What is the difference between diprolene and diprolene af

In rare cases, a person who uses corticosteroids on their skin may experience hypothalamic-pituitary-adrenal HPA axis suppression and adrenal insufficiency. The HPA axis produces steroids that control and regulate many body functions. When people use corticosteroids, the body may stop producing steroids. As a result, the adrenal glands may shrink and stop working properly. Although HPA suppression is rare, it is more common if a person:.

When people use betamethasone appropriately, they will rarely experience this serious side effect. Young children are more susceptible to HPA axis suppression because of their larger skin surface to body weight ratio. Betamethasone injections can interact with many drugs. There are no data available on the safety of using betamethasone topically during pregnancy.

Doctors will only prescribe betamethasone skin products during pregnancy if the benefits of use outweigh the possible risks.

Betamethasone is an effective anti-inflammatory treatment that doctors prescribe in injectable and topical forms. There are many topical options that people can use to treat skin conditions that cause inflammation and redness. People use each of the different forms of betamethasone differently, and some products are expensive. Allergic reactions are numerous and varied, and the best treatments depend on the specific symptoms, such as rashes or sinus problems, and their….

Itchy skin can result from various conditions, including allergies and eczema. Here, learn about some causes and treatment options, including home…. What to know about betamethasone. Medically reviewed by Zara Risoldi Cochrane, Pharm. What is it? Types and uses How it works Dosage Side effects Warnings Interactions Pregnancy Cost Summary Betamethasone is a corticosteroid that doctors use to treat skin conditions that cause inflammation and itchiness.

What is betamethasone? Types and uses. Share on Pinterest Doctors may prescribe betamethasone to treat various skin conditions. How does betamethasone work? How to use and dosage. Approval: Risk factor s include the use of high-potency topical corticosteroids, use over a large surface area or to areas under occlusion, prolonged use, altered skin barrier, liver failure, and use in pediatric patients.

Modify use should HPA axis suppression develop. If visual symptoms occur, consider referral to an ophthalmologist for evaluation. Avoid contact with eyes. Wash hands after each application.

Avoid use on the face, groin, or axillae, or if skin atrophy is present at the treatment site. It is not for oral, ophthalmic, or intravaginal use. Data Animal Data Betamethasone dipropionate has been shown to cause malformations in rabbits when given by the intramuscular route at doses of 0.

Inform patients of the following: Discontinue therapy when control is achieved, unless directed otherwise by the physician. Use no more than 50 grams per week. Avoid contact with the eyes. Advise patients to report any visual symptoms to their healthcare providers. Do not occlude the treatment area with bandage or other covering, unless directed by the physician. Note that local reactions and skin atrophy are more likely to occur with occlusive use, prolonged use or use of higher potency corticosteroids.

Food and Drug Administration. DIPROLENE AF Cream is a prescription corticosteroid medicine used on the skin topical for the relief of redness, swelling, heat, pain inflammation and itching, caused by certain skin problems in people 13 years of age and older. Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Especially tell your healthcare provider if you take other corticosteroid medicines by mouth or injection or use other products on your skin or scalp that contain corticosteroids.

Do not bandage, cover, or wrap the treated skin area unless your healthcare provider tells you to. Your healthcare provider may do blood tests to check for adrenal gland problems. Cushing's syndrome, a condition that happens when your body is exposed to too much of the hormone cortisol.

High blood sugar hyperglycemia. Effects on growth and weight in children. Vision problems. Skin problems. Your healthcare provider may do certain blood tests to check for side effects. Call your doctor for medical advice about side effects. Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. It may harm them. Rx only. Version Files Sep 15, 18 current download Nov 16, 17 download Jul 10, 16 download May 14, 15 download Apr 10, 12 download May 17, 10 download Oct 17, 9 download Aug 16, 6 download Jun 23, 5 download Jul 25, 4 download Dec 10, 2 download Oct 12, 1 download.

NDC 1 2 This Patient Information has been approved by the U. Dosage may be increased in stubborn cases.

Following improvement, apply lotion once daily. Apply twice daily to the affected area s of the scalp, morning and night. Discontinue use when control is achieved. If no improvement within 2 weeks, reassess the diagnosis. Apply topically to the affected area s twice daily.

Rub in gently. Do not use on the face, groin, axilla or other intertriginous areas. Do not use if atropy is present at the affected area. Discontinue treatment once condition is under control. Treatment for longer than 4 weeks is not recommended. Occlusive dressings may be used for the management of psoriasis, as long as infection is not present. Apply topically to the affected area s of the scalp twice daily, morning and night. Discontinue when control achieved. If no improvement after 2 weeks, re-evaluate diagnosis.

Dosage requirements are variable and must be individualized. After a favorable response is noted, the proper maintenance dosage should be determined by decreasing the initial drug dosage in small decrements at appropriate time intervals until the lowest dosage which will maintain an adequate clinical response is reached.

A single course of corticosteroids may also be considered starting at 23 weeks gestation for pregnant women who are at risk of preterm delivery within 7 days, regardless of membrane status. However, no additional benefit has been demonstrated for courses of antenatal steroids with shorter dosage intervals than those recommended, often referred to as accelerated dosing, even when delivery is imminent.

A repeat or rescue course of corticosteroids may be considered in women who are less than 34 weeks gestation, who are at risk of preterm delivery within the next 7 days, and whose prior course of antenatal corticosteroids was administered more than 14 days previously.

Rescue course corticosteroids could be provided as early as 7 days from the prior dose if indicated by clinical situation. Corticosteroid dosage must be individualized and is highly variable depending on the nature and severity of the disease, route of treatment, and on patient response.

Betamethasone dipropionate augmented topical products e. Specific guidelines for dosage adjustments in hepatic impairment are not available; it appears that no dosage adjustments are needed. Specific guidelines for dosage adjustments in renal impairment are not available; it appears that no dosage adjustments are needed. Administer with meals to minimize indigestion or gastric irritation. If given once daily, administer in the morning to coincide with the body's normal cortisol secretion. Visually inspect parenteral products for particulate matter and discoloration prior to administration whenever solution and container permit.

If coadministration of a local anesthetic is desired with betamethasone sodium phosphate; betamethasone acetate injectable suspension, do not use anesthetics containing preservatives e.

Similar local anesthetics may also be used. Do not inject the anesthetic into the vial containing betamethasone; withdraw betamethasone into a syringe, then draw the local anesthetic into the same syringe and shake briefly. Direct intravenous injection: Use only betamethasone sodium phosphate. Administer slowly into a vein over at least 1 minute.

Intermittent intravenous infusion: Use only betamethasone sodium phosphate. Infuse slowly at a rate prescribed by the physician. Betamethasone sodium phosphate; betamethasone acetate injectable suspension may be administered intramuscularly. Intra-articular, Intra-bursal, Intradermal, or Intralesional injection Administration of betamethasone via these routes require specialized techniques.

Only clinicians familiar with these methods of administration and with management of potential complications should administer betamethasone by these routes.

For acute subdeltoid, subacromial, olecranon, and prepatellar bursitis, inject into the affected tendon sheaths rather than into the tendons themselves. In ganglions of joint capsules and tendon sheaths, injection of 0. For intra-articular injection, insert a to gauge needle on an empty syringe into the synovial cavity and withdraw a few drops of synovial fluid to confirm that the needle is in the joint.

Replace the aspirating syringe with a syringe containing betamethasone suspension, and inject into the joint. For intralesional treatment, inject betamethasone suspension intradermally not subcutaneously using a tuberculin syringe with a gauge, half-inch needle. Care should be taken to deposit a uniform depot of medication intradermally.

A tuberculin syringe with a gauge, three-fourth-inch needle is suitable for most injections into the foot. Betamethasone dipropionate and valerate are used topically.

Betamethasone valerate may be used with occlusive dressings for the management of psoriasis or recalcitrant conditions. Betamethasone dipropionate in augmented vehicles should NOT be used with occlusive dressings; instruct patients using these formulations not to bandage, cover, or wrap area in any way that may be occlusive.

Using gloves, apply sparingly in a thin film and rub gently into the cleansed, slightly moist affected area. Gel: Using gloves, apply sparingly in a thin film and rub gently into the cleansed, slightly moist affected area.

Scalp foam: Invert can and dispense a small amount of foam onto a saucer or other cool surface. Do not dispense directly onto hands because foam will begin to melt immediately upon contact with warm skin. Pick up small amounts of foam with fingers and gently massage into affected area until foam disappears. Repeat until entire affected scalp area is treated. Topical Spray: Avoid use on the face, scalp, axilla, groin, or other intertriginous areas.

Shake well before use. Wash hands before and after treatment. Spray directly onto the affected skin areas; rub in gently but completely. Once spray is in use, any unused spray should be discarded after 28 days. Acute adrenal insufficiency and even death may occur following abrupt discontinuation of prolonged systemic therapy.

In addition, a withdrawal syndrome unrelated to adrenocortical insufficiency may occur following sudden discontinuation of corticosteroid therapy.

These effects are thought to be due to the sudden change in glucocorticoid concentration rather than to low corticosteroid levels. Withdrawal from prolonged systemic corticosteroid therapy should be gradual.

HPA suppression can last for up to 12 months following cessation of systemic therapy. Recovery of HPA axis function is generally prompt and complete upon discontinuation of the topical corticosteroid. HPA-suppressed patients may need supplemental corticosteroid treatment during periods of physiologic stress, such as surgical procedures, acute blood loss, or sepsis, even after the corticosteroid has been discontinued.

The naturally occurring corticosteroids i. Conditions that increase systemic absorption of topical corticosteroids include use over large surface areas, prolonged use, use in areas where the epidermal barrier is disrupted i. Occlusive dressings should not be used with augmented formulations of topical betamethasone e.

Diapers or plastic pants may be considered occlusive dressings, therefore, topical betamethasone should not be used for the treatment of diaper dermatitis. If these effects are noted, an attempt should be made to withdraw the drug, to reduce the frequency of application, or to substitute a less potent corticosteroid. The efficacy and safety of corticosteroids in the pediatric population are based on the well-established course of effect of corticosteroids, which is similar in children and adult populations.

Chronic corticosteroid therapy e. The smallest dosage producing the desired clinical response should be used. The effects are not limited to systemic therapy; neonates, infants, and children may absorb proportionally larger amounts of topical corticosteroids than adults due to a larger skin surface area to body weight ratio, and therefore are more susceptible to developing systemic toxicity, especially with very-high-potency products.

Hypothalamic-pituitary-adrenal HPA axis suppression, Cushing's syndrome, growth inhibition, and increased intracranial pressure have been reported in children receiving topical corticosteroids. Some betamethasone topical products are more likely to cause systemic effects in children; the use of augmented formulations of topical betamethasone e.

The proportion of patients with adrenal suppression in this study was progressively greater the younger the age group. Occlusive dressings may increase systemic exposure in children and infants; parents or caregivers of pediatric patients should be advised not to use tight-fitting diapers or plastic pants on a child being treated topically in the diaper area, as these garments may constitute occlusive dressings.

Patients receiving high-dose e. Topical corticosteroids cause localized immunosuppression as part of their pharmacologic effect; although, systemic responses are possible. When betamethasone is given in combination with other immunosuppressive agents, there is a risk of over-immunosuppression. Systemic corticosteroid therapy can mask the symptoms of infection and should not be used in cases of viral infection, fungal infection, or bacterial infection that are not adequately controlled by antiinfective agents.

Although the manufacturers state that systemic betamethasone is not recommended in patients with systemic fungal infections, most clinicians believe that systemic corticosteroids can be administered to these patients as long as appropriate antiinfective therapy is administered simultaneously. Systemic corticosteroids can reactivate tuberculosis and should not be used in patients with a history of active tuberculosis, except when chemoprophylaxis is instituted concomitantly.

Patients receiving immunosuppressive doses of systemic corticosteroids should be advised to avoid exposure to viral infections i. Pediatric patients dependent on systemic corticosteroids should undergo anti-varicella-zoster virus antibody testing.

In addition, corticosteroids should be used with caution in patients with known or suspected Strongyloides threadworm infestation; patients that are immunosuppressed secondary to corticosteroid therapy may acquire Strongyloides hyperinfection and dissemination with widespread larval migration, which may be accompanied by severe enterocolitis and potentially fatal gram-negative septicemia.

Application of topical corticosteroids to areas of infection, including tuberculosis of the skin, dermatologic fungal infection, and cutaneous or systemic viral infection e. If the infection does not respond to the antimicrobial therapy, the concurrent use of the topical corticosteroid should be discontinued until the infection is controlled. Topical corticosteroids should not be used to treat acne vulgaris, acne rosacea, or perioral dermatitis as they may exacerbate these conditions.

Topical corticosteroids may delay the healing of non-infected wounds, such as venous stasis ulcers. Use topical betamethasone preparations with caution in patients with markedly impaired circulation or peripheral vascular disease; skin ulceration has been reported in these patients following topical corticosteroid use.

Exposure to physiologic stress, such as surgery, may produce adrenocortical and pituitary unresponsiveness in patients receiving chronic systemic corticosteroid therapy. If surgery is required, patients should advise their physician that they received systemic betamethasone therapy within the last 12 months and state the disease for which they were being treated.

Identification cards that include disease state, type and dose of corticosteroid, and physician should always be carried with the patient. In patients on corticosteroid therapy subjected to any unusual stress, hydrocortisone or cortisone is the drug of choice as a supplement during and after the event. Systemic corticosteroid therapy has been associated with left ventricular free-wall rupture in patients with recent myocardial infarction.

Betamethasone use should be employed with extreme caution in these patients. Systemic corticosteroids can cause edema and weight gain. Patients with congestive heart failure or hypertension can have an exacerbation of their condition. Systemic betamethasone should be used with caution in these patients. The risks and benefits of systemic corticosteroid therapy should be considered for any individual patient.

Prolonged systemic corticosteroid therapy can lead to osteoporosis, vertebral compression fractures, aseptic necrosis of femoral and humoral heads, and pathologic fractures of long bones secondary to protein catabolism.

Use systemic betamethasone cautiously in elderly, debilitated, or postmenopausal patients because they are especially susceptible to these adverse effects. A high-protein diet may alleviate or prevent the adverse effects associated with protein catabolism. Systemically absorbed corticosteroids may decrease glucose tolerance, produce hyperglycemia, and aggravate or precipitate diabetes mellitus.

This may especially occur in patients predisposed to diabetes mellitus. Topical corticosteroids should be used with caution in patients with diabetes mellitus; due to the potential for delay healing of skin ulcers or the presence of microvascular complications of the skin and surrounding tissues.

Systemic corticosteroids such as betamethasone should be used with caution in active or latent peptic ulcer disease, diverticulitis, fresh intestinal anastomoses fistula , and nonspecific ulcerative colitis, since they may increase the risk of gastrointestinal perforation GI perforation. Signs of peritoneal irritation following GI perforation in patients receiving systemic corticosteroids may be minimal or absent.

As sodium retention with resultant edema and potassium loss may occur in patients receiving corticosteroids, these agents should be used with caution in patients with renal disease or insufficiency. Systemic corticosteroids should be used with extreme caution in patients with psychosis, emotional instability, and seizure disorder because corticosteroids can exacerbate these conditions.

Patients with hepatic disease, such as cirrhosis, can have an exaggerated response to systemic corticosteroids. Metabolic clearance of corticosteroids is decreased in hypothyroidism and increased in hyperthyroidism; changes in the thyroid disease status of the patient may necessitate adjustment in dosage.

An acute myopathy has been observed with the use of high doses of systemic corticosteroids, most often occurring in patients with disorders of neuromuscular transmission e.

This acute myopathy is generalized, may involve ocular and respiratory muscles, and may result in quadriparesis. Elevation of creatinine kinase may occur. Clinical improvement or recovery after stopping corticosteroids may require weeks to years.

Systemic corticosteroids rarely may increase blood coagulability, causing intravascular thrombosis, thrombophlebitis, and thromboembolism.

Therefore, systemic betamethasone should be used with caution in patients with preexisting thromboembolic disease. Intramuscular corticosteroid preparations like betamethasone acetate-betamethasone sodium phosphate injection i. Treatment with systemic or topical corticosteroids, including betamethasone, may increase the risk for posterior subcapsular cataracts and glaucoma exacerbation; therefore, caution is advised when considering use of these products in patients with glaucoma, cataracts, or other visual problems.

There is also an increase in the propensity for secondary ocular infection caused by fungal or viral infections. Patients receiving corticosteroids chronically should be periodically assessed for cataract formation, intraocular pressure, glaucoma, or any other visual disturbance. Consider referring patients who develop ocular symptoms or use corticosteroid-containing products for more than 6 weeks to an ophthalmologist for evaluation. Avoid ocular exposure to betamethasone during product use; topical betamethasone products are generally not recommended for use on the face, groin, or axillae.

Preexisting glaucoma may be aggravated if betamethasone is applied in the periorbital area. Visual impairment, ocular hypertension and worsened cataracts have been reported with ocular exposure to other high potency topical corticosteroids.

To prevent accidental ocular exposure wash hands after each application. Systemic betamethasone use should be approached with caution during pregnancy and should be used during pregnancy only when the anticipated benefit outweighs the potential fetal risk.

Complications, including cleft palate, still birth, and premature abortion, have been reported when systemic corticosteroids were administered during pregnancy.

If systemic betamethasone must be used chronically during pregnancy, the potential risks should be discussed with the patient. Infants born to women receiving large doses of systemic corticosteroids during pregnancy should be monitored for signs of adrenal insufficiency, and appropriate therapy should be initiated, if necessary. Betamethasone suspension for injection has been used off-label in later stages of pregnancy to induce fetal lung maturation in patients at risk for pre-term birth, but use is typically limited to select circumstances.

Topical use of betamethasone during pregnancy should also be approached with caution. Topical corticosteroids, including betamethasone, should not be used in large amounts, on large areas, or for prolonged periods of time in pregnant women.

Guidelines recommend mild to moderate potency agents over potent corticosteroids, which should be used in short durations. Fetal growth restriction and a significantly increased risk of low birthweight has been reported with use of potent or very potent topical corticosteroids during the third trimester, particularly when using more than grams.

Corticosteroids are generally teratogenic in laboratory animals when administered systemically at relatively low dosage levels. The more potent corticosteroids have been shown to be teratogenic after dermal application in laboratory animals. Caution should be exercised when systemic corticosteroids are prescribed during breast-feeding.

Systemically administered corticosteroids appear in human milk in small quantities, and while not likely to have a deleterious effect in most infants, could suppress growth, interfere with endogenous corticosteroid production, or cause other untoward effects. However, reviewers and an expert panel consider oral corticosteroids acceptable to use during breast-feeding.

Alternative systemic agents, such as prednisone and prednisolone, are also usually considered compatible with breast-feeding. It is not known whether topical administration of betamethasone could result in sufficient systemic absorption to produce detectable quantities in breast milk.

However, most dermatologists stress that topical corticosteroids can be safely used during lactation and breast-feeding. If applied topically, care should be used to ensure the infant will not come into direct contact with the area of application, such as the breast. Increased blood pressure has been reported in an infant whose mother applied a high potency topical corticosteroid ointment directly to the nipples. Consider therapy with less-potent topical agents, like hydrocortisone or triamcinolone, in nursing mothers requiring long-term therapy with a topical corticosteroid.

Consider the benefits of breast-feeding, the risk of potential infant drug exposure, and the risk of an untreated or inadequately treated condition. If a breast-feeding infant experiences an adverse effect related to a maternally ingested drug, healthcare providers are encouraged to report the adverse effect to the FDA.

Corticosteroid therapy e. In general, patients with severe immunosuppression due to large doses of corticosteroids should not receive vaccination with live-virus vaccines. When cancer chemotherapy or immunosuppressive therapy is being considered e. Patients vaccinated while on immunosuppressive therapy or in the 2 weeks prior to starting therapy should be considered unimmunized and should be revaccinated at least 3 months after discontinuation of therapy.

Some commercially available formulations of betamethasone may contain sulfites. Sulfites may cause allergic reactions in some people.

They should be used with caution in patients with known sulfite hypersensitivity. Patients with asthma are more likely to experience this sensitivity reaction than non-asthmatic patients. Do not give betamethasone acetate formulations e.

Epidural administration of corticosteroids should be used with great caution. Rare, but serious adverse reactions, including cortical blindness, stroke, spinal cord infarction, paralysis, seizures, nerve injury, brain edema, and death have been associated with epidural administration of injectable corticosteroids. These events have been reported with and without the use of fluoroscopy. Many cases were temporally associated with the corticosteroid injection; reactions occurred within minutes to 48 hours after injection.

Some cases of neurologic events were confirmed through magnetic resonance imaging MRI or computed tomography CT scan. Many patients did not recover from the reported adverse effects. Discuss the benefits and risks of epidural corticosteroid injections with the patient before treatment.

If a decision is made to proceed with corticosteroid epidural administration, counsel patients to seek emergency medical attention if they experience symptoms after injection such as vision changes, tingling in the arms or legs, dizziness, severe headache, seizures, or sudden weakness or numbness of face, arm, or leg. Although true corticosteroid hypersensitivity is rare, betamethasone is contraindicated in patients with a prior hypersensitivity reaction to betamethasone or other corticosteroids.

It is advisable that patients who have a hypersensitivity reaction to any corticosteroid undergo skin testing, which, although not a conclusive predictor, may help to determine if hypersensitivity to another corticosteroid exists.

Such patients should be carefully monitored during and following the administration of any corticosteroid. The international Corticosteroid Randomization After Significant Head injury CRASH collaborators noted an increase in early mortality at 2 weeks and late mortality at 6 months in patients with head trauma treated with high dose methylprednisolone who were determined not to have other clear indications for corticosteroid treatment.

The study did not include cause of death data but did note an association between steroid treatment and higher mortality rates without determining a causal relationship. The authors suggest that corticosteroids should not be used routinely to treat patients with head trauma. Corticosteroids can cause skin atrophy with topical application. Elderly patients may be more likely to have preexisting skin atrophy secondary to aging; therefore, purpura and skin lacerations that may raise the skin and subcutaneous tissue from deep fascia may be more likely to occur with the use of topical corticosteroids in such patients.

According to the Beers Criteria, systemic corticosteroids are considered potentially inappropriate medications PIMs for use in geriatric patients with delirium or at high risk for delirium and should be avoided in these patient populations due to the possibility of new-onset delirium or exacerbation of the current condition.

The Beers expert panel notes that oral and parenteral corticosteroids may be required for conditions such as exacerbation of chronic obstructive pulmonary disease COPD but should be prescribed in the lowest effective dose and for the shortest possible duration. The federal Omnibus Budget Reconciliation Act OBRA regulates medication use in residents of long-term care facilities; the need for continued use of a systemic glucocorticoid should be documented, along with monitoring for adverse consequences during intermediate or longer-term use.

Abatacept: Moderate Concomitant use of immunosuppressives, as well as long-term corticosteroids, may potentially increase the risk of serious infection in abatacept treated patients. Advise patients taking abatacept to seek immediate medical advice if they develop signs and symptoms suggestive of infection.

While there is controversy regarding the ulcerogenic potential of corticosteroids alone, concomitant administration of corticosteroids with aspirin may increase the GI toxicity of aspirin and other non-acetylated salicylates. Withdrawal of corticosteroids can result in increased plasma concentrations of salicylate and possible toxicity. Although some patients may need to be given corticosteroids and NSAIDs concomitantly, which can be done successfully for short periods of time without sequelae, prolonged coadministration should be avoided.

Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Monitor patients for increased pressor effect if these agents are administered concomitantly. Acetaminophen; Chlorpheniramine; Phenylephrine : Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.

Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.

Acetaminophen; Dextromethorphan; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Acetaminophen; Guaifenesin; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Acetazolamide: Moderate Corticosteroids may increase the risk of hypokalemia if used concurrently with acetazolamide.

Hypokalemia may be especially severe with prolonged use of corticotropin, ACTH. Acetohexamide: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Systemic and inhaled corticosteroids are known to increase blood glucose and worsen glycemic control in patients taking antidiabetic agents.

The main risk factors for impaired glucose tolerance due to corticosteroids are the dose of steroid and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance.

Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. Adalimumab: Moderate Closely monitor for the development of signs and symptoms of infection if coadministration of a corticosteroid with adalimumab is necessary. Adalimumab treatment increases the risk for serious infections that may lead to hospitalization or death.

Patients taking concomitant immunosuppressants including corticosteroids may be at greater risk of infection. Albiglutide: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued.

Alemtuzumab: Moderate Concomitant use of alemtuzumab with immunosuppressant doses of corticosteroids may increase the risk of immunosuppression. Monitor patients carefully for signs and symptoms of infection. Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids.

Monitoring serum potassium levels and cardiac function is advised, and potassium supplementation may be required. Aliskiren; Hydrochlorothiazide, HCTZ: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids.

Alogliptin; Metformin: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Alpha-glucosidase Inhibitors: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued.

Altretamine: Minor Concurrent use of altretamine with other agents which cause bone marrow or immune suppression such as corticosteroids may result in additive effects. Ambenonium Chloride: Moderate Concomitant use of anticholinesterase agents, such as ambenonium chloride, and corticosteroids may produce severe weakness in patients with myasthenia gravis. If possible, anticholinesterase agents used to treat myasthenia should be withdrawn at least 24 hours before initiating corticosteroid therapy.

Amifampridine: Moderate Carefully consider the need for concomitant treatment with systemic corticosteroids and amifampridine, as coadministration may increase the risk of seizures. If coadministration occurs, closely monitor patients for seizure activity. Seizures have been observed in patients without a history of seizures taking amifampridine at recommended doses.

Systemic corticosteroids may increase the risk of seizures in some patients. Amiloride; Hydrochlorothiazide, HCTZ: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids. Aminolevulinic Acid: Minor Corticosteroids administered prior to or concomitantly with photosensitizing agents used in photodynamic therapy may decrease the efficacy of the treatment.

Amlodipine; Valsartan; Hydrochlorothiazide, HCTZ: Moderate Additive hypokalemia may occur when non-potassium sparing diuretics, including thiazide diuretics, are coadministered with other drugs with a significant risk of hypokalemia, such as corticosteroids. Amoxicillin; Clarithromycin; Omeprazole: Moderate Monitor for corticosteroid-related adverse effects if coadministration is necessary.

Amphotericin B cholesteryl sulfate complex ABCD : Moderate The potassium-wasting effects of corticosteroid therapy can be exacerbated by concomitant administration of other potassium-depleting drugs including amphotericin B.

Serum potassium levels should be monitored in patients receiving these drugs concomitantly. Amphotericin B lipid complex ABLC : Moderate The potassium-wasting effects of corticosteroid therapy can be exacerbated by concomitant administration of other potassium-depleting drugs including amphotericin B.

Amphotericin B liposomal LAmB : Moderate The potassium-wasting effects of corticosteroid therapy can be exacerbated by concomitant administration of other potassium-depleting drugs including amphotericin B. Amphotericin B: Moderate The potassium-wasting effects of corticosteroid therapy can be exacerbated by concomitant administration of other potassium-depleting drugs including amphotericin B. Argatroban: Moderate Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention.

Assess sodium chloride intake from all sources, including intake from sodium-containing intravenous fluids and antibiotic admixtures. Carefully monitor sodium concentrations and fluid status if sodium-containing drugs and corticosteroids must be used together.