Patients with any of the following conditions should be monitored: Latent or overt cardiac failure, renal dysfunction, hypertension or migraine since glucocorticoids may induce fluid retention, osteoporosis since glucocorticoids have a negative effect on the calcium balance; a history of psychotic illness; latent tuberculosis, since glucocorticoids may induce reactivation; certain parasitic infestation in particular amoebiasis; incomplete statural growth since glucocorticoids on prolonged administration may accelerate epiphyseal closure. Glucocorticoid therapy is non specific, suppresses the symptoms and signs of disease and decrease resistance to infections. Appropriate antibacterial therapy should accompany glucocorticoid therapy when necessary e.g. tuberculosis and viral and fungal infections of the eye. Patients in long-term glucocorticoid therapy should be regularly examined with respect to their glucose metabolism. Before, during and after stressful situations, dosages may need to be increased in patients currently in glucocorticoids or resumed in patients who have undergone prolonged glucocorticoid treatment in the previous year. Discontinuation of prolonged therapy should be carried out by gradual reduction of dosage and under strict medical supervision, since withdrawal may result in acute exacerbation of the disease and acute adrenocortical insufficiency. Local injection of a glucocorticoid may produce systemic effects. After parenteral administration of glucocorticoids, serious anaphylactoid reactions e.g. glottis edema and bronchospasm, have occasionally occurred, particularly in patients with a history of allergy. If such an anaphylactoid reaction occurs, the following measures are recommended: Immediate slow IV administration of 0.1-0.5 mL of adrenaline 1:1000 (0.1-0.5 mg), IV administration of aminophylline and artificial respiration. The use of corticosteroids may influence the results of certain laboratory tests.
Use in pregnancy and lactation: There are insufficient data on the use of this drug during human pregnancy to assess potential harm to the fetus. However, there are indications for a harmful effect in animal experiments. Infants whose mother received substantial doses of glucocorticoids during pregnancy should be carefully observed for signs of renal insufficiency. Glucocorticoids appear in breast milk in very small quantities, but it is unknown whether this can adversely affect the infant.