Drug Interaction Report
1 drug interaction and 61 additional warnings found for the following 2 drugs:
- Predcor (prednisolone)
- selpercatinib
Drug interactions
Moderate drug interactions
Moderate:prednisoLONE selpercatinib
Applies to: Predcor (prednisolone), selpercatinib
Selpercatinib may increase the blood levels and effects of prednisoLONE.
Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring to safely use both medications.
Contact your doctor if your condition changes or you experience increased side effects.
It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.
Food/lifestyle interactions
Major food/lifestyle interactions
Major:Food/Lifestyle selpercatinib
Applies to: selpercatinib
You should limit or avoid consumption of grapefruit and grapefruit juice during treatment with selpercatinib unless directed otherwise by your doctor.
Grapefruit juice may increase the blood levels of selpercatinib. High levels of selpercatinib can increase the risk of an irregular heart rhythm that may be serious and potentially life-threatening, although it is a relatively rare side effect.
You may be more susceptible if you have:
- a heart condition called congenital long QT syndrome
- other cardiac diseases
- conduction abnormalities
- electrolyte disturbances (for example, magnesium or potassium loss due to severe or prolonged diarrhea or vomiting)
The risk and/or severity of other side effects may also increase, including:
- nausea
- vomiting
- constipation
- diarrhea
- rash
- muscle and joint pain
- swelling of arms or legs
- liver problems
- high blood pressure
- bleeding complications
Talk to your doctor if you experience intolerable or troublesome side effects, or you have other questions or concerns.
You should seek immediate medical attention if you develop sudden dizziness, lightheadedness, fainting, shortness of breath, or heart palpitations during treatment with selpercatinib.
It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.
Moderate food/lifestyle interactions
Moderate:Food/Lifestyle prednisoLONE
Applies to: Predcor (prednisolone)
Using prednisoLONE together with alcohol or grapefruit may increase the risk of side effects of prednisoLONE.
You may want to limit your consumption of grapefruit, grapefruit juice, and/or alcohol during treatment with prednisoLONE.
Talk to your doctor if you have any questions or concerns.
You should seek immediate medical attention if you experience any unusual bleeding or bruising, or have other signs and symptoms of bleeding such as:
- dizziness
- lightheadedness
- red or black, tarry stools
- coughing up or vomiting fresh or dried blood that looks like coffee grounds
- severe headache
- weakness
It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.
Disease interactions
59 potential interactionsApplies to: 51 conditions, including High Blood Pressure, High Cholesterol, Depression, Underactive Thyroid, and Heart Failure.
Abnormal Glucose Tolerance
Moderate:Predcor
The prednisoLONE in Predcor has a moderate potential interaction with 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.
Adrenal Tumor
Moderate:Predcor
The prednisoLONE in Predcor has a moderate potential interaction with Adrenal Tumor.
Corticosteroids mimic the effects of endogenous cortisol and aldosterone. Use of these agents may aggravate conditions of hyperadrenocorticalism in a dose-dependent manner.
Arrhythmia
Moderate:selpercatinib
Selpercatinib has a moderate potential interaction with Arrhythmia.
Selpercatinib can cause concentration-dependent QT interval prolongation. Monitor patients who are at significant risk of developing QTc prolongation, including patients with known long QT syndromes, clinically significant bradyarrhythmias, and severe or uncontrolled heart failure. This drug has not been studied in patients with clinically significant active cardiovascular disease or recent myocardial infarction. Assess QT interval, electrolytes, and TSH at baseline and periodically during treatment, adjusting frequency based upon risk factors, including diarrhea or drug interactions. Correct hypokalemia, hypomagnesemia, and hypocalcemia prior to initiating therapy.
Bleeding Disorder
Moderate:selpercatinib
Selpercatinib has a moderate potential interaction with Bleeding Disorder.
Serious including fatal hemorrhagic events can occur with the use of selpercatinib. Care should be exercised when using this agent in patients with bleeding disorders. It is recommended to permanently discontinue treatment in patients with severe or life-threatening hemorrhage.
Cardiovascular Conditions and Disorders
Moderate:selpercatinib
Selpercatinib has a moderate potential interaction with Cardiovascular Conditions and Disorders.
Selpercatinib can cause concentration-dependent QT interval prolongation. Monitor patients who are at significant risk of developing QTc prolongation, including patients with known long QT syndromes, clinically significant bradyarrhythmias, and severe or uncontrolled heart failure. This drug has not been studied in patients with clinically significant active cardiovascular disease or recent myocardial infarction. Assess QT interval, electrolytes, and TSH at baseline and periodically during treatment, adjusting frequency based upon risk factors, including diarrhea or drug interactions. Correct hypokalemia, hypomagnesemia, and hypocalcemia prior to initiating therapy.
Cataract
Moderate:Predcor
The prednisoLONE in Predcor has a moderate potential interaction with Cataract.
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.
Cirrhosis
Moderate:Predcor
The prednisoLONE in Predcor has a moderate potential interaction with 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.
Depression
Moderate:Predcor
The prednisoLONE in Predcor has a moderate potential interaction with 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.
Diabetes Mellitus
Moderate:Predcor
The prednisoLONE in Predcor has a moderate potential interaction with Diabetes Mellitus.
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.
Diverticulitis
Moderate:Predcor
The prednisoLONE in Predcor has a moderate potential interaction with Diverticulitis.
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.
Electrolyte Abnormalities
Moderate:Predcor
The prednisoLONE in Predcor has a moderate potential interaction with 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.
Moderate:selpercatinib
Selpercatinib has a moderate potential interaction with Electrolyte Abnormalities.
Selpercatinib can cause concentration-dependent QT interval prolongation. Monitor patients who are at significant risk of developing QTc prolongation, including patients with known long QT syndromes, clinically significant bradyarrhythmias, and severe or uncontrolled heart failure. This drug has not been studied in patients with clinically significant active cardiovascular disease or recent myocardial infarction. Assess QT interval, electrolytes, and TSH at baseline and periodically during treatment, adjusting frequency based upon risk factors, including diarrhea or drug interactions. Correct hypokalemia, hypomagnesemia, and hypocalcemia prior to initiating therapy.
Fluid Retention
Moderate:Predcor
The prednisoLONE in Predcor has a moderate potential interaction with Fluid Retention.
Corticosteroids may cause hypernatremia, hypokalemia, fluid retention, and elevation in blood pressure. Large doses of any corticosteroid can demonstrate these effects, particularly if given for longer 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.
Glaucoma/Intraocular Hypertension
Moderate:Predcor
The prednisoLONE in Predcor has a moderate potential interaction with Glaucoma/Intraocular Hypertension.
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.
Heart Attack
Moderate:Predcor
The prednisoLONE in Predcor has a moderate potential interaction with Heart Attack.
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.
Heart Failure
Moderate:Predcor
The prednisoLONE in Predcor has a moderate potential interaction with Heart Failure.
Corticosteroids may cause hypernatremia, hypokalemia, fluid retention, and elevation in blood pressure. Large doses of any corticosteroid can demonstrate these effects, particularly if given for longer 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.
Moderate:selpercatinib
Selpercatinib has a moderate potential interaction with Heart Failure.
Selpercatinib can cause concentration-dependent QT interval prolongation. Monitor patients who are at significant risk of developing QTc prolongation, including patients with known long QT syndromes, clinically significant bradyarrhythmias, and severe or uncontrolled heart failure. This drug has not been studied in patients with clinically significant active cardiovascular disease or recent myocardial infarction. Assess QT interval, electrolytes, and TSH at baseline and periodically during treatment, adjusting frequency based upon risk factors, including diarrhea or drug interactions. Correct hypokalemia, hypomagnesemia, and hypocalcemia prior to initiating therapy.
Herpetic Keratitis
Moderate:Predcor
The prednisoLONE in Predcor has a moderate potential interaction with Herpetic Keratitis.
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.
High Blood Pressure
Moderate:Predcor
The prednisoLONE in Predcor has a moderate potential interaction with High Blood Pressure.
Corticosteroids may cause hypernatremia, hypokalemia, fluid retention, and elevation in blood pressure. Large doses of any corticosteroid can demonstrate these effects, particularly if given for longer 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.
Moderate:selpercatinib
Selpercatinib has a moderate potential interaction with High Blood Pressure.
Selpercatinib may cause hypertension and therapy should not be initiated in patients with uncontrolled hypertension. Care should be exercised when using this agent in hypertensive patients. Optimize blood pressure before starting treatment. It is recommended to monitor blood pressure after 1 week, and regularly as clinically indicated. Initiate or adjust anti-hypertensive therapy as appropriate. Withhold, reduce dose, or permanently discontinue treatment based on the severity.
High Cholesterol
Moderate:Predcor
The prednisoLONE in Predcor has a moderate potential interaction with High Cholesterol.
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.
History, Peptic Ulcer
Moderate:Predcor
The prednisoLONE in Predcor has a moderate potential interaction with History, 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 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.
History, Thrombotic/Thromboembolic Disorder
Moderate:Predcor
The prednisoLONE in Predcor has a moderate potential interaction with History, 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 who have or may be predisposed to thrombotic or thromboembolic disorders.
History, Tuberculosis
Moderate:Predcor
The prednisoLONE in Predcor has a moderate potential interaction with History, Tuberculosis.
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.
History - Myocardial Infarction
Moderate:selpercatinib
Selpercatinib has a moderate potential interaction with History - Myocardial Infarction.
Selpercatinib can cause concentration-dependent QT interval prolongation. Monitor patients who are at significant risk of developing QTc prolongation, including patients with known long QT syndromes, clinically significant bradyarrhythmias, and severe or uncontrolled heart failure. This drug has not been studied in patients with clinically significant active cardiovascular disease or recent myocardial infarction. Assess QT interval, electrolytes, and TSH at baseline and periodically during treatment, adjusting frequency based upon risk factors, including diarrhea or drug interactions. Correct hypokalemia, hypomagnesemia, and hypocalcemia prior to initiating therapy.
Hyperadrenocorticism
Moderate:Predcor
The prednisoLONE in Predcor has a moderate potential interaction with Hyperadrenocorticism.
Corticosteroids mimic the effects of endogenous cortisol and aldosterone. Use of these agents may aggravate conditions of hyperadrenocorticalism in a dose-dependent manner.
Hyperaldosteronism
Moderate:Predcor
The prednisoLONE in Predcor has a moderate potential interaction with Hyperaldosteronism.
Corticosteroids mimic the effects of endogenous cortisol and aldosterone. Use of these agents may aggravate conditions of hyperadrenocorticalism in a dose-dependent manner.
Hypernatremia
Moderate:Predcor
The prednisoLONE in Predcor has a moderate potential interaction with Hypernatremia.
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.
Hypocalcemia
Moderate:Predcor
The prednisoLONE in Predcor has a moderate potential interaction with Hypocalcemia.
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.
Moderate:selpercatinib
Selpercatinib has a moderate potential interaction with Hypocalcemia.
Selpercatinib can cause concentration-dependent QT interval prolongation. Monitor patients who are at significant risk of developing QTc prolongation, including patients with known long QT syndromes, clinically significant bradyarrhythmias, and severe or uncontrolled heart failure. This drug has not been studied in patients with clinically significant active cardiovascular disease or recent myocardial infarction. Assess QT interval, electrolytes, and TSH at baseline and periodically during treatment, adjusting frequency based upon risk factors, including diarrhea or drug interactions. Correct hypokalemia, hypomagnesemia, and hypocalcemia prior to initiating therapy.
Hypokalemia
Moderate:Predcor
The prednisoLONE in Predcor has a moderate potential interaction with Hypokalemia.
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.
Moderate:selpercatinib
Selpercatinib has a moderate potential interaction with Hypokalemia.
Selpercatinib can cause concentration-dependent QT interval prolongation. Monitor patients who are at significant risk of developing QTc prolongation, including patients with known long QT syndromes, clinically significant bradyarrhythmias, and severe or uncontrolled heart failure. This drug has not been studied in patients with clinically significant active cardiovascular disease or recent myocardial infarction. Assess QT interval, electrolytes, and TSH at baseline and periodically during treatment, adjusting frequency based upon risk factors, including diarrhea or drug interactions. Correct hypokalemia, hypomagnesemia, and hypocalcemia prior to initiating therapy.
Infection
Major:Predcor
The prednisoLONE in Predcor has a major potential interaction with Infection.
The immunosuppressant and anti-inflammatory effects of corticosteroids, particularly at higher dosages, may reduce resistance to infectious agents, increase the risk of disseminated infections, mask symptoms of infection, and reactivate or exacerbate latent/resolved infections; fatal cases have been reported. Avoid use of corticosteroids in patients with cerebral malaria. Screen patients for active (or history of) infection with tuberculosis, hepatitis, varicella, measles, and amebiasis, especially prior to prolonged treatment. Closely monitor for reactivation of latent infections; chemoprophylaxis may be required. In general, corticosteroids should not be used in patients with active infections, especially systemic fungal infections, unless medically necessary to control drug reactions. 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.
Interstitial Lung Disease
Moderate:selpercatinib
Selpercatinib has a moderate potential interaction with Interstitial Lung Disease.
Selpercatinib may cause severe, life-threatening, or fatal interstitial lung disease (ILD)/pneumonitis. Monitor for new or worsening pulmonary symptoms. Withhold therapy and promptly investigate acute or worsening respiratory symptoms suggestive of ILD/pneumonitis (e.g., dyspnea, cough, and fever).
Intestinal Anastomoses
Moderate:Predcor
The prednisoLONE in Predcor has a moderate potential interaction with Intestinal Anastomoses.
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.
Liver Disease
Moderate:Predcor
The prednisoLONE in Predcor has a moderate potential interaction with 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.
Moderate:selpercatinib
Selpercatinib has a moderate potential interaction with Liver Disease.
Selpercatinib is metabolized predominantly by CYP450 3A4. The dose of selpercatinib should be reduced in patients with severe hepatic impairment. No dosage modification is recommended for patients with mild or moderate hepatic impairment. Serious hepatic adverse reactions have been reported in patients treated with selpercatinib. Monitor ALT and AST before starting therapy with selpercatinib, every two weeks during the first three months, then monthly thereafter and as clinically indicated. It is recommended to withhold, reduce dose or permanently discontinue treatment based on the severity of selpercatinib-related adverse reactions in patients with hepatic impairment.
Long QT Syndrome
Moderate:selpercatinib
Selpercatinib has a moderate potential interaction with Long QT Syndrome.
Selpercatinib can cause concentration-dependent QT interval prolongation. Monitor patients who are at significant risk of developing QTc prolongation, including patients with known long QT syndromes, clinically significant bradyarrhythmias, and severe or uncontrolled heart failure. This drug has not been studied in patients with clinically significant active cardiovascular disease or recent myocardial infarction. Assess QT interval, electrolytes, and TSH at baseline and periodically during treatment, adjusting frequency based upon risk factors, including diarrhea or drug interactions. Correct hypokalemia, hypomagnesemia, and hypocalcemia prior to initiating therapy.
Magnesium Imbalance
Moderate:selpercatinib
Selpercatinib has a moderate potential interaction with Magnesium Imbalance.
Selpercatinib can cause concentration-dependent QT interval prolongation. Monitor patients who are at significant risk of developing QTc prolongation, including patients with known long QT syndromes, clinically significant bradyarrhythmias, and severe or uncontrolled heart failure. This drug has not been studied in patients with clinically significant active cardiovascular disease or recent myocardial infarction. Assess QT interval, electrolytes, and TSH at baseline and periodically during treatment, adjusting frequency based upon risk factors, including diarrhea or drug interactions. Correct hypokalemia, hypomagnesemia, and hypocalcemia prior to initiating therapy.
Myasthenia Gravis
Moderate:Predcor
The prednisoLONE in Predcor has a moderate potential interaction with 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.
Myoneural Disorder
Moderate:Predcor
The prednisoLONE in Predcor has a moderate potential interaction with 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 (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.
Myopathy
Moderate:Predcor
The prednisoLONE in Predcor has a moderate potential interaction with Myopathy.
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.
Osteoporosis
Moderate:Predcor
The prednisoLONE in Predcor has a moderate potential interaction with 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.
Peptic Ulcer
Moderate:Predcor
The prednisoLONE in Predcor has a moderate potential interaction with 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 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.
Post MI Syndrome
Moderate:Predcor
The prednisoLONE in Predcor has a moderate potential interaction with 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.
Prematurity/Underweight in Infancy
Major:Predcor
The prednisoLONE in Predcor has a major potential interaction with 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.
Psychosis
Moderate:Predcor
The prednisoLONE in Predcor has a moderate potential interaction with Psychosis.
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.
Renal Dysfunction
Moderate:Predcor
The prednisoLONE in Predcor has a moderate potential interaction with Renal Dysfunction.
Corticosteroids may cause hypernatremia, hypokalemia, fluid retention, and elevation in blood pressure. Large doses of any corticosteroid can demonstrate these effects, particularly if given for longer 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.
Moderate:selpercatinib
Selpercatinib has a moderate potential interaction with Renal Dysfunction.
A recommended dose of selpercatinib has not been established for patients with end-stage renal disease. No dosage modification is recommended for patients with mild to severe renal impairment. The use of selpercatinib may increase serum creatinine. It is recommended to consider alternative markers of renal function if persistent elevations in serum creatinine are observed.
Moderate:selpercatinib
Selpercatinib has a moderate potential interaction with Renal Dysfunction.
Tumor lysis syndrome has been reported with use of selpercatinib in patients with medullary thyroid carcinoma. Patients with rapidly growing tumors, a high tumor burden, renal dysfunction, or dehydration who take selpercatinib may be at increased risk. Closely monitor at-risk patients and consider appropriate prophylaxis, including hydration.
Seizures
Moderate:Predcor
The prednisoLONE in Predcor has a moderate potential interaction with Seizures.
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.
Strongyloidiasis
Moderate:Predcor
The prednisoLONE in Predcor has a moderate potential interaction with 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. For patients on corticosteroids who develop known or suspected Strongyloides infestation, withdrawal of corticosteroids or reduction of the dose of corticosteroids is recommended.
Systemic Sclerosis
Moderate:Predcor
The prednisoLONE in Predcor has a moderate potential interaction with 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.
Thrombotic/Thromboembolic Disorder
Moderate:Predcor
The prednisoLONE in Predcor has a moderate potential interaction with 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 who have or may be predisposed to thrombotic or thromboembolic disorders.
Thyroid Disease
Moderate:selpercatinib
Selpercatinib has a moderate potential interaction with Thyroid Disease.
Selpercatinib can cause concentration-dependent QT interval prolongation. Monitor patients who are at significant risk of developing QTc prolongation, including patients with known long QT syndromes, clinically significant bradyarrhythmias, and severe or uncontrolled heart failure. This drug has not been studied in patients with clinically significant active cardiovascular disease or recent myocardial infarction. Assess QT interval, electrolytes, and TSH at baseline and periodically during treatment, adjusting frequency based upon risk factors, including diarrhea or drug interactions. Correct hypokalemia, hypomagnesemia, and hypocalcemia prior to initiating therapy.
Tuberculosis, Latent
Moderate:Predcor
The prednisoLONE in Predcor has a moderate potential interaction with 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.
Tumor Lysis Syndrome
Moderate:selpercatinib
Selpercatinib has a moderate potential interaction with Tumor Lysis Syndrome.
Tumor lysis syndrome has been reported with use of selpercatinib in patients with medullary thyroid carcinoma. Patients with rapidly growing tumors, a high tumor burden, renal dysfunction, or dehydration who take selpercatinib may be at increased risk. Closely monitor at-risk patients and consider appropriate prophylaxis, including hydration.
Ulcerative Colitis
Moderate:Predcor
The prednisoLONE in Predcor has a moderate potential interaction with 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 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.
Underactive Thyroid
Moderate:Predcor
The prednisoLONE in Predcor has a moderate potential interaction with Underactive Thyroid.
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.
Drug Interaction Classification
| Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. | |
| Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. | |
| 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. | |
| No interaction information available. |
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