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Abrupt withdrawal of doses up to payday loans. Patients who, during systemic treatment, encounter stresses such as trauma, surgery or infection and who are at risk of adrenal insufficiency, should receive additional systemic dexamethasone cover during these periods. This includes patients who have finished a course of systemic dexamethasone of less than three weeks duration in the week prior to the stress.

Patients on systemic dexamethasone therapy who are at risk of adrenal suppression and are unable to take tablets by mouth should receive parenteral dexamethasone cover during these payday advance periods. Too rapid a reduction of dexamethasone dosage following prolonged treatment can lead to acute adrenal insufficiency, hypotension and death.

In post-marketing experience tumour lysis syndrome (TLS) has been reported in patients with haematological malignancies following the use of dexamethasone alone or in combination with other chemotherapeutic payday loans. Patients at high risk of TLS such as patients with high proliferative rate, high tumour burden, and high sensitivity to cytotoxic payday loans, should be monitored closely and appropriate precaution taken. Adrenal cortical atrophy develops during prolonged therapy and may persist for years after stopping treatment.

Glucocorticoid therapy is non-specific, suppresses the symptoms and signs of disease and decreases the resistance to infections. The clinical presentation may often be atypical and serious infections such as septicaemia and tuberculosis may be masked and may reach an advanced stage before being recognised. Strong antimicrobial therapy should accompany glucocorticoid therapy when necessary. Vaccines should not be given to individuals with glucocorticoid therapy-induced immunosuppression.

Vaccination with live vaccines, payday loans. Chickenpox is of particular concern. Chickenpox is a normally minor illness but may be fatal in immunosuppressed patients. Patients (or parents of children) without a definite history of chickenpox should be advised to avoid close personal contact with chickenpox or herpes zoster and if exposed they should seek urgent medical attention.

If a diagnosis of chickenpox is confirmed, the illness warrants specialist care and urgent treatment. Corticosteroids should not be stopped and even the dose may need to be increased. Measles can have a more serious or even fatal course in immunosuppressed patients.

In such children or adults, particular care should be taken to avoid exposure to measles. If exposed, prophylaxis with intramuscular pooled immunoglobulin (IVIG) may be indicated. Exposed patients should be advised to seek medical advice without delay. Prolonged use of corticosteroids may produce posterior subcapsular cataracts, glaucoma with possible damage to the optic nerve and may enhance the establishment of secondary ocular infections due to fungi or viruses.

Visual disturbance may be reported with systemic and topical corticosteroid use. If a patient presents with symptoms such as blurred vision or other visual disturbances, the patient should be considered for referral to an ophthalmologist for evaluation of possible causes which may include cataract, glaucoma or rare diseases such as central serous chorioretinopathy (CSCR) which have been reported after use of systemic and topical corticosteroids.

Glucocorticoids can cause dose-related growth retardation in infancy, childhood and adolescence, which may be irreversible. Therefore, Dexamethasone should only be used in children with caution. The common adverse effects of systemic glucocorticoids may be associated with more serious consequences in old age, especially osteoporosis, hypertension, hypokalaemia, diabetes, susceptibility to infection and thinning of the skin.

Close clinical supervision is required to avoid life-threatening reactions. Symptoms typically emerge within a few days or weeks of starting the treatment. Most reactions recover after either dose reduction or withdrawal, although specific treatment may be necessary. Particular care is required when considering the use of systemic corticosteroids in patients with existing or previous history of severe affective disorders in themselves or in their first degree relatives.

These would include depressive or manic-depressive illness and previous steroid psychosis. Preterm neonates: Available evidence suggests long-term neurodevelopment adverse events after early treatment (Rifampin, rifabutin, carbamazepine, phenobarbitone, phenytoin, primidone and aminoglutethimide enhance the metabolism of glucocorticoids and the therapeutic effects may be reduced.

Dexamethasone is a moderate inducer of CYP 3A4. Co-administration of dexamethasone with other drugs that are metabolized by CYP 3A4 (e. 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.

The desired effects of hypoglycaemic agents (including insulin), antihypertensives and diuretics are antagonised by glucocorticoids. Concurrent use of potassium-depleting diuretics (e. The efficacy of coumarin anticoagulants may be altered payday advance by concurrent glucocorticoid therapy and close monitoring of the International Normalised Ratio or prothrombin time is required. The renal clearance of salicylates is increased by glucocorticoids and steroid withdrawal may result in salicylate intoxication.

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