- Prednisone (Oral Route) Precautions - Mayo Clinic
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Drug information provided by: IBM Micromedex. Prednisone provides relief for inflamed areas of the body. It is used to treat a number of different conditions, such as inflammation swellingsevere allergies, adrenal problems, arthritis, asthma, blood or bone marrow problems, endocrine problems, eye or vision problems, stomach or bowel problems, lupus, skin conditions, kidney problems, ulcerative colitis, and flare-ups of multiple sclerosis.
Prednisone is a corticosteroid cortisone-like medicine or steroid. It works on the immune system to help relieve swelling, redness, itching, and allergic reactions. In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:. Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines.
Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of prednisone in children. However, pediatric patients are more likely to have slower growth and bone problems if prednisone is used for a long time.
Recommended doses should not be exceeded, and the patient should be carefully monitored during therapy. Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of prednisone in the elderly. However, elderly patients are more likely to have age-related liver, kidney, or heart problems, which may require caution and an adjustment in the dose for elderly patients receiving prednisone. There are no adequate studies in women for determining infant risk when using this medication during breastfeeding.
Weigh the potential benefits against the potential risks before taking this medication while breastfeeding. Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur.
In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive. Using this medicine with any of the following medicines is not recommended.
Your doctor may decide not to treat you with this medication or change some of the other medicines you take. Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases.
If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines. Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur.
Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco. The presence of other medical problems may affect the use of this medicine.
Make sure you tell your doctor if you have any other medical problems, especially:. Take this medicine exactly as directed by your doctor.
Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. To do so may increase the chance for unwanted effects. Measure the oral liquid with a marked measuring spoon, oral syringe, or medicine cup.
The average household teaspoon may not hold the right amount of liquid. Measure the concentrated liquid with the special oral dropper that comes with the package. If you use this medicine for a long time, do not suddenly stop using it without checking first with your doctor.
You may need to slowly decrease your dose before stopping it completely. The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine. If you miss a dose of this medicine, take it as soon as possible.
However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses. Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing. If you will be taking this medicine for a long time, it is very important that your doctor check you at regular visits for any unwanted effects that may be caused by this medicine.
Blood or urine tests may be needed to check for unwanted effects. Using this medicine while you are pregnant can harm your unborn baby.
Use an effective form of birth control to keep from getting pregnant. If you think you have become pregnant while using this medicine, tell your doctor right away. If you are using this medicine for a long time, tell your doctor about any extra stress or anxiety in your life, including other health concerns and emotional stress.
Your dose of this medicine might need to be changed for a short time while you have extra stress. Using too much of this medicine or using it for a long time may increase your risk of having adrenal gland problems. Talk to your doctor right away if you have more than one of these symptoms while you are using this medicine: blurred vision, dizziness or fainting, a fast, irregular, or pounding heartbeat, increased thirst or urination, irritability, or unusual tiredness or weakness.
This medicine may cause you to get more infections than usual. Avoid people who are sick or have infections and wash your hands often. If you are exposed to chickenpox or measles, tell your doctor right away. If you start to have a fever, chills, sore throat, or any other sign of an infection, call your doctor right away. Check with your doctor right away if blurred vision, difficulty in reading, eye pain, or any other change in vision occurs during or after treatment.
Your doctor may want you to have your eyes checked by an ophthalmologist eye doctor. While you are being treated with prednisone, do not have any immunizations vaccines without your doctor's approval. Prednisone may lower your body's resistance and the vaccine may not work as well or you might get the infection the vaccine is meant to prevent. In addition, you should not be around other persons living in your household who receive live virus vaccines because there is a chance they could pass the virus on to you.
Some examples of live vaccines include measles, mumps, influenza nasal flu vaccinepoliovirus oral formrotavirus, and rubella. Do not get close to them and do not stay in the same room with them for very long. If you have questions about this, talk to your doctor. This medicine may cause changes in mood or behavior for some patients. Tell your doctor right away if you have depression, mood swings, a false or unusual sense of well-being, trouble with sleeping, or personality changes while taking this medicine.
This medicine might cause thinning of the bones osteoporosis or slow growth in children if used for a long time. Tell your doctor if you have any bone pain or if you have an increased risk for osteoporosis. If your child is using this medicine, tell the doctor if you think your child is not growing properly. Make sure any doctor or dentist who treats you knows that you are using this medicine.
This medicine may affect the results of certain skin tests. Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription over-the-counter [OTC] medicines and herbal or vitamin supplements. Along with its needed effects, a medicine may cause some unwanted effects.
Although not all of these side effects may occur, if they do occur they may need medical attention. Some side effects may occur that usually do not need medical attention.
These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:.
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.
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❿- Drug interaction information
Prednisolone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with Ceritinib. Both Prednisolone and Chlorothiazide can increase the risk of hypokalaemia.
Prednisolone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with Chlorpromazine. Both Prednisolone and Chlortalidone can increase the risk of hypokalaemia.
Prednisolone is predicted to decrease the concentration of Choline salicylate. Prednisolone is predicted to decrease the effects of Cisatracurium. Prednisolone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with Citalopram. Prednisolone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with Clarithromycin. Clarithromycin is predicted to increase the exposure to Prednisolone. Prednisolone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with Clomipramine.
Cobicistat is predicted to increase the exposure to Prednisolone. Prednisolone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with Crizotinib. Darunavir is predicted to increase the exposure to Prednisolone. Prednisolone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with Dasatinib. Prednisolone is predicted to increase the risk of gastrointestinal bleeding when given with Deferasirox.
Prednisolone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with Delamanid. Prednisolone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with Desflurane. Dexketoprofen increases the risk of gastrointestinal bleeding when given with Prednisolone. Diclofenac increases the risk of gastrointestinal bleeding when given with Prednisolone.
Prednisolone is predicted to increase the risk of Digoxin toxicity when given with Digoxin. Prednisolone is predicted to increase the risk of immunosuppression when given with Dinutuximab. Manufacturer advises avoid except in life-threatening situations. Prednisolone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with Disopyramide. Prednisolone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with Dronedarone.
Prednisolone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with Droperidol. Prednisolone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with Efavirenz. Prednisolone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with Encorafenib.
Prednisolone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with Entrectinib. Enzalutamide is predicted to decrease the exposure to Prednisolone. Prednisolone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with Eribulin. Erlotinib is predicted to increase the risk of gastrointestinal perforation when given with Prednisolone.
Prednisolone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with Erythromycin. Prednisolone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with Escitalopram. Etodolac increases the risk of gastrointestinal bleeding when given with Prednisolone.
Etoricoxib increases the risk of gastrointestinal bleeding when given with Prednisolone. Felbinac increases the risk of gastrointestinal bleeding when given with Prednisolone. Prednisolone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with Flecainide.
Prednisolone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with Fluconazole. Flurbiprofen increases the risk of gastrointestinal bleeding when given with Prednisolone. Both Prednisolone and Formoterol can increase the risk of hypokalaemia. Fosamprenavir is predicted to increase the exposure to Prednisolone.
Fosphenytoin is predicted to decrease the exposure to Prednisolone. Both Prednisolone and Furosemide can increase the risk of hypokalaemia. Prednisolone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with Glasdegib. Prednisolone potentially opposes the effects of Glycerol phenylbutyrate. Manufacturer advises monitor ammonia concentrations. Prednisolone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with Haloperidol.
Herpes-zoster vaccine, live is predicted to increase the risk of generalised infection possibly life-threatening when given with Prednisolone high-dose.
Both Prednisolone and Hydrochlorothiazide can increase the risk of hypokalaemia. Both Prednisolone and Hydroflumethiazide can increase the risk of hypokalaemia.
Prednisolone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with Hydroxychloroquine.
Prednisolone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with Hydroxyzine. Ibuprofen increases the risk of gastrointestinal bleeding when given with Prednisolone. Idelalisib is predicted to increase the exposure to Prednisolone. Both Prednisolone and Indacaterol can increase the risk of hypokalaemia. Both Prednisolone and Indapamide can increase the risk of hypokalaemia. Indometacin increases the risk of gastrointestinal bleeding when given with Prednisolone.
Influenza vaccine live is predicted to increase the risk of generalised infection possibly life-threatening when given with Prednisolone high-dose. Prednisolone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with Inotuzumab ozogamicin. Prednisolone is predicted to decrease the efficacy of Ipilimumab. Prednisolone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with Isoflurane.
Itraconazole is predicted to increase the exposure to Prednisolone. Ketoconazole is predicted to increase the exposure to Prednisolone. Ketoprofen increases the risk of gastrointestinal bleeding when given with Prednisolone. Ketorolac increases the risk of gastrointestinal bleeding when given with Prednisolone. Prednisolone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with Lapatinib.
Prednisolone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with Lenvatinib. Prednisolone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with Levomepromazine. Not all medications that may interact with ritonavir-boosted nirmatrelvir are included in Box 2.
Deviation from the recommended strategies may be appropriate in certain clinical scenarios. It may be acceptable to continue clopidogrel if the benefits of using ritonavir-boosted nirmatrelvir outweigh the risk of reduced clopidogrel effectiveness.
Some chemotherapeutic agents may decrease the effectiveness of ritonavir-boosted nirmatrelvir. For patients with a lower risk for arterial or venous thrombosis, clinicians may consider administering low-dose aspirin while rivaroxaban is being withheld. These immunosuppressants have significant drug-drug interaction potential with ritonavir, and they should not be used if close monitoring, including therapeutic drug monitoring, is not feasible.
See the American Society of Transplantation statement for more information. Withhold atorvastatin and rosuvastatin at the beginning of treatment with ritonavir-boosted nirmatrelvir and resume after completion of the 5-day course. If withholding a statin is not clinically appropriate e.
Note that abrupt discontinuation or rapid dose reduction of benzodiazepines may precipitate an acute withdrawal reaction. Patients who are receiving higher doses of dexamethasone will be at a greater risk of AEs. Therapies Statement on Omicron Subvariants. Summary Recommendations. Drug-Drug Interactions Drug Info. Box 1. Medications That Have Clinically Relevant Drug-Drug Interactions With Ritonavir-Boosted Nirmatrelvir Clinicians should be aware that, in some cases, drug-drug interactions with ritonavir-boosted nirmatrelvir may lead to serious or life-threatening drug toxicities.
Consult 1 or more of the following resources for information on identifying and managing drug-drug interactions: Quick reference lists: Box 1 lists select outpatient medications that are not expected to have clinically relevant interactions with ritonavir-boosted nirmatrelvir.
Box 2 lists select outpatient medications that have clinically relevant drug-drug interactions with ritonavir-boosted nirmatrelvir. This also applies to any over-the-counter medicines and any herbal, complementary or alternative medicines and treatments.
You should tell any doctor or dentist treating you that you are taking steroids. Some key drugs that interact with steroids include anticoagulants such as warfarin , drugs for blood pressure, antiepileptics, antidiabetic drugs, antifungal drugs, bronchodilators such as salbutamol and diuretics. Studies suggest taking steroids with aspirin and nonsteroidal anti inflammatory drugs NSAIDs , such as ibuprofen, increases the risk of peptic ulcers. If you need both medications, ask your IBD team if you might benefit from taking proton pump inhibitors as well to help prevent ulcers.
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❾-50%}Codeine prednisone interactions
Apalutamide is predicted to decrease the exposure to Prednisolone. Manufacturer advises monitor and adjust dose. Prednisolone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with Apomorphine. Prednisolone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with Arsenic trioxide.
Prednisolone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with Artemether. Prednisolone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with Artenimol.
Prednisolone is predicted to decrease the concentration of Aspirin high-dose and Aspirin high-dose increases the risk of gastrointestinal bleeding when given with Prednisolone. Atazanavir is predicted to increase the exposure to Prednisolone.
Manufacturer advises avoid or monitor adverse effects. Prednisolone is predicted to decrease the efficacy of Atezolizumab. Manufacturer advises use with caution or avoid.
Prednisolone is predicted to decrease the effects of Atracurium. Both Prednisolone and Bambuterol can increase the risk of hypokalaemia. Prednisolone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with Bedaquiline. Both Prednisolone and Bendroflumethiazide can increase the risk of hypokalaemia. Benzydamine increases the risk of gastrointestinal bleeding when given with Prednisolone.
Prednisolone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with Bosutinib. Bromfenac increases the risk of gastrointestinal bleeding when given with Prednisolone. Both Prednisolone and Bumetanide can increase the risk of hypokalaemia. Prednisolone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with Cabozantinib.
Carbamazepine is predicted to decrease the exposure to Prednisolone. Celecoxib increases the risk of gastrointestinal bleeding when given with Prednisolone. Prednisolone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with Ceritinib.
Both Prednisolone and Chlorothiazide can increase the risk of hypokalaemia. Prednisolone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with Chlorpromazine. Both Prednisolone and Chlortalidone can increase the risk of hypokalaemia. Prednisolone is predicted to decrease the concentration of Choline salicylate. Prednisolone is predicted to decrease the effects of Cisatracurium.
Prednisolone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with Citalopram. Prednisolone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with Clarithromycin. Clarithromycin is predicted to increase the exposure to Prednisolone. Prednisolone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with Clomipramine.
Cobicistat is predicted to increase the exposure to Prednisolone. Prednisolone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with Crizotinib. Darunavir is predicted to increase the exposure to Prednisolone.
Prednisolone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with Dasatinib. Prednisolone is predicted to increase the risk of gastrointestinal bleeding when given with Deferasirox. Prednisolone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with Delamanid.
Prednisolone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with Desflurane. Dexketoprofen increases the risk of gastrointestinal bleeding when given with Prednisolone. Diclofenac increases the risk of gastrointestinal bleeding when given with Prednisolone. Prednisolone is predicted to increase the risk of Digoxin toxicity when given with Digoxin.
Prednisolone is predicted to increase the risk of immunosuppression when given with Dinutuximab. Manufacturer advises avoid except in life-threatening situations. Prednisolone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with Disopyramide. Prednisolone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with Dronedarone.
Prednisolone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with Droperidol. Prednisolone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with Efavirenz. Prednisolone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with Encorafenib. Prednisolone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with Entrectinib.
Enzalutamide is predicted to decrease the exposure to Prednisolone. Prednisolone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with Eribulin. Erlotinib is predicted to increase the risk of gastrointestinal perforation when given with Prednisolone.
Prednisolone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with Erythromycin. Prednisolone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with Escitalopram. Etodolac increases the risk of gastrointestinal bleeding when given with Prednisolone. Etoricoxib increases the risk of gastrointestinal bleeding when given with Prednisolone. Felbinac increases the risk of gastrointestinal bleeding when given with Prednisolone.
Prednisolone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with Flecainide. Prednisolone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with Fluconazole.
Flurbiprofen increases the risk of gastrointestinal bleeding when given with Prednisolone. Both Prednisolone and Formoterol can increase the risk of hypokalaemia. Fosamprenavir is predicted to increase the exposure to Prednisolone. Fosphenytoin is predicted to decrease the exposure to Prednisolone.
Both Prednisolone and Furosemide can increase the risk of hypokalaemia. Prednisolone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with Glasdegib. Prednisolone potentially opposes the effects of Glycerol phenylbutyrate. Manufacturer advises monitor ammonia concentrations. The guidance in this document is based on the drug-drug interaction potential of the FDA-authorized 5-day course of ritonavir-boosted nirmatrelvir.
Ritonavir-boosted nirmatrelvir should not be given within 2 weeks of administering a strong CYP3A4 inducer e. Ritonavir-boosted nirmatrelvir is contraindicated in this setting, because strong CYP3A4 inducers may reduce the concentrations of nirmatrelvir and ritonavir, rendering the treatment ineffective against SARS-CoV Consult 1 or more of the following resources for information on identifying and managing drug-drug interactions:.
Consider consulting with an expert e. Consider the magnitude and significance of the potential drug-drug interaction when choosing management strategies for patients who will be receiving ritonavir-boosted nirmatrelvir. Potential strategies include:. Use the chosen strategy for the 5-day duration of ritonavir-boosted nirmatrelvir treatment and for at least 2 to 3 days after treatment completion.
The strategy may need to continue for a longer duration if ritonavir-boosted nirmatrelvir is initiated in an adult of advanced age or if the interacting medication has a long half-life. If ritonavir-boosted nirmatrelvir is prescribed to patients who take certain recreational drugs, those patients will require counseling and careful monitoring for adverse effects.
Not all medications that may interact with ritonavir-boosted nirmatrelvir are included in Box 2. Deviation from the recommended strategies may be appropriate in certain clinical scenarios.
It may be acceptable to continue clopidogrel if the benefits of using ritonavir-boosted nirmatrelvir outweigh the risk of reduced clopidogrel effectiveness. Some chemotherapeutic agents may decrease the effectiveness of ritonavir-boosted nirmatrelvir. For patients with a lower risk for arterial or venous thrombosis, clinicians may consider administering low-dose aspirin while rivaroxaban is being withheld. These immunosuppressants have significant drug-drug interaction potential with ritonavir, and they should not be used if close monitoring, including therapeutic drug monitoring, is not feasible.
See the American Society of Transplantation statement for more information. Withhold atorvastatin and rosuvastatin at the beginning of treatment with ritonavir-boosted nirmatrelvir and resume after completion of the 5-day course. What checks will I need for long-term steroid treatment? What special information should you give your doctor?
Side effects When should I seek medical help? Should I be doing anything to protect my bones from osteoporosis? Do steroids affect fertility, pregnancy, and breastfeeding? Tell us about yourself Are you primarily a: Healthcare provider in an academic clinic. Healthcare provider in a community clinic.
Ritonavir, a strong cytochrome P CYP 3A4 inhibitor and a P-glycoprotein inhibitor, is coadministered with nirmatrelvir to increase the blood concentration of nirmatrelvir, thereby making it effective against SARS-CoV Ritonavir may also increase blood concentrations of certain concomitant medications.
Because ritonavir-boosted nirmatrelvir Paxlovid is the only highly effective oral antiviral for the treatment of COVID, drug interactions that can be safely managed should not preclude the use of this medication.
Clinicians should be aware that many commonly used medications can be safely coadministered with ritonavir-boosted nirmatrelvir despite its drug-drug interaction potential. Box 1 includes commonly prescribed medications that are not expected to have clinically relevant interactions with ritonavir-boosted nirmatrelvir. This is not a comprehensive list of all the medications that are not expected to have clinically relevant interactions with ritonavir-boosted nirmatrelvir.
However, the low level is not expected to be clinically significant during the 5 days of therapy. The progestin concentration of a combined hormonal contraceptive is expected to remain similar or increase with coadministration, which would maintain the effectiveness of the oral contraceptive.
These include brentuximab vedotin, enfortumab vedotin, polatuzumab vedotin, and tisotumab vedotin. Clinicians should be aware that, in some cases, drug-drug interactions with ritonavir-boosted nirmatrelvir may lead to serious or life-threatening drug toxicities. After the last dose is administered, most of the interaction potential resolves within 2 to 3 days, although resolution may take longer in adults of advanced age.
The guidance in this document is based on the drug-drug interaction potential of the FDA-authorized 5-day course of ritonavir-boosted nirmatrelvir. Ritonavir-boosted nirmatrelvir should not be given within 2 weeks of administering a strong CYP3A4 inducer e. Ritonavir-boosted nirmatrelvir is contraindicated in this setting, because strong CYP3A4 inducers may reduce the concentrations of nirmatrelvir and ritonavir, rendering the treatment ineffective against SARS-CoV Consult 1 or more of the following resources for information on identifying and managing drug-drug interactions:.
Consider consulting with an expert e. Consider the magnitude and significance of the potential drug-drug interaction when choosing management strategies for patients who will be receiving ritonavir-boosted nirmatrelvir. Potential strategies include:. Use the chosen strategy for the 5-day duration of ritonavir-boosted nirmatrelvir treatment and for at least 2 to 3 days after treatment completion. The strategy may need to continue for a longer duration if ritonavir-boosted nirmatrelvir is initiated in an adult of advanced age or if the interacting medication has a long half-life.
If ritonavir-boosted nirmatrelvir is prescribed to patients who take certain recreational drugs, those patients will require counseling and careful monitoring for adverse effects. Not all medications that may interact with ritonavir-boosted nirmatrelvir are included in Box 2. Deviation from the recommended strategies may be appropriate in certain clinical scenarios. It may be acceptable to continue clopidogrel if the benefits of using ritonavir-boosted nirmatrelvir outweigh the risk of reduced clopidogrel effectiveness.
Some chemotherapeutic agents may decrease the effectiveness of ritonavir-boosted nirmatrelvir. For patients with a lower risk for arterial or venous thrombosis, clinicians may consider administering low-dose aspirin while rivaroxaban is being withheld. These immunosuppressants have significant drug-drug interaction potential with ritonavir, and they should not be used if close monitoring, including therapeutic drug monitoring, is not feasible.
See the American Society of Transplantation statement for more information. Withhold atorvastatin and rosuvastatin at the beginning of treatment with ritonavir-boosted nirmatrelvir and resume after completion of the 5-day course. If withholding a statin is not clinically appropriate e.
Note that abrupt discontinuation or rapid dose reduction of benzodiazepines may precipitate an acute withdrawal reaction. Patients who are receiving higher doses of dexamethasone will be at a greater risk of AEs.
Therapies Statement on Omicron Subvariants. Summary Recommendations. Drug-Drug Interactions Drug Info. Box 1. Medications That Have Clinically Relevant Drug-Drug Interactions With Ritonavir-Boosted Nirmatrelvir Clinicians should be aware that, in some cases, drug-drug interactions with ritonavir-boosted nirmatrelvir may lead to serious or life-threatening drug toxicities.
Consult 1 or more of the following resources for information on identifying and managing drug-drug interactions: Quick reference lists: Box 1 lists select outpatient medications that are not expected to have clinically relevant interactions with ritonavir-boosted nirmatrelvir. Box 2 lists select outpatient medications that have clinically relevant drug-drug interactions with ritonavir-boosted nirmatrelvir. Management Strategies for Drug-Drug Interactions Consider the magnitude and significance of the potential drug-drug interaction when choosing management strategies for patients who will be receiving ritonavir-boosted nirmatrelvir.
Potential strategies include: Increasing monitoring for potential adverse reactions to the concomitant medication. Adjusting the dose of the concomitant medication. Temporarily withholding the concomitant medication. Using an alternative to the concomitant medication.
Box 2. They may need to be withheld for longer if the patient is an adult of advanced age or the medication has a long half-life. If withholding is not clinically appropriate, use an alternative concomitant medication or COVID therapy. Educate patients about potential adverse effects. J Antimicrob Chemother. Food and Drug Administration. FDA requiring Boxed Warning updated to improve safe use of benzodiazepine drug class. Assessment of drug-drug interactions between voriconazole and glucocorticoids.
J Chemother. These medications may be coadministered without dose adjustment and without increased monitoring. For these medications, management strategies are not possible or feasible, or the risks outweigh the potential benefits.
Withhold these medications during ritonavir-boosted nirmatrelvir treatment and for at least 2—3 days after treatment completion.
Drug Interactions. Although certain medicines should not be used together at all, in other cases two different medicines may be used together. WebMD provides information about interactions between ABC Compound with Codeine #3 oral and salicylates-corticosteroids. Prednisone is first metabolized in the liver to its active form, prednisolone, a glucocorticoid agonist corticosteroid. The short term effects of. WebMD provides information about interactions between ABC Compound with Codeine #3 oral and salicylates-corticosteroids. Drug-Drug Interactions Between Ritonavir-Boosted Nirmatrelvir (Paxlovid) Acetaminophen; Aspirin; Codeine; Ibuprofen; Meloxicam; Naproxen. Healthcare provider in a community clinic. Food and Drug Administration.Before you take any new medicines, check with your IBD team or pharmacist whether there could be an interaction with steroids. This also applies to any over-the-counter medicines and any herbal, complementary or alternative medicines and treatments. You should tell any doctor or dentist treating you that you are taking steroids. Some key drugs that interact with steroids include anticoagulants such as warfarin , drugs for blood pressure, antiepileptics, antidiabetic drugs, antifungal drugs, bronchodilators such as salbutamol and diuretics.
Studies suggest taking steroids with aspirin and nonsteroidal anti inflammatory drugs NSAIDs , such as ibuprofen, increases the risk of peptic ulcers. If you need both medications, ask your IBD team if you might benefit from taking proton pump inhibitors as well to help prevent ulcers.
Search Login. Inflammatory Bowel Disease Clinic. Can I take other medications along with steroids? Steroids How effective are steroids in IBD? How do I take it? How long should I be on steroid treatment for? Why you should not suddenly stop taking steroids? What is budesonide? Will I need to take any special precautions while being treated with steroids? Are there alternatives to steroids? What checks will I need for long-term steroid treatment?
What special information should you give your doctor? Side effects When should I seek medical help? Should I be doing anything to protect my bones from osteoporosis?
Do steroids affect fertility, pregnancy, and breastfeeding? Tell us about yourself Are you primarily a: Healthcare provider in an academic clinic. Healthcare provider in a community clinic.
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