What factors may affect Glucocorticoids dose efficacy?
- • Age.
- Children aged <12 years clear GCs 33% faster.
- • Diseases.
- Severe liver disease: may not convert prednisone to prednisolone (active form). Failure to normalize the INR with vitamin K indicates severe liver disease.
- Hyperthyroidism, nephrotic syndrome, and hemodialysis increases GC clearance.
- • Medications.
- Aluminum/magnesium antacids reduce absorption by 40%.
- Most anticonvulsants and rifampin enhance GC metabolism by upregulating the CYP3A4 hepatic enzyme. On these medications, the GC dose will need to be increased (often doubled) to achieve the same immunosuppressive effects.
- Erythromycin and ketoconazole decrease GC metabolism.
