Interactions with other patient drugs, OTC or herbalmedicines
(ask patient specifically)
: Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associatedwith fluoroquinolone treatment. The mechanism is unknown.Tendinitis and tendon rupture have most frequently involvedthe Achilles tendon, although cases involving the rotator cuff (the shoulder), the hand, the biceps, and the thumb have also been reported. Some have required surgical repair or resultedin prolonged disability. Tendon rupture can occur during or upto several months after completion of fluoroquinolone therapy.
: The overuse or abuse of laxatives can causesignificant loss of electrolytes and potentiate the risk of hypokalemia associated with corticosteroid therapy.Corticosteroids promote the retention of sodium and water andthe excretion of potassium. Although these effects are primarilyassociated with mineralocorticoids like fludrocortisone, theymay also occur with higher dosages of glucocorticoids or adrenocorticotropic agents, particularly if given systemicallyfor longer than brief periods.
: Systemically administered corticosteroids mayinduce hypokalemia and possibly increase the risk of digoxintoxicity. In addition, corticosteroid-induced sodium and water retention can result in edema leading to heart failure. Theseeffects may be more common with the natural corticosteroids(cortisone, hydrocortisone) which have greater mineralocorticoid activity.
: Coadministration with corticosteroids may decrease theserum concentrations and therapeutic effects of salicylates.Likewise, serum salicylate levels may increase followingwithdrawal of corticosteroid therapy, potentially resulting insalicylate toxicity. This interaction has been reported in patients receiving intra-articular as well as oral corticosteroids.One or more mechanisms may be involved, including anincrease in the renal clearance and/or an induction of hepaticmetabolism of salicylates caused by corticosteroids.Pharmacologically, the potential for increased gastrointestinal(GI) toxicity, including inflammation, bleeding, ulceration and perforation, should be considered due to additive ulcerogeniceffects of these agents (especially aspirin) on the GI mucosa.
: Grapefruit juice may increase the plasmaconcentrations of some orally administered drugs that aresubstrates of the CYP450 3A4 isoenzyme. The proposedmechanism is inhibition of CYP450 3A4-mediated first-passmetabolism in the gut wall by certain compounds present ingrapefruits. The extent and clinical significance are unknown.Moreover, pharmacokinetic alterations associated withinteractions involving grapefruit juice are often subject to ahigh degree of interpatient variability.
Lab value alterations caused by medicine
Monitor serum electrolytes periodically during therapy.Fludrocortisone causes decrease in serum potassium levels.
Be sure to teach the patient the following about this medication
Instruct patient to take medication as directed. Take missed doses assoon as remembered but not just before next dose is due. Explain thatlifelong therapy may be necessary and that abrupt discontinuation maylead to addisonian crisis. Patient should keep an adequate supplyavailable at all times. Advise patient to follow dietary modification prescribed by health care professional. Instruct patient to follow a diethigh in potassium. Amount of sodium allowed in diet varies with pathophysiology. Instruct patient to inform health care provider if weight gain or edema, muscle weakness, cramps, nausea, anorexia, or dizziness occurs. Advise patient to carry identification at all timesdescribing disease process and medication regimen.