Glucocorticoid contraindications

Glucocorticoids increase the risk of gastrointestinal complications caused by NSAEDs. Considerable caution is necessary when using NSAIDs in patients with severe liver and kidney damage and they should not be combined with coumarines. Owing to the limited experience obtained, these precautions and contraindications also apply to COX-2-selective inhibitors. 

The glucocorticoids are contraindicated in patients widi serious infections, such as tuberculosis and fungal and antibiotic-resistant infections. 

The indications, rationale, techniques, alternatives, contraindications, complications, and efficacy of lumbar and caudal epidural glucocorticoid injections have been reviewed (SEDA-21, 420 452). 

Besides the adverse effects just described, glucocorticoid therapy is contraindicated under the following circumstances diabetes mellitus, digitalis therapy, glaucoma, hypertension, infection, osteoporosis, peptic ulcer, tuberculosis, and viral infection. 

The toxicity of therapeutic doses of ACTH resembles that of the glucocorticoids (see Chapter 39 Adrenocorticosteroids Adrenocortical Antagonists), with the added adverse effect of hyperandrogenism in women. The occasional development of antibodies to animal ACTH or to depot cosyntropin (a preparation not currently available in the USA) has produced anaphylactic reactions or refractoriness to ACTH therapy in a few individuals. Painful swelling occurs at the injection site more often with the zinc hydroxide depot preparation than with the gelatin preparation. Contraindications are similar to those of glucocorticoids. When immediate effects are desired, glucocorticoids are preferable. 

Medicaments Glucocorticoids are contraindicated. Administration of interferon a is more dangerous than helpful. Other medicaments should not be used unless this is absolutely necessary — it must be noted that the disturbed metabolism may alter in unforeseen ways. In contrast, misoprostol (153) and lamivudine (141, 248, 250) showed remarkably positive effects. Especially in fulminant hepatitis B, administration of lamivudine (100 mg/day) proved to be effective. In patients with reactivation due to cytostatic therapy after liver transplantation, lamivudine was much more efficacious than famciclovir. 

There are no known contraindications to the use of IPV. OPV should not be given to persons who are immunocompromised due to immunodeficiency diseases, leukemia, lymphoma or generalized malignancy or who are immunosuppressed due to therapy with glucocorticoids, alkylating drugs, antimetabolites, or radiation. If poliomyelitis immunization is indicated in such persons, IPV should be used. OPV should also be avoided when immunizing household contacts of immunocompromised patients. 

Melarsoprol is administered by slow intravenous injection, with care to avoid tissue extravasation. A typical course of treatment is three 3- to 4-day courses of 2-3.6 mg/kg with 7-day intervals between courses. Lesser doses should be given to children and debilitated patients. A continuous 10-day course of 2.2 mg/kg/day also is effective and will likely become standard. Unless contraindicated, glucocorticoids should be given to decrease the incidence of reactive encephalopathy. 

PRECAUTIONS AND CONTRAINDICATIONS Population-based therapy with diethyl-catbamazine should be avoided in areas where onchocerciasis or loiasis is endemic, although the drug can be used to protect foreign travelers from these infections. Pretreatment with glucocorticoids and antihistamines often is given to minimize indirect reactions to diethylcarbamazine that result from dying microfilariae. 

Achilles tendon rupture or tendinitis has occurred rarely. Renal disease, hemodialysis, and glucocorticoid use may be predisposing factors. Traditionally, the use of quinolones in children has been contraindicated because they have produced arthropathy in animal jnodels. However, children with cystic fibrosis given ciprofloxacin, norfloxacin, and nalidixic acid have had few, and reversible, joint symptoms. Therefore, the benefits may outweigh the risks in some children. 

Somatrem and somatropin are contraindicated in patients with known hypersensitivity to somatropin or sensitivity to beii2yl alcohol, and tliose witli epiphyseal closure or underlying cranial lesions. The drug is used cautiously in patients witli tliyroid disease or diabetes, and during pr iancy (Piregnancy Category C) and lactation. Excessive amounts of glucocorticoids may decrease response to somatropin. 

Most important, glucocorticoids should not be withdrawn abruptly in cases of acute infections or severe stress, such as surgery or trauma. Myasthenia gravis, peptic ulcer, diabetes mellitus, hyperthyroidism, hypertension, psychological disturbances, pregnancy (first trimester), and infections may be aggravated by glucocorticoid administration. Hormone therapy is contraindicated in these conditions and should be used only with the utmost precaution. 

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