Drug Interaction Report

ADJUST DOSING INTERVAL: Concurrent administration of bile acid sequestrants may delay and/or decrease the absorption of oral corticosteroids. Bile acid sequestrants can bind certain drugs in the intestine to form an insoluble complex that is excreted in the feces. Reduced bioavailability of hydrocortisone has been reported during concomitant administration with cholestyramine and colestipol. It is not known whether the interaction occurs with other bile acid binding resins such as colesevelam or with corticosteroids other than hydrocortisone, but the possibility should be considered.

MANAGEMENT: Oral corticosteroids should be administered at least 1 hour before or 4 to 6 hours after a cholestyramine or colestipol dose, and at least 4 hours before a colesevelam dose.

MONITOR: Coadministration of two or more sympathomimetic agents may increase the risk of adverse effects such as nervousness, irritability, and increased heart rate. Central nervous system (CNS) stimulants, particularly amphetamines, can potentiate the adrenergic response to vasopressors and other sympathomimetic agents. Additive increases in blood pressure and heart rate may occur due to enhanced peripheral sympathetic activity.

MANAGEMENT: Caution is advised if two or more sympathomimetic agents are coadministered. Pulse and blood pressure should be closely monitored.