Corticosteroids And Anesthetics For Spinal Disc Pain:
Drug Interactions

(Cortisone Injections, Epidurals And Oral Steroids)

What you will learn in this article:

- Corticosteroids and Anesthetics: Powerful treatments for spinal disc pain, with distinct mechanisms of action that provide relief but come with potential interactions.

- Common Drug Interactions: Many medications can interact with corticosteroids and anesthetics, emphasizing the importance of being aware of these implications.

- Specifics on Cortisone and Epidurals: Both cortisone injections and epidurals offer targeted pain relief but have their own set of potential drug interactions and risks.

- Empowerment through Knowledge: Making informed decisions is crucial. Discuss potential drug interactions with healthcare providers, utilize resources, and prioritize personal research to navigate the world of medications confidently.

Navigating the world of corticosteroids and anesthetics can be a maze, especially when considering their potential interactions with other medications.

Cortisone injections, epidurals, and oral steroids, while powerful tools in managing pain, come with a complex web of drug interactions that can influence their efficacy and safety.

This article dives deep into these interactions, shedding light on the intricacies of combining these treatments with other medications.

Whether you're a patient seeking relief or a healthcare professional aiming for the best patient outcomes, understanding these drug interactions is crucial.

From common over-the-counter medications to specific prescription drugs, we'll explore the landscape of potential interactions, ensuring you're equipped with the knowledge to make informed decisions.

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Understanding Corticosteroids and Anesthetics

Corticosteroids & Anesthetics Drug Interactions

Corticosteroids, often simply referred to as steroids, are a class of medications designed to mimic the effects of naturally occurring hormones produced by the adrenal glands.

These powerhouses work by reducing inflammation, suppressing the immune system, and aiding in protein metabolism.

Their anti-inflammatory properties make them invaluable in treating a plethora of conditions, from asthma and allergies to autoimmune diseases and, of course, spinal disc pain.

On the other hand, anesthetics are agents that induce a loss of sensation. They come in two main types: local and general.

Local anesthetics numb a small area, making them perfect for minor surgeries or procedures like epidurals.

General anesthetics, however, affect the entire body, inducing unconsciousness for major surgeries.

Their primary mechanism revolves around blocking nerve signals, ensuring that pain messages don't reach the brain.

Whether it's a simple dental procedure or a complex spinal surgery, anesthetics play a pivotal role in ensuring patient comfort and pain management.

Together, corticosteroids and anesthetics form a dynamic duo in the medical world, offering relief and comfort to countless individuals.

Their distinct mechanisms of action, targeting inflammation and pain respectively, make them indispensable tools in a physician's arsenal.

Common Drug Interactions

When it comes to corticosteroids and anesthetics, their powerful effects can sometimes clash with other medications, leading to a cascade of potential interactions.

For instance, corticosteroids, when combined with anticoagulants like warfarin, can increase the risk of bleeding.

Similarly, combining them with diuretics might elevate potassium levels, posing a risk to heart health.

Anesthetics, too, have their share of interactions.

When combined with medications for high blood pressure, they can cause a significant drop in blood pressure levels.

Furthermore, certain anesthetics might interact with monoamine oxidase inhibitors (MAOIs), a class of antidepressants, leading to potential cardiovascular complications.

But it's not just prescription medications that pose a risk.

Over-the-counter drugs, like nonsteroidal anti-inflammatory drugs (NSAIDs), can also interact with corticosteroids, increasing the risk of stomach ulcers.

Even herbal supplements aren't exempt.

St. John's Wort, for example, can reduce the effectiveness of some anesthetics.

The implications of these interactions range from mild discomfort to severe health risks.

Some might reduce the effectiveness of the treatment, while others can lead to unforeseen side effects.

It's crucial to be aware of these potential pitfalls, ensuring that any treatment plan is tailored to the individual, minimizing risks and maximizing benefits.

The following is a list of the possible drug interactions that can occur with these medications. It’s important that you speak with your doctor or pharmacist about any potential interactions that could take place with the medications you are taking.

Do not take any of these medications with alcohol.

Antifungal drugs (e.g., itraconazole, ketoconazole)

Barbiturates (e.g., phenobarbital, primidone)

Blood thinners (e.g., warfarin)

Estrogen-containing drugs (e.g., birth control pills, estradiol)

High-dose aspirin or aspirin-like drugs (e.g., salsalate, magnesium salicylate)

Macrolide antibiotics (e.g., clarithromycin, erythromycin)

Neuromuscular blocking drugs (e.g., pancuronium, vecuronium)


Rifamycin antibiotics (e.g., rifampin, rifabutin)

Water pills (e.g., potassium-sparing diuretics such as spironolactone or triamterene)

Ambien (zolpidem)

AndroGel (testosterone)



Celexa (citalopram)


Cymbalta (duloxetine)


Lexapro (escitalopram)

Lunesta (eszopiclone)

Lyrica (pregabalin)

Nexium (esomeprazole)

OxyContin (oxycodone)


Seroquel (quetiapine)


Vicodin (acetaminophen / hydrocodone)

Wellbutrin SR (bupropion)

Xanax (alprazolam)

Zoloft (sertraline)

Advair Diskus (fluticasone / salmeterol)

Ambien (zolpidem)

Aspirin Low Strength (aspirin)

Cymbalta (duloxetine)

Fish Oil (omega-3 polyunsaturated fatty acids)

Flexeril (cyclobenzaprine)

Lasix (furosemide)

Lipitor (atorvastatin)

Lyrica (pregabalin)

Nexium (esomeprazole)

Plavix (clopidogrel)

Protonix (pantoprazole)

Singulair (montelukast)

Symbicort (budesonide / formoterol)

Synthroid (levothyroxine)

Vicodin (acetaminophen / hydrocodone)

Vitamin B12 (cyanocobalamin)

Vitamin C (ascorbic acid)

Vitamin D3 (cholecalciferol)

Zyrtec (cetirizine) 

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Specific Interactions with Cortisone Injections

Cortisone injections, a popular treatment for inflammation and pain, come with their own set of potential drug interactions.

When cortisone enters the body, it can interact with various medications, leading to altered effects or new side effects.

For instance, combining cortisone injections with blood thinners like aspirin or warfarin can increase the risk of bleeding at the injection site.

Similarly, medications for diabetes, such as insulin or metformin, might need dose adjustments, as cortisone can elevate blood sugar levels.

Another area of concern is the interaction with immunosuppressive drugs, like cyclosporine.

When combined with cortisone, there's a heightened risk of infections due to a doubly suppressed immune system.

Even certain antifungal medications, like ketoconazole, can increase the levels of cortisone in the blood, amplifying its effects and potential side effects.

Navigating these interactions requires a keen eye and thorough knowledge.

The potential risks range from mild, like slight discomfort at the injection site, to more severe, like increased susceptibility to infections.

It's imperative to discuss any medications, supplements, or over-the-counter drugs you're taking with your healthcare provider before receiving a cortisone injection.

This proactive approach ensures that the benefits of the injection aren't overshadowed by unforeseen interactions.

Epidurals and Drug Interactions

Epidurals, commonly associated with childbirth, are also a potent tool against chronic back pain.

But like any medical procedure, they come with a set of considerations, especially when other medications are in the mix.

For instance, anticoagulants, like heparin or warfarin, can be a concern.

When combined with an epidural, there's an increased risk of developing a spinal hematoma, a rare but serious complication.

Another group to watch out for is the antiplatelet drugs, such as clopidogrel.

These can increase the risk of bleeding during the procedure.

Even some over-the-counter pain relievers, like ibuprofen or naproxen, can pose risks when combined with an epidural due to their blood-thinning properties.

For those on medications affecting the central nervous system, like certain antidepressants or antipsychotics, there might be an increased sensitivity to the anesthetic used in the epidural, potentially leading to heightened effects.

Safety is paramount when considering an epidural.

It's essential to provide your healthcare provider with a comprehensive list of all medications, supplements, and over-the-counter drugs you're taking.

This ensures they have a full picture and can guide you appropriately.

Regular monitoring post-procedure and adhering to any guidelines or recommendations provided will further ensure that the benefits of the epidural are realized without any unwanted surprises.

Oral Steroids: Potential Drug Interactions

Oral steroids, while incredibly effective, come with a labyrinth of potential interactions that can be a minefield to navigate.

These medications, often prescribed for conditions like asthma, autoimmune disorders, and inflammatory diseases, can clash with a variety of other drugs.

For instance, when combined with anticoagulants, there's an amplified risk of stomach ulcers or bleeding.

Similarly, certain antifungal medications, such as itraconazole or voriconazole, can increase steroid levels in the blood, leading to intensified effects and potential side effects.

Another noteworthy interaction is with antiseizure drugs like phenytoin or carbamazepine.

These can decrease steroid levels, potentially reducing their effectiveness.

Even some vaccines might not play well with oral steroids, as the latter can suppress the immune response, making the vaccine less effective.

Navigating these interactions requires vigilance and open communication with healthcare providers.

If you're on oral steroids, it's crucial to inform any doctor or pharmacist about all other medications and supplements you're taking.

Regular monitoring and dose adjustments can help mitigate potential risks.

And always be on the lookout for any unusual symptoms or side effects.

With the right guidance and a proactive approach, the therapeutic benefits of oral steroids can be harnessed while minimizing potential drug interactions.

Making Informed Decisions

Navigating the world of medications and their potential interactions can feel like walking through a maze blindfolded.

But with the right tools and approach, you can confidently make decisions that prioritize your health.

When discussing treatments with healthcare providers, always be transparent about every medication, supplement, or over-the-counter drug you're taking.

This isn't the time to leave out details.

Even seemingly harmless herbal supplements can have significant interactions with powerful medications.

Personal research is another pillar of informed decision-making.

While your healthcare provider is an invaluable resource, taking the initiative to understand your medications empowers you.

Dive into reputable medical websites, read patient forums, and even consider mobile apps designed to check drug interactions.

Tools like or the Medscape Interaction Checker can offer insights right at your fingertips.

However, while these resources are beneficial, they shouldn't replace professional advice.

Always cross-check any findings with your healthcare provider.

Remember, it's a partnership. With open communication, personal initiative, and the right tools, you can ensure that your treatment journey is both effective and safe.

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Cortisone injections can be a game-changer for many, offering rapid relief from debilitating pain. But, like all treatments, they come with potential side effects. The key is understanding these risks and weighing them against the benefits.

While epidurals are commonly associated with childbirth, they're also used for spinal pain relief. However, they're not without their potential side effects, both immediate and long-term.

Diving deep into this, I found that oral steroids have a unique mechanism of action. They can be incredibly effective, but they also come with a slew of potential interactions. It's a balance, and it's essential to be aware of both the pros and the cons.

I've been there, feeling overwhelmed and unsure. My advice? Be transparent and proactive. List every medication and supplement you're on, and don't hesitate to ask questions. Remember, it's your health on the line.

Absolutely! I've personally found tools like and the Medscape Interaction Checker to be lifesavers. But always cross-check with your healthcare provider. It's better to be safe than sorry.

Stay informed, do your research, and maintain open communication with your healthcare provider. It's a partnership, and with the right approach, you can navigate the world of medications confidently.


Hany Mickhael, A. Mohamed, A. Roushdy, Asaad Labib (2020). Ultrasound Versus Fluoroscopic Guided Sacroiliac Joint Injection In Patient With Chronic Sacroiliac Joint Pain. Minia Journal of Medical Research.

Muhammad Yasir; Amandeep Goyal; Sidharth Sonthalia (2023). Corticosteroid Adverse Effects. National Library of Medicine.

Johannesdottir, S. A., Horváth-Puhó, E., Dekkers, O. M., Cannegieter, S. C., Jørgensen, J. O. L., Ehrenstein, V., & Vandenbroucke, J. P. (2020). Updated Understanding of the Degenerative Disc Diseases - Causes Versus Effects - Treatments, Studies and Hypothesis. Current Genomics.

Miriam Ciriaco, Pasquale Ventrice, Gaetano Russo,1 Maria Scicchitano,1 Giovanni Mazzitello,2 Francesca Scicchitano, and Emilio Russo (2013). Corticosteroid-related central nervous system side effects. Journal of Pharmacological Pharmacotherapy.

Manchikanti, L., Sanapati, M. R., Pampati, V., & Boswell, M. V. (2019). Corticosteroids. Nijkamp and Parnham's Principles of Immunopharmacology.

Manchikanti, L., Kaye, A. M., Knezevic, N. N., McAnally, H., Slavin, K., Trescot, A. M., ... & Hirsch, J. A. (2016). Infection Risk and Safety of Corticosteroid Use. Rheum Dis Clin North Am.

Dr. Ron Daulton, Jr.

About the Author

Dr. Ron Daulton, Jr., an acclaimed chiropractor, esteemed educator, and inspiring author, has devoted his life to fostering understanding of natural healthcare and enhancing well-being across society.

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