NSAID + corticosteroid dramatically increases risk of GI ulceration and perforation
Management: AVOID concurrent use. Allow 3-5 day washout between drugs. If overlap unavoidable, add GI protectant (omeprazole + sucralfate).
NSAID + corticosteroid dramatically increases risk of GI ulceration and perforation
Management: AVOID concurrent use. Allow 3-5 day washout between drugs.
Corticosteroids cause insulin resistance and hyperglycaemia, directly opposing glipizide's hypoglycaemic effect
Management: Avoid concurrent use in diabetic patients. If corticosteroid is essential, monitor blood glucose intensively and increase glipizide/insulin dose.
Combined NSAID + corticosteroid use greatly increases risk of GI ulceration and perforation
Management: Avoid concurrent use. If unavoidable, add GI protectant (omeprazole + sucralfate) and monitor for melena.
COX-2 selective NSAID + corticosteroid still carries significant GI ulceration risk despite COX-2 selectivity.
Management: Avoid concurrent use. COX-2 selectivity does not eliminate risk when combined with corticosteroids.
NSAID + corticosteroid: additive GI ulceration risk regardless of COX-2 selectivity.
Management: Avoid concurrent use. Allow 3-5 day washout when transitioning.
Corticosteroids cause insulin resistance by increasing hepatic gluconeogenesis and reducing peripheral glucose uptake, directly antagonizing insulin therapy.
Management: Insulin dose may need 50-100% increase during corticosteroid therapy. Monitor blood glucose curves closely. Adjust insulin when tapering steroids (hypoglycemia risk on discontinuation).
Insulin, NPH (Isophane)
majorCorticosteroid-induced insulin resistance destabilizes diabetic control.
Management: Closely monitor blood glucose. Significant insulin dose adjustments likely needed. Hypoglycemia risk when steroid discontinued.
Insulin, Lente (Porcine)
majorCorticosteroid-induced insulin resistance. Glucocorticoids increase hepatic gluconeogenesis and decrease peripheral glucose uptake, directly antagonizing insulin.
Management: Avoid steroids in diabetic patients. If essential, monitor glucose curves closely. Expect 50-100% insulin dose increase. Hypoglycemia risk when steroid tapered.
Insulin, PZI (Protamine Zinc)
majorCorticosteroid-induced insulin resistance destabilizes diabetic control in cats.
Management: Avoid if possible. If steroid needed (e.g., IBD in diabetic cat), monitor glucose intensively and adjust insulin dose. Budesonide may be preferred (less systemic effect).
Insulin, Regular (Crystalline Zinc)
majorCorticosteroids cause insulin resistance, counteracting insulin therapy in DKA management.
Management: Avoid steroids during DKA stabilization. Address underlying steroid need after DKA resolved.
Aspirin (Acetylsalicylic Acid)
majorAspirin (irreversible COX inhibition + direct GI irritant) + corticosteroid: very high GI ulceration risk. Also, steroids increase aspirin clearance.
Management: Avoid concurrent use. If low-dose aspirin antiplatelet therapy needed with steroids, add omeprazole + misoprostol and monitor closely for melena.
Corticosteroids directly antagonize metformin's insulin-sensitizing effect by increasing hepatic gluconeogenesis and peripheral insulin resistance.
Management: Avoid steroids with metformin. If unavoidable, metformin alone will be inadequate — insulin therapy likely needed.
NSAID + corticosteroid: additive GI ulceration risk. Etodolac specifically also causes KCS — corticosteroids may mask inflammatory signs.
Management: Do not combine. Allow 3-5 day washout when switching.
NSAID + corticosteroid: ketorolac is a particularly potent NSAID with high GI ulceration risk. Combined with steroid: very dangerous.
Management: Do not combine. Allow 3-5 day washout.
Long-acting NSAID (80-day half-life) + corticosteroid: extremely dangerous because mavacoxib CANNOT be rapidly discontinued if GI ulceration occurs.
Management: NEVER combine. The extremely long half-life of mavacoxib means that if toxicity occurs, the drug persists for weeks. Allow 3+ month washout of mavacoxib before steroid.
NSAID + corticosteroid: additive GI ulceration risk.
Management: Do not combine. Allow 3-5 day washout when switching.