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Benzodiazepines may influence neurosteroid metabolism by virtue of their actions on translocator protein (TSPO; "peripheral benzodiazepine receptor"). [59] The pharmacological actions of benzodiazepines at the GABA A receptor are similar to those of neurosteroids . Factors which affect the ability of individual benzodiazepines to alter neurosteroid levels may depend upon whether the individual benzodiazepine drug interacts with TSPO. Some benzodiazepines may also inhibit neurosteroidogenic enzymes reducing neurosteroid synthesis. [60]

Stages of Liver Damage




A group of enzymes, that are located in the endoplasmic reticulum, known as cytochrome P-450, is the most important family of metabolizing enzymes found in the liver. Cytochrome P-450 is the terminal oxidase component of an electron transport chain. It’s not a single enzyme, but consists of a family of closely related 50 isoforms. Six of them metabolize 90% of drugs. There is a great diversity of individual P-450 gene products and this heterogeneity allows the liver to perform oxidation on a vast array of chemicals, which includes almost all drugs.


Laboratory monitoring with a CBC, liver function tests, and urinalysis is performed every month for the first three months and then less often. A four- to six-week trial is usually sufficient to determine effectiveness. British guidelines recommend monitoring with CBC, blood urea nitrogen, creatinine, electrolytes, and liver function tests monthly during the first three months and then every three months thereafter [ 35 ]. Other guidelines suggested weekly or every other week blood counts and transaminases during the first month. Monitoring in patients with rheumatologic diseases is reviewed in greater detail elsewhere. (See "Sulfasalazine: Pharmacology, administration, and adverse effects in the treatment of rheumatoid arthritis", section on 'Dosing and monitoring' .)

Refractory to steroids definition

refractory to steroids definition

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