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Azmacort

Drug Name: Azmacort

Drug ID: 119

Nutritional Considerations

  • Chronic use of Azmacort in higher doses may impair calcium absorption and bone formation. Supplementation with calcium and vitamin D is strongly encouraged. Inform your pharmacist if you have osteoporosis.

    1. Sambrook PN: Calcium and vitamin D therapy in corticosteroid bone loss: what is the evidence? J Rheumatol 1996; 23:963-964.
    2. Buckley LM, Leib ES, Cartularo KS, et al. Calcium and vitamin D3 supplementation prevents bone loss in the spine secondary to low-dose corticosteroids in patients with rheumatoid arthritis. A randomized, double-blind, placebo-controlled trial. Ann Intern Med 1996;125:961-68.
    3. Lems WF, Van Veen GJ, Gerrits MI, et al: Effect of low-dose prednisone (with calcium and calcitrol supplementation) on calcium and bone metabolism in healthy volunteers, Br J Rheumatol, 1998, 37(1):27-33.
    4. Lems WF, Jacobs JW, Netelenbos JC, et al: Pharmacological prevention of osteoporosis in patients on corticosteroid mediciation, Ned Tijdschr Geneeskd, 1998, 142(34):1905-8.
    5. Gennari C, Differential effect of glucocorticoids on calcium absorption and bone mass, Br J Rheumatol, 1993, 32 (suppl 2):11-4.
    6. Reid IR, Ibbertson HK, Calcium supplements in the prevention of steroid-induced osteoporosis, Am J Clin Nutr, 1986, 44 (2):287-90.
    7. Weryha G, Klein M, Guillemin F, et al: Corticosteroids osteoporosis in the adult, Presse Med, 1998, 27(32):1641-6.
    8. Hachulla E, Cortet B: Prevention of glucocorticoid-induced osteoporosis, Rev Med Interne, 1998, 19(7): 492-500.
    9. Gerster JC, So AK, Burkhardt P: Systemic corticosteroid therapy in rheumatology - advantages and risks, Schweiz Rundsch Med Prax, 1998, 87(33):1024-7.
  • Chronic, long-term use of Azmacort at higher doses may also compromise the immune system and deplete several important nutrients. Supplementation with vitamins A, C, E, selenium, magnesium, potassium, vitamin B6 and zinc may be beneficial.

    1. AMA Drug Evaluations, 1995 Annual, American Medical Association.
    2. Holt GA. Food & Drug Interactions. Chicago: Precept Press, 1998, 83.
    3. Thelkeld DS, ed. Hormones, Adrenal Cortical Steroids, Glucocorticoids. In Facts and Comparisons , Clinisphere 2.0, Wolters Kluwer Company, 2000
    4. Trovato A et al. Drug-nutrient interactions. Am Family Phys 1991;44:1651-58 [review].
    5. Chesney RW et al. Reduction of serum-1,25-dihydroxyvitamin-D, in children receiving glucocorticoids. Lancet 1978;ii:1123-25.
    6. Widmer P, Maibach R, Kunzi UP, et al: Diuretic-Related hypokalaemia - the role of diuretics, potassium supplements, glucocorticoids, and beta-2-adrenoceptor agonists - results from the Comprehensive Hospital Drug Monitoring program, Berne (CHDM), Eur J Clin Pharmacol, 1995, 49(1-2): 31-6.
    7. Shenfield GM, Knowles GK, Thomas N, et al: Potassium supplements in patients treated with corticosteroids, Br J Dis chest, 1975, 69:171-6.
    8. Gol’berg ED, Eshchenko VA, Bovt VD, et al: The effect of immunosuppressive substances on the zinc content in cells, Biull Eksp Biol Med, 1993, 116(10):412-3.
    9. Yunice AA, Czerwinski AW, Lindeman RD: Influence of synthetic corticosteroids on plasma zinc and copper levels in humans, Am J Med Sci, 1981, 282(2):68-74.
    10. Fodor L, Ahnefeld FW, Fazekas AT: Studies on the glucocorticoid control of zinc metabolism, Infusionsther Klin Ernahr, 1975, 2(3):210-3.
    11. Atkinson SA, Halton JM, Bradley C, et al: Bone and mineral abnormalities in childhood acute lymphoblastic leukemia - influence of disease, drugs, and nutrition, Int J Cancer Suppl, 1998, 11:35-9.
    12. Simeckova A, Neradilova M, Reisenauer R: Effect of prednisolone on the rat bone calcium, phosphorus, and magnesium concentration, Physiol Bohemoslov, 1985, 34(2):155-60.
    13. Frequin ST, Wevers RA, Braam M, et al: Decreased vitamin B12 and folate levels in cerebrospinal fluid and serum of multiple sclerosis patients after high-dose intravenous methylprednisone, J Neurol, 1993, 240(5):305-8.
    14. Peretz A, Neve J, Vertongen F, et al: Selenium status in relation to clinical variables and corticosteroid treatment in rheumatoid arthritis, J Rheumatol, 1987, 14(6):1104-7.

Herbal Considerations

  • Ephedra (Ma huang) may increase the clearance of Azmacort and thereby may decrease its effectiveness.

    1. Jubiz W, Meikle AW. Alterations of glucocorticoid actions by other drugs and disease states. Drugs 1979;18:113-21.
  • Licorice may decrease the clearance of Azmacort and may possibly intensify the duration of its activity and side effects.

    1. Chen MF, Shimada F, Kato H, et al. Effect of glycyrrhizin on the pharmacokinetics of prednisolone following low dosage of prednisolone hemisuccinate. Endocrinol Japon 1990;37:331-41.

NDC Codes

00075006037, 00075006039, 00801006037, 00801006039, 17270057437, 17270057439, 53002087758, 54868126801