Drug Interaction:
        
        
            
	Glucorticoids include -
	Short acting- Cortisone, Hydrocortisone
	Intermediate acting - Prednisone, Prednisolone, Triamcinolone, Methylprednisolone
	Long acting- Dexamethasone, Betamethasone
	Refer- Dexamethasone
	 
	Interacting drugs - summary
	 
	 +Corticosteroids
	 
	Aminoglutethimide/dexamethosone +
	 possible loss of dexamethosone-induced adrenal  suppression               
	 
	Barbiturates
	   decreased pharmacolgic effects of the corticosteroids metabolism 
	   through the induction of hepatic microsomal enzymes
	 
	Cholestyramine/  Hydrocortisone+  
	 hydrocortisine AUC decreased 
	 
	Contraceptives Oral-
	 Hepatic metabolism  decreased by OCs, resulting in
	 increased therapeutic effects or toxicity
	 
	Ephedrine /Dexamethasone+  
	 a decreased half-life and increased clearance of dexamethsone
	 may occur
	 
	Estrogens
	 estrogen coadministration reduce the clearance and 
	 increase the elimination half-life of corticosteroids
	 
	Hydantoins 
	  corticosteroids clearance  decreased and the AUC increased
	   resulting in reduced therapeutic effects
	 
	Ketoconazole
	  corticosteroid clearance decreased and the AUC increased                          
	 
	Macrolide Antibiotics/  Methyl prednisolone +   
	 significant decrease in methylprednisolone clearance has been used 
	  to decrease methylprednisolone dose          
	 
	Rifampicin 
	 corticosteroid clearance increased resulting in decreased 
	  therapeutic effects
	 
	Corticosteroids +
	 
	Anticholinesterases  
	 anticholinesterase effect  antagonised in myasthenia gravis
	 
	Anticoagulants oral
	  anticoagulant dose requirements  reduced. Conversely, 
	  corticosteroids may oppose the anticoagulant action.
	 
	Cyclosporine 
	   although this combination is therapeutically beneficial for organ 
	   transplant,  toxicity may be enhanced
	 
	Digitalis glycosides
	 coadministratin enhance the possibility ofdigitalis toxicity 
	   associated with hypokalemia
	 
	Isoniazid
	  isoniazid serum concentration  decreased
	 
	Nondepolarising muscle relaxants 
	 corticosteroids potentiate, counteract or have no effect on the
	 neuromuscular blocking action
	 
	Poatssium depleting agents eg.diuretics   
	 observe patients for hypokalemia
	 
	Salicylates   
	 corticosteroids will reduce serum salicylate levels and  decrease
	 their  effectiveness
	 
	Somatrem
	 growth-promoting effect of somatrem  inhibited
	             
	Theophyllines
	   alterations in the pharmacologic activity of either agent occur
	   
	 
	 
        
     
    
    
           
            Adverse Reaction:
        
        
            
	Acute adrenal insufficiency may be precipitated by infection trauma,  in patients on long term corticosteroid therapy. 
	Cushings syndrome, growth retardation in children, osteoporosis and vertebral compression fractures. 
	Peptic ulceration, haemorrhage and perforation, glaucoma,hyperglycaemia. 
	GI upsets, nocturia, increased appetite, obesity, facial rounding, increased fragility of skin,
	 behavioural changes.
	 
	Topical applications to skin: Systemic absorption if applied to large areas,broken skin under 
	occlusive dressing.
	 
	Intra articular injection: Aseptic bone necrosis.
	 
	Inhalation: Cough, irritation, swallowed inhalation may cause epigastric pain.If no releif with usual dose symtoms may be aggrevated due to hypoxia.