Sodium retention

Potassium loss

Fluid retention

Hypokalemic alkalosis

Congestive heart failure in susceptible patients

Hypertension

Muscle weakness

Vertebral compression fractures

Steroid myopathy

Aseptic necrosis of femoral and humeral heads

Loss of muscle mass

Osteoporosis

Tendon rupture, particularly of the Achilles tendon

Pathologic fracture of long bones

Peptic ulcer with possible perforation and hemorrhage

Abdominal distention

Ulcerative esophagitis

Pancreatitis

Increases in alanine transaminase (ALT, SGPT), aspartate transaminase (AST, SGOT) and alkaline phosphatase have been observed following corticosteroid treatment. These changes are usually small, not associated with any clinical syndrome and are reversible upon discontinuation.

Impaired wound healing

Facial erythema

Thin fragile skin

Increased sweating

Petechiae and ecchymoses

May suppress reactions to skin tests

Increased intracranial pressure with papil-ledema (pseudotumor cerebri) usually after treatment

Convulsions

Vertigo

Headache

Menstrual irregularities

Suppression of growth in children

Development of Cushingoid state

Decreased carbohydrate tolerance

Secondary adrenocortical and pituitary unresponsiveness, particularly in times of stress, as in trauma, surgery or illness

Manifestations of latent diabetes mellitus Increased requirements for insulin or oral hypoglycemic agents in diabetics

Posterior subcapsular cataracts Glaucoma

Increased intraocular pressure Exophthalmos

Negative nitrogen balance due to protein catabolism

The pharmacokinetic interactions listed below are potentially clinically important. Drugs that induce hepatic enzymes such as phenobarbital, phenytoin and rifampin may increase the clearance of corticosteroids and may require increases in corticosteroid dose to achieve the desired response. Drugs such as troleandomycin and ketoconazole may inhibit the metabolism of corticosteroids and thus decrease their clearance. Therefore, the dose of corticosteroid should be titrated to avoid steroid toxicity. Corticosteroids may increase the clearance of chronic high dose aspirin. This could lead to decreased salicylate serum levels or increase the risk of salicylate toxicity when corticosteroid is withdrawn. Aspirin should be used cautiously in conjunction with cortico-steroids in patients suffering from hypopro-thrombinemia. The effect of corticosteroids on oral anticoagulants is variable. There are reports of enhanced as well as diminished effects of anticoagulants when given concurrently with corticosteroids. Therefore, coagulation indices should be monitored to maintain the desired anticoagulant effect.

Bookmark this page: