Florinef Drug Interactions

Amphotericin B injection and potassium-depleting agents: Patients should be observed for hypokalemia.
Anticholinesterases: Effects of anticholinesterase agents may be antagonised.
Anticoagulants, oral: Corticosteroids may potentiate or decrease anticoagulant action. Patients receiving oral anticoagulants and corticosteroids should therefore be closely monitored.
Antidiabetics: Corticosteroids may increase blood glucose; diabetic control should be monitored, especially when corticosteroids are initiated, discontinued, or changed in dosage.
Antihypertensives, including diuretics: Corticosteroids antagonise the effects of antihypertensives and diuretics. The hypokalaemic effect of diuretics, including acetazolamide, is enhanced.
Anti-tubercular drugs: Isoniazid serum concentrations may be decreased.
Cyclosporin: Monitor for evidence of increased toxicity of cyclosporin when the two are used concurrently.
CYP3A inhibitors: Co-treatment with CYP3A inhibitors, including 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.
Digitalis glycosides: Enhanced possibility of arrhythmias or digitalis toxicity associated with hypokalemia.
Oestrogens, including oral contraceptives: Corticosteroid half-life and concentration may be increased and clearance decreased. A reduction in corticosteroid dosage may be required when oestrogen therapy is initiated, and an increase required when oestrogen is stopped.
Hepatic Enzyme Inducers (e.g. aminoglutethimide, barbiturates, carbamazepine, phenytoin, primidone, rifabutin, rifampicin): There may be increased metabolic clearance of Fludrocortisone acetate. Patients should be carefully observed for possible diminished effect of steroid, and the dosage should be adjusted accordingly.
Human growth hormone: The growth-promoting effect may be inhibited.
Ketoconazole: Corticosteroid clearance may be decreased, resulting in increased effects.
Nondepolarising muscle relaxants: Corticosteroids may decrease or enhance the neuromuscular blocking action.
Nonsteroidal anti-inflammatory agents (NSAIDS): Corticosteroids may increase the incidence and/or severity of GI bleeding and ulceration associated with NSAIDS. Also, corticosteroids can reduce serum salicylate levels and therefore decrease their effectiveness. Conversely, discontinuing corticosteroids during high-dose salicylate therapy may result in salicylate toxicity. Aspirin should be used cautiously in conjunction with corticosteroids in patients with hypoprothrombinaemia.
Thyroid drugs: Metabolic clearance of adrenocorticoids is decreased in hypothyroid patients and increased in hyperthyroid patients. Changes in thyroid status of the patient may necessitate adjustment in adrenocorticoid dosage.
Vaccines: Neurological complications and lack of antibody response may occur when patients taking corticosteroids are vaccinated (see Precautions).