Interactions : אינטראקציות

4.5   Interaction with other medicinal products and other forms of interaction
Hydrocortisone is metabolised by cytochrome P450 3A4 (CYP3A4). Concomitant administration of medicinal products that are inhibitors or inducers of CYP3A4 may therefore lead to unwanted alterations in serum concentrations of hydrocortisone with the risk of adverse reactions, particularly adrenal crisis. The need for dose adjustment when such medicinal products are used can be anticipated and patients should be closely monitored.

Medicinal products inducing CYP3A4, requiring a potential increase in Efmody dosing, include but are not limited to:

-     Anticonvulsants: phenytoin, carbamazepine and oxcarbazepine
-     Antibiotics: rifampicin and rifabutin
-     Barbiturates including phenobarbital and primidone
-     Antiretroviral medicinal products: efavirenz and nevirapine
Efmody-S P C-0923                                                                    Efmody-5_10 mg-SPC -      Herbal medicinal products such as St. John's Wort

Medicinal products/substances inhibiting CYP3A4, requiring a potential decrease in hydrocortisone dosing, include but are not limited to:

-      Anti-fungals: itraconazole, posaconazole, voriconazole
-      Antibiotics: erythromycin and clarithromycin
-      Antiretroviral medicinal products: ritonavir
-      Grapefruit juice
-      Liquorice

The desired actions of hypoglycaemic medicinal products including insulin are antagonised by corticosteroids.