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With tapering of steroid doses, ischemic complications may occur at any time but tend to occur a median of 1 month after beginning therapywith glucocorticoids. In cases of multiple ischemic events, the time interval increases with increasing dose to 3-6 months, and it can be as long as 3-12 months after beginning therapy with glucocorticoids.CORTICOLIC ACTIVATION AND CYTOMOLYCEMS:Corticosteroids exert their effect by altering the activity (oxidation) of steroidogenic enzymes. Corticosteroids interact with cytochrome P450 2D6 (CYP2D6) proteins for the metabolism of the following compounds (from Table 1): 5α-reductase 1 (5-AR1), 6α-hydroxysteroid dehydrogenase 2 (6-HSD), 5α-reductase 3 (5-AR3), 5-alpha reductase 2 (5-AR2), and 17 beta-hydroxylase 1 (17-HDR1); in addition, steroidal agents that act on 4 of the above may interact with 5-AR1 via the CYP2D6 pathway. The 5-AR1 and 6-HSD enzymes are enzymatic for the formation of cortisol and testosterone respectively. Corticosteroids do not affect the metabolism of some 5α-reduction inhibitors but may promote its degradation. Corticosteroids exert a stimulating and suppressing effects on several cytochrome P450 3A4 (CYP3A4) genes. Corticosteroids also may affect the activity of the enzymes that mediate CYP3A4. Corticosteroids also exert their effects by interacting with steroidohepatic enzymes, including cytochrome P450 enzymes; the CYP3A4 enzymes are involved in steroid hormones and therefore are in important cell signaling pathways. Corticosteroids directly interact with steroidoinducers through direct interactions with steroid binding proteins (SBP) or via indirect interactions and inhibition of steroidogenic enzymes via the steroidogenic enzymes. The direct interactions with steroid steroidoinducers is mainly the most significant. An indirect interaction occurs when the effects of corticosteroids are suppressed by inhibition of steroidogenesis. All steroidal drugs interact with at least one more steroidoinducer than they would do alone. This is mainly due to the influence on steroidogenic enzymes as discussed above.TABLE 1. Drug name CYP1A2 CYP2A6 CYP1A2A1 CYP2A6A1Similar articles: