Erythromycin Corticosteroids

Drugs that may affect repaglinide include CYP 450 inhibitors (eg, clarithromycin, erythromycin, ketoconazole, miconazole), CYP 450 inducers (eg, barbiturates, carbamazepine, rifampin), beta blockers, calcium channel blockers, chloramphenicol, corticosteroids, coumarins, estrogens, gemfibrozil, isoniazid, itraconazole, levonorgestrel and ethinyl estradiol, MAOIs, nicotinic acid, NSAIDs, oral contraceptives, phenothiazines, phenytoin, probenecid, salicylates, simvastatin, sulfonamides, sympathomimetics, thiazides and other diuretics, and thyroid products. 

Budesonide, Oral (Entocort EC) [Anti-inflammatory> Corticosteroid] Uses Mild-mod Crohn Dz Action Steroid, anti-inflammatory Dose Adults. Initial, 9 mg PO qAM to 8 wk max maint 6 mg PO qAM taper by 3 mo avoid grapefruit juice Contra Active TB and fungal Infxn Caution [C, /-] DM, glaucoma, cataracts, HTN, CHF Disp Caps SE HA, cough, hoarseness, Candida Infxn, epistaxis Interactions T Effects W/ erythromycin, indinavir, itraconazole, ketoconazole, ritonavir, grapefruit EMS Monitor ECG and BP for signs of electrolyte disturbances and hypovolemia OD Acute OD unlikely to cause a problem, chronic OD can reduce natural production of certain steroids symptomatic and supportive... 

Prednisolone [Corticosteroid] [See Steroids and Table VI-1] Interactions T Effects W/ clarithromycin, erythromycin, estrogen, ketoconazole, OCPs, troleandomycin X effects W/ antacids, aminoglutethimide, barbiturates, cholestyramine, colestipol, phenytoin, rifampin X effects OF anticoagulants, hypoglycemics, INH, salicylates, vaccine toxoids EMS Infxns may be masked OD May cause wt gain, T hair growth, acne, HTN, peripheral edema, and sore muscles symptomatic and supportive... 

Zafirlukast and montelukast are well tolerated. Zafirlukast increases plasma concentrations of warfarin and decreases the concentrations of theophylline and erythromycin. In rare cases, treatment of patients with CysLT receptor antagonists is associated with the development of Churg-Strauss syndrome, a condition marked by acute vasculitis, eosinophilia, and a worsening of pulmonary symptoms. Because these symptoms often appear when patients are given the leukotriene receptor antagonists when they are being weaned from oral corticosteroid therapy, it is not clear whether they are related to the action of the antagonists or are due to a sudden reduction in corticosteroid therapy. 

CORTICOSTEROIDS MACROUDES- CLARITHROMYCIN, ERYTHROMYCIN, TELITHROMYCIN t adrenal suppressive effects of corticosteroids, which may t risk of infections and produce an inadequate response to stress scenarios Due to inhibition of metabolism of corticosteroids Monitor cortisol levels and warn patients to report symptoms such as fever and sore throat... 

Caspofungin, itraconazole, ketoconazole, posaconazole Systemic corticosteroids, caspofungin, itraconazole, voriconazole, ketoconazole, fluconazole, erythromycins... 

Topical corticosteroids are used in cases of exacerbation and should be applied sparingly to the affected area. Hydrocortisone 1% twice a day or dexamethasone 0.1% applied to the periorbital area helps to relieve symptoms during these periods. Secondary infection manifested as blepharitis or keratoconjimctivitis should be treated with topical ophthalmic antibiotic ointments such as bacitracin or erythromycin.Topical antihistamines, NSAIDs, or mast cell stabilizers can be used to control itching, and topical steroids are sometimes required to treat severe keratoconjunctivitis associated with the atopic response. Because of side effects, steroids are not indicated for longterm use. 

Most applications of DLI LC-MS deal with qualitative analysis, where in most cases only molecular-mass information is obtained. DLI LC-MS found extensive apphcation in the analysis of pesticides and related compounds [35], in the quahtative and quantitative determination of corticosteroids and metabolites in equine urine [36]. Highly labile compounds such as vitamin B12 (molecular weight 1354) and erythromycin A (molecular weight 733) were analysed by DLI negative-ion Cl LC-MS [33]. As an example, the negative-ion Cl spectram of 92 ng vitamin B12 is shown in Figure 4.7. 

Clinically important, potentially hazardous interactions with amiloride, aminoglycosides, amphotericin B, ampicillin, anisindione, anticoagulants, armodafinil, atorvastatin, azathioprine, azithromycin, bacampicillin, basiliximab, bezafibrate, bosentan, bupropion, carbenicillin, caspofungin, cholestyramine, clarithromycin, cloxacillin, co-trimoxazole, corticosteroids, cyclophosphamide, daclizumab, danazol, dicloxacillin, dicumarol, digoxin, diltiazem, disulfiram, echinacea, erythromycin, ethotoin, etoposide, ezetimibe, flunisolide, fluoxymesterone, fluvastatin, foscarnet, fosphenytoin, gemfibrozil, hemophilus B vaccine, HMG-CoA reductase inhibitors, imatinib, imipenem/cilastatin, influenza vaccines, ketoconazole, lanreotide, lopinavir, lovastatin, mephenytoin, methicillin, methoxsalen, methylphenidate, methylprednisolone, methyltestosterone, mezlocillin, mizolastine, mycophenolate, nafcillin, nisoldipine, NSAIDs, orlistat, oxacillin, penicillins, phellodendron, phenytoin, pravastatin, prednisolone, prednisone, pristinamycin, ranolazine, red rice yeast, rifabutin, rifampin, rifapentine, ritonavir, rosuvastatin, simvastatin, sirolimus, spironolactone, St John s wort, sulfacetamide, sulfadiazine, sulfamethoxazole, sulfisoxazole, sulfonamides, tacrolimus, telithromycin, tenoxicam, testosterone, ticarcillin, tolvaptan, trabectedin, triamterene, troleandomycin, ursodeoxycholic acid, vaccines, vecuronium, warfarin, zofenopril... 

Clinically important, potentially hazardous interactions with alfuzosin, amiodarone, aprepitant, carbamazepine, celiprolol, corticosteroids, cyclosporine, epirubicin, erythromycin, mistletoe, moricizine, oxprenolol, ranolazine, simvastatin, sulpiride... 

Clinically important, potentially hazardous interactions with amlodipine, anisindione, anticoagulants, aprepitant, atorvastatin, barbiturates, benzodiazepines, butabarbital, carbamazepine, chlordiazepoxide, clarithromycin, clonazepam, dorazepate, corticosteroids, cyclosporine, dexamethasone, diazepam, dicumarol, erythromycin, ethotoin, felodipine, flurazepam, fluvastatin, fosphenytoin, isradipine, itraconazole, ketoconazole, lorazepam, lovastatin, mephenytoin, mephobarbital, midazolam, nicardipine, nifedipine, nimodipine, nisoldipine, oxazepam, pentobarbital, phenobarbital, pimozide, pravastatin, primidone, quazepam, rifampin, secobarbital, simvastatin, St John s wort, temazepam, warfarin... 

A4 Barbiturates, carbamazepine, corticosteroids, efavirenz, phenytoin, rifampin, troglitazone Antiarrhythmics, antidepressants, azole antifungals, benzc iazepines, calcium channel blockers, cyclosporine, delavirdine, doxorubicin, efavirenz, erythromycin, estrogens, HIV protease inhibitors, nefazodone, paclitaxel, proton pump inhibitors, HMG-CoA reductase inhibitors, rifabutin, rifampin, sildenafil, SSRIs, tamoxifen, trazodone, vinca anticancer agents... 

Information about the clarithromycin or erythromycin interactions with methylprednisolone is much more limited than with the interaction between troleandomycin and methylprednisolone, but they all appear to be established and of clinical importance. The effect should be taken into account during concurrent use and appropriate dosage reductions made to avoid the development of corticosteroid adverse effects. The authors of one study suggest that this reduction should be empirical, based primarily on clinical symptomatology. Another group found that a 68% reduction in methylprednisolone dosage was possible within 2 weeks. Troleandomycin appears to have a greater effect than erythromycin or clarithromycin. 

For example in the alcoholic erythromycin gel (Table 12.36) erythromycin is dissolved in ethanol first. Hypromellose has to be dispersed in this water free solution. Finally water and glycerol 85 % are added and the gelling agent starts to swell. The gel can be prepared in a flask because it is relatively thin. Substances that are insoluble in water such as corticosteroids and metronidazole are dispersed in an equal volume of gel and subsequently geometrically mixed with the rest of the base. 

Some macrohdes have been found to have anti-inflammatory properties and are being used in airway diseases such as panbronchioUtis, cystic fibrosis, bronchiectasis, and asthma. The treatment of OP with erythromycin or clarithromycin has been reported in small series (121—124). After three months of therapy, full or partial remission was achieved in most patients, whereas others required addition of prednisone for disease control. Although their effect appears slower and less constant than with corticosteroids, macrolides might become a therapeutic option in OP, either alone or associated with corticosteroids. This issue requires further studies. 

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