In patients on corticosteroid
therapy subjected to unusual stress, increased dosage of rapidly acting
corticosteroids before, during, and after the stressful situation is indicated.
Corticosteroids may mask some
signs of infection, and new infections may appear during their use. Infections
with any pathogen including viral, bacterial, fungal, protozoan or helminthic
infections, in any location of the body, may be associated with the use of
corticosteroids alone or in combination with other immunosuppressive agents
that affect cellular immunity, humoral immunity, or neutrophil function.1
These infections may be mild,
but can be severe and at times fatal. With increasing doses of corticosteroids,
the rate of occurrence of infectious complications increases.2 There
may be decreased resistance and inability to localize infection when
corticosteroids are used.
Prolonged use of
corticosteroids may produce posterior subcapsular cataracts, glaucoma with
possible damage to the optic nerves, and may enhance the establishment of
secondary ocular infections due to fungi or viruses.
Usage In Pregnancy
Since adequate human
reproduction studies have not been done with corticosteroids, the use of these
drugs in pregnancy, nursing mothers or women of childbearing potential requires
that the possible benefits of the drug be weighed against the potential hazards
to the mother and embryo or fetus. Infants born of mothers who have received
substantial doses of corticosteroids during pregnancy, should be carefully observed
for signs of hypoadrenalism.
Average and large doses of
hydrocortisone or cortisone can cause elevation of blood pressure, salt and
water retention, and increased excretion of potassium. These effects are less
likely to occur with the synthetic derivatives except when used in large doses.
Dietary salt restriction and potassium supplementation may be necessary. All
corticosteroids increase calcium excretion.
Administration of live or live,
attenuated vaccines is contraindicated in patients receiving immunosuppressive
doses of corticosteroids. Killed or inactivated vaccines may be administered to
patients receiving immunosuppressive doses of corticosteroids; however, the
response to such vaccines may be diminished. Indicated immunization procedures
may be undertaken in patients receiving nonimmunosuppressive doses of
The use of CORTEF Tablets in
active tuberculosis should be restricted to those cases of fulminating or
disseminated tuberculosis in which the corticosteroid is used for the
management of the disease in conjunction with an appropriate antituberculous
If corticosteroids are
indicated in patients with latent tuberculosis or tuberculin reactivity, close
observation is necessary as reactivation of the disease may occur. During
prolonged corticosteroid therapy, these patients should receive
Persons who are on drugs which
suppress the immune system are more susceptible to infections than healthy
individuals. Chicken pox and measles, for example, can have a more serious or
even fatal course in non-immune children or adults on corticosteroids. In such
children or adults who have not had these diseases, particular care should be
taken to avoid exposure. How the dose, route and duration of corticosteroid administration
affects the risk of developing a disseminated infection is not known. The
contribution of the underlying disease and/or prior corticosteroid treatment to
the risk is also not known. If exposed to chicken pox, prophylaxis with
varicella zoster immune globulin (VZIG) may be indicated. If exposed to
measles, prophylaxis with pooled intramuscular immunoglobulin (IG) may be
indicated. (See the respective package inserts for complete VZIG and IG
prescribing information.) If chicken pox develops, treatment with antiviral
agents may be considered. Similarly, corticosteroids should be used with great
care in patients with known or suspected Strongyloides (threadworm) infestation.
In such patients, corticosteroid-induced immunosuppression may lead to
Strongyloides hyperinfection and dissemination with widespread larval
migration, often accompanied by severe enterocolitis and potentially fatal
1 Fekety R. Infections associated with corticosteroids
and immunosuppressive therapy. In: Gorbach SL, Bartlett JG, Blacklow NR, eds. Infectious
Diseases. Philadelphia: WB Saunders Company 1992:1050–1.
2 Stuck AE, Minder CE, Frey FJ. Risk of infectious
complications in patients taking glucocorticoids. Rev Infect Dis 1989:11(6):954–63.