Steroid-sparing drug

Concomitant therapy - Concomitant therapy with other second-line drugs (eg, gold salts) demonstrates additional therapeutic benefit. Use with partially effective doses of corticosteroids for a steroid-sparing effect and result in greater improvement is not established. 

Markham A, Faulds D. Theophylline. A review of its potential steroid sparing effects in asthma. Drugs 1998 56 1081-91. 

Bailey RR. Adverse renal reactions to non-steroidal antiinflammatory drugs and potassium-sparing diuretics. Adv Drug React Bull 1988 131 492. 

Cyclodextrin complexation (See Chapter 40) can also represent a way to improve the stability and the solubility of sensitive drugs such as thalidomide. Thalidomide is currently in clinical use for the treatment and prevention of graft-versus-host disease in leukemia patients after bone marrow transplant. However, this drug is sparingly soluble in aqueous solutions (50 Kig/mL) and is readily hydrolyzed. Complexation with hydroxypropyl (3-cyclodextrin increases the solubility to 1700 Kig/mL and extends the half-life of a dilute solution from 2.1 to 4.1 h. Other vulnerable and sparingly soluble drugs stabilized by means of cyclodextrin complexation are the non-steroidal antiinflammatory drugs diclofenac, piroxicam, and indomethacin and the anthra-cycline antibiotic daunorubicin. ... 

In combination with potassium-sparing diuretics severe hyperkalaemia may occur. The elimination of lithium is prolonged. Non-steroidal anti-inflammatory drugs (NSAIDs) may reduce the antihypertensive effect of ACE inhibitors. 

Albumin is the most abundant protein in human and other animal plasma. It is estimated that up to 40% of the total albumin in humans is in circulation transporting essential nutrients, especially those that are sparingly soluble in aqueous-based plasma. For example, the fatty acids, which are important fuel molecules for the peripheral tissue, are distributed by albumin. In addition, albumin is the plasma transport protein for other substances including bilirubin, thyroxine, and steroid hormones. Also, many drugs including aspirin, sulfanilamides, clofibrate, and digitalis bind to albumin and are most likely carried to their sites of action by the protein. 

Hyperkalemia due to a decrease in aldosterone secretion is rarely found in patients with normal renal function, but it is relatively common in those with CHF and in the elderly. Hyperkalemia is more frequent in patients with renal impairment, diabetes, and in those receiving either K+ or potassium K+-sparing diuretics, heparin or non-steroidal anti-inflammatory drugs (NSAIDs). 

Close laboratory monitoring and judicious use of spironolactone is needed to reduce the risk of hyperkalemia. The excess of hyperkalemia in clinical practice compared with RALES can be explained largely by the use of higher doses of spironolactone and the inclusion of patients with lower glomerular filtration rates and whose aldosterone-mediated compensatory distal tubular potassium excretion is already attenuated (5). Such patients include elderly people, people with diabetes, and those taking beta-blockers, non-steroidal anti-inflammatory drugs, potassium salts, potassium-sparing diuretics, or trimethoprim. 

Running, R.D. and Werner, F.B. (1982). Sulindac A potential renal-sparing non-steroidal anti-inflammatory drug. ]. Am. Med. Assoc., 248, 2864-67... 

Jahr JS, Donkor KN, Sinatra RS. Non-selective non-steroidal anti-inflammatory drugs (NSAIDs), cyclooxygenase-2 inhibitors (COX-2Is), and acetaminophen in acute perioperative pain analgesic efficacy, opiate-sparing effects, and adverse effects. In Sinatra R, de Leon-Casasola O, Ginsberg B, Viscusi ER, eds. Acute Pain Management, 2nd ed. 

Excessive potassium levels can lead to cardiac arrest. People on non-steroidal anti-inflammatory drugs, ACE inhibitors and potassium-sparing diuretics should seek medical advice before taking potassium supplements. 

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