In normal situations inhalation fluticasone propionate its accompanied by low concentrations in plasma due to an intensive metabolism in the “first” pass and high systemic clearance influenced isoenzyme of cytochrome in the gut and liver. This clinically relevant interactions involving fluticasone propionate are unlikely.
Investigation of drug interactions in healthy volunteers has shown that ritonavir – a highly active inhibitor of deca durabolin side effectsisoenzyme – can cause a sharp increase in the concentration of fluticasone propionate in plasma, resulting in significantly reduced serum cortisol concentrations.
During post-marketing observations have been received reports of clinically significant drug interactions in patients who are concurrently receiving fluticasone propionate (intranasally or by inhalation) and ritonavir. These interactions cause systemic side effects associated with corticosteroids, such as Cushing’s syndrome and adrenal suppression. Given this, you should avoid simultaneous use of fluticasone propionate and ritonavir, unless the potential benefit to the patient outweighs the risk of systemic side effects of corticosteroids.
Studies have shown that other inhibitors produce negligible (erythromycin) and minor (ketoconazole) increased content of fluticasone propionate in plasma, in which almost no decrease in serum cortisol concentrations. Despite this, it is advisable to be careful while applying fluticasone propionate and potent inhibitors of CYP3A4 (e.g., ketoconazole), since under such combinations do not exclude the probability of increasing the concentration of fluticasone propionate in plasma, which could potentially increase the systemic effects of fluticasone propionate.
When studying drug interactions was found that the use as a concomitant systemic therapy significantly increases the concentration of ketoconazole in plasma salmeterol . This can lead to a lengthening of QTc interval. Caution must be exercised with concomitant use of strong inhibitors (eg, ketoconazole) and salmeterol.
Xanthine derivatives, corticosteroids and diuretics increase the risk of hypokalemia (especially in patients with acute exacerbation of bronchial asthma, during hypoxia). Monoamine oxidase inhibitors and tricyclic antidepressants increase the risk of side effects from the cardiovascular system. Drug deca durabolin side effects compatible with kromoglitsievoy acid.
Is not designed to relieve acute symptoms, since in such cases should be applied rapidly and short-inhaled bronchodilator (eg, salbutamol).
Patients should be informed of that they have always had a drug on hand for relief of acute symptoms.
The combination of salmeterol and fluticasone propionate can be used for the initial maintenance therapy in patients with persistent asthma (daily occurrence of symptoms or daily use of cupping) in the presence of indications for corticosteroids and determining their approximate dosage.
More frequent use of short-acting bronchodilators to relieve symptoms indicates deterioration of disease control, and in such situations the patient should seek medical advice.
A sudden and increasing deterioration in control of asthma is potentially life threatening, and in such situations the patient should also seek medical attention. The physician should consider the appointment of a high-dose corticosteroids. If your dose of Seretide Multidisk product does not provide adequate control of the disease, the patient should also seek medical advice.
Patients with asthma can not abruptly stop treatment with Seretide Multidisk because of the risk of exacerbation of, the dose should be reduced gradually under medical supervision. In patients , removal of the drug may be associated with symptoms of decompensation and requires medical supervision.
In clinical studies, there is evidence of an increase in the incidence of pneumonia in patients with receiving Seretide drug Multidisk (see. “Side effects” section). Physicians should be aware of the possibility of the development of pneumonia in patients as the clinical picture of pneumonia and exacerbations are often similar.
Any inhaled corticosteroids may cause systemic effects, especially with prolonged use at high doses; It should be noted, however, that the probability of occurrence of such symptoms are much lower than in the treatment of oral corticosteroids . Possible systemic effects include deca durabolin side effects, , adrenal suppression, growth retardation in children and adolescents, decrease in bone mineral density, cataract and glaucoma. Therefore, in the treatment of asthma, it is important to reduce the dose to the lowest dose that provides effective control of symptoms.
In emergency and planned situations that can cause stress, you should always keep in mind the possibility of adrenal suppression and be ready to use corticosteroids (see. “Overdose” section).
If resuscitation or surgical procedures require a degree of adrenal insufficiency.
It is recommended to regularly measure the growth of children who receive long-term treatment with inhaled corticosteroids.
In view of the possibility of adrenal suppression patients transferred from oral corticosteroids to inhalation of fluticasone propionate therapy should be treated with extreme caution and regular monitoring of their function of the adrenal cortex. When transferring patients receiving systemic corticosteroids allergic reactions may occur on inhalation therapy (eg, allergic rhinitis, eczema), which previously suppressed by systemic GCS. In such situations, it is recommended to carry out symptomatic treatment with antihistamines and / or topical preparations, including SCS for local use.
After initiation of treatment with inhaled fluticasone propionate systemic corticosteroids should be lifted gradually, and such patients should be in possession of a special patient card, containing an indication of the possible need for additional administration of deca durabolin side effects in stressful situations.
In patients with acute exacerbation of asthma, hypoxia necessary to control the concentration in the plasma.
There are very rare reports of increased blood glucose levels, and this should be remembered by assigning a combination of salmeterol and fluticasone propionate in patients with diabetes mellitus. newpublish.club