Indications

Congenital adrenal hyperplasia, Allergic and inflammatory disorders, Corticosteroid-responsive dermatoses, Mild to moderate plaque psoriasis

Contraindication

Untreated infections (systemic and topical). Idiopathic thrombocytopenic purpura (IM).

Special Precautions

Patient w/ history of severe affective disorder esp steroid psychosis, osteoporosis, CHF or HTN, recent MI, DM, history of TB, glaucoma, corticosteroid-induced myopathy, epilepsy, peptic ulceration, hypothyroidism, myasthenia gravis; psoriasis (topical). Renal and hepatic impairment. Childn. Pregnancy and lactation. Patient Counselling Avoid abrupt withdrawal. Avoid exposure to chickenpox or measles. Monitoring Parameters Monitor for hypothalamic-pituitary-adrenal (HPA) axis suppression, esp in childn.

Side Effects

Suppression of HPA axis, growth suppression esp in childn, menstrual irregularity and amenorrhoea, Cushingoid facies, hirsutism, wt gain, impaired carbohydrate tolerance, increased appetite, hyperhidrosis; recurrence of dormant TB, opportunistic infections; osteoporosis, vertebral and long bone fractures, avascular osteonecrosis, tendon rupture, proximal myopathy; Na and water retention, HTN, K loss, hypokalaemic alkalosis; affective disorder (e.g. irritable, euphoric, depressed and labile mood, suicidal thoughts), psychotic reactions ( e.g. mania, delusions, hallucinations and aggravation of schizophrenia), behavioural disturbances, irritability, anxiety, sleep disturbances and cognitive dysfunction (e.g. confusion, amnesia), epilepsy aggravation; increased intraocular pressure, glaucoma, papilloedema, posterior subcapsular cataracts, corneal or scleral thinning, exacerbation of ophth viral or fungal disease; abdominal distension, oesophageal ulceration, nausea, dyspepsia, peptic ulceration w/ perforation and haemorrhage, acute pancreatitis, candidiasis; impaired healing, skin atrophy, bruising, telangiectasia, striae, acne, Stevens-Johnson syndrome; thrombo-embolism, malaise, hiccups.

Drug Interactions

Increased plasma concentration when used w/ CYP3A4 inhibitors (e.g. ritonavir, itraconazole), and OCs. Decreased therapeutic effect when concurrently used w/ rifampicin, rifabutin, carbamazepine, phenobarbitone, phenytoin, primidone, aminoglutethimide and ephedrine. May antagonise the effect of hypoglycaemic agents, antihypertensives, neuromuscular blockers (e.g. vecuronium), and diuretics. Increased risk of hypokalaemia w/ acetazolamide, loop/thiazide diuretics, carbenoxolone, theophylline, cardiac glycosides. May inhibit the growth promoting effects of somatropin. Increased risk of tendon rupture w/ concurrent use of fluoroquinolones. May increase the metabolism of quetiapine and tretinoin. Increased risk of GI bleeding when used w/ NSAIDs. May enhance the efficacy of coumarin anticoagulants.

Route of Administration

Oral, Opthalmic, Nasal, Topical

Dosage

As directed by the physician