Hydrocortisone with Cisatracurium Interaction Details
Brand Names Associated with Hydrocortisone
- Alkindi Sprinkle®
- Cortef®
- Cortisol
- Cortril®
- Hydrocortisone
- Hydrocortone®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Dec 03, 2023
Interaction Effect
Decreased cisatracurium effectiveness; prolonged muscle weakness and myopathy
Interaction Summary
In a number of case reports, the concomitant use of corticosteroids with neuromuscular blocking agents has been reported to antagonize neuromuscular blockade. In addition, prolonged coadministration of these agents may increase the risk and/or severity of myopathy resulting in prolonged flaccid paralysis following discontinuation of the neuromuscular blocking agent .
Severity
Moderate
Onset
Delayed
Evidence
Theoretical
How To Manage Interaction
If concurrent therapy is required, monitor the effectiveness of cisatracurium and adjust the dose as required, especially in patients receiving high-dose corticosteroids. With prolonged coadministration of these agents, consider allowing the patient to have unparalyzed periods to reduce the total dose of the neuromuscular blocker.
Mechanism Of Interaction
Unknown
Literature Reports
A) A 21-year-old male with idiopathic thrombocytopenic purpura was treated unsuccessfully with prednisone (100 to 250 mg/day) and was scheduled for splenectomy. Prior to the procedure the patient received pancuronium bromide 8 mg (0.1 mg/kg) and intubated. One hour into the procedure, there was inadequate muscle relaxation. Even after 4 additional 2-mg doses, abdominal relaxation did not improve. The author speculated that the decreased effectiveness of the pancuronium was due to the high-dose corticosteroid therapy. The mechanism of the interaction may involve competition at the myoneural junction, alterations in protein binding, or induction of pancuronium metabolism .
B) A previously healthy 2-year-old burn patient was intubated and paralyzed with vecuronium (290 mg/kg; total dose 2433 mg) to allow artificial ventilation. In addition, the patient was given aminoglycosides and other antibiotics for sepsis. Dexamethasone 2.5 mg every 6 hours was administered intravenously for 18 days during the period of ventilation (45 days). When the vecuronium was discontinued, the patient showed no movement in any extremities other than trace finger movement. Muscle biopsy results were most consistent with a myopathy. Nearly eight months were required for the patient to recover sufficient muscle tone and strength .
Hydrocortisone Overview
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Hydrocortisone is used alone or with other medications to treat the symptoms of low corticosteroid levels (lack of certain substances that are usually produced by the body and are needed for normal body functioning). Hydrocortisone is also used to treat other conditions in patients with normal corticosteroid levels. These conditions include certain types of arthritis; severe allergic reactions; lupus (a disease in which the body attacks many of its own organs); and certain conditions that affect the lungs, skin, eyes, kidneys, blood, thyroid, stomach, and intestines. It is also sometimes used to treat the symptoms of certain types of cancer. Hydrocortisone is in a class of medications called corticosteroids. It works to treat patients with low levels of corticosteroids by replacing steroids that are normally produced naturally by the body. It works to treat other conditions by reducing swelling and redness and by changing the way the immune system works.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.