Endurance exercise is also known to produce heat from skeletal muscle tissue, and an increase in internal temperature occurs when the production of heat from metabolism exceeds release. Get at least 8 hours of sleep a night. Do not worry about getting too large. I play a lot of competitive sports, go to the gym, got some friends.. Nic and The Britch teally have a natural, effortless chemistry. That leaves the hydroxyecdysterone.
The misc.fitness.weights FAQ Table of Contents
I have done a lot of research and experimentation over 20 years to figure out what works for me in the gym. My journey to fast muscle gains started when I finally found the book that helped me crack the hardgainer label I had given myself for years.
I started lifting weights at age It highlighted all the errors I was making in training and how to fix them based on scientific research. I want to share with you not just what works for me, but what I also did wrong over the years. In doing so, it is my hope you will recognize some part of yourself in my muscle journey and learn from the path I have walked in trying to build my ultimate physique. Western Cancer wrote a great article on the origin of somatotypes — ectomorph, mesomorph, and endomorph.
While the origins of these body type classifications may be less than scientific by 21st century standards, there is no questioning the wise generalization of body types they attempt to describe.
No matter how much you close your eyes and try to wish it away, you are your genes. Your genetic profile—bone density, muscle fiber type composition, height, limb length, tendon insertion points, skeletal structure, etc.
When it comes to those former body type classifications, I now like to think of them in terms of muscle fiber type composition and proportion — i. They can actually mimic, be turned into, or switched from, a type I or a type IIb muscle fiber depending on the type of training you do. So in one way, Western Cancer was right. That said, you are limited by your overall muscle fiber type composition, and thus, how much potential it has to be modified by training and diet.
Some guys will be bursting with type IIa miracle fibers that naturally just blow up and become huge with little fat gain and basic training regimens. The guy that just grows walking into the gym. Other guys will take forever to grow because their overall muscle fiber type is for endurance type I ectomorphs and will forever be dominated by a more lean and athletic build instead of big and beefy. Then you have the guys that can naturally lift huge weights and thus gravitate to power lifting where they find tremendous success type IIb mesomorphs.
Shedding fat is almost impossible for them without God-like discipline and submission to a very strict diet and exercise regimen. I think you can see where this is going. The science of muscle fiber types is now explaining why men on the same training program get different results.
Each body is different in its muscle fiber type composition and proportion, and thus a single training program is not going to work for every man. Your goal in training is to find out which muscle fibre type dominates your body as a whole and perhaps even within each muscle group and then optimize your training to develop ALL your muscle fiber types to their maximum genetic potential.
You want to get big? You are going to have to train hard and be prepared to make pain your friend. 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; Caffeine; Magnesium Salicylate; Phenyltoloxamine: Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide: 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; Phenyltoloxamine: Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine: Moderate Corticosteroids may increase the risk of hypokalemia if used concurrently with acetazolamide.
Hypokalemia may be especially severe with prolonged use of corticotropin, ACTH. 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.
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.
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. Minor Concurrent use of altretamine with other agents which cause bone marrow or immune suppression such as corticosteroids may result in additive effects.
Minor Corticosteroids may interact with cholinesterase inhibitors including ambenonium, neostigmine, and pyridostigmine, occasionally causing severe muscle weakness in patients with myasthenia gravis. Glucocorticoids are occasionally used therapeutically, however, in the treatment of some patients with myasthenia gravis. In such patients, it is recommended that corticosteroid therapy be initiated at low dosages and with close clinical monitoring.
The dosage should be increased gradually as tolerated, with continued careful monitoring of the patient's clinical status. Aminosalicylate sodium, Aminosalicylic acid: Moderate Clarithromycin inhibits CYP3A4 and has the potential to result in increased plasma concentrations of corticosteroids. Therefore, the dose of corticosteroid should be titrated to avoid steroid toxicity. 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 liposomal LAmB: However, these drugs are commonly used together in treatment Antithymocyte Globulin: 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. Major Because electrolyte abnormalities increase the risk of QT interval prolongation and serious arrhythmias, avoid the concomitant use of arsenic trioxide with drugs that may cause electrolyte abnormalities, particularly hypokalemia and hypomagnesemia.
Examples of drugs that may cause electrolyte abnormalities include corticosteroids. If concomitant drug use is unavoidable, frequently monitor serum electrolytes and replace as necessary and electrocardiograms. Moderate Concomitant use of L-asparaginase with corticosteroids can result in additive hyperglycemia. L-Asparaginase transiently inhibits insulin production contributing to hyperglycemia seen during concurrent corticosteroid therapy.
Insulin therapy may be required in some cases. Administration of L-asparaginase after rather than before corticosteroids reportedly has produced fewer hypersensitivity reactions. Moderate Caution and close monitoring are advised if corticosteroids and neuromuscular blockers are used together, particularly for long periods, due to enhanced neuromuscular blocking effects.
In such patients, a peripheral nerve stimulator may be of value in monitoring the response. Concurrent use may increase the risk of acute myopathy. This acute myopathy is generalized, may involve ocular and respiratory muscles, and may result in quadriparesis. Elevation of creatine kinase may occur. Clinical improvement or recovery after stopping corticosteroids may require weeks to years.
Severe Live virus vaccines should generally not be administered to an immunosuppressed patient. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses.
If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. Children who are receiving high doses of systemic corticosteroids i.
The CDC has stated that discontinuation of steroids for 1 month prior to varicella virus vaccine live administration may be sufficient. Budesonide may affect the immunogenicity of live vaccines. An open-label study examined the immune responsiveness to varicella vaccine in pediatric asthma patients who were treated with budesonide inhalation suspension 0. Even though no patient treated with budesonide inhalation suspension developed chicken pox because of vaccination, live-virus vaccines should not be given to individuals who are considered to be immunocompromised until more information is available.
Moderate Hypokalemia-producing agents, including corticosteroids, may increase the risk of bepridil-induced arrhythmias and should therefore be administered cautiously in patients receiving bepridil therapy. Bismuth Subsalicylate; Metronidazole; Tetracycline: Major Bupropion is associated with a dose-related risk of seizures.
Extreme caution is recommended during concurrent use of other drugs that may lower the seizure threshold such as systemic corticosteroids. The manufacturer recommends low initial dosing and slow dosage titration if these combinations must be used; the patient should be closely monitored.
Moderate Calcium absorption is reduced when calcium carbonate is taken concomitantly with systemic corticosteroids. Systemic corticosteroids induce a negative calcium balance by inhibiting intestinal calcium absorption as well as by increasing renal calcium losses. The mechanism by which these drugs inhibit calcium absorption in the intestine is likely to involve a direct inhibition of absorptive cell function.
Calcium Carbonate; Magnesium Hydroxide: Moderate Cholestyramine has been shown to bind to hydrocortisone. To minimize drug interactions, the manufacturer recommends to administer other drugs at least 1 hour before or at least 4 to 6 hours after the administration of cholestyramine. Choline Salicylate; Magnesium Salicylate: Major Citalopram causes dose-dependent QT interval prolongation.
Concurrent use of citalopram and medications known to cause electrolyte imbalance may increase the risk of developing QT prolongation. Therefore, caution is advisable during concurrent use of citalopram and corticosteroids. It should be noted that CYP3A4 is one of the isoenzymes involved in the metabolism of citalopram, and dexamethasone is an inducer of this isoenzyme. In theory, decreased efficacy of citalopram is possible during combined use with dexamethasone; however, because citalopram is metabolized by multiple enzyme systems, induction of one pathway may not appreciably increase citalopram clearance.
Minor A relationship of functional antagonism exists between vitamin D analogs, which promote calcium absorption, and corticosteroids, which inhibit calcium absorption. Therapeutic effect of cod liver oil should be monitored when used concomitantly with corticosteroids. Moderate The bile-acid sequestrant colestipol is well-known to cause drug interactions by binding and decreasing the oral administration of many drugs.
Colestipol can bind with and possibly decrease the oral absorption of hydrocortisone. According to the manufacturer, administer other drugs at least 1 hour before or at least 4 to 6 hours after the administration of colestipol. Moderate Conivaptan has been associated with hypokalemia 9. Although not studied, consider the potential for additive hypokalemic effects if conivaptan is coadministered with drugs known to induce hypokalemia, such as corticosteroids.
Major Patients receiving hydrocortisone should omit their pre-test doses on the day selected for testing. Patients taking inadvertent doses of hydrocortisone may exhibit abnormally high basal plasma cortisol concentrations and a decreased response to the test. A paradoxical decrease in plasma cortisol concentrations may be seen in patients receiving hydrocortisone following a stimulating dose of cosyntropin injection.
Moderate The safety and efficacy of denosumab use in patients with immunosuppression have not been evaluated. Patients receiving immunosuppressives along with denosumab may be at a greater risk of developing an infection. Major Desmopressin, when used in the treatment of nocturia is contraindicated with corticosteroids because of the risk of severe hyponatremia. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer.
Moderate Hypokalemia, hypomagnesemia, or hypercalcemia increase digoxin's effect. Corticosteroids can precipitate digoxin toxicity via their effect on electrolyte balance. It is recommended that serum potassium, magnesium, and calcium be monitored regularly in patients receiving digoxin. Major Corticosteroids can cause increases in blood pressure, sodium and water retention, and hypokalemia, predisposing patients to interactions with certain other medications.
Corticosteroid-induced hypokalemia could also enhance the proarrhythmic effects of dofetilide. Moderate Caution is advised when using droperidol in combination with corticosteroids which may lead to electrolyte abnormalities, especially hypokalemia or hypomagnesemia, as such abnormalities may increase the risk for QT prolongation or cardiac arrhythmias.
Moderate Echinacea possesses immunostimulatory activity and may theoretically reduce the response to immunosuppressant drugs like corticosteroids.
For some patients who are using corticosteroids for serious illness, such as cancer or organ transplant, this potential interaction may result in the preferable avoidance of Echinacea.
Although documentation is lacking, coadministration of echinacea with immunosuppressants is not recommended by some resources. Minor In vitro studies indicate that corticosteroids inhibit the antifungal activity of econazole against C. When the concentration of the corticosteroid was equal to or greater than that of econazole on a weight basis, the antifungal activity of econazole was substantially inhibited.
When the corticosteroid concentration was one-tenth that of econazole, no inhibition of antifungal activity was observed. Major Patients receiving immunosuppressives should not receive concurrent therapy with efalizumab because of the possibility of increased infections and malignancies.
Moderate Ephedrine may enhance the metabolic clearance of corticosteroids. Decreased blood concentrations and lessened physiologic activity may necessitate an increase in corticosteroid dosage. Moderate Monitor for symptoms of gastrointestinal GI perforation e. Permanently discontinue erlotinib in patients who develop GI perforation. The pooled incidence of GI perforation clinical trials of erlotinib ranged from 0. Moderate Erythromycin inhibits CYP3A4 and has the potential to result in increased plasma concentrations of corticosteroids.
Hydrocodone is metabolized by CYP3A4. Coadministration may cause increased clearance of hydrocodone, which could result in lack of efficacy or the development of an abstinence syndrome in a patient who had developed physical dependence to hydrocodone.
Monitor the patient for reduced efficacy of hydrocodone. A higher hydrocodone dose may be needed if used with eslicarbazepine. Moderate Estrogens have been associated with elevated serum concentrations of corticosteroid binding globulin CBG , leading to increased total circulating corticosteroids, although the free concentrations of these hormones may be lower; the clinical significance is not known.
Patients should be monitored for signs of decreased clinical effects of estrogens e. Moderate Coadministration of corticosteroids and fluoxymesterone may increase the risk of edema, especially in patients with underlying cardiac or hepatic disease. Corticosteroids with greater mineralocorticoid activity, such as fludrocortisone, may be more likely to cause edema.
Administer these drugs in combination with caution. Gallium Ga 68 Dotatate: Moderate Corticosteroids may accentuate the electrolyte loss associated with diuretic therapy resulting in hypokalemia. Also, corticotropin may cause calcium loss and sodium and fluid retention.
Mannitol itself can cause hypernatremia. Close monitoring of electrolytes should occur in patients receiving these drugs concomitantly. Moderate Corticosteroids may induce elevated blood ammonia concentrations. Corticosteroids should be used with caution in patients receiving glycerol phenylbutyrate. Monitor ammonia concentrations closely. Major QT prolongation has been observed during haloperidol treatment. Use of haloperidol and medications known to cause electrolyte imbalance may increase the risk of QT prolongation.
Therefore, caution is advisable during concurrent use of haloperidol and corticosteroids. Topical corticosteroids are less likely to interact. Moderate Hemin works by inhibiting aminolevulinic acid synthetase. Corticosteroids increase the activity of this enzyme should not be used with hemin.
Moderate Patients receiving corticosteroids during propranolol therapy may be at increased risk of hypoglycemia due to the loss of counter-regulatory cortisol response. This effect may be more pronounced in infants and young children. If concurrent use is necessary, carefully monitor vital signs and blood glucose concentrations as clinically indicated. Major The safety and efficacy of hylan G-F 20 given concomitantly with other intra-articular injectables have not been established.
Other intra-articular injections may include intra-articular steroids betamethasone, dexamethasone, hydrocortisone, prednisolone, methylprednisolone, and triamcinolone. Moderate Use sodium phosphate cautiously with corticosteroids, especially mineralocorticoids or corticotropin, ACTH, as concurrent use can cause hypernatremia. Moderate Additive hypokalemia may occur when indapamide is coadministered with other drugs with a significant risk of hypokalemia such as systemic corticosteroids.
Coadminister with caution and careful monitoring. Moderate Monitor patients receiving insulin closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Major Serious adverse events, including death, have been observed during intrathecal administration of both corticosteroids i.
Cases of cortical blindness, stroke, spinal cord infarction, paralysis, seizures, nerve injury, brain edema, and death have been temporally associated i.
In addition, patients inadvertently administered iohexol formulations not indicated for intrathecal use have experienced seizures, convulsions, cerebral hemorrhages, brain edema, and death. Administering these medications together via the intrathecal route may increase the risk for serious adverse events. Severe Because both intrathecal corticosteroids i. Moderate The risk of cardiac toxicity with isoproterenol in asthma patients appears to be increased with the coadministration of corticosteroids.
Intravenous infusions of isoproterenol in refractory asthmatic children at rates of 0. Minor Both isotretinoin and corticosteroids can cause osteoporosis during chronic use. Patients receiving systemic corticosteroids should receive isotretinoin therapy with caution.
Major Caution is advised when using levomethadyl in combination with other agents, such as corticosteroids, that may lead to electrolyte abnormalities, especially hypokalemia or hypomagnesemia. While glucocorticoids with mineralocorticoid activity e. Major Avoid use of macimorelin with drugs that directly affect pituitary growth hormone secretion, such as corticosteroids. Healthcare providers are advised to discontinue corticosteroid therapy and observe a sufficient washout period before administering macimorelin.
Use of these medications together may impact the accuracy of the macimorelin growth hormone test. Moderate Additional monitoring may be required when coadministering systemic or inhaled corticosteroids and mecasermin, recombinant, rh-IGF In animal studies, corticosteroids impair the growth-stimulating effects of growth hormone GH through interference with the physiological stimulation of epiphyseal chondrocyte proliferation exerted by GH and IGF Dexamethasone administration on long bone tissue in vitro resulted in a decrease of local synthesis of IGF Similar counteractive effects are expected in humans.
If systemic or inhaled glucocorticoid therapy is required, the steroid dose should be carefully adjusted and growth rate monitored. Minor Anticholinergics, such as mepenzolate, antagonize the effects of antiglaucoma agents. Mepenzolate is contraindicated in patients with glaucoma and therefore should not be coadministered with medications being prescribed for the treatment of glaucoma.
In addition, anticholinergic drugs taken concurrently with corticosteroids in the presence of increased intraocular pressure may be hazardous. Moderate Corticosteroids may increase the risk of hypokalemia if used concurrently with methazolamide. Methenamine; Sodium Acid Phosphate: Severe Medications which affect pituitary or adrenocortical function, including all corticosteroid therapy, should be discontinued prior to and during testing with metyrapone.
Patients taking inadvertent doses of corticosteroids on the test day may exhibit abnormally high basal plasma cortisol levels and a decreased response to the test. Although systemic absorption of topical corticosteroids is minimal, temporary discontinuation of these products should be considered if possible to reduce the potential for interference with the test results. Moderate Leukopenia, neutropenia, anemia, and thrombocytopenia have been associated with micafungin. Patients who are taking immunosuppressives such as the corticosteroids with micafungin concomitantly may have additive risks for infection or other side effects.
In a pharmacokinetic trial, micafungin had no effect on the pharmacokinetics of prednisolone. Acute intravascular hemolysis and hemoglobinuria was seen in a healthy volunteer during infusion of micafungin mg and oral prednisolone 20 mg. This reaction was transient, and the subject did not develop significant anemia. Major Mifepristone for termination of pregnancy is contraindicated in patients on long-term corticosteroid therapy and mifepristone for Cushing's disease or other chronic conditions is contraindicated in patients who require concomitant treatment with systemic corticosteroids for life-saving purposes, such as serious medical conditions or illnesses e.
For other situations where corticosteroids are used for treating non-life threatening conditions, mifepristone may lead to reduced corticosteroid efficacy and exacerbation or deterioration of such conditions.
This is because mifepristone exhibits antiglucocorticoid activity that may antagonize corticosteroid therapy and the stabilization of the underlying corticosteroid-treated illness. Mifepristone may also cause adrenal insufficiency, so patients receiving corticosteroids for non life-threatening illness require close monitoring. Because serum cortisol levels remain elevated and may even increase during treatment with mifepristone, serum cortisol levels do not provide an accurate assessment of hypoadrenalism.
Patients should be closely monitored for signs and symptoms of adrenal insufficiency, If adrenal insufficiency occurs, stop mifepristone treatment and administer systemic glucocorticoids without delay; high doses may be needed to treat these events. Factors considered in deciding on the duration of glucocorticoid treatment should include the long half-life of mifepristone 85 hours.
While therapy is designed to take advantage of this effect, patients may be predisposed to over-immunosuppression resulting in an increased risk for the development of severe infections.
Close clinical monitoring is advised with concurrent use; in the presence of serious infections, continuation of the corticosteroid or immunosuppressive agent may be necessary but should be accompanied by appropriate antimicrobial therapies as indicated.
Major Ordinarily, patients receiving chronic immunosuppressant therapy should not be treated with natalizumab. Treatment recommendations for combined corticosteroid therapy are dependent on the underlying indication for natalizumab therapy.
Corticosteroids should be tapered in those patients with Crohn's disease who are on chronic corticosteroids when they start natalizumab therapy, as soon as a therapeutic benefit has occurred. If the patient cannot discontinue systemic corticosteroids within 6 months, discontinue natalizumab.
The concomitant use of natalizumab and corticosteroids may further increase the risk of serious infections, including progressive multifocal leukoencephalopathy, over the risk observed with use of natalizumab alone.
In multiple sclerosis MS clinical trials, an increase in infections was seen in patients concurrently receiving short courses of corticosteroids. However, the increase in infections in natalizumab-treated patients who received steroids was similar to the increase in placebo-treated patients who received steroids.
Short courses of steroid use during natalizumab, such as when they are needed for MS relapse treatment, appear to be acceptable for use concurrently. Moderate 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 concomitant administration should be avoided. Corticosteroids can have profound effects on sodium-potassium balance; NSAIDs also can affect sodium and fluid balance.
Monitor serum potassium concentrations; potassium supplementation may be necessary. In addition, NSAIDs may mask fever, pain, swelling and other signs and symptoms of an infection; use NSAIDs with caution in patients receiving immunosuppressant dosages of corticosteroids.
The Beers criteria recommends that this drug combination be avoided in older adults; if coadministration cannot be avoided, provide gastrointestinal protection. Moderate Ocrelizumab has not been studied in combination with other immunosuppressive or immune modulating therapies used for the treatment of multiple sclerosis, including immunosuppressant doses of corticosteroids.
Concomitant use of ocrelizumab with any of these therapies may increase the risk of immunosuppression. Monitor patients carefully for signs and symptoms of infection. Moderate Concomitant use of oxymetholone with corticosteroids or corticotropin, ACTH may cause increased edema.
Moderate Concomitant use of pegaspargase with corticosteroids can result in additive hyperglycemia. Major Agents such as immunosuppressives have adverse reactions similar to those of penicillamine. Concomitant use of penicillamine with these agents is contraindicated because of the increased risk of developing severe hematologic and renal toxicity.
Minor Corticosteroids administered systemically prior to or concomitantly with photosensitizing agents may decrease the efficacy of photodynamic therapy.
Minor Corticosteroids may interact with cholinesterase inhibitors, occasionally causing severe muscle weakness in patients with myasthenia gravis. Moderate According to the manufacturer of pimozide, the drug should not be coadministered with drugs known to cause electrolyte imbalances, such as high-dose, systemic corticosteroid therapy. Pimozide is associated with a well-established risk of QT prolongation and torsade de pointes TdP , and electrolyte imbalances e.
Pimozide is contraindicated in patients with known hypokalemia or hypomagnesemia. Potassium Phosphate; Sodium Phosphate: Moderate Corticotropin can cause alterations in serum potassium levels. The use of potassium salts or supplements would be expected to alter the effects of corticotropin on serum potassium levels.
Therefore, magnesium sulfate; potassium sulfate; sodium sulfate should be administered with caution during concurrent use of medications that lower the seizure threshold such as systemic corticosteroids. Minor The manufacturer of spironolactone lists corticosteroids as a potential drug that interacts with spironolactone.
Intensified electrolyte depletion, particularly hypokalemia, may occur. However, potassium-sparing diuretics such as spironolactone do not induce hypokalemia. In fact, hypokalemia is one of the indications for potassium-sparing diuretic therapy. Therefore, drugs that induce potassium loss, such as corticosteroids, could counter the hyperkalemic effects of potassium-sparing diuretics. Minor Concurrent use of purine analogs with other agents which cause bone marrow or immune suppression such as other antineoplastic agents or immunosuppressives may result in additive effects.
Major QT prolongation has occurred during concurrent use of quetiapine and medications known to cause electrolyte imbalance. Therefore, caution is advisable during concurrent use of quetiapine and corticosteroids. Major Ritodrine has caused maternal pulmonary edema, which appears more often in patients treated concomitantly with corticosteroids.
Patients so treated should be closely monitored in the hospital. Moderate Rituximab and corticosteroids are commonly used together; however, monitor the patient for immunosuppression and signs and symptoms of infection during combined chronic therapy.
Rubella Virus Vaccine Live: Major Avoid the concomitant use of sargramostim and systemic corticosteroid agents due to the risk of additive myeloproliferative effects. If coadministration of these drugs is required, frequently monitor patients for clinical and laboratory signs of excess myeloproliferative effects e. Sargramostim is a recombinant human granulocyte-macrophage colony-stimulating factor that works by promoting proliferation and differentiation of hematopoietic progenitor cells.
Smallpox Vaccine, Vaccinia Vaccine: Sodium Benzoate; Sodium Phenylacetate: Moderate Corticosteroids may cause protein breakdown, which could lead to elevated blood ammonia concentrations, especially in patients with an impaired ability to form urea. Corticosteroids should be used with caution in patients receiving treatment for hyperammonemia. Moderate The concurrent use of corticosteroids with sodium phenylbutyrate may increase plasma ammonia levels hyperammonemia by causing the breakdown of body protein.
Patients with urea cycle disorders being treated with sodium phenylbutyrate usually should not receive regular treatment with corticosteroids. Moderate Corticosteroids can retard bone growth and therefore, can inhibit the growth-promoting effects of somatropin. If corticosteroid therapy is required, the corticosteroid dose should be carefully adjusted. Moderate The risk of myopathy may be increased if corticosteroids are coadministered with telbivudine.
Monitor patients for any signs or symptoms of unexplained muscle pain, tenderness, or weakness, particularly during periods of upward dosage titration.
Moderate Coadministration of corticosteroids and testosterone may increase the risk of edema, especially in patients with underlying cardiac or hepatic disease. Moderate The metabolism of corticosteroids is increased in hyperthyroidism and decreased in hypothyroidism. Dosage adjustments may be necessary when initiating, changing or discontinuing thyroid hormones or antithyroid agents. Moderate Closely observe patients for signs of infection.
Most patients taking tocilizumab who developed serious infections were taking concomitant immunosuppressives such as systemic corticosteroids. Moderate Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Varicella-Zoster Virus Vaccine, Live: Major Vigabatrin should not be used with corticosteroids, which are associated with serious ophthalmic effects e. Minor Use caution when administering vinblastine concurrently with a CYP3A4 inducer such as dexamethasone.
Vinblastine is metabolized by CYP3A4 and dexamethasone may decrease vinblastine plasma concentrations. Theoretically, reduced metabolism of hydrocortisone might occur when voriconazole is co-administered. The clinical impact of this potential interaction is not certain. Moderate Use vorinostat and corticosteroids together with caution; the risk of QT prolongation and arrhythmias may be increased if electrolyte abnormalities occur.
Corticosteroids may cause electrolyte imbalances; hypomagnesemia, hypokalemia, or hypocalcemia and may increase the risk of QT prolongation with vorinostat. Frequently monitor serum electrolytes if concomitant use of these drugs is necessary. Moderate The effect of corticosteroids on oral anticoagulants e.
There are reports of enhanced as well as diminished effects of anticoagulants when given concurrently with corticosteroids; however, limited published data exist, and the mechanism of the interaction is not well described.
High-dose corticosteroids appear to pose a greater risk for increased anticoagulant effect. In addition, corticosteroids have been associated with a risk of peptic ulcer and gastrointestinal bleeding. Thus corticosteroids should be used cautiously and with appropriate clinical monitoring in patients receiving oral anticoagulants; coagulation indices e. During high-dose corticosteroid administration, daily laboratory monitoring may be desirable.
Yellow Fever Vaccine, Live: Minor Zileuton is metabolized by the cytochrome P isoenzyme 3A4. Zileuton could potentially compete with other CYP3A4 substrates.
Endogenous corticosteroids are secreted by the adrenal cortex, and their effects are believed to be due to enzyme modification rather than to a direct hormone-induced action. Corticosteroids are loosely classified into two categories, mineralocorticoids and glucocorticoids, depending on their primary pharmacological activity.
Mineralocorticoids alter electrolyte and fluid balance by facilitating sodium resorption and hydrogen and potassium excretion at the level of the distal renal tubule, resulting in edema and hypertension. Glucocorticoids exert some mineralocorticoid effects but are also involved in a number of other metabolic pathways including gluconeogenesis, fat redistribution, protein metabolism, and calcium balance.
Hydrocortisone possesses both mineralocorticoid actions and glucocorticoid actions. Corticosteroids exhibit anti-inflammatory, antipruritic, and vasoconstrictive properties. At the cellular level, corticosteroids induce peptides called lipocortins.
Lipocortins antagonize phospholipase A2, an enzyme which causes the breakdown of leukocyte lysosomal membranes to release arachidonic acid. This action decreases the subsequent formation and release of endogenous inflammatory mediators including prostaglandins, kinins, histamine, liposomal enzymes and the complement system.
Early anti-inflammatory effects of topical corticosteroids include the inhibition of macrophage and leukocyte movement and activity in the inflamed area by reversing vascular dilation and permeability.
Later inflammatory processes such as capillary production, collagen deposition, keloid scar formation also are inhibited by corticosteroids.
Clinically, these actions correspond to decreased edema, erythema, pruritus, plaque formation and scaling of the affected skin. In the treatment of asthma, corticosteroids block the late phase allergic response to allergens.
Mediators involved in the pathogenesis of asthma include histamine, leukotrienes slow releasing substance of anaphylaxis, SRS-A , eosinophil chemotactic factor of anaphylaxis ECF-A , neutrophil chemotactic factor NCF , cytokines, hydroxyeicosatetraenoic acids, prostaglandin-generating factor of anaphylaxis PGF-A , prostaglandins, major basic protein, bradykinin, adenosine, peroxides, and superoxide anions.
Different cell types are responsible for release of these mediators including airway epithelium, eosinophils, basophils, lung parenchyma, lymphocytes, macrophages, mast cells, neutrophils, and platelets. Corticosteroids inhibit the release of these mediators as well as inhibit IgE synthesis, attenuate mucous secretion and eicosanoid generation, up-regulate beta-receptors, promote vasoconstriction, and suppress inflammatory cell influx and inflammatory processes.
Clinical effects in asthma include a reduction in bronchial hyperresponsiveness to allergens, a decreased number of asthma exacerbations, and an improvement in FEV1, peak-flow rate, and respiratory symptoms.
Since corticosteroid effects take several hours to days to become clinically noticeable, they are ineffective for primary treatment of severe acute bronchospastic attacks or for status asthmaticus. Inhaled corticosteroids have no bronchodilatory properties. Hydrocortisone is administered via oral, parenteral, topical, and rectal routes. Circulating drug binds extensively to plasma proteins, and only the unbound portion of a dose is active. Systemic hydrocortisone is quickly distributed into the kidneys, intestines, skin, liver, and muscle.
Corticosteroids distribute into breast milk and cross the placenta. Systemic hydrocortisone is metabolized by the liver to inactive metabolites. These inactive metabolites, as well as a small portion of unchanged drug, are excreted in the urine.
The biological half-life of hydrocortisone is 8 to 12 hours. Affected cytochrome P CYP isoenzymes and drug transporters: After intramuscular administration of hydrocortisone, the onset and duration of action depend on the type of injection and the extent of the local blood supply. Systemic absorption after topical application of hydrocortisone is dependant on the vehicle, the state of the skin at the application site, the use of occlusive dressings, and the age of the patient.
Absorption is increased in areas that have skin damage, inflammation, or occlusion, or where the stratum corneum is thin such as the eyelids, genitalia, and face. Factors that can increase systemic absorption of topical hydrocortisone include occlusive dressings, large surface area, frequent application, longer duration of treatment, increased humidity or temperature, and younger age.
Topical preparations distribute throughout the area of application but are only minimally absorbed into the circulation. Topical preparations of hydrocortisone are metabolized in the skin. Hydrocortisone rectal suspension is partially absorbed after rectal administration. Intra-articular Route The onset and duration of action depend on type of hydrocortisone injection and the extent of the local blood supply.
Your Name Your name is required. Recipient's Email Separate multiple email address with a comma Please enter valid email address Recipient's email is required. Your email has been sent. Related Drug Information Drug Summary. For adrenal crisis prophylaxis in adult patients with known or suspected adrenal insufficiency undergoing minor surgery or with a minor illness e.
Intravenous or Intramuscular dosage hydrocortisone sodium succinate injection. For adrenal crisis prophylaxis in adult patients with known or suspected adrenal insufficiency undergoing moderate surgery or with a moderate illness e.
For adrenal crisis prophylaxis in adult patients with known or suspected adrenal insufficiency undergoing major surgery, or with other acute stressors e. For adrenal crisis prophylaxis in adult patients with known or suspected adrenal insufficiency and a critical illness e. For the treatment of acute adrenocortical insufficiency. Intramuscular or Intravenous dosage hydrocortisone sodium succinate injection. For adrenal crisis prophylaxis in pediatric patients with known or suspected adrenal insufficiency with other acute stressors e.
Adolescents and Children 6 years and older. Children 1 to 5 years. Adolescents, Children, Infants, and Neonates. Adolescents, Children, and Infants. For adrenal crisis prophylaxis in pediatric patients with known or suspected adrenal insufficiency undergoing surgery accompanied by general anesthesia. For use in nonspecific proctitis, postirradiation factitial proctitis, cryptitis, or for other non-specific inflammatory conditions of the anorectum. Rectal dosage rectal suppositories.
For the treatment of inflammatory bowel disease Crohn's disease or ulcerative colitis. For adjunctive treatment of Crohn's disease or ulcerative colitis using oral or parenteral therapy. Infants, Children, and Adolescents. For adjunctive rectal treatment of chronic ulcerative colitis, particularly if disease limited to the distal portion of the rectum. Rectal dosage rectal retention enema suspension.