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Drug Interactions between prednisone and pyridostigmine

This report displays the potential drug interactions for the following 2 drugs:

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Moderate

predniSONE pyRIDostigmine

Applies to: prednisone and pyridostigmine

ADJUST DOSE: Corticosteroids and adrenocorticotropic agents may diminish the therapeutic effects of acetylcholinesterase inhibitors in myasthenia gravis. The mechanism of interaction is unknown. Marked deterioration in muscle strength has been reported in patients with myasthenia gravis shortly after the initiation of corticosteroid therapy, particularly when high dosages were used. In most cases, the decline in muscular function was relatively refractory to acetylcholinesterase inhibitors. However, clinical improvement generally occurs during prolonged corticosteroid therapy when administered properly.

MANAGEMENT: Corticosteroid therapy should be instituted at relatively low dosages (15 to 25 mg/day of prednisone or equivalent) and in a controlled setting in patients with myasthenia gravis. Respiratory support should be available, and the dosage should 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). Dose reductions of the acetylcholinesterase inhibitor may be required as symptoms improve, which often may be delayed and gradual.

References

  1. Namba T "Corticotropin therapy in patients with myasthenia gravis." Arch Neurol 26 (1972): 144-50
  2. Brunner NG, Namba T, Grob D "Corticosteroids in management of severe, generalized myasthenia gravis." Neurology 22 (1972): 603-10
  3. Millikan CH, Eaton LM "Clinical evaluation of ACTH and cortisone in myasthenia gravis." Neurology 1 (1951): 145-52
  4. Patten BM, Oliver KL, Engel WK "Adverse interaction between steroid hormones and anticholinesterase drugs." Neurology 24 (1974): 442-9
  5. 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):
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Drug and food interactions

No alcohol/food interactions were found. However, this does not necessarily mean no interactions exist. Always consult your healthcare provider.

Therapeutic duplication warnings

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Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.


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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
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 interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.