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MLK F2 (bupivacaine / lidocaine / triamcinolone) Disease Interactions

There are 34 disease interactions with MLK F2 (bupivacaine / lidocaine / triamcinolone):

Major

Antiarrhythmics (Includes MLK F2) ↔ Cardiovascular Dysfunction

Severe Potential Hazard, High plausibility

Applies to: Congestive Heart Failure, Hypotension

Antiarrhythmic agents can induce severe hypotension (particularly with IV administration) or induce or worsen congestive heart failure (CHF). Patients with primary cardiomyopathy or inadequately compensated CHF are at increased risk. Antiarrhythmic agents should be administered cautiously and dosage and/or frequency of administration modified in patients with hypotension or adequately compensated CHF. Alternative therapy should be considered unless these conditions are secondary to cardiac arrhythmia.

References

  1. Halkin H, Meffin P, Melmon KL, Rowland M "Influence of congestive heart failure on blood levels of lidocaine and its active monodeethylated metabolite." Clin Pharmacol Ther 17 (1975): 669-76
  2. Crouthamel WG "The effect of congestive heart failure on quinidine pharmacokinetics." Am Heart J 90 (1975): 335-9
  3. "Product Information. Cordarone (amiodarone)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  4. "Product Information. Mexitil (mexiletine)." Boehringer-Ingelheim, Ridgefield, CT.
  5. Gottlieb SS, Packer M "Deleterious hemodynamic effects of lidocaine in severe congestive heart failure." Am Heart J 118 (1989): 611-2
  6. "Product Information. Quinidex (quinidine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  7. "Product Information. Corvert (ibutilide)." Pharmacia and Upjohn, Kalamazoo, MI.
  8. Ravid S, Podrid PJ, Lampert S, Lown B "Congestive heart failure induced by six of the newer antiarrhythmic drugs." J Am Coll Cardiol 14 (1989): 1326-30
  9. "Product Information. Xylocaine (lidocaine)." Astra USA, Westborough, MA.
  10. Thomson P, Melmon K, Richardson J, Cohn K Steinbrunn W, Cudihee R, Rowland M "Lidocaine pharmacokinetics in advanced heart failure, liver disease, and renal failure in humans." Ann Intern Med 78 (1973): 499-508
  11. Prescott LF, Adjepon-Yamoah KK, Talbot RG "Impaired lignocaine metabolism in patients with myocardial infarction and cardiac failure." Br Med J 1 (1976): 939-41
  12. "Product Information. Adenocard (adenosine)." Fujisawa, Deerfield, IL.
  13. "Product Information. Quiniglute (quinidine)." Berlex, Richmond, CA.
  14. Ochs HR, Grube E, Greenblatt DJ, Arendt R "Intravenous quinidine in congestive cardiomyopathy." Eur J Clin Pharmacol 19 (1981): 173-6
  15. Singh SN, Fletcher RD, Fisher SG, et al. "Amiodarone in patients with congestive heart failure and asymptomatic ventricular arrhythmia." N Engl J Med 333 (1995): 77-82
  16. Swiryn S, Kim SS "Quinidine-induced syncope." Arch Intern Med 143 (1983): 314-6
  17. "Product Information. Cordarone Intravenous (amiodarone)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
View all 17 references
Major

Antiarrhythmics (Includes MLK F2) ↔ Proarrhythmic Effects

Severe Potential Hazard, High plausibility

Applies to: Arrhythmias

Antiarrhythmic agents can induce or worsen ventricular arrhythmias. Ventricular tachycardia, ventricular fibrillation, and torsades de pointes have occurred in some patients. Patients with underlying cardiac dysfunction, bradycardia, hypokalemia, hypomagnesemia, or high antiarrhythmic serum concentrations are at increased risk for drug-induced arrhythmias. Therapy with antiarrhythmics should be used with extreme caution in patients with or predisposed to arrhythmias. Evidence of improved survival is lacking for use of antiarrhythmic therapy in asymptomatic, non-life-threatening arrhythmias. Therapy with antiarrhythmic agents should be reserved for patients with life-threatening arrhythmias.

References

  1. "Product Information. Tambocor (flecainide)." 3M Pharmaceuticals, St. Paul, MN.
  2. "Product Information. Adenocard (adenosine)." Fujisawa, Deerfield, IL.
  3. Andrivet P, Beaslay V, Canh VD "Torsades de pointe with flecainide-amiodarone therapy." Intensive Care Med 16 (1990): 342-3
  4. "Product Information. Bretylol (bretylium)." DuPont Pharmaceuticals, Wilmington, DE.
  5. Nora MO, Chandrasekaran K, Hammill SC, Reeder GS "Prolongation of ventricular depolarization: ECG manifestation of mexiletine toxicity." Chest 95 (1989): 925-8
  6. "Product Information. Procan SR (procainamide)." Parke-Davis, Morris Plains, NJ.
  7. Morganroth J, Horowitz LN "Incidence of proarrhythmic effects from quinidine in the outpatient treatment of benign or potentially lethal ventricular arrhythmias." Am J Cardiol 56 (1985): 585-7
  8. Cheesman M, Ward DE "Exacerbation of ventricular tachycardia by tocainide." Clin Cardiol 8 (1985): 47-50
  9. "Product Information. Cordarone Intravenous (amiodarone)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  10. Lo KS, Gantz KB, Stetson PL, et al "Disopyramide-induced ventricular tachycardia." Arch Intern Med 140 (1980): 413-4
  11. Said SAM, Somer ST, Luttikhuis HAO "Flecainide-induced JT prolongation, t wave inversion and ventricular tachycardia during treatment for symptomatic atrial fibrillation." Int J Cardiol 44 (1994): 285-7
  12. "Product Information. Rhythmol (propafenone)." Knoll Pharmaceutical Company, Whippany, NJ.
  13. Reed R, Falk JL, O'Brien J "Untoward reaction to adenosine therapy for supraventricular tachycardia." Am J Emerg Med 9 (1991): 566-70
  14. Ben-Sorek ES, Wiesel J "Ventricular fibrillation following adenosine administration. A case report." Arch Intern Med 153 (1993): 2701-2
  15. Meurer MK "A 21-year-old woman with rapid atrial fibrillation after adenosine administration." J Emerg Nurs 17 (1991): 135-6
  16. Anderson JL, Popat KD "Paradoxical ventricular tachycardia and fibrillation after intravenous bretylium therapy." Arch Intern Med 141 (1981): 801-2
  17. Hii JT, Wyse DG, Gillis AM, et al "Propafenone-induced torsade de pointes: cross-reactivity with quinidine." Pacing Clin Electrophysiol 14 (1991): 1568-70
  18. Makkar RR, Fromm BS, Steinman RT, Meissner MD, Lehmann MH "Female gender as a risk factor for torsades de pointes associated with cardiovascular drugs." JAMA 270 (1993): 2590-7
  19. Riccioni N, Castiglioni M, Bartolomei C "Disopyramide-induced QT prolongation and ventricular tachyarrhythmias." Am Heart J 105 (1983): 870-1
  20. "Product Information. Cordarone (amiodarone)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  21. Raehl CL, Patel AK, LeRoy M "Drug-induced torsade de pointes." Clin Pharm 4 (1985): 675-90
  22. Boriani G, Biffi M, Frabetti L, Azzolini U, Sabbatani P, Bronzetti G, Capucci A, Magnani B "Ventricular fibrillation after intravenous amiodarone in wolff-parkinson-white syndrome with atrial fibrillation." Am Heart J 131 (1996): 1214-6
  23. "Product Information. Mexitil (mexiletine)." Boehringer-Ingelheim, Ridgefield, CT.
  24. "Product Information. Tonocard (tocainide)." Merck & Co, Inc, West Point, PA.
  25. "Product Information. Norpace (disopyramide)." Searle, Skokie, IL.
  26. Tzivoni D, Keren A, Stern S, Gottlieb S "Disopyramide-induced Torsade de pointes." Arch Intern Med 141 (1981): 946-7
  27. Celiker A, Tokel K, Cil E, Ozkutlu S, Ozme S "Adenosine induced torsades de pointes in a child with congenital long QT syndrome." Pacing Clin Electrophysiol 17 (1994): 1814-7
  28. Strickberger SA, Man KC, Daoud EG, et al. "Adenosine-induced atrial arrhythmia: a prospective analysis." Ann Intern Med 127 (1997): 417-22
  29. Silverman AJ, Machado C, Baga JJ, Meissner MD, Lehmann MH, Steinman RT "Adenosine-induced atrial fibrillation." Am J Emerg Med 14 (1996): 300-1
  30. Stratmann H, Walter K, Kennedy H "Torsade de pointes associated with elevated N-acetylprocainamide levels." Am Heart J 109 (1985): 375-6
  31. Buss J, Neuss H, Bilgin Y, Schlepper M "Malignant ventricular tachyarrhythmias in association with propafenone treatment." Eur Heart J 6 (1985): 424-8
  32. Sulke AN, Holt P, Sowton GE "Acceleration of conduction within an accessory pathway with propafenone." Int J Cardiol 28 (1990): 105-7
  33. Romer M, Candinas R "Adenosine-induced non-sustained polymorphic ventricular tachycardia." Eur Heart J 15 (1994): 281-2
  34. Nathan AW, Hellestrand KJ, Bexton RS, Camm AJ "Fatal ventricular tachycardia in association with propafenone, a new class IC antiarrhythmic agent." Postgrad Med J 60 (1984): 155-6
  35. "Product Information. Pronestyl (procainamide)." Apothecon Inc, Plainsboro, NJ.
  36. Damle R, Levine J, Matos J, et al "Efficacy and risks of moricizine in inducible sustained ventricular tachycardia." Ann Intern Med 116 (1992): 375-81
  37. Exner DV, Muzyka T, Gillis AM "Proarrhythmia in patients with the Wolff-Parkinson-White Syndrome after standard doses of intravenous adenosine." Ann Intern Med 122 (1995): 351-2
  38. Cocco G, Strozzi C, Chu D, Pansini R "Torsades de pointes as a manifestation of mexiletine toxicity." Am Heart J 100 (1980): 878-80
  39. Faggiano P, Gardini A, Daloia A, Benedini G, Giordano A "Torsade de pointes occurring early during oral amiodarone treatment." Int J Cardiol 55 (1996): 205-8
  40. Dhein S, Schott M, Gottwald E, Klaus W "Electrocardiological profile and proarrhythmic effects of quinidine, verapamil and their combination: a mapping study." Naunyn Schmiedebergs Arch Pharmacol 352 (1995): 94-101
  41. Bauman JL, Bauernfeind RA, Hoff JV, et al "Torsade de pointes due to quinidine: observations in 31 patients." Am Heart J 107 (1984): 425-30
  42. "Product Information. Corvert (ibutilide)." Pharmacia and Upjohn, Kalamazoo, MI.
  43. Heisler BE, Ferrier GR "Proarrhythmic actions of flecainide in an isolated tissue model of ischemia and reperfusion." J Pharmacol Exp Ther 279 (1996): 317-24
  44. Strasberg B, Sclarovsky S, Erdberg A, et al "Procainamide-induced polymorphous ventricular tachycardia." Am J Cardiol 47 (1981): 1309-14
  45. Sclarovsky S, Lewin RF, Kracoff O, Strasberg B, Arditti A, Agmon J "Amiodarone-induced polymorphous ventricular tachycardia." Am Heart J 105 (1983): 6-12
  46. Koenig W, Schinz AM "Spontaneous ventricular flutter and fibrillation during quinidine medication." Am Heart J 105 (1983): 863-5
  47. Wesley RC Jr, Turnquest P "Torsades de pointe after intravenous adenosine in the presence of prolonged QT syndrome." Am Heart J 123 (1992): 794-6
  48. Hohnloser SH, Vandeloo A, Baedeker F "Efficacy and proarrhythmic hazards of pharmacologic cardioversion of atrial fibrillation: prospective comparison of sotalol versus quinidine." J Am Coll Cardiol 26 (1995): 852-8
  49. "Product Information. Xylocaine (lidocaine)." Astra USA, Westborough, MA.
  50. Au PK, Bhandari AK, Bream R, et al "Proarrhythmic effects of antiarrhythmic drugs during programmed ventricular stimulation in patients without ventricular tachycardia." J Am Coll Cardiol 9 (1987): 389-97
  51. Stavens CS, McGovern B, Garan H, Ruskin JN "Aggravation of electrically provoked ventricular tachycardia during treatment with propafenone." Am Heart J 110 (1985): 24-9
  52. Oberg KC, Otoole MF, Gallastegui JL, Bauman JL "''late'' proarrhythmia due to quinidine." Am J Cardiol 74 (1994): 192-4
  53. Dougherty AH, Gilman JK, Wiggins S, Jalal S, Naccarelli GV "Provocation of atrioventricular reentry tachycardia: a paradoxical effect of adenosine." Pacing Clin Electrophysiol 16 (1993): 8-12
  54. Williamson BD, Hummel J, Niebauer M, Man C, Strickberger SA, Daoud E, Morady F "Bradycardia-facilitated polymorphic ventricular tachycardia caused by amiodarone after radiofrequency modification of atrioventricular conduction." Am Heart J 130 (1995): 399-401
  55. Engler RL, LeWinter M "Tocainide-induced ventricular fibrillation." Am Heart J 101 (1981): 494-6
  56. Orebaugh SL, Handy M "Intravenous adenosine therapy accelerating rate of paroxysmal supraventricular tachycardia." Am J Emerg Med 10 (1992): 326-30
  57. Morganroth J, Pratt CM "Prevalence and characteristics of proarrhythmia from moricizine (themozine)." Am J Cardiol 63 (1989): 172-6
  58. Chia BL "Disopyramide induced atypical ventricular tachycardia." Aust N Z J Med 10 (1980): 665-8
  59. Hohnloser SH, Klingenheben T, Singh BN "Amiodarone-associated proarrhythmic effects - a review with special reference to torsade de pointes tachycardia." Ann Intern Med 121 (1994): 529-35
  60. "Product Information. Ethmozine (moricizine)." DuPont Pharmaceuticals, Wilmington, DE.
  61. Kinney EL, Field EH, Salmon MP, Zelis R "Cardiac arrhythmias associated with disopyramide." N Engl J Med May (1990): 1146
  62. Schweitzer P, Mark H "Torsade de pointes caused by disopyramide and hypokalemia." Mt Sinai J Med 49 (1982): 110-4
View all 62 references
Major

Corticosteroids (Includes MLK F2) ↔ (+) Tuberculin Test

Severe Potential Hazard, High plausibility

Applies to: History - Tuberculosis, Tuberculosis -- Latent

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.

References

  1. "Product Information. Decadron (dexamethasone)." Merck & Co, Inc, West Point, PA.
  2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn, Kalamazoo, MI.
  3. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn, Kalamazoo, MI.
  4. "Product Information. Celestone (betamethasone)." Schering Corporation, Kenilworth, NJ.
  5. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb, Princeton, NJ.
  6. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb, Princeton, NJ.
  7. Swartz SL, Dluhy RG "Corticosteroids: clinical pharmacology and therapeutic use." Drugs 16 (1978): 238-55
  8. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co, Inc, West Point, PA.
  9. "Product Information. Hydeltrasol (prednisolone)." Merck & Co, Inc, West Point, PA.
  10. "Product Information. Cortone Acetate (cortisone)." Merck & Co, Inc, West Point, PA.
View all 10 references
Major

Corticosteroids (Includes MLK F2) ↔ Electrolyte Imbalance

Severe Potential Hazard, Moderate plausibility

Applies to: Hypernatremia, Hypocalcemia, Hypokalemia, Seizures, Electrolyte Abnormalities

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.

References

  1. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn, Kalamazoo, MI.
  2. "Product Information. Celestone (betamethasone)." Schering Corporation, Kenilworth, NJ.
  3. Morris GC, Egan JG, Jones MK "Hypokalaemic paralysis induced by bolus prednisolone in Graves' disease." Aust N Z J Med 22 (1992): 312
  4. Ramsahoye BH, Davies SV, el-Gaylani N, Sandeman D, Scanlon MF "The mineralocorticoid effects of high dose hydrocortisone." BMJ 310 (1995): 656-7
  5. Powell JR "Steroid and hypokalemic myopathy after corticosteroids for ulcerative colitis. Systemic and tropical application." Am J Gastroenterol 52 (1969): 425-32
  6. Thomas TP "The complications of systemic corticosteroid therapy in the elderly." Gerontology 30 (1984): 60-5
  7. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb, Princeton, NJ.
  8. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb, Princeton, NJ.
  9. "Product Information. Hydeltrasol (prednisolone)." Merck & Co, Inc, West Point, PA.
  10. Lieberman P, Patterson R, Kunske R "Complications of long-term steroid therapy for asthma." J Allergy Clin Immunol 49 (1972): 329-36
  11. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co, Inc, West Point, PA.
  12. Seale JP, Compton MR "Side-effects of corticosteroid agents." Med J Aust 144 (1986): 139-42
  13. "Product Information. Decadron (dexamethasone)." Merck & Co, Inc, West Point, PA.
  14. "Product Information. Cortone Acetate (cortisone)." Merck & Co, Inc, West Point, PA.
  15. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn, Kalamazoo, MI.
View all 15 references
Major

Corticosteroids (Includes MLK F2) ↔ Gi Perforation

Severe Potential Hazard, Moderate plausibility

Applies to: Diverticulitis, Intestinal Anastomoses, Ulcerative Colitis

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 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.

References

  1. Fadul CE, Lemann W, Thaler HT, Posner JB "Perforation of the gastrointestinal tract in patients receiving steroids for neurologic disease." Neurology 38 (1988): 348-52
  2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn, Kalamazoo, MI.
  3. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn, Kalamazoo, MI.
  4. "Product Information. Celestone (betamethasone)." Schering Corporation, Kenilworth, NJ.
  5. Chrousos GA, Kattah JC, Beck RW, Cleary PA "Side effects of glucocorticoid treatment. Experience of the Optic Neuritis Treatment Trial." JAMA 269 (1993): 2110-2
  6. Swartz SL, Dluhy RG "Corticosteroids: clinical pharmacology and therapeutic use." Drugs 16 (1978): 238-55
  7. Baethge BA, Lidsky MD, Goldberg JW "A study of adverse effects of high-dose intravenous (pulse) methylprednisolone therapy in patients with rheumatic disease." Ann Pharmacother 26 (1992): 316-20
  8. Seale JP, Compton MR "Side-effects of corticosteroid agents." Med J Aust 144 (1986): 139-42
  9. "Product Information. Cortone Acetate (cortisone)." Merck & Co, Inc, West Point, PA.
  10. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co, Inc, West Point, PA.
  11. "Product Information. Decadron (dexamethasone)." Merck & Co, Inc, West Point, PA.
  12. ReMine SG, McIlrath DC "Bowel perforation in steroid-treated patients." Ann Surg 192 (1980): 581-6
  13. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb, Princeton, NJ.
  14. Thomas TP "The complications of systemic corticosteroid therapy in the elderly." Gerontology 30 (1984): 60-5
  15. "Product Information. Hydeltrasol (prednisolone)." Merck & Co, Inc, West Point, PA.
  16. Bohrer H, Schmidt H, Bach A, Bottiger BW, Motsch J "Masking of the symptoms of esophageal and bowel perforation by combination treatment of sepsis with polyvalent immunoglobulins and low-dose hydrocortisone." Hepatogastroenterology 43 (1996): 515-8
  17. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb, Princeton, NJ.
  18. Heimdal K, Hirschberg H, Slettebo H, Watne K, Nome O, Sletteb H "High incidence of serious side effects of high-dose dexamethasone treatment in patients with epidural spinal cord compression." J Neurooncol 12 (1992): 141-4
View all 18 references
Major

Corticosteroids (Includes MLK F2) ↔ Infections

Severe Potential Hazard, High plausibility

Applies to: Infection - Bacterial/Fungal/Protozoal/Viral

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.

References

  1. Swartz SL, Dluhy RG "Corticosteroids: clinical pharmacology and therapeutic use." Drugs 16 (1978): 238-55
  2. "Product Information. Hydeltrasol (prednisolone)." Merck & Co, Inc, West Point, PA.
  3. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co, Inc, West Point, PA.
  4. "Product Information. Cortone Acetate (cortisone)." Merck & Co, Inc, West Point, PA.
  5. Berger BB, Weinberg RS, Tessler HH, Wyhinny GJ, Vygantas CM "Bilateral cytomegalovirus panuveitis after high-dose corticosteroid therapy." Am J Ophthalmol 88 (1979): 1020-5
  6. Seale JP, Compton MR "Side-effects of corticosteroid agents." Med J Aust 144 (1986): 139-42
  7. "Product Information. Decadron (dexamethasone)." Merck & Co, Inc, West Point, PA.
  8. Baethge BA, Lidsky MD, Goldberg JW "A study of adverse effects of high-dose intravenous (pulse) methylprednisolone therapy in patients with rheumatic disease." Ann Pharmacother 26 (1992): 316-20
  9. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn, Kalamazoo, MI.
  10. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn, Kalamazoo, MI.
  11. Borges AA, Krasnow SH, Wadleigh RG, Cohen MH "Nocardiosis after corticosteroid therapy for malignant thymoma." Cancer 71 (1993): 1746-50
  12. DeMaria EJ, Reichman W, Kenney PR, Armitage JM, Gann DS "Septic complications of corticosteroid administration after central nervous system trauma." Ann Surg 202 (1985): 248-52
  13. Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL, Hauser SL, Longo DL, eds. "Harrison's Principles of Internal Medicine. 14th ed." New York, NY: McGraw-Hill Health Professionals Division (1998):
  14. "Product Information. Celestone (betamethasone)." Schering Corporation, Kenilworth, NJ.
  15. Carrel TP, Schaffner A, Schmid ER, Schneider J, Bauer EP, Laske A, von Segesser LK, Turina MI "Fatal fungal pericarditis after cardiac surgery and immunosuppression." J Thorac Cardiovasc Surg 101 (1991): 161-4
  16. Weissman DE, Dufer D, Vogel V, Abeloff MD "Corticosteroid toxicity in neuro-oncology patients." J Neurooncol 5 (1987): 125-8
  17. Cisneros JR, Murray KM "Corticosteroids in tuberculosis." Ann Pharmacother 30 (1996): 1298-303
  18. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb, Princeton, NJ.
  19. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb, Princeton, NJ.
View all 19 references
Major

Corticosteroids (Includes MLK F2) ↔ Mi

Severe Potential Hazard, Moderate plausibility

Applies to: Myocardial Infarction, Post MI Syndrome

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.

References

  1. "Product Information. Decadron (dexamethasone)." Merck & Co, Inc, West Point, PA.
  2. "Product Information. Cortone Acetate (cortisone)." Merck & Co, Inc, West Point, PA.
  3. "Product Information. Celestone (betamethasone)." Schering Corporation, Kenilworth, NJ.
  4. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn, Kalamazoo, MI.
  5. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn, Kalamazoo, MI.
  6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb, Princeton, NJ.
  7. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb, Princeton, NJ.
  8. "Product Information. Hydeltrasol (prednisolone)." Merck & Co, Inc, West Point, PA.
  9. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co, Inc, West Point, PA.
View all 9 references
Major

Corticosteroids (Includes MLK F2) ↔ Ocular Herpes Simplex

Severe Potential Hazard, Moderate plausibility

Applies to: Ocular Herpes Simplex

Pharmacologic dosages of corticosteroids should be used cautiously in patients with ocular herpes simplex because of the risk of corneal perforation.

References

  1. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn, Kalamazoo, MI.
  2. "Product Information. Celestone (betamethasone)." Schering Corporation, Kenilworth, NJ.
  3. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn, Kalamazoo, MI.
  4. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb, Princeton, NJ.
  5. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb, Princeton, NJ.
  6. "Product Information. Hydeltrasol (prednisolone)." Merck & Co, Inc, West Point, PA.
  7. "Product Information. Cortone Acetate (cortisone)." Merck & Co, Inc, West Point, PA.
  8. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co, Inc, West Point, PA.
  9. "Product Information. Decadron (dexamethasone)." Merck & Co, Inc, West Point, PA.
View all 9 references
Major

Corticosteroids (Includes MLK F2) ↔ Pud

Severe Potential Hazard, High plausibility

Applies to: History - Peptic Ulcer, Peptic Ulcer

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 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.

References

  1. Thomas TP "The complications of systemic corticosteroid therapy in the elderly." Gerontology 30 (1984): 60-5
  2. Heimdal K, Hirschberg H, Slettebo H, Watne K, Nome O, Sletteb H "High incidence of serious side effects of high-dose dexamethasone treatment in patients with epidural spinal cord compression." J Neurooncol 12 (1992): 141-4
  3. Weissman DE, Dufer D, Vogel V, Abeloff MD "Corticosteroid toxicity in neuro-oncology patients." J Neurooncol 5 (1987): 125-8
  4. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb, Princeton, NJ.
  5. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb, Princeton, NJ.
  6. Lieberman P, Patterson R, Kunske R "Complications of long-term steroid therapy for asthma." J Allergy Clin Immunol 49 (1972): 329-36
  7. "Product Information. Celestone (betamethasone)." Schering Corporation, Kenilworth, NJ.
  8. Seale JP, Compton MR "Side-effects of corticosteroid agents." Med J Aust 144 (1986): 139-42
  9. "Product Information. Decadron (dexamethasone)." Merck & Co, Inc, West Point, PA.
  10. Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL, Hauser SL, Longo DL, eds. "Harrison's Principles of Internal Medicine. 14th ed." New York, NY: McGraw-Hill Health Professionals Division (1998):
  11. Baethge BA, Lidsky MD, Goldberg JW "A study of adverse effects of high-dose intravenous (pulse) methylprednisolone therapy in patients with rheumatic disease." Ann Pharmacother 26 (1992): 316-20
  12. Messer J, Reitman D, Sacks HS, et al "Association of adrenocorticosteroid therapy and peptic-ulcer disease." N Engl J Med 309 (1983): 21-4
  13. Allan SG, Leonard RC "Dexamethasone antiemesis and side-effects." Lancet 1 (1986): 1035
  14. Pang S, Clark AT, Freeman LC, Dolan LM, Immken L, Mueller OT, Stiff D, Shulman DI "Maternal side effects of prenatal dexamethasone therapy for fetal congenital adrenal hyperplasia." J Clin Endocrinol Metab 75 (1992): 249-53
  15. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co, Inc, West Point, PA.
  16. "Product Information. Hydeltrasol (prednisolone)." Merck & Co, Inc, West Point, PA.
  17. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn, Kalamazoo, MI.
  18. "Product Information. Cortone Acetate (cortisone)." Merck & Co, Inc, West Point, PA.
  19. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn, Kalamazoo, MI.
  20. Swartz SL, Dluhy RG "Corticosteroids: clinical pharmacology and therapeutic use." Drugs 16 (1978): 238-55
  21. Chrousos GA, Kattah JC, Beck RW, Cleary PA "Side effects of glucocorticoid treatment. Experience of the Optic Neuritis Treatment Trial." JAMA 269 (1993): 2110-2
View all 21 references
Major

Corticosteroids (Includes MLK F2) ↔ Scleroderma

Severe Potential Hazard, Moderate plausibility

Applies to: Systemic Sclerosis

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.

References

  1. "Product Information. Decadron (dexamethasone)." Merck & Co, Inc, West Point, PA.
  2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn, Kalamazoo, MI.
  3. "Product Information. Celestone (betamethasone)." Schering Corporation, Kenilworth, NJ.
  4. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn, Kalamazoo, MI.
  5. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb, Princeton, NJ.
  6. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb, Princeton, NJ.
  7. Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL, Hauser SL, Longo DL, eds. "Harrison's Principles of Internal Medicine. 14th ed." New York, NY: McGraw-Hill Health Professionals Division (1998):
  8. "Product Information. Hydeltrasol (prednisolone)." Merck & Co, Inc, West Point, PA.
  9. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co, Inc, West Point, PA.
  10. "Product Information. Cortone Acetate (cortisone)." Merck & Co, Inc, West Point, PA.
View all 10 references
Major

Corticosteroids (Includes MLK F2) ↔ Strongyloidiasis

Severe Potential Hazard, High plausibility

Applies to: Strongyloidiasis

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.

References

  1. "Product Information. Cortone Acetate (cortisone)." Merck & Co, Inc, West Point, PA.
  2. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co, Inc, West Point, PA.
  3. "Product Information. Decadron (dexamethasone)." Merck & Co, Inc, West Point, PA.
  4. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn, Kalamazoo, MI.
  5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn, Kalamazoo, MI.
  6. "Product Information. Celestone (betamethasone)." Schering Corporation, Kenilworth, NJ.
  7. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb, Princeton, NJ.
  8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb, Princeton, NJ.
  9. Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL, Hauser SL, Longo DL, eds. "Harrison's Principles of Internal Medicine. 14th ed." New York, NY: McGraw-Hill Health Professionals Division (1998):
  10. "Product Information. Hydeltrasol (prednisolone)." Merck & Co, Inc, West Point, PA.
  11. Swartz SL, Dluhy RG "Corticosteroids: clinical pharmacology and therapeutic use." Drugs 16 (1978): 238-55
View all 11 references
Major

Lidocaine (Includes MLK F2) ↔ Hepatic Dysfunction

Severe Potential Hazard, High plausibility

Applies to: Liver Disease

Lidocaine is rapidly and extensively metabolized by the liver. Less than 10% is eliminated unchanged in the urine. Several inactive and two active forms (MEGX and GX) have been identified. MEGX and GX exhibit antiarrhythmic and convulsant properties. GX accumulates during prolonged intravenous lidocaine infusion. The pharmacokinetic disposition of lidocaine is altered by changes in hepatic function, including hepatic blood flow. Therapy with lidocaine should be administered cautiously and dosing modifications for repeated or loading and maintenance doses may be necessary. Clinical monitoring of cardiac (continuous ECG) is required and serum metabolite concentrations and monitoring hepatic function are recommended.

References

  1. Thomson AH, Elliott HL, Kelman AW, et al "The pharmacokinetics and pharmacodynamics of lignocaine and MEGX in healthy subjects." J Pharmacokinet Biopharm 15 (1987): 101-15
  2. Huang YS, Lee SD, Deng JF, Wu JC, Lu RH, Lin YF, Wang YJ, Lo KJ "Measuring lidocaine metabolite - monoethylglycinexylidide as a quantitative index of hepatic function in adults with chronic hepatitis and cirrhosis." J Hepatol 19 (1993): 140-7
  3. Huet P-M, LeLorier J "Effects of smoking and chronic hepatitis B on lidocaine and indocyanine green kinetics." Clin Pharmacol Ther 28 (1980): 208-15
  4. Barry M, Keeling PW, Weir D, Feely J "Severity of cirrhosis and the relationship of a1-acid glycoprotein concentration to plasma protein binding of lidocaine." Clin Pharmacol Ther 47 (1990): 366-70
  5. Bauer LA, Brown T, Gibaldi M, et al "Influence of long-term infusions on lidocaine kinetics." Clin Pharmacol Ther 31 (1982): 433-7
  6. Huet PM, Villeneuve JP "Determinants of drug disposition in patients with cirrhosis." Hepatology 3 (1983): 913-8
  7. "Product Information. Xylocaine (lidocaine)." Astra USA, Westborough, MA.
  8. Forrest JA, Finlayson ND, Adjepon-Yamoah KK, Prescott LF "Antipyrine, paracetamol, and lignocaine elimination in chronic liver disease." Br Med J 1 (1977): 1384-7
  9. Colli A, Buccino G, Cocciolo M, et al "Disposition of a flow-limited drug (lidocaine) and a metabolic capacity-limited drug (theophylline) in liver cirrhosis." Clin Pharmacol Ther 44 (1988): 642-9
  10. Shiffman ML, Luketic VA, Sanyal AJ, Duckworth PF, Purdum PP, Contos MJ, Mills AS, Edinboro LE, Poklis A "Hepatic lidocaine metabolism and liver histology in patients with chronic hepatitis and cirrhosis." Hepatology 19 (1994): 933-40
  11. Thomson P, Melmon K, Richardson J, Cohn K Steinbrunn W, Cudihee R, Rowland M "Lidocaine pharmacokinetics in advanced heart failure, liver disease, and renal failure in humans." Ann Intern Med 78 (1973): 499-508
  12. Villeneuve JP, Thibeault MJ, Ampelas M, et al "Drug disposition in patients with HBsAg-positive chronic liver disease." Dig Dis Sci 32 (1987): 710-4
  13. Williams RL, Blaschke TF, Meffin PJ, et al "Influence of viral hepatitis on the disposition of two compounds with high hepatic clearance: lidocaine and indocyanine green." Clin Pharmacol Ther 20 (1976): 290-9
View all 13 references
Major

Lidocaine (Includes MLK F2) ↔ Renal Dysfunction

Severe Potential Hazard, High plausibility

Applies to: Renal Dysfunction

Lidocaine is primarily eliminated by the kidney. Less than 10% is eliminated unchanged in the urine. Two active metabolites (MEGX and GX) have been identified that exhibit antiarrhythmic and convulsant properties. GX accumulates during prolonged intravenous lidocaine infusion. Serum concentrations of lidocaine and the active metabolites are increased and the half-life prolonged in patients with renal impairment. Therapy with lidocaine should be administered cautiously and dosing modified for repeated or maintenance doses in patients with compromised renal function. Clinical monitoring of cardiac function (continual ECG) is required and serum metabolite concentrations and monitoring renal function are recommended.

References

  1. Collinsworth KA, Strong JM, Atkinson AJ Jr, et al "Pharmacokinetics and metabolism of lidocaine in patients with renal failure." Clin Pharmacol Ther 18 (1975): 59-64
  2. Jacobi J, McGory RW, McCoy H, Matzke GR "Hemodialysis clearance of total and unbound lidocaine." Clin Pharm 2 (1983): 54-7
  3. Thomson PD, Rowland M, Melmon KL "The influence of heart failure, liver disease, and renal failure on the disposition of lidocaine in man." Am Heart J 82 (1971): 417-21
  4. "Product Information. Xylocaine (lidocaine)." Astra USA, Westborough, MA.
  5. Grossman S, Davis D, Kitchell B, Shand D, Routledge P "Diazepam and lidocaine plasma protein binding in renal disease." Clin Pharmacol Ther 31 (1982): 350-7
  6. Vaziri ND, Saiki JK, Hughes W "Clearance of lidocaine by hemodialysis." South Med J 72 (1979): 1567-8
  7. Eriksson E, Granberg P-O, Ortengren B "Study of renal excretion of prilocaine and lidocaine." Acta Chem Scand 358 (1966): 55-69
  8. Thomson P, Melmon K, Richardson J, Cohn K Steinbrunn W, Cudihee R, Rowland M "Lidocaine pharmacokinetics in advanced heart failure, liver disease, and renal failure in humans." Ann Intern Med 78 (1973): 499-508
View all 8 references
Major

Lidocaine (Includes MLK F2) ↔ Seizures

Severe Potential Hazard, High plausibility

Applies to: Seizures

Seizures have occurred during lidocaine therapy and have been associated with the rapid administration of a large intravenous doses or accumulation of active metabolites with maintenance therapy. Therapy with lidocaine should be administered cautiously to patients with or predisposed to seizure disorders. Clinical monitoring of cardiac (continuous ECG) is required, and serum metabolite concentrations are recommended.

References

  1. Wu FL, Razzaghi A, Souney PF "Seizure after lidocaine for bronchoscopy: case report and review of the use of lidocaine in airway anesthesia." Pharmacotherapy 13 (1993): 72-8
  2. Crampton RS, Oriscello RG "Petit and grand mal convulsions during lidocaine hydrochloride treatment of ventricular tachycardia." JAMA 204 (1968): 109-12
  3. Fortuna A, Fortuna AO "Convulsion during lignocaine infiltration." Anaesth Intensive Care 21 (1993): 483
  4. Sundaram MB "Seizures after intraurethral instillation of lidocaine." Can Med Assoc J 137 (1987): 219-20
  5. Pelter MA, Vollmer TA, Blum RL "Seizure-like reaction associated with subcutaneous lidocaine injection ." Clin Pharm 8 (1989): 767-8
  6. Ryan CA, Robertson M, Coe JY "Seizures due to lidocaine toxicity in a child during cardiac catheterization." Pediatr Cardiol 14 (1993): 116-8
  7. "Product Information. Xylocaine (lidocaine)." Astra USA, Westborough, MA.
View all 7 references
Major

Lidocaine (Includes MLK F2) ↔ Sinus/Av Node Dysfunction

Severe Potential Hazard, High plausibility

Applies to: Heart Block

The use of lidocaine is contraindicated in patients with Stokes-Adam syndrome, Wolff-Parkinson White syndrome, or second- or third-degree AV block in the absence of a functional artificial pacemaker, or congenital QT prolongation.

References

  1. Keidar S, Grenadier E, Palant A "Sinoatrial arrest due to lidocaine injection in sick sinus syndrome during amiodarone administration." Am Heart J 104 (1982): 1384-5
  2. Tagliente TM, Jayagopal S "Transient left bundle branch block following lidocaine." Anesth Analg 69 (1989): 545-7
  3. Hilleman DE, Mohiuddin SM, Destache CJ "Lidocaine-induced second-degree mobitz type II heart block." Drug Intell Clin Pharm 19 (1985): 669-73
  4. "Product Information. Xylocaine (lidocaine)." Astra USA, Westborough, MA.
View all 4 references
Moderate

Antiarrhythmics (Includes MLK F2) ↔ Electrolyte Imbalance

Moderate Potential Hazard, High plausibility

Applies to: Hypokalemia, Hyperkalemia, Magnesium Imbalance

Electrolyte imbalance can alter the therapeutic effectiveness of antiarrhythmic agents. Hypokalemia and hypomagnesemia can reduce the effectiveness of antiarrhythmic agents. In some cases, these disorders can exaggerate the degree of QTc prolongation and increase the potential for torsades de pointes. Hyperkalemia can potentiate the toxic effects of antiarrhythmic agents. Electrolyte imbalance should be corrected prior to initiating antiarrhythmic therapy. Clinical monitoring of cardiac function and electrolyte concentrations is recommended.

References

  1. "Product Information. Tonocard (tocainide)." Merck & Co, Inc, West Point, PA.
  2. "Product Information. Norpace (disopyramide)." Searle, Skokie, IL.
  3. "Product Information. Quinidex (quinidine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  4. "Product Information. Mexitil (mexiletine)." Boehringer-Ingelheim, Ridgefield, CT.
  5. "Product Information. Pronestyl (procainamide)." Apothecon Inc, Plainsboro, NJ.
  6. "Product Information. Corvert (ibutilide)." Pharmacia and Upjohn, Kalamazoo, MI.
  7. "Product Information. Xylocaine (lidocaine)." Astra USA, Westborough, MA.
  8. "Product Information. Rhythmol (propafenone)." Knoll Pharmaceutical Company, Whippany, NJ.
  9. "Product Information. Ethmozine (moricizine)." DuPont Pharmaceuticals, Wilmington, DE.
  10. "Product Information. Tambocor (flecainide)." 3M Pharmaceuticals, St. Paul, MN.
  11. "Product Information. Procan SR (procainamide)." Parke-Davis, Morris Plains, NJ.
  12. "Product Information. Cordarone Intravenous (amiodarone)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  13. "Product Information. Cordarone (amiodarone)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
View all 13 references
Moderate

Bupivacaine (Includes MLK F2) ↔ Cardiovascular Disease

Moderate Potential Hazard, Moderate plausibility

Applies to: Cardiovascular Disease

Bupivacaine and other amide- containing products should be used with caution in patients with impaired cardiovascular function, as they may be less able to compensate for functional changes associated with the prolongation of AV conduction produced by these drugs. Toxic blood concentrations can depress cardiac conductivity and excitability, which can lead to atrioventricular block, ventricular arrhythmias, and cardiac arrest. In addition, myocardial contractility is depressed and peripheral vasodilation occurs, leading to decreased cardiac output and arterial blood pressure.

Moderate

Bupivacaine (Includes MLK F2) ↔ Liver Disease

Moderate Potential Hazard, Moderate plausibility

Applies to: Liver Disease

Amide-type local anesthetics, such as bupivacaine, are metabolized by the liver. Bupivacaine should be used cautiously in patients with hepatic disease. Patients with severe hepatic disease, because of their inability to metabolize local anesthetics normally, are at a greater risk of developing toxic plasma concentrations.

Moderate

Bupivacaine (Includes MLK F2) ↔ Renal Impairment

Moderate Potential Hazard, Moderate plausibility

Applies to: Renal Dysfunction

Bupivacaine is substantially excreted by the kidney, and the risk of toxic reactions may be greater in patients with impaired renal function. Care should be taken in dose selection in patients with renal impairment.

Moderate

Corticosteroids (Includes MLK F2) ↔ Cirrhosis

Moderate Potential Hazard, Moderate plausibility

Applies to: Cirrhosis

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.

Moderate

Corticosteroids (Includes MLK F2) ↔ Depression/Psychoses

Moderate Potential Hazard, Moderate plausibility

Applies to: Psychosis, Depression

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.

References

  1. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co, Inc, West Point, PA.
  2. "Product Information. Cortone Acetate (cortisone)." Merck & Co, Inc, West Point, PA.
  3. Swartz SL, Dluhy RG "Corticosteroids: clinical pharmacology and therapeutic use." Drugs 16 (1978): 238-55
  4. Sechi GP, Piras MR, Demurtas A, Tanca S, Rosati G "Dexamethasone-induced schizoaffective-like state in multiple sclerosis: prophylaxis and treatment with carbamazepine." Clin Neuropharmacol 10 (1987): 453-7
  5. Chrousos GA, Kattah JC, Beck RW, Cleary PA "Side effects of glucocorticoid treatment. Experience of the Optic Neuritis Treatment Trial." JAMA 269 (1993): 2110-2
  6. Campbell IA "Aggressive psychosis in AIDS patient on high-dose steroids." Lancet 2 (1987): 750-1
  7. "Product Information. Decadron (dexamethasone)." Merck & Co, Inc, West Point, PA.
  8. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn, Kalamazoo, MI.
  9. Alpert E, Seigerman C "Steroid withdrawal psychosis in a patient with closed head injury." Arch Phys Med Rehabil 67 (1986): 766-9
  10. Seale JP, Compton MR "Side-effects of corticosteroid agents." Med J Aust 144 (1986): 139-42
  11. Goldstein ET, Preskorn SH "Mania triggered by a steroid nasal spray in a patient with stable bipolar disorder." Am J Psychiatry 146 (1989): 1076-7
  12. Baethge BA, Lidsky MD, Goldberg JW "A study of adverse effects of high-dose intravenous (pulse) methylprednisolone therapy in patients with rheumatic disease." Ann Pharmacother 26 (1992): 316-20
  13. Travlos A, Hirsch G "Steroid psychosis: a cause of confusion on the acute spinal cord injury unit." Arch Phys Med Rehabil 74 (1993): 312-5
  14. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn, Kalamazoo, MI.
  15. Pies R "Persistent bipolar illness after steroid administration." Arch Intern Med 141 (1981): 1087
  16. Raskin DE "Steroid-induced panic disorder." Am J Psychiatry 141 (1984): 1647
  17. Kaufmann M, Kahaner K, Peselow ED, Gershon S "Steroid psychoses: case report and brief overview." J Clin Psychiatry 43 (1982): 75-6
  18. Klein JF "Adverse psychiatric effects of systemic glucocorticoid therapy." Am Fam Physician 46 (1992): 1469-74
  19. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb, Princeton, NJ.
  20. "Product Information. Celestone (betamethasone)." Schering Corporation, Kenilworth, NJ.
  21. Perry PJ, Tsuang MT, Hwang MH "Prednisolone psychosis: clinical observations." Drug Intell Clin Pharm 18 (1984): 603-9
  22. Swinburn CR, Wakefield JM, Newman SP, Jones PW "Evidence of prednisolone induced mood change ('steroid euphoria') in patients with chronic obstructive airways disease." Br J Clin Pharmacol 26 (1988): 709-13
  23. d'Orban PT "Steroid-induced psychosis." Lancet 2 (1989): 694
  24. Phelan MC "Beclomethasone mania." Br J Psychiatry 155 (1989): 871-2
  25. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb, Princeton, NJ.
  26. "Product Information. Hydeltrasol (prednisolone)." Merck & Co, Inc, West Point, PA.
  27. Greeves JA "Rapid-onset steroid psychosis with very low dosage of prednisolone." Lancet 05/19/84 (1984): 1119-20
View all 27 references
Moderate

Corticosteroids (Includes MLK F2) ↔ Diabetes

Moderate Potential Hazard, High plausibility

Applies to: Diabetes Mellitus, Abnormal Glucose Tolerance

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.

References

  1. Black DM, Filak AT "Hyperglycemia with non-insulin-dependent diabetes following intraarticular steroid injection." J Fam Pract 28 (1989): 462-3
  2. "Product Information. Celestone (betamethasone)." Schering Corporation, Kenilworth, NJ.
  3. Ludvik B, Clodi M, Kautzky-Willer A, Capek M, Hartter E, Pacini G, Prager R "Effect of dexamethasone on insulin sensitivity, islet amyloid polypeptide and insulin secretion in humans." Diabetologia 36 (1993): 84-7
  4. Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL, Hauser SL, Longo DL, eds. "Harrison's Principles of Internal Medicine. 14th ed." New York, NY: McGraw-Hill Health Professionals Division (1998):
  5. Gunnarsson R, Lundgren G, Magnusson G, Ost L, Groth CG "Steroid diabetes--a sign of overtreatment with steroids in the renal graft recipient?" Scand J Urol Nephrol Suppl 54 (1980): 135-8
  6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb, Princeton, NJ.
  7. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb, Princeton, NJ.
  8. Lieberman P, Patterson R, Kunske R "Complications of long-term steroid therapy for asthma." J Allergy Clin Immunol 49 (1972): 329-36
  9. "Product Information. Hydeltrasol (prednisolone)." Merck & Co, Inc, West Point, PA.
  10. Greenstone MA, Shaw AB "Alternate day corticosteroid causes alternate day hyperglycaemia." Postgrad Med J 63 (1987): 761-4
  11. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co, Inc, West Point, PA.
  12. "Product Information. Cortone Acetate (cortisone)." Merck & Co, Inc, West Point, PA.
  13. Seale JP, Compton MR "Side-effects of corticosteroid agents." Med J Aust 144 (1986): 139-42
  14. "Product Information. Decadron (dexamethasone)." Merck & Co, Inc, West Point, PA.
  15. Allan SG, Leonard RC "Dexamethasone antiemesis and side-effects." Lancet 1 (1986): 1035
  16. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn, Kalamazoo, MI.
  17. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn, Kalamazoo, MI.
View all 17 references
Moderate

Corticosteroids (Includes MLK F2) ↔ Fluid Retention

Moderate Potential Hazard, Moderate plausibility

Applies to: Congestive Heart Failure, Fluid Retention, Hypertension, Renal Dysfunction

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.

References

  1. Klepikov PV, Kutyrina IM, Tareyeva IE "Steroid-induced hypertension in patients with nephrotic syndrome." Nephron 48 (1988): 286-90
  2. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb, Princeton, NJ.
  3. Pang S, Clark AT, Freeman LC, Dolan LM, Immken L, Mueller OT, Stiff D, Shulman DI "Maternal side effects of prenatal dexamethasone therapy for fetal congenital adrenal hyperplasia." J Clin Endocrinol Metab 75 (1992): 249-53
  4. Lieberman P, Patterson R, Kunske R "Complications of long-term steroid therapy for asthma." J Allergy Clin Immunol 49 (1972): 329-36
  5. Jackson SH, Beevers DG, Myers K "Does long-term low-dose corticosteroid therapy cause hypertension?" Clin Sci 61 (1981): s381-3
  6. "Product Information. Hydeltrasol (prednisolone)." Merck & Co, Inc, West Point, PA.
  7. Swartz SL, Dluhy RG "Corticosteroids: clinical pharmacology and therapeutic use." Drugs 16 (1978): 238-55
  8. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co, Inc, West Point, PA.
  9. "Product Information. Cortone Acetate (cortisone)." Merck & Co, Inc, West Point, PA.
  10. Seale JP, Compton MR "Side-effects of corticosteroid agents." Med J Aust 144 (1986): 139-42
  11. Baethge BA, Lidsky MD, Goldberg JW "A study of adverse effects of high-dose intravenous (pulse) methylprednisolone therapy in patients with rheumatic disease." Ann Pharmacother 26 (1992): 316-20
  12. "Product Information. Decadron (dexamethasone)." Merck & Co, Inc, West Point, PA.
  13. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn, Kalamazoo, MI.
  14. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn, Kalamazoo, MI.
  15. "Product Information. Celestone (betamethasone)." Schering Corporation, Kenilworth, NJ.
  16. Thomas TP "The complications of systemic corticosteroid therapy in the elderly." Gerontology 30 (1984): 60-5
  17. Ramsahoye BH, Davies SV, el-Gaylani N, Sandeman D, Scanlon MF "The mineralocorticoid effects of high dose hydrocortisone." BMJ 310 (1995): 656-7
  18. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb, Princeton, NJ.
View all 18 references
Moderate

Corticosteroids (Includes MLK F2) ↔ Hyperadrenocorticalism

Moderate Potential Hazard, High plausibility

Applies to: Hyperadrenocorticism, Hyperaldosteronism, Adrenal Tumor

Corticosteroids mimic the effects of endogenous cortisol and aldosterone. The use of these agents may aggravate conditions of hyperadrenocorticalism in a dose-dependent manner.

References

  1. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb, Princeton, NJ.
  2. Lieberman P, Patterson R, Kunske R "Complications of long-term steroid therapy for asthma." J Allergy Clin Immunol 49 (1972): 329-36
  3. "Product Information. Hydeltrasol (prednisolone)." Merck & Co, Inc, West Point, PA.
  4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co, Inc, West Point, PA.
  5. "Product Information. Cortone Acetate (cortisone)." Merck & Co, Inc, West Point, PA.
  6. "Product Information. Decadron (dexamethasone)." Merck & Co, Inc, West Point, PA.
  7. Swartz SL, Dluhy RG "Corticosteroids: clinical pharmacology and therapeutic use." Drugs 16 (1978): 238-55
  8. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn, Kalamazoo, MI.
  9. Tsuruoka S, Sugimoto K, Fujimura A "Drug-induced Cushing syndrome in a patient with ulcerative colitis after betamethasone enema: Evaluation of plasma drug concentration." Ther Drug Monit 20 (1998): 387-9
  10. Seale JP, Compton MR "Side-effects of corticosteroid agents." Med J Aust 144 (1986): 139-42
  11. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn, Kalamazoo, MI.
  12. Kimmerle R, Rolla AR "Iatrogenic Cushing's syndrome due to dexamethasone nasal drops." Am J Med 79 (1985): 535-7
  13. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb, Princeton, NJ.
  14. "Product Information. Celestone (betamethasone)." Schering Corporation, Kenilworth, NJ.
View all 14 references
Moderate

Corticosteroids (Includes MLK F2) ↔ Hyperlipidemia

Moderate Potential Hazard, Moderate plausibility

Applies to: Hyperlipidemia

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.

References

  1. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb, Princeton, NJ.
  2. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb, Princeton, NJ.
  3. "Product Information. Hydeltrasol (prednisolone)." Merck & Co, Inc, West Point, PA.
  4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co, Inc, West Point, PA.
  5. "Product Information. Decadron (dexamethasone)." Merck & Co, Inc, West Point, PA.
  6. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn, Kalamazoo, MI.
  7. "Product Information. Cortone Acetate (cortisone)." Merck & Co, Inc, West Point, PA.
  8. Seale JP, Compton MR "Side-effects of corticosteroid agents." Med J Aust 144 (1986): 139-42
  9. "Product Information. Celestone (betamethasone)." Schering Corporation, Kenilworth, NJ.
  10. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn, Kalamazoo, MI.
View all 10 references
Moderate

Corticosteroids (Includes MLK F2) ↔ Hypothyroidism

Moderate Potential Hazard, Moderate plausibility

Applies to: Hypothyroidism

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.

References

  1. "Product Information. Celestone (betamethasone)." Schering Corporation, Kenilworth, NJ.
  2. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb, Princeton, NJ.
  3. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn, Kalamazoo, MI.
  4. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb, Princeton, NJ.
  5. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co, Inc, West Point, PA.
  6. "Product Information. Cortone Acetate (cortisone)." Merck & Co, Inc, West Point, PA.
  7. O'Connor P, Feely J "Clinical pharmacokinetics and endocrine disorders. Therapeutic implications." Clin Pharmacokinet 13 (1987): 345-64
  8. "Product Information. Hydeltrasol (prednisolone)." Merck & Co, Inc, West Point, PA.
  9. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn, Kalamazoo, MI.
  10. "Product Information. Decadron (dexamethasone)." Merck & Co, Inc, West Point, PA.
View all 10 references
Moderate

Corticosteroids (Includes MLK F2) ↔ Liver Disease

Moderate Potential Hazard, High plausibility

Applies to: Liver Disease

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.

References

  1. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn, Kalamazoo, MI.
  2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn, Kalamazoo, MI.
  3. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb, Princeton, NJ.
  4. "Product Information. Celestone (betamethasone)." Schering Corporation, Kenilworth, NJ.
  5. "Product Information. Hydeltrasol (prednisolone)." Merck & Co, Inc, West Point, PA.
  6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb, Princeton, NJ.
  7. Cunliffe WJ, Burton JL, Holti G, Wright V "Hazards of steroid therapy in hepatic failure." Br J Dermatol 93 (1975): 183-5
  8. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co, Inc, West Point, PA.
  9. "Product Information. Cortone Acetate (cortisone)." Merck & Co, Inc, West Point, PA.
  10. "Product Information. Decadron (dexamethasone)." Merck & Co, Inc, West Point, PA.
View all 10 references
Moderate

Corticosteroids (Includes MLK F2) ↔ Myasthenia Gravis

Moderate Potential Hazard, High plausibility

Applies to: Myasthenia Gravis

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.

References

  1. Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL, Hauser SL, Longo DL, eds. "Harrison's Principles of Internal Medicine. 14th ed." New York, NY: McGraw-Hill Health Professionals Division (1998):
Moderate

Corticosteroids (Includes MLK F2) ↔ Myopathy

Moderate Potential Hazard, High plausibility

Applies to: Myopathy, Myoneural Disorder

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 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 or no changes of myopathy on EMG, 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.

References

  1. Seale JP, Compton MR "Side-effects of corticosteroid agents." Med J Aust 144 (1986): 139-42
  2. "Product Information. Decadron (dexamethasone)." Merck & Co, Inc, West Point, PA.
  3. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn, Kalamazoo, MI.
  4. Decramer M, Stas KJ "Corticosteroid-induced myopathy involving respiratory muscles in patients with chronic obstructive pulmonary disease or asthma." Am Rev Respir Dis 146 (1992): 800-2
  5. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn, Kalamazoo, MI.
  6. "Product Information. Hydeltrasol (prednisolone)." Merck & Co, Inc, West Point, PA.
  7. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co, Inc, West Point, PA.
  8. Dropcho EJ, Soong SJ "Steroid-induced weakness in patients with primary brain tumors." Neurology 41 (1991): 1235-9
  9. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb, Princeton, NJ.
  10. "Product Information. Cortone Acetate (cortisone)." Merck & Co, Inc, West Point, PA.
  11. Powell JR "Steroid and hypokalemic myopathy after corticosteroids for ulcerative colitis. Systemic and tropical application." Am J Gastroenterol 52 (1969): 425-32
  12. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb, Princeton, NJ.
  13. Weissman DE, Dufer D, Vogel V, Abeloff MD "Corticosteroid toxicity in neuro-oncology patients." J Neurooncol 5 (1987): 125-8
  14. "Product Information. Celestone (betamethasone)." Schering Corporation, Kenilworth, NJ.
  15. Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL, Hauser SL, Longo DL, eds. "Harrison's Principles of Internal Medicine. 14th ed." New York, NY: McGraw-Hill Health Professionals Division (1998):
  16. Bowyer SL, LaMothe MP, Hollister JR "Steroid myopathy: incidence and detection in a population with asthma." J Allergy Clin Immunol 76 (1985): 234-42
  17. Hardman JG, Gilman AG, Limbird LE eds. "Goodman and Gilman's the Pharmacological Basis of Therapeutics. 9th ed." New York, NY: McGraw-Hill (1995):
  18. Ojeda VJ "Necrotizing myopathy associated with steroid therapy. Report of two cases." Pathology 14 (1982): 435-8
  19. Pacy PJ, Halliday D "Muscle protein synthesis in steroid-induced proximal myopathy: a case report." Muscle Nerve 12 (1989): 378-81
View all 19 references
Moderate

Corticosteroids (Includes MLK F2) ↔ Ocular Toxicities

Moderate Potential Hazard, Moderate plausibility

Applies to: Glaucoma/Intraocular Hypertension, Cataracts

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.

References

  1. Kobayashi Y, Akaishi K, Nishio T, Kobayashi Y, Kimura Y "Posterior subcapsular cataract in nephrotic children receiving steroid therapy." Am J Dis Child 128 (1974): 671-3
  2. "Product Information. Cortone Acetate (cortisone)." Merck & Co, Inc, West Point, PA.
  3. "Product Information. Decadron (dexamethasone)." Merck & Co, Inc, West Point, PA.
  4. Francois J "Corticosteroid glaucoma." Ann Ophthalmol 9 (1977): 1075-80
  5. Seale JP, Compton MR "Side-effects of corticosteroid agents." Med J Aust 144 (1986): 139-42
  6. Debnath SC, Abomelha MS, Jawdat M, et al "Ocular side effects of systemic steroid therapy in renal transplant patients." Ann Ophthalmol 19 (1987): 435-7
  7. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn, Kalamazoo, MI.
  8. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn, Kalamazoo, MI.
  9. "Product Information. Celestone (betamethasone)." Schering Corporation, Kenilworth, NJ.
  10. Thomas TP "The complications of systemic corticosteroid therapy in the elderly." Gerontology 30 (1984): 60-5
  11. Kitazawa Y "Increased intraocular pressure induced by corticosteroids." Am J Ophthalmol 82 (1976): 492-5
  12. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb, Princeton, NJ.
  13. Bluming AZ, Zeegen P "Cataracts induced by intermittent Decadron used as an antiemetic." J Clin Oncol 4 (1986): 221-3
  14. McDonnell PJ, Kerr Muir MG "Glaucoma associated with systemic corticosteroid therapy." Lancet 08/17/85 (1985): 386-7
  15. "Product Information. Hydeltrasol (prednisolone)." Merck & Co, Inc, West Point, PA.
  16. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co, Inc, West Point, PA.
  17. Godel V, Regenbogen L, Stein R "On the mechanism of corticosteroid-induced ocular hypertension." Ann Ophthalmol 10 (1978): 191-6
  18. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb, Princeton, NJ.
  19. Swartz SL, Dluhy RG "Corticosteroids: clinical pharmacology and therapeutic use." Drugs 16 (1978): 238-55
View all 19 references
Moderate

Corticosteroids (Includes MLK F2) ↔ Osteoporosis

Moderate Potential Hazard, High plausibility

Applies to: Osteoporosis

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.

References

  1. Anderton JM, Helm R "Multiple joint osteonecrosis following short-term steroid therapy. Case report." J Bone Joint Surg Am 64 (1982): 139-41
  2. Goldstein MF, Fallon JJ, Harning R "Chronic glucocorticoid therapy-induced osteoporosis in patients with obstructive lung disease." Chest 116 (1999): 1733-49
  3. "Product Information. Decadron (dexamethasone)." Merck & Co, Inc, West Point, PA.
  4. Seale JP, Compton MR "Side-effects of corticosteroid agents." Med J Aust 144 (1986): 139-42
  5. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn, Kalamazoo, MI.
  6. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn, Kalamazoo, MI.
  7. Packe GE, Douglas JG, McDonald AF, Robins SP, Reid DM "Bone density in asthmatic patients taking high dose inhaled beclomethasone diproprionate and intermittent systemic corticosteroids." Thorax 47 (1992): 414-7
  8. Fordyce MJ, Solomon L "Early detection of avascular necrosis of the femoral head by MRI." J Bone Joint Surg Br 75 (1993): 365-7
  9. Rizzato G, Montemurro L "Reversibility of exogenous corticosteroid-induced bone loss." Eur Respir J 6 (1993): 116-9
  10. Hahn TJ, Halstead LR, Baran DT "Effects of short term glucocorticoid administration on intestinal calcium absorption and circulating vitamin d metabolite concentrations in man." J Clin Endocrinol Metab 52 (1981): 111-5
  11. "Product Information. Celestone (betamethasone)." Schering Corporation, Kenilworth, NJ.
  12. Taylor LJ "Multifocal avascular necrosis after short-term high-dose steroid therapy. A report of three cases." J Bone Joint Surg Br 66 (1984): 431-3
  13. Black KA, Khangure MS, Owen ET "Dexamethasone and osteonecrosis." Aust N Z J Med 11 (1981): 521-5
  14. Fast A, Alon M, Weiss S, Zer-Aviv FR "Avascular necrosis of bone following short-term dexamethasone therapy for brain edema. Case report." J Neurosurg 61 (1984): 983-5
  15. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb, Princeton, NJ.
  16. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb, Princeton, NJ.
  17. Elliott ME, Farrah RM, Binkley NC, Cames ML, Gudmundsson A "Management of glucocorticoid-induced osteoporosis in male veterans." Ann Pharmacother 34 (2000): 1380-4
  18. Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL, Hauser SL, Longo DL, eds. "Harrison's Principles of Internal Medicine. 14th ed." New York, NY: McGraw-Hill Health Professionals Division (1998):
  19. Thomas TP "The complications of systemic corticosteroid therapy in the elderly." Gerontology 30 (1984): 60-5
  20. McCluskey J, Gutteridge DH "Avascular necrosis of bone after high doses of dexamethasone during neurosurgery." Br Med J (Clin Res Ed) 284 (1982): 333-4
  21. Archer AG, Nelson MC, Abbondanzo SL, Bogumill GP "Case report 554: Osteonecrosis at multiple sites as noted." Skeletal Radiol 18 (1989): 380-4
  22. Saisu T, Sakamoto K, Yamada K, Kashiwabara H, Yokoyama T, Iida S, Harada Y, Ikenoue S, Sakamoto M, Moriya H "High incidence of osteonecrosis of femoral head in patients receiving more than 2 g of intravenous methylprednisolone after renal transplantation." Transplant Proc 28 (1996): 1559-60
  23. Mitchison HC, Bassendine MF, Malcolm AJ, et al "A pilot, double-blind, controlled 1-year trial of prednisolone treatment in primary biliary cirrhosis: hepatic improvement but greater bone loss." Hepatology 10 (1989): 420-9
  24. Cruess RL "Experience with steroid-induced avascular necrosis of the shoulder and etiologic considerations regarding osteonecrosis of the hip." Clin Orthop Jan-Feb(13 (1978): 86-93
  25. Ledford D, Apter A, Brenner AM, Rubin K, Prestwood K, Frieri M, Lukert B "Osteoporosis in the corticosteroid-treated patient with asthma." J Allergy Clin Immunol 102 (1998): 353-62
  26. Marystone JF, Barrettconnor EL, Morton DJ "Inhaled and oral corticosteroids: their effects on bone mineral density in older adults." Am J Public Health 85 (1995): 1693-5
  27. Mizuta H, Kubota K, Shiraishi M, Kai K, Nakamura E, Takagi K "Steroid-related bilateral osteonecrosis of the patella." Arthroscopy 9 (1993): 114-6
  28. Bijlsma JW, Duursma SA, Bosch R, Raymakers JA, Huber-Bruning O "Acute changes in calcium and bone metabolism during methylprednisolone pulse therapy in rheumatoid arthritis." Br J Rheumatol 27 (1988): 215-9
  29. Sambrook PN, Hassall JE, York JR "Osteonecrosis after high dosage, short term corticosteroid therapy." J Rheumatol 11 (1984): 514-6
  30. Weissman DE, Dufer D, Vogel V, Abeloff MD "Corticosteroid toxicity in neuro-oncology patients." J Neurooncol 5 (1987): 125-8
  31. "Product Information. Hydeltrasol (prednisolone)." Merck & Co, Inc, West Point, PA.
  32. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co, Inc, West Point, PA.
  33. Need AG, Philcox JC, Hartley TF, Nordin BE "Calcium metabolism and osteoporosis in cortiscosteroid-treated postmenopausal women." Aust N Z J Med 16 (1986): 341-6
  34. Williams IA, Mitchell AD, Rothman W, Tallett P, Williams K, Pitt P "Survey of the long term incidence of osteonecrosis of the hip and adverse medical events in rheumatoid arthritis after high dose intravenous methylprednisolone." Ann Rheum Dis 47 (1988): 930-3
  35. Fentiman IS, Saad Z, Caleffi M, et al "Tamoxifen protects against steroid-induced bone loss." Eur J Cancer 28 (1992): 684-5
  36. "Product Information. Cortone Acetate (cortisone)." Merck & Co, Inc, West Point, PA.
View all 36 references
Moderate

Corticosteroids (Includes MLK F2) ↔ Prematurity

Moderate Potential Hazard, Moderate plausibility

Applies to: Prematurity/Underweight in Infancy

The use of certain parenteral formulations of dexamethasone, hydrocortisone, methylprednisolone, prednisolone and triamcinolone is considered by the drug manufacturers to be contraindicated in neonates, particularly premature infants and infants of low birth weight. Some formulations of these drugs contain benzyl alcohol which, when used in bacteriostatic saline intravascular flush and endotracheal tube lavage solutions, has been associated with fatalities and severe respiratory and metabolic complications in low-birth-weight premature infants. However, many experts feel that, in the absence of benzyl alcohol-free equivalents, the amount of the preservative present in these formulations should not necessarily preclude their use if they are clearly indicated. The American Academy of Pediatrics considers benzyl alcohol in low doses (such as when used as a preservative in some medications) to be safe for newborns. Continuous infusions of high dosages of medications containing benzyl alcohol may, however, cause toxicity and should be avoided if possible.

References

  1. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn, Kalamazoo, MI.
  2. "Product Information. Celestone (betamethasone)." Schering Corporation, Kenilworth, NJ.
  3. ""Inactive" ingredients in pharmaceutical products: update (subject review). American Academy of Pediatrics Committee on Drugs. Available from: URL: http://www.aap.org/policy/re9706.html." Pediatrics 99 (1997): 268-78
  4. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb, Princeton, NJ.
  5. "Product Information. Cortone Acetate (cortisone)." Merck & Co, Inc, West Point, PA.
  6. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb, Princeton, NJ.
  7. "Product Information. Hydeltrasol (prednisolone)." Merck & Co, Inc, West Point, PA.
  8. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co, Inc, West Point, PA.
  9. "Product Information. Decadron (dexamethasone)." Merck & Co, Inc, West Point, PA.
  10. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn, Kalamazoo, MI.
View all 10 references
Moderate

Corticosteroids (Includes MLK F2) ↔ Thromboembolism

Moderate Potential Hazard, Low plausibility

Applies to: History - Thrombotic/Thromboembolic Disorder, Thrombotic/Thromboembolic Disorder

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 with thrombotic or thromboembolic disorders.

References

  1. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb, Princeton, NJ.
  2. "Product Information. Hydeltrasol (prednisolone)." Merck & Co, Inc, West Point, PA.
  3. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb, Princeton, NJ.
  4. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn, Kalamazoo, MI.
  5. Wadman B, Werner I "Thromboembolic complications during corticosteroid treatment of temporal arteritis." Lancet 1 (1972): 907
  6. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co, Inc, West Point, PA.
  7. "Product Information. Cortone Acetate (cortisone)." Merck & Co, Inc, West Point, PA.
  8. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn, Kalamazoo, MI.
  9. "Product Information. Decadron (dexamethasone)." Merck & Co, Inc, West Point, PA.
  10. "Product Information. Celestone (betamethasone)." Schering Corporation, Kenilworth, NJ.
View all 10 references
Moderate

Corticosteroids (Includes MLK F2) ↔ Vaccination

Moderate Potential Hazard, High plausibility

Applies to: Vaccination

The administration of live or live attenuated vaccines is contraindicated in patients receiving large or immunosuppressive doses of corticosteroids. Inactivated viral or bacterial vaccines should be used with caution, since their administration may pose a risk of neurological complications in these patients. Additionally, a diminished or inadequate serum antibody response may be anticipated. Immunization may be undertaken in patients receiving corticosteroids as replacement therapy, such as for Addison's disease.

References

  1. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb, Princeton, NJ.
  2. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb, Princeton, NJ.
  3. "Product Information. Hydeltrasol (prednisolone)." Merck & Co, Inc, West Point, PA.
  4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co, Inc, West Point, PA.
  5. "Product Information. Cortone Acetate (cortisone)." Merck & Co, Inc, West Point, PA.
  6. "Product Information. Decadron (dexamethasone)." Merck & Co, Inc, West Point, PA.
  7. Swartz SL, Dluhy RG "Corticosteroids: clinical pharmacology and therapeutic use." Drugs 16 (1978): 238-55
  8. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn, Kalamazoo, MI.
  9. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn, Kalamazoo, MI.
  10. "Product Information. Celestone (betamethasone)." Schering Corporation, Kenilworth, NJ.
View all 10 references

MLK F2 (bupivacaine / lidocaine / triamcinolone) drug Interactions

There are 857 drug interactions with MLK F2 (bupivacaine / lidocaine / triamcinolone)

MLK F2 (bupivacaine / lidocaine / triamcinolone) alcohol/food Interactions

There are 2 alcohol/food interactions with MLK F2 (bupivacaine / lidocaine / triamcinolone)

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No information available.

Do not stop taking any medications without consulting your healthcare provider.

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