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Dietary restrictions with lower salt intake and potassium supplementation may be necessary. Long-term treatment with pharmacological doses of corticosteroid may lead to secondary adrenal insufficiency. The risk can be reduced by giving the treatment every other day (see section 4.2). If corticosteroids are indicated in patients with latent tuberculosis or tuberculin reactivity, careful monitoring is necessary as the disease can be reactivated. In long-term corticosteroid therapy, these patients should receive tuberculosis prophylaxis. Administration of live vaccines is contraindicated in patients receiving corticosteroids in immunosuppressive doses.

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Too rapid a reduction of corticosteroid dosage following prolonged treatment can lead to acute adrenal insufficiency, hypotension and death (see section 4.4). Concomitant use of aspirin and Non-Steroidal Anti-Inflammatory Drugs with corticosteroids increases the risk of gastro-intestinal bleeding and ulceration. The efficacy of coumarin anticoagulants and warfarin may be enhanced by concurrent corticosteroid therapy and close monitoring of the INR or prothrombin time is required to avoid spontaneous bleeding. The desired effects of hypoglycemic agents , anti-hypertensives and diuretics are antagonised by corticosteroids. Rifampicin, rifabutin, carbamazepine, phenobarbitone, phenytoin, primidone, ephedrine and aminoglutethimide enhance the metabolism of corticosteroids and its therapeutic effects may be reduced. This medicinal product contains 37.6 mg sodium per dose, equivalent to 1.88% of the WHO recommended maximum daily intake for sodium.