Transfer from another glucocorticosteroid therapy may result in reappearance or recurrence of symptoms relating to the change in systemic steroid levels. Patients w/ TB, HTN, DM, osteoporosis, peptic ulcer (gastric or duodenal ulcer), glaucoma, cataract; family history of diabetes, glaucoma. Cushing's syndrome, adrenal suppression, growth retardation, decreased bone mineral density, cataract, glaucoma & a wide range of psychiatric/behavioural effects may occur, particularly at high doses & prolonged use. Increased susceptibility to infections & their severity. Patients w/o a definite history of chickenpox should avoid close contact w/ persons suffering from chickenpox or shingles. Do not give live vaccines to persons w/ chronic glucocorticosteroid use. Blurred vision or other visual disturbance warrants referral to an ophthalmologist. May suppress the hypothalamic-pituitary-adrenal axis & reduce stress response (supplementary systemic glucocorticoid treatment is recommended where patients are subject to surgery or other stresses). Monitor for skin irritations (eg, contact dermatitis). Avoid concomitant use w/ ketoconazole or other CYP3A inhibitors. Systemic glucocorticoid-like side effects (higher than recommended doses). Late stage primary biliary cirrhosis w/ hepatic cirrhosis; severe hepatic impairment. Pregnancy & lactation.
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