Interactions : אינטראקציות

4.5 Interaction with other medicinal products and other forms of interaction
Heart glycosides                                   Increased glycoside action by hypokalaemia Medicinal products leading to QT prolongation      Hypokalaemia has to be corrected if appropriate and clinical condition has to be
Antidiabetics                                      The blood glucose-lowering effect of insulin and oral antidiabetics can be reduced.
Cumarin derivates                                  Action of anticoagulants is decreased Anticoagulants                                     Possible increased or decreased anti-coagulant Barbiturates, Hydantoin, Rifampicin                Action of corticoids is decreased Nonsteroidal antiphlogistics, antirheumatics       Increased incidence of stomach ulcers and stomach bleeding
Oestrogens                                         Corticoid action may be increased, therefore dose adjustment may be necessary if oestrogens are used or discontinued.
Vaccines                                           Live vaccines may be more toxic due to the immune suppressing effect of corticosteroids
Disseminated viral infections can occur. For inactivated or toxoid vaccines the immune response can fail or can be reduced (see 4.3
Contraindications)
Aluminium salts - complex-forming acids            If taken in combination with complex-forming acids, such as citric acid in drinks or medicinal products (for the treatment of acidosis or urinary alkalinisation) or ascorbic acid for several weeks, the aluminium concentration in the plasma may increase.
Bupropion                                          Increased risk of seizures.
Quinidine                                          The action of quinidine may be increased.
Non-depolarising muscle relaxants                  Muscle relaxation may last longer.
Atropine, other anticholinergics                   Possible additional increase of intraocular Praziquantel                                       Possible decrease of the concentration of praziquantel in the
Chloroquine, Hydrochloroquine, Mefloquine          Increased risk of myopathy and Somatropin                                         Effect of somatropin may be reduced Protirelin                                         After administration of protirelin, TSH increase Ciclosporin                                        Possible increase of cyclosporine blood levels. Increased risk of cerebral
ACE-Inhibitors                                     Increased risk of blood count changes.
Ephedrine                                          The metabolism of glucocorticoids can be accelerated and this can reduce its efficacy.
Diuretics                                          Increased loss of potassium - increased risk of hypokalaemia.
Azole Antimycotics (such as ketoconazole           Increased action of glucocorticoids or itraconazole)
Enzyme inductors (CYP 3A4)                         Decreased action of glucocorticoids Copper (intrauterine devices)                      Decreased action of intrauterine devices Lithium salts                                      Possible decreased action of lithium Influence on analytical methods                    Skin reactions to allergy tests (prick test) may be suppressed.
CYP3-inhibitors (including cobicistat-containing   Co-treatment with CYP3A inhibitors, including products)                                          cobicistat-containing products, is expected to increase the risk of systemic side-effects. The combination should be avoided unless the benefit outweighs the increased risk of systemic corticosteroid side-effects, in which case patients should be monitored for systemic corticosteroid side-effects.