Drug Interaction Report

GENERALLY AVOID: Administration of intravesical BCG during immunosuppressive corticosteroid therapy may be associated with a risk of disseminated infection due to enhanced replication of the BCG strain of Mycobacterium bovis in the presence of diminished immune competence. Deaths have been reported as a result of systemic BCG infection and sepsis. Patients may be immunosuppressed if they have recently received or are receiving high dosages of corticosteroids or adrenocorticotropic agents (e.g., greater than or equal to 2 mg/kg/day or 20 mg/day of prednisone or equivalent for 14 consecutive days or more), or long-term topical or inhaled corticosteroids. In addition, these patients may not develop an adequate immune response to BCG, which would reduce its anti-tumor efficacy.

MANAGEMENT: In general, intravesical BCG should not be used in patients receiving immunosuppressive corticosteroid therapy. Patients who have been treated with topical or inhaled corticosteroids for a prolonged period should be evaluated to determine if they are immunosuppressed prior to receiving intravesical BCG.