma concentrations of amiodarone. The proposed mechanism is azole inhibition of…2 documented mechanisms	8 sources — open the full entry
Atracurium Besilatevia Betamethasone, Gentamicin	Major	Synergy	Aminoglycosides possess neuromuscular blocking activity, which may be additive with that of depolarizing and nondepolarizing muscle relaxants, potentially…2 documented mechanisms	25 sources — open the full entry
Bacitracin Zinc + Polymyxin B Sulfatevia Gentamicin	Major	Synergy	The combination of a polypeptide antibiotic and an aminoglycoside may increase the risk of neurotoxicity, respiratory paralysis, and renal dysfunction. The…2 documented mechanisms	7 sources — open the full entry
Baricitinibvia Betamethasone	Major	Others	Coadministration of baricitinib or tofacitinib with other immuno- or myelosuppressive agents may potentiate the risk of infections as well as lymphoma and…	6 sources — open the full entry
Bempedoic acidvia Betamethasone	Major	Synergy	Concomitant administration of bempedoic acid may potentiate the risk of tendon rupture or injury associated with fluoroquinolones and corticosteroids. The…	2 sources — open the full entry
Bempedoic acid + Ezetimibevia Betamethasone, Clotrimazole	Major	Synergy · Unknown	Concomitant administration of bempedoic acid may potentiate the risk of tendon rupture or injury associated with fluoroquinolones and corticosteroids. The…2 documented mechanisms	2 sources — open the full entry
Brexpiprazolevia Clotrimazole	Major	Metabolism	Coadministration with inhibitors of CYP450 3A4 and/or 2D6 may significantly increase the plasma concentrations of brexpiprazole, which is metabolized by these…	5 sources — open the full entry
Bumetanidevia Betamethasone, Clotrimazole, Gentamicin	Major	Synergy · Unknown	Coadministration of parenteral or inhaled aminoglycoside antibiotics or oral neomycin in combination with loop diuretics may potentiate the risk of oto- or…3 documented mechanisms	27 sources — open the full entry
Bupropion Hydrochloridevia Betamethasone, Clotrimazole, Gentamicin	Major	Synergy · Unknown	The use of bupropion is associated with a dose-related risk of seizures. The risk may be further increased when coadministered with selective serotonin…3 documented mechanisms	19 sources — open the full entry
Ciprofloxacinbase Ophthalmicvia Gentamicin, Betamethasone, Clotrimazole	Major	Synergy · Unknown	Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism…3 documented mechanisms	7 sources — open the full entry
Ciprofloxacin + Dexamethasonevia Gentamicin, Betamethasone, Clotrimazole	Major	Synergy · Unknown	Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism…5 documented mechanisms	7 sources — open the full entry
Ciprofloxacin + Hydrocortisone Acetatevia Gentamicin, Betamethasone, Clotrimazole	Major	Synergy · Unknown	Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism…3 documented mechanisms	7 sources — open the full entry
Cisatracurium Besylatevia Gentamicin, Betamethasone	Major	Synergy	Aminoglycosides possess neuromuscular blocking activity, which may be additive with that of depolarizing and nondepolarizing muscle relaxants, potentially…2 documented mechanisms	25 sources — open the full entry
Clobetasol Propionate + Ofloxacin + Ornidazole + Terbinafinevia Betamethasone, Clotrimazole, Gentamicin	Major	Synergy · Unknown	Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism…5 documented mechanisms	7 sources — open the full entry
Colistimethate Sodiumvia Gentamicin	Major	Synergy	The combination of a polypeptide antibiotic and an aminoglycoside may increase the risk of neurotoxicity, respiratory paralysis, and renal dysfunction. The…	7 sources — open the full entry
Deferasiroxvia Betamethasone, Gentamicin	Major	Synergy	Coadministration with drugs that have known ulcerogenic or hemorrhagic potential may increase the risk of gastrointestinal bleeding associated with the use of…2 documented mechanisms	6 sources — open the full entry
Delafloxacinvia Betamethasone	Major	Synergy	Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism…	7 sources — open the full entry
Desmopressin Acetatevia Betamethasone	Major	Synergy	Coadministration of desmopressin with loop diuretics or systemic or inhaled corticosteroids may increase the risk of severe hyponatremia. Loop diuretics and…	9 sources — open the full entry
Dexamethasone + Levofloxacinvia Betamethasone, Clotrimazole, Gentamicin	Major	Synergy · Unknown	Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism…3 documented mechanisms	7 sources — open the full entry
Dexamethasone + Neomycin Sulphate + Polymyxin B Sulphatevia Gentamicin, Clotrimazole	Major	Synergy · Unknown	The combination of a polypeptide antibiotic and an aminoglycoside may increase the risk of neurotoxicity, respiratory paralysis, and renal dysfunction. The…4 documented mechanisms	21 sources — open the full entry
Dextromethorphan + Bupropionvia Betamethasone, Clotrimazole, Gentamicin	Major	Synergy · Unknown	The use of bupropion is associated with a dose-related risk of seizures. The risk may be further increased when coadministered with selective serotonin…3 documented mechanisms	19 sources — open the full entry
Eplerenonevia Betamethasone, Clotrimazole	Major	Antagonism · Metabolism	Coadministration with inhibitors of CYP450 3A4 may increase the plasma concentrations of eplerenone, which is primarily metabolized by the isoenzyme.2 documented mechanisms	3 sources — open the full entry
Etanerceptvia Betamethasone	Major	Synergy	The use of tumor necrosis factor (TNF) blockers with other immunosuppressive or myelosuppressive agents may increase the risk of infections. Serious infections…	6 sources — open the full entry
Everolimusvia Clotrimazole, Gentamicin	Major	Absorption · Synergy	Coadministration of macrolide immunosuppressants with other nephrotoxic agents may increase the risk and/or severity of renal impairment due to additive…2 documented mechanisms	8 sources — open the full entry
Fentanyl Citratevia Clotrimazole, Gentamicin	Major	Metabolism · Unknown	Coadministration with inhibitors of CYP450 3A4 may increase the plasma concentrations of fentanyl, which is primarily metabolized by the isoenzyme. Increased…2 documented mechanisms	12 sources — open the full entry
Furosemidevia Gentamicin, Betamethasone, Clotrimazole	Major	Synergy · Unknown	Coadministration of parenteral or inhaled aminoglycoside antibiotics or oral neomycin in combination with loop diuretics may potentiate the risk of oto- or…3 documented mechanisms	27 sources — open the full entry
Furosemide + Spironolactonevia Betamethasone, Gentamicin, Clotrimazole	Major	Antagonism · Metabolism · Synergy · Unknown	Coadministration of parenteral or inhaled aminoglycoside antibiotics or oral neomycin in combination with loop diuretics may potentiate the risk of oto- or…6 documented mechanisms	29 sources — open the full entry
Gatifloxacinvia Betamethasone, Clotrimazole	Major	Synergy · Unknown	Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism…2 documented mechanisms	7 sources — open the full entry
Gatifloxacin + Dexamethasonevia Betamethasone, Clotrimazole, Gentamicin	Major	Synergy · Unknown	Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism…4 documented mechanisms	7 sources — open the full entry
Gemifloxacinvia Betamethasone	Major	Synergy	Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism…	7 sources — open the full entry
Golimumabvia Betamethasone	Major	Synergy	The use of tumor necrosis factor (TNF) blockers with other immunosuppressive or myelosuppressive agents may increase the risk of infections. Serious infections…	6 sources — open the full entry
Gramacidin + Neomycin + Polymixin Bvia Gentamicin	Major	Synergy	The combination of a polypeptide antibiotic and an aminoglycoside may increase the risk of neurotoxicity, respiratory paralysis, and renal dysfunction. The…2 documented mechanisms	21 sources — open the full entry
Human Anti-D Immunoglobulinsvia Gentamicin	Major	Synergy	Coadministration of intravenous immune globulin preparations with nephrotoxic agents may potentiate the risk of renal impairment. Many commercially available…	11 sources — open the full entry
Hydrocortisone + Neomycin Sulphate + Polymixin Bvia Gentamicin, Clotrimazole	Major	Synergy · Unknown	The combination of a polypeptide antibiotic and an aminoglycoside may increase the risk of neurotoxicity, respiratory paralysis, and renal dysfunction. The…4 documented mechanisms	21 sources — open the full entry
Infliximabvia Betamethasone	Major	Synergy	The use of tumor necrosis factor (TNF) blockers with other immunosuppressive or myelosuppressive agents may increase the risk of infections. Serious infections…	6 sources — open the full entry
Iodixanolvia Gentamicin	Major	Synergy	Concomitant use of intravascular radiocontrast media with other nephrotoxic agents may potentiate the risk of contrast-induced nephropathy and renal…	7 sources — open the full entry
Iohexolvia Betamethasone, Gentamicin	Major	Others · Synergy	Coadministration of corticosteroids with iodinated contrast media by the intrathecal route may be associated with a high incidence of radiographic…2 documented mechanisms	12 sources — open the full entry
Iopamidolvia Betamethasone, Gentamicin	Major	Others · Synergy	Coadministration of corticosteroids with iodinated contrast media by the intrathecal route may be associated with a high incidence of radiographic…2 documented mechanisms	12 sources — open the full entry
Ivabradinevia Clotrimazole	Major	Metabolism	Coadministration with moderate inhibitors of CYP450 3A4 may significantly increase the plasma concentrations of ivabradine, which is primarily metabolized by…	9 sources — open the full entry
Leflunomidevia Betamethasone, Clotrimazole	Major	Synergy	The use of leflunomide with other immunosuppressive or myelosuppressive agents may increase the risk of infections. The risk is thought to extend to…2 documented mechanisms	5 sources — open the full entry
Levofloxacin (Eye/Ear)via Betamethasone	Major	Synergy	Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism…	7 sources — open the full entry
Levofloxacin Hemihydratevia Betamethasone	Major	Synergy	Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism…	7 sources — open the full entry
Lomefloxacinvia Betamethasone	Major	Synergy	Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism…	7 sources — open the full entry
Loteprednol Etabonate + Gatifloxacinvia Betamethasone, Clotrimazole	Major	Synergy · Unknown	Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism…2 documented mechanisms	7 sources — open the full entry
Magnesium Sulfatevia Gentamicin, Betamethasone	Major	Antagonism · Synergy	Aminoglycosides possess neuromuscular blocking activity, which may be additive with that of parenteral magnesium, potentially resulting in severe and/or…2 documented mechanisms	14 sources — open the full entry
Mannitolvia Gentamicin, Clotrimazole	Major	Synergy · Unknown	Coadministration of parenteral or inhaled aminoglycoside antibiotics or oral neomycin in combination with loop diuretics may potentiate the risk of oto- or…2 documented mechanisms	19 sources — open the full entry
Metronidazole + Neomycin Sulphate + Polymyxin B + Nystatinvia Gentamicin, Clotrimazole	Major	Synergy · Unknown	The combination of a polypeptide antibiotic and an aminoglycoside may increase the risk of neurotoxicity, respiratory paralysis, and renal dysfunction. The…6 documented mechanisms	21 sources — open the full entry
Mifepristonevia Betamethasone, Clotrimazole	Major	Antagonism · Metabolism	Mifepristone is a potent antiglucocorticoid and may antagonize the effects of corticosteroids. Pharmacokinetically, mifepristone may increase the plasma…2 documented mechanisms	9 sources — open the full entry

Conditions

Conditions in which Betamethasone + Clotrimazole + Gentamicin needs care, as documented in this source.

Dehydration
Major
Adequate hydration is crucial to minimize the risk of oto- and nephrotoxicity associated with the use of aminoglycosides. Dehydration should preferably be corrected prior to initiation of therapy. In patients who may be at risk for dehydration, such as those with severe and/or prolonged diarrhea or vomiting, fluid status should be monitored closely. If signs of renal irritation develop during therapy, hydration should be increased as indicated, accompanied by a reduction in dosage if necessary. Therapy should be withdrawn if urinary output decreases progressively or azotemia increases.
6 sources
1. "Product Information. Amikin (amikacin)." Bristol-Myers Squibb (2002):
2. "Product Information. Garamycin (gentamicin)." Schering-Plough Corporation (2007):
3. "Product Information. Netromycin (netilmicin)." Schering Corporation (2002):
4. "Product Information. Streptomycin Sulfate (streptomycin)." Pfizer U.S. Pharmaceuticals
5. "Product Information. Nebcin (tobramycin)." Lilly, Eli and Company (2001):
6. "Product Information. Mycifradin (neomycin)." Emerson Laboratories (2001):
Infections
Major
The immunosuppressant and anti-inflammatory effects of corticosteroids, particularly in higher dosages, may decrease host resistance to infectious agents, decrease the ability to localize infections, and mask the symptoms of infection. Secondary infections may be more likely to develop. In general, corticosteroids should not be used in patients with active infections, especially systemic fungal infections, unless they are medically necessary and effective antimicrobial therapy or other appropriate treatment has been instituted. However, for corticosteroid-dependent patients who develop a severe or life-threatening infection, continuation of corticosteroid therapy with at least physiologic replacement dosages should be considered, since these patients may have secondary adrenocortical insufficiency. Removal of external steroid during periods of stress may be detrimental to these patients.
9 sources
1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):
Show all 9 sourcesShow fewer sources
1. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
Kidney Diseases
Major
Aminoglycosides are potentially oto- and nephrotoxic. Eighth cranial nerve damage may manifest as vestibular and/or auditory toxicities, including dizziness, nystagmus, vertigo, ataxia, tinnitus, and varying degrees of hearing impairment. Nephrotoxicity is usually evidenced by tubular necrosis; increases in BUN, nonprotein nitrogen, and serum creatinine concentration; decreases in urine specific gravity and creatinine clearance; proteinuria; and cells or casts in the urine. Rarely, renal electrolyte wasting may occur, resulting in hypocalcemia, hypomagnesemia, and hypokalemia that may be associated with paresthesia, tetany, confusion, and positive Chvostek and Trousseau signs. Although aminoglycoside- induced nephrotoxicity is generally reversible following discontinuation of the drug, death from uremia has occurred rarely. Therapy with aminoglycosides should be administered cautiously at reduced dosages in patients with renal impairment, since they may be at increased risk for oto- and nephrotoxicity due to drug accumulation. To minimize the risk of toxicity, patients should be adequately hydrated, the usual aminoglycoside dosage should not be exceeded, use with other neuro- and nephrotoxic agents should be avoided, and peak and trough serum aminoglycoside concentrations should be periodically determined and dosage adjusted to maintain desired levels. Renal and eighth cranial nerve function should be closely monitored, and the dosage reduced or therapy withdrawn if toxicity develops.
59 sources
1. Beauchamp D, Gourde P, Theriault G, Bergeron MG "Age-dependent gentamicin experimental nephrotoxicity." J Pharmacol Exp Ther 260 (1992): 444-9
2. Dahlgren JG, Anderson ET, Hewitt WL "Gentamicin blood levels: a guide to nephrotoxicity." Antimicrob Agents Chemother 8 (1975): 58-62
3. Fanning WL, Gump D, Jick H "Gentamicin and cephalothin-associated rises in blood urea nitrogen." Antimicrob Agents Chemother 10 (1976): 80-2
4. Madhavan T, Yaremchuk K, Levin N, et al. "Effect of renal failure and dialysis on the serum concentration of the aminoglycoside amikacin." Antimicrob Agents Chemother 10 (1976): 464-5
5. Plantier J, Forrey AW, O'Neill MA, Blair AD, Christopher TG, Cutler RE "Pharmacokinetics of amikacin in patients with normal or impaired renal function: radioenzymatic acetylation assay." J Infect Dis 134 Suppl (1976): s323-30
6. McHenry MC, Wagner JG, Hall PM, Vidt DG, Gavan TL "Pharmacokinetics of amikacin in patients with impaired renal function." J Infect Dis 134 Suppl (1976): s343-54
7. Sarubbi FA, Hull JH "Amikacin serum concentrations: prediction of levels and dosage guidelines." Ann Intern Med 89 (1978): 612-8
8. Bock BV, Edelstein PH, Meyer RD "Prospective comparative study of efficacy and toxicity of netilmicin and amikacin." Antimicrob Agents Chemother 17 (1980): 217-25
Show all 59 sourcesShow fewer sources
1. Lerner SA, Schmitt BA, Seligsohn R, Matz G "Comparative study of ototoxicity and nephrotoxicity in patients randomly assigned to treatment with amikacin or gentamicin." Am J Med 80 Suppl 6 (1986): 98-104
2. Williams PJ, Hull JH, Sarubbi FA, Rogers JF, Wargin WA "Factors associated with nephrotoxicity and clinical outcome in patients receiving amikacin." J Clin Pharmacol 26 (1986): 79-86
3. Emanuelli G, Anfossi G, Calcamuggi G, Marcarino C, Lanzio M "Urinary enzyme release following aminoglycoside administration in single low dose." Enzyme 39 (1988): 119-22
4. Contreras AM, Gamba G, Cortes J, et al. "Serial trough and peak amikacin levels in plasma as predictors of nephrotoxicity." Antimicrob Agents Chemother 33 (1989): 973-6
5. French MA, Cerra FB, Plaut ME, Schentag JJ "Amikacin and gentamicin accumulation pharmacokinetics and nephrotoxicity in critically ill patients." Antimicrob Agents Chemother 19 (1981): 147-52
6. Pijck J, Hallynck T, Soep H, Baert L, Daniels R, Boelaert J "Pharmacokinetics of amikacin in patients with renal insufficiency: relation of half-life and creatinine clearance." J Infect Dis 134 (1976): s331-41
7. Solberg CO, Madsen ST, Digranes A, et al. "High dose netilmicin therapy: efficacy, tolerance and tissue penetration." J Antimicrob Chemother 6 (1980): 133-41
8. Bhattacharya BK, Gorringe H, Farr MJ "Netilmicin and nephrotoxicity." Lancet 2 (1983): 216-7
9. Bergeron MG, Lessard C, Ronald A, Stiver G, Van Roogen CE, Chadwick P "Three to eight weeks of therapy with netilmicin: toxicity in normal and diabetic patients." J Antimicrob Chemother 12 (1983): 245-8
10. Bernstein JM, Gorse GJ, Linzmayer MI, et al. "Relative efficacy and toxicity of netilmicin and tobramycin in oncology patients." Arch Intern Med 146 (1986): 2329-34
11. Matzke GR, Millikin, Kovarik JM "Variability in pharmacokinetic values for gentamicin, tobramycin, and netilmicin in patients with renal insufficiency." Clin Pharm 8 (1989): 800-6
12. Herrero A, Alarco FR, Diez JM, Mahiques E, Domingo JV "Pharmacokinetics of netilmicin in renal insufficiency and hemodialysis." Int J Clin Pharmacol Ther Toxicol 26 (1988): 84-7
13. Craig WA, Gudmundsson S, Reich RM "Netilmicin sulfate: a comparative evaluation of antimicrobial activity, pharmacokinetics, adverse reactions and clinical efficacy." Pharmacotherapy 3 (1983): 305-15
14. Luft FC, Brannon DR, Stropes LL, Costello RJ, Sloan RS, Maxwell DR "Pharmacokinetics of netilmicin in patients with renal impairment and in patients on dialysis." Antimicrob Agents Chemother 14 (1978): 403-7
15. Humbert G, Leroy A, Fillastre JP, Oksenhendler G "Pharmacokinetics of netilmicin in the presence of normal or impaired renal function." Antimicrob Agents Chemother 14 (1978): 40-4
16. Russo ME, Atkin-Thor E "Gentamicin and ticarcillin in subjects with end-stage renal disease." Clin Nephrol 15 (1981): 175-80
17. Federspil P, Schatzle W, Tiesler E "Pharmacokinetics and ototoxicity of gentamicin, tobramycin and amikacin." J Infect Dis 134 (1976): s200-5
18. Smith CR, Lipsky JJ, Laskin OL, et al. "Double-blind comparison of the nephrotoxicity and auditory toxicity of gentamicin and tobramycin." N Engl J Med 302 (1980): 1106-9
19. Kumin GD "Clinical nephrotoxicity of tobramycin and gentamicin." JAMA 244 (1980): 1808-10
20. Keys TF, Kurtz SB, Jones JD, Muller SM "Renal toxicity during therapy with gentamicin or tobramycin." Mayo Clin Proc 56 (1981): 556-9
21. Schentag JJ, Cerra FB, Plaut ME "Clinical and pharmacokinetic characteristics of aminoglycoside nephrotoxicity in 201 critically ill patients." Antimicrob Agents Chemother 21 (1982): 721-6
22. Pines A, Goldhammer E, Kaplinsky N, Frankl O "Hypopotassemia associated with tobramycin treatment." Infection 10 (1982): 101-
23. Tablan OC, Reyes MP, Rintelmann WF, Lerner AM "Renal and auditory toxicity of high-dose, prolonged therapy with gentamicin and tobramycin in pseudomonas endocarditis." J Infect Dis 149 (1984): 257-63
24. Watson AJ, Watson MM, Keogh JA "Metabolic abnormalities associated with tobramycin therapy." Isr J Med Sci 153 (1984): 96-9
25. Gatell JM, SanMiguel JG, Araujo V, et al. "Prospective randomized double-blind comparison of nephrotoxicity and auditory toxicity of tobramycin and netilmicin." Antimicrob Agents Chemother 26 (1984): 766-9
26. Cimino MA, Rotstein C, Slaughter RL, Emrich LJ "Relationship of serum antibiotic concentrations to nephrotoxicity in cancer patients receiving concurrent aminoglycoside and vancomycin therapy." Am J Med 83 (1987): 1091-7
27. Contrepois A, Brion N, Garaud JJ, et al. "Renal disposition of gentamicin, dibekacin, tobramycin, netilmicin, and amikacin in humans." Antimicrob Agents Chemother 27 (1985): 520-4
28. Wilkinson R, Lucas GL, Heath DA, et al. "Hypomagnesaemic tetany associated with prolonged treatment with aminoglycosides." Br Med J 292 (1986): 818-9
29. Pedersen SS, Jensen J, Osterhammel D, Osterhammel P "Cumulative and acute toxicity of repeated high-dose tobramycin treatment in cystic fibrosis." Antimicrob Agents Chemother 31 (1987): 594-9
30. Kunin CM, Finland M "Persistence of antibiotics in blood of patients with acute renal failure. III. Penicillin, streptomycin, erythromycin and kanamycin." J Clin Invest 38 (1959): 1509-19
31. Yoshikawa TT, Nagami PH "Adverse drug reactions in TB therapy: risks and recommendations." Geriatrics 37 (1982): 61-3, 67-8
32. Siegenthaler WE, Bonetti A, Luthy R "Aminoglycoside antibiotics in infectious diseases: an overview." Am J Med 80 (1986): 2-14
33. Ristuccia AM, Cunha BA "The aminoglycosides." Med Clin North Am 66 (1982): 303-12
34. Trollfors B, Alestig K, Krantz I, Norrby R "Quantitative nephrotoxicity of gentamicin in nontoxic doses." J Infect Dis 141 (1980): 306-9
35. Letona JM, Barbolla L, Frieyro E, et al. "Immune haemolytic anaemia and renal failure induced by streptomycin." Br J Haematol 35 (1977): 561-71
36. McQueen EG "Antibiotic allergy and acute renal failure." N Z Med J 64 (1965): 561-3
37. Gyselnyck AM, Forrey A, Cutler R "Pharmacokinetics of gentamicin: distribution and plasma and renal clearance." J Infect Dis 124 (1971): s70
38. Jaffe, Meyers BR, Hirschman SZ "Pharmacokinetics of tobramycin in patients with stable renal impairment, patients undergoing peritoneal dialysis, and patients on chronic hemodialysis." Antimicrob Agents Chemother 5 (1974): 611-6
39. Schentag JJ, Lasezkay G, Cumbo TJ, et al. "Accumulation pharmacokinetics of tobramycin." Antimicrob Agents Chemother 13 (1978): 649-56
40. Pechere JC, Dugal R, Pechere MM "Pharmacokinetics of netilmicin in renal insufficiency and haemodialysis." Clin Pharmacokinet 3 (1978): 395-406
41. "Product Information. Amikin (amikacin)." Bristol-Myers Squibb (2002):
42. "Product Information. Garamycin (gentamicin)." Schering-Plough Corporation (2007):
43. "Product Information. Netromycin (netilmicin)." Schering Corporation (2002):
44. "Product Information. Streptomycin Sulfate (streptomycin)." Pfizer U.S. Pharmaceuticals
45. "Product Information. Nebcin (tobramycin)." Lilly, Eli and Company (2001):
46. Gilbert DN, Bennett WM "Use of antimicrobial agents in renal failure." Infect Dis Clin North Am 3 (1989): 517-31
47. Matz GJ, Naunton RF "Ototoxic drugs and poor renal function." JAMA 206 (1968): 2119
48. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
49. "Product Information. Mycifradin (neomycin)." Emerson Laboratories (2001):
50. "Product Information. Zemdri (plazomicin)." Achaogen (2018):
51. "Product Information. Arikayce (amikacin liposome)." Insmed Incorporated (2018):
Neuromuscular Diseases
Major
Aminoglycosides can cause dose-related neuromuscular blockade and muscle weakness, particularly in patients with neuromuscular disease or hypocalcemia and in patients receiving general anesthetics, neuromuscular blocking agents, or massive transfusions of citrate-anticoagulated blood. Although aminoglycoside- induced neuromuscular blockade is generally self-limiting, it may rarely result in respiratory paralysis. Neomycin is thought to be the most potent neuromuscular blocking agent in the class. However, the risk is greatest with intraperitoneal or intrapleural instillation of large doses or rapid intravenous administration of parenteral aminoglycosides. Therapy with aminoglycosides should be administered cautiously in patients with neuromuscular disorders (e.g., myasthenia gravis, parkinsonian syndrome, botulism) or hypocalcemia. If signs of respiratory paralysis occur during aminoglycoside therapy, the drug should be discontinued and mechanical respiratory assistance provided if necessary.
11 sources
1. Kaeser HE "Drug-induced myasthenic syndromes." Acta Neurol Scand 70 (1984): 39-47
2. Ristuccia AM, Cunha BA "The aminoglycosides." Med Clin North Am 66 (1982): 303-12
3. "Product Information. Amikin (amikacin)." Bristol-Myers Squibb (2002):
4. "Product Information. Garamycin (gentamicin)." Schering-Plough Corporation (2007):
5. "Product Information. Netromycin (netilmicin)." Schering Corporation (2002):
6. "Product Information. Streptomycin Sulfate (streptomycin)." Pfizer U.S. Pharmaceuticals
7. "Product Information. Nebcin (tobramycin)." Lilly, Eli and Company (2001):
8. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
Show all 11 sourcesShow fewer sources
1. "Product Information. Mycifradin (neomycin)." Emerson Laboratories (2001):
2. "Product Information. Zemdri (plazomicin)." Achaogen (2018):
3. "Product Information. Arikayce (amikacin liposome)." Insmed Incorporated (2018):
Ototoxicity
Major
Aminoglycosides can cause eighth cranial nerve damage, resulting in vestibular and/or auditory toxicities. Symptoms include dizziness, nystagmus, vertigo, ataxia, tinnitus, and varying degrees of hearing impairment. Permanent hearing loss may occur, including, rarely, total or partial irreversible bilateral deafness after the drug has been discontinued. Therapy with aminoglycosides, particularly if prolonged (> 10 days), should be administered cautiously in patients with preexisting vestibular and/or auditory impairment, since it may delay the recognition or confound the diagnosis of a drug-induced ototoxic effect. To minimize the risk of toxicity, patients should be adequately hydrated, the usual aminoglycoside dosage should not be exceeded, use with other ototoxic agents should be avoided, and peak and trough serum aminoglycoside concentrations should be periodically determined and dosage adjusted to maintain desired levels. Serial audiograms should be obtained in patients old enough to be tested, since loss of high- frequency perception usually precedes clinical hearing loss. The dosage should be reduced or therapy withdrawn promptly if signs and symptoms of toxicity develop.
35 sources
1. Barza M, Lauermann MW, Tally FP, Gorbach SL "Prospective, randomized trial of netilmicin and amikacin, with emphasis on eighth-nerve toxicity." Antimicrob Agents Chemother 17 (1980): 707-14
2. Barza M, Lauermann MW, Tally FP, Gorbach SL "Prospective, randomized trial of netilmicin and amikacin, with emphasis on eighth-nerve toxicity." Antimicrob Agents Chemother 17 (1980): 707-14
3. Bock BV, Edelstein PH, Meyer RD "Prospective comparative study of efficacy and toxicity of netilmicin and amikacin." Antimicrob Agents Chemother 17 (1980): 217-25
4. Danhauer FJ, Fortner CL, Schimpff SC, DeJongh CA, Wesley MN, Wiernik PH "Ototoxicity and pharmacokinetically determined dosages of amikacin in granulocytopenic cancer patients." Clin Pharm 1 (1982): 539-43
5. Uziel A "Non-genetic factors affecting hearing development." Acta Otolaryngol (Stockh) 421 (1985): 57-61
6. Lerner SA, Schmitt BA, Seligsohn R, Matz G "Comparative study of ototoxicity and nephrotoxicity in patients randomly assigned to treatment with amikacin or gentamicin." Am J Med 80 Suppl 6 (1986): 98-104
7. Bock BV, Edelstein PH, Meyer RD "Prospective comparative study of efficacy and toxicity of netilmicin and amikacin." Antimicrob Agents Chemother 17 (1980): 217-25
8. Bernstein JM, Gorse GJ, Linzmayer MI, et al. "Relative efficacy and toxicity of netilmicin and tobramycin in oncology patients." Arch Intern Med 146 (1986): 2329-34
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1. Smith CR, Lipsky JJ, Laskin OL, et al. "Double-blind comparison of the nephrotoxicity and auditory toxicity of gentamicin and tobramycin." N Engl J Med 302 (1980): 1106-9
2. Tablan OC, Reyes MP, Rintelmann WF, Lerner AM "Renal and auditory toxicity of high-dose, prolonged therapy with gentamicin and tobramycin in pseudomonas endocarditis." J Infect Dis 149 (1984): 257-63
3. Gatell JM, SanMiguel JG, Araujo V, et al. "Prospective randomized double-blind comparison of nephrotoxicity and auditory toxicity of tobramycin and netilmicin." Antimicrob Agents Chemother 26 (1984): 766-9
4. Bernstein JM, Gorse GJ, Linzmayer I, et al. "Relative efficacy and toxicity of netilmicin and tobramycin in oncology patients." Arch Intern Med 146 (1986): 2329-34
5. Mathog RH, Klein WJ "Ototoxicity of ethacrynic acid and aminoglycoside antibiotics in uremia." N Engl J Med 280 (1969): 1223-4
6. Ristuccia AM, Cunha BA "The aminoglycosides." Med Clin North Am 66 (1982): 303-12
7. Gailiunas P, Dominguez-Moreno M, Lazarus JM, et al. "Vestibular toxicity of gentamicin: incidence in patients receiving long-term hemodialysis therapy." Arch Intern Med 138 (1978): 1621-4
8. Deka RC, Ghosh P, Kacker SK "Streptomycin ototoxicity: an audiologic and vestibular study." Ear Nose Throat J 56 (1977): 218-24
9. Esterhai JL, Bednar J, Kimmelman CP "Gentamicin-induced ototoxicity complicating treatment of chronic osteomyelitis." Clin Orthop Aug (1986): 185-6
10. "Product Information. Amikin (amikacin)." Bristol-Myers Squibb (2002):
11. "Product Information. Garamycin (gentamicin)." Schering-Plough Corporation (2007):
12. "Product Information. Netromycin (netilmicin)." Schering Corporation (2002):
13. "Product Information. Streptomycin Sulfate (streptomycin)." Pfizer U.S. Pharmaceuticals
14. "Product Information. Nebcin (tobramycin)." Lilly, Eli and Company (2001):
15. Gendeh BS, Said H, Gibb AG, Aziz NS, Kong N, Zahir ZM "Gentamicin ototoxicity in continuous ambulatory peritoneal dialysis." J Laryngol Otol 107 (1993): 681-5
16. Hybels RL "Drug toxicity of the inner ear." Med Clin North Am 63 (1979): 309-19
17. Marlowe FI "Ototoxic agents." Otolaryngol Clin North Am 11 (1978): 791-800
18. Sheffield PA, Turner JS Jr "Ototoxic drugs: a review of clinical aspects, histopathologic changes and mechanisms of action." South Med J 64 (1971): 359-63
19. Ballantyne J "Ototoxicity: a clinical review." Audiology 12 (1973): 325-36
20. Ajodhia JM, Dix MR "Drug-induced deafness and its treatment." Practitioner 216 (1976): 561-70
21. Boston Collaborative Drug Surveillance Program "Drug-induced deafness." JAMA 224 (1973): 515-6
22. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
23. Minor LB "Gentamicin-induced bilateral vestibular hypofunction." JAMA 279 (1998): 541-4
24. ElBakri F, Pallett A, Smith AG, Duncombe AS "Ototoxicity induced by once-daily gentamicin." Lancet 351 (1998): 1407-8
25. "Product Information. Mycifradin (neomycin)." Emerson Laboratories (2001):
26. "Product Information. Zemdri (plazomicin)." Achaogen (2018):
27. "Product Information. Arikayce (amikacin liposome)." Insmed Incorporated (2018):
Cushing Syndrome
Moderate
Corticosteroids mimic the effects of endogenous cortisol and aldosterone. Use of these agents may aggravate conditions of hyperadrenocorticalism in a dose-dependent manner.
10 sources
1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):
Show all 10 sourcesShow fewer sources
1. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
2. "Product Information. Emflaza (deflazacort)." PTC Therapeutics, Inc. (2021):
Diabetes Mellitus
Moderate
Corticosteroids can raise blood glucose level by antagonizing the action and suppressing the secretion of insulin, which results in inhibition of peripheral glucose uptake and increased gluconeogenesis. Therapy with corticosteroids should be administered cautiously in patients with diabetes mellitus, glucose intolerance, or a predisposition to hyperglycemia. Patients with diabetes mellitus should be monitored more closely during corticosteroid therapy, and their antidiabetic regimen adjusted accordingly.
10 sources
1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):
Show all 10 sourcesShow fewer sources
1. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
2. "Product Information. Emflaza (deflazacort)." PTC Therapeutics, Inc. (2021):
Fibrosis
Moderate
Corticosteroids may have enhanced effects on patients with cirrhosis due to decreased metabolism of these agents. Patients with cirrhosis should be monitored more closely for excessive cortisol effects. Dosage adjustments may be required in these patients.
9 sources
1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):
Show all 9 sourcesShow fewer sources
1. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
Hyperlipidemias
Moderate
Corticosteroids may elevate serum triglyceride and LDL cholesterol levels if used for longer than brief periods. Patients with preexisting hyperlipidemia may require closer monitoring during prolonged corticosteroid therapy, and adjustments made accordingly in their lipid-lowering regimen.
10 sources
1. Seale JP, Compton MR "Side-effects of corticosteroid agents." Med J Aust 144 (1986): 139-42
2. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
3. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
4. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
5. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
6. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
7. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
8. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
Show all 10 sourcesShow fewer sources
1. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):
2. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
Hypothyroidism
Moderate
Corticosteroids may have enhanced effects in hypothyroidism due to decreased metabolism of these agents. Patients with hypothyroidism should be monitored more closely for excessive cortisol effects. Dosage adjustments may be required secondary to changes in their thyroid condition.
10 sources
1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):
Show all 10 sourcesShow fewer sources
1. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
2. "Product Information. Emflaza (deflazacort)." PTC Therapeutics, Inc. (2021):
Keratitis, Herpetic
Moderate
Pharmacologic dosages of corticosteroids should be used cautiously in patients with ocular herpes simplex because of the risk of corneal perforation. Corticosteroids are not recommended for patients with active ocular herpes simplex.
10 sources
1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):
Show all 10 sourcesShow fewer sources
1. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
2. "Product Information. Emflaza (deflazacort)." PTC Therapeutics, Inc. (2021):
Latent Tuberculosis
Moderate
In patients with latent tuberculosis or tuberculin reactivity, the use of pharmacologic dosages of corticosteroids may cause a reactivation of the disease. Close monitoring for signs and symptoms of tuberculosis is recommended if corticosteroid therapy is administered to patients with a history of tuberculosis or tuberculin reactivity. During prolonged corticosteroid therapy, tuberculosis chemoprophylaxis may be considered.
9 sources
1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):
Show all 9 sourcesShow fewer sources
1. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
Liver Diseases
Moderate
Corticosteroids are primarily metabolized by the liver and may have enhanced effects in patients with liver disease. Dosage adjustments may be necessary in these patients.
10 sources
1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
2. Cunliffe WJ, Burton JL, Holti G, Wright V "Hazards of steroid therapy in hepatic failure." Br J Dermatol 93 (1975): 183-5
3. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
4. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
5. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
6. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
7. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
8. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
Show all 10 sourcesShow fewer sources
1. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):
2. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
Liver Diseases
Moderate
Abnormal liver function tests, most often consisting of mild elevations in SGOT levels, have been reported during administration of clotrimazole troches. The manufacturer recommends periodic assessment of liver function in patients with preexisting hepatic impairment.
1 source
1. "Product Information. Mycelex (clotrimazole)." Bayer (2001):
Muscular Diseases
Moderate
Toxic myopathy has been observed with the chronic use or the administration of large doses of corticosteroids, often in patients with disorders of neuromuscular transmission such as myasthenia gravis or in patients receiving neuromuscular blocking agents. Fluorinated corticosteroids such as betamethasone, dexamethasone, and triamcinolone appear to cause more severe muscle atrophy and weakness than the nonfluorinated agents. Moreover, multiple-daily doses are more toxic than once-daily or, preferably, alternate-day morning doses. Steroid myopathy is generalized and sometimes accompanied by respiratory weakness and dyspnea. In some cases, it has resulted in quadriparesis. Elevations of creatine kinase (CK) may also occur, albeit infrequently. After withdrawal of corticosteroid therapy, recovery may be slow and incomplete. Therapy with corticosteroids should be administered cautiously in patients with preexisting myopathy or myoneural disorders since these conditions may confound the diagnosis of steroid-induced myopathy. The presence of a normal serum CK level, minimal/no changes of myopathy on electromyography, and type 2 muscle fiber atrophy on biopsy are helpful in suggesting steroid-induced weakness. If steroid myopathy is suspected, a dosage reduction or discontinuation of the steroid should be considered.
10 sources
1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):
Show all 10 sourcesShow fewer sources
1. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
2. "Product Information. Emflaza (deflazacort)." PTC Therapeutics, Inc. (2021):
Myasthenia Gravis
Moderate
Although corticosteroids are commonly used in the treatment of myasthenia gravis to increase muscle strength, these agents should nevertheless be administered with caution in such setting. Patients should be treated in an intensive care unit and receive respiratory support, since muscle strength may markedly decrease initially, particularly with high dosages. Preferably, therapy should begin with relatively low dosages (15 to 25 mg/day of prednisone or equivalent) and be increased stepwise as tolerated (approximately 5 mg/day of prednisone or equivalent at 2- to 3-day intervals until marked clinical improvement or a dosage of 50 mg/day is reached). Improvement may be delayed and gradual. Thus, it is important not to discontinue therapy prematurely.
1 source
1. Braunwald E, Hauser SL, Kasper DL, Fauci AS, Isselbacher KJ, Longo DL, Martin JB, eds., Wilson JD "Harrison's Principles of Internal Medicine." New York, NY: McGraw-Hill Health Professionals Division (1998):
Myocardial Infarction
Moderate
The use of corticosteroids may be associated with left ventricular free-wall rupture in patients who have had a recent myocardial infarction. Pharmacologic dosages of corticosteroids should be administered with great caution in such patients.
10 sources
1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):
Show all 10 sourcesShow fewer sources
1. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
2. "Product Information. Emflaza (deflazacort)." PTC Therapeutics, Inc. (2021):
Osteoporosis
Moderate
Corticosteroids reduce osteoblastic function and inhibit the absorption of intestinal calcium, which can result in bone resorption and bone loss during prolonged therapy. In addition, bone matrix may be affected by the protein-catabolic effects of corticosteroids, especially when given in high dosages or for prolonged periods, leading to aseptic necrosis and fractures. Long-term or high-dose corticosteroid therapy should be administered cautiously and only if necessary in patients with or at risk for osteoporosis. Adverse skeletal effects may be minimized by alternate-day or intermittent administration. Any patient receiving prolonged therapy with the equivalent of 7.5 mg prednisone/day or more are at risk for glucocorticoid-induced osteoporosis and should be managed according to The American College of Rheumatology (ACR) guidelines.
10 sources
1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):
Show all 10 sourcesShow fewer sources
1. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
2. "Product Information. Emflaza (deflazacort)." PTC Therapeutics, Inc. (2021):
Peptic Ulcer
Moderate
Corticosteroids may cause peptic ulcer disease and gastrointestinal (GI) hemorrhage, usually when given in high dosages or for prolonged periods. However, even conventional dosages may aggravate symptoms in patients with a history of peptic ulcers. Delayed healing of ulcers has also been reported. Therapy with corticosteroids should be avoided or administered cautiously in patients with active or latent peptic ulcers or other risk factors for GI bleeding. Some clinicians recommend the use of prophylactic antacids or H2-antagonists between meals when large doses of corticosteroids are necessary.
10 sources
1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):
Show all 10 sourcesShow fewer sources
1. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
2. "Product Information. Emflaza (deflazacort)." PTC Therapeutics, Inc. (2021):
Peptic Ulcer Perforation
Moderate
Corticosteroids may cause gastrointestinal perforation and hemorrhage, usually when given in high dosages or for prolonged periods. They may also mask symptoms of complications such as peritonitis or intraabdominal sepsis. Therapy with corticosteroids should be avoided or administered cautiously in patients with diverticulitis, nonspecific ulcerative colitis (if there is a probability of impending perforation, abscess, or other pyogenic infection), or recent intestinal anastomoses.
10 sources
1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):
Show all 10 sourcesShow fewer sources
1. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
2. "Product Information. Emflaza (deflazacort)." PTC Therapeutics, Inc. (2021):
Psychotic Disorders
Moderate
Corticosteroids may aggravate the symptoms of psychosis and emotional instability. Patients with these conditions should be monitored for increased or worsened symptoms during corticosteroid therapy.
10 sources
1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):
Show all 10 sourcesShow fewer sources
1. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
2. "Product Information. Emflaza (deflazacort)." PTC Therapeutics, Inc. (2021):
Scleroderma, Localized
Moderate
In patients with scleroderma, corticosteroids may precipitate renal crisis with malignant hypertension, possibly via steroid-induced increases in renin substrate and angiotensin II levels and decreases in vasodilator prostaglandin production. Renal failure may ensue. Therapy with corticosteroids should be administered cautiously in patients with scleroderma. In addition, they should be limited to short-term use.
10 sources
1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):
Show all 10 sourcesShow fewer sources
1. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
2. Braunwald E, Hauser SL, Kasper DL, Fauci AS, Isselbacher KJ, Longo DL, Martin JB, eds., Wilson JD "Harrison's Principles of Internal Medicine." New York, NY: McGraw-Hill Health Professionals Division (1998):
Strongyloidiasis
Moderate
Unlike most helminths, Strongyloides stercoralis has the ability to replicate in the human host. In patients with strongyloidiasis, the use of pharmacologic or immunosuppressive dosages of corticosteroids may result in Strongyloides hyperinfection and dissemination with widespread larval migration, often accompanied by severe enterocolitis and potentially fatal gram-negative septicemia. Therapy with corticosteroids should be administered with extreme caution, if at all, in these patients. For patients on corticosteroids who develop known or suspected Strongyloides infestation, withdrawal of corticosteroids or reduction of the dose of corticosteroids is recommended.
10 sources
1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):
Show all 10 sourcesShow fewer sources
1. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
2. "Product Information. Emflaza (deflazacort)." PTC Therapeutics, Inc. (2021):
Thromboembolism
Moderate
Corticosteroids may increase blood coagulability and have rarely been associated with the development of intravascular thrombosis, thromboembolism, and thrombophlebitis. Therapy with corticosteroids should be administered cautiously in patients who have or may be predisposed to thrombotic or thromboembolic disorders.
10 sources
1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):
Show all 10 sourcesShow fewer sources
1. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
2. "Product Information. Emflaza (deflazacort)." PTC Therapeutics, Inc. (2021):
Toxic Optic Neuropathy
Moderate
Prolonged use of corticosteroids may cause posterior subcapsular cataracts and elevated intraocular pressure, the latter of which may lead to glaucoma and/or damage to the optic nerves. Long-term therapy with corticosteroids should be administered cautiously in patients with a history of cataracts, glaucoma, or increased intraocular pressure.
10 sources
1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):
Show all 10 sourcesShow fewer sources
1. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
2. "Product Information. Emflaza (deflazacort)." PTC Therapeutics, Inc. (2021):
Water-Electrolyte Imbalance
Moderate
Corticosteroids can cause hypernatremia, hypokalemia, and fluid retention. These mineralocorticoid effects are most significant with fludrocortisone, followed by hydrocortisone and cortisone, then by prednisone and prednisolone. The remaining corticosteroids, betamethasone, dexamethasone, methylprednisolone, and triamcinolone, have little mineralocorticoid activities. However, large doses of any corticosteroid can demonstrate these effects, particularly if given for longer than brief periods. All corticosteroids also increase excretion of calcium and can cause hypocalcemia. Therapy with corticosteroids should be administered cautiously in patients with preexisting electrolyte disturbances. Caution is also advised when treating patients with seizure disorders, since electrolyte disturbances may trigger seizure activity.
10 sources
1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):
Show all 10 sourcesShow fewer sources
1. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
2. "Product Information. Emflaza (deflazacort)." PTC Therapeutics, Inc. (2021):
Water-Electrolyte Imbalance
Moderate
Corticosteroids may cause hypernatremia, hypokalemia, fluid retention, and elevation in blood pressure. These mineralocorticoid effects are most significant with fludrocortisone, followed by hydrocortisone and cortisone, then by prednisone and prednisolone. The remaining corticosteroids, betamethasone, dexamethasone, methylprednisolone, and triamcinolone, have little mineralocorticoid activities. However, large doses of any corticosteroid can demonstrate these effects, particularly if given for longer than brief periods. Therapy with corticosteroids should be administered cautiously in patients with preexisting fluid retention, hypertension, congestive heart failure, and/or renal dysfunction. Dietary sodium restriction and potassium supplementation may be advisable.
10 sources
1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):
Show all 10 sourcesShow fewer sources
1. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
2. "Product Information. Emflaza (deflazacort)." PTC Therapeutics, Inc. (2021):

Therapeutic duplication

Drug classes that overlap with Betamethasone + Clotrimazole + Gentamicin, so taking both doubles up the same effect. This source publishes no per-row citations for duplication.

cortisones
The recommended maximum number of medicines in the 'cortisones' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'cortisones' category.
Example product in the source data (US market): Formoterol/mometasone
cortisones
The recommended maximum number of medicines in the 'cortisones' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'cortisones' category.
Example product in the source data (US market): Trelegy ellipta
cortisones
The recommended maximum number of medicines in the 'cortisones' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'cortisones' category.
Example product in the source data (US market): Fluticasone/vilanterol
cortisones
The recommended maximum number of medicines in the 'cortisones' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'cortisones' category.
Example product in the source data (US market): Symbicort
cortisones
The recommended maximum number of medicines in the 'cortisones' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'cortisones' category.
Example product in the source data (US market): Budesonide/formoterol/glycopyrrolate
cortisones
The recommended maximum number of medicines in the 'cortisones' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'cortisones' category.
Example product in the source data (US market): Albuterol/budesonide
cortisones
The recommended maximum number of medicines in the 'cortisones' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'cortisones' category.
Example product in the source data (US market): Wixela inhub

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Water-Electrolyte Imbalance

Water-Electrolyte Imbalance

Therapeutic duplication

cortisones

cortisones

cortisones

cortisones

cortisones

cortisones

cortisones