Patients w/ infections, HTN, DM, osteoporosis, peptic ulcer, glaucoma, cataracts; w/ family history of diabetes or glaucoma or w/ any other condition where use of glucocorticoids may have unwanted effects. Possible visual disturbance w/ systemic & topical corticosteroid use; consider referral to ophthalmologist for evaluation of possible causes if patient presents w/ symptoms (eg, blurred vision or other visual disturbances). Reduced liver function may cause higher systemic exposure; potential systemic effects including glaucoma. Gradually reduce dose when treatment is to be discontinued. May result in lower systemic steroid levels than conventional oral glucocorticoid therapy. Transfer from other steroid therapy may result in symptoms relating to change in systemic steroid levels. May reduce immune response to vaccines. Avoid concomitant administration w/ ketoconazole or other potent CYP3A4 inhibitors; regular ingestion of grapefruit or its juice. Contains lecithin & lactose monohydrate. Not to be taken by patients w/ rare hereditary problems (eg, galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption). Adrenocortical suppression; increased susceptibility to infections; HPA axis suppression & reduced stress response; systemic effects of steroids may occur particularly at high doses & prolonged periods. More serious course of chicken pox & measles; consider reduction or discontinuation of treatment if patients are infected or suspected of being infected. Current or history of severe affective disorders in the patient or any 1st degree relatives. Replacement of high systemic effect corticosteroid treatment sometimes unmasks allergies (eg, rhinitis & eczema). Occasional dizziness or tiredness may occur; may affect ability to drive & use machines. Hepatic & renal impairment. Pregnancy & lactation. Not recommended in childn 0-18 yr. Elderly.
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