corticosteroid

Class Name: corticosteroid (Oral route, Parenteral route)

Commonly used brand name(s)

In the U.S.

  • Aristocort
  • Bubbli-Pred
  • Celestone
  • Cortone Acetate
  • Cotolone
  • Decadron
  • Deltasone
  • Dexamethasone Intensol
  • Entocort EC
  • Florinef Acetate
  • Medrol
  • Methylpred-DP
  • Prednicot
  • Prelone

In Canada

  • Pediapred 5
  • Pms-Prednisolone
  • Pulmicort
  • Pulmicort Spacer

Available Dosage Forms:

  • Tablet
  • Capsule, Delayed Release
  • Tablet, Extended Release
  • Capsule, Extended Release
  • Syrup
  • Solution
  • Elixir
  • Suspension
  • Tablet, Delayed Release
  • Liquid
  • Tablet, Disintegrating

Uses For This Medicine

Corticosteroids (cortisone-like medicines) are used to provide relief for inflamed areas of the body. They lessen swelling, redness, itching, and allergic reactions. They are often used as part of the treatment for a number of different diseases, such as severe allergies or skin problems, asthma, or arthritis. Corticosteroids may also be used for other conditions as determined by your doctor.

Your body naturally produces certain cortisone-like hormones that are necessary to maintain good health. If your body does not produce enough, your doctor may have prescribed this medicine to help make up the difference.

Corticosteroids are very strong medicines. In addition to their helpful effects in treating your medical problem, they have side effects that can be very serious. If your adrenal glands are not producing enough cortisone-like hormones, taking this medicine is not likely to cause problems unless you take too much of it. If you are taking this medicine to treat another medical problem, be sure that you discuss the risks and benefits of this medicine with your doctor.

These medicines are available only with your doctor's prescription.

Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although this use is not included in product labeling, some corticosteroids are used in certain patients with the following medical condition:

  • Bell's palsy (prednisolone)
  • Croup in children (dexamethasone)

Importance of Diet

If you will be using this medicine for a long time, your doctor may want you to:

  • Follow a low-salt diet and/or a potassium-rich diet.
  • Watch your calories to prevent weight gain.
  • Add extra protein to your diet.

Make certain your health care professional knows if you are already on any special diet, such as a low-sodium or low-sugar diet.

Before Using This Medicine

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to medicines in this group or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Corticosteroids may cause infections such as chickenpox or measles to be more serious in children who catch them. These medicines can also slow or stop growth in children and in growing teenagers, especially when they are used for a long time. Before this medicine is given to children or teenagers, you should discuss its use with your child's doctor and then carefully follow the doctor's instructions.

Geriatric

Older patients may be more likely to develop high blood pressure or osteoporosis (bone disease) from corticosteroids. Women are especially at risk of developing bone disease.

Pregnancy

Studies on birth defects with corticosteroids have not been done in humans. However, studies in animals have shown that corticosteroids cause birth defects

Breast Feeding

Corticosteroids pass into breast milk and may cause problems with growth or other unwanted effects in nursing babies. Depending on the amount of medicine you are taking every day, it may be necessary for you to take another medicine or to stop breast-feeding during treatment.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking any of these medicines, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using medicines in this class with any of the following medicines is not recommended. Your doctor may decide not to treat you with a medication in this class or change some of the other medicines you take.

  • Artemether
  • Praziquantel
  • Rilpivirine
  • Rotavirus Vaccine, Live

Using medicines in this class with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Aldesleukin
  • Asparaginase
  • Atazanavir
  • Axitinib
  • Boceprevir
  • Bosutinib
  • Bupropion
  • Carbamazepine
  • Clarithromycin
  • Clozapine
  • Cobicistat
  • Conivaptan
  • Crizotinib
  • Dabrafenib
  • Darunavir
  • Dasatinib
  • Doxorubicin
  • Doxorubicin Hydrochloride Liposome
  • Efavirenz
  • Elvitegravir
  • Enzalutamide
  • Eslicarbazepine Acetate
  • Etravirine
  • Fluindione
  • Fosamprenavir
  • Gatifloxacin
  • Hydrocodone
  • Imatinib
  • Indinavir
  • Itraconazole
  • Ivabradine
  • Ixabepilone
  • Ketoconazole
  • Lapatinib
  • Lopinavir
  • Mitotane
  • Nefazodone
  • Nelfinavir
  • Nevirapine
  • Nifedipine
  • Nilotinib
  • Nimodipine
  • Piperaquine
  • Pixantrone
  • Posaconazole
  • Primidone
  • Ritonavir
  • Rivaroxaban
  • Romidepsin
  • Saquinavir
  • Simeprevir
  • Sunitinib
  • Telaprevir
  • Telithromycin
  • Temsirolimus
  • Thalidomide
  • Ticagrelor
  • Tipranavir
  • Vincristine Sulfate
  • Vincristine Sulfate Liposome
  • Voriconazole
  • Vortioxetine

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of medicines in this class. Make sure you tell your doctor if you have any other medical problems, especially:

  • Acquired immunodeficiency syndrome (AIDS) or
  • Fungus infection or
  • Herpes simplex infection of the eye or
  • Human immunodeficiency virus (HIV) infection or
  • Infection at the place of treatment or
  • Other infection or
  • Recent surgery or serious injury or
  • Strongyloides (worm) infestation or
  • Tuberculosis (active TB, nonactive TB, or past history of)—Corticosteroids can cause slower healing, worsen existing infections, or cause new infections.
  • Chickenpox (including recent exposure) or
  • Measles (including recent exposure)—Risk of severe disease affecting other parts of the body.
  • Diabetes mellitus (sugar diabetes)—Corticosteroids may cause a loss of control of diabetes by increasing blood glucose (sugar).
  • Diverticulitis or
  • Stomach ulcer or other stomach or intestine problems or
  • Ulcerative colitis, severe—Corticosteroids may cover up symptoms of a worsening stomach or intestinal condition. A patient would not know if his or her condition was getting worse and would not get medical help when needed.
  • Glaucoma—Corticosteroids may cause the pressure within the eye to increase.
  • Heart disease or
  • High blood pressure or
  • Kidney disease (especially if you are receiving dialysis) or
  • Kidney stones—Corticosteroids cause the body to retain (keep) more salt and water. These conditions may be made worse by this extra body water.
  • High cholesterol levels—Corticosteroids may increase blood cholesterol levels.
  • Liver disease or
  • Overactive thyroid or
  • Underactive thyroid—With these conditions, the body may not eliminate the corticosteroid at the usual rate, which may change the medicine's effect.
  • Myasthenia gravis—When you first start taking corticosteroids, muscle weakness may occur. Your doctor may want to take special precautions because this could cause problems with breathing.
  • Osteoporosis (bone disease)—Corticosteroids may worsen bone disease because they cause the body to lose more calcium.
  • Psychosis—This condition may be made worse.
  • Systemic lupus erythematosus (SLE)—This condition may cause certain side effects of corticosteroids to occur more easily.

Proper Use of This Medicine

For patients taking this medicine by mouth:

  • Take this medicine with food to help prevent stomach upset. If stomach upset, burning, or pain continues, check with your doctor.
  • Stomach problems may be more likely to occur if you drink alcoholic beverages while being treated with this medicine. You should not drink alcoholic beverages while taking this medicine, unless you have first checked with your doctor.

For patients taking budesonide extended-release capsules:

  • Swallow the capsule whole, without breaking, crushing, or chewing it.

Use this medicine only as directed by your doctor. Do not use more or less of it, do not use it more often, and do not use it for a longer time than your doctor ordered. To do so may increase the chance of side effects.

Dosing

The dose medicines in this class will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of these medicines. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For betamethasone
  • For oral dosage forms (syrup, tablets, effervescent tablets):
    • Adults and teenagers—Dose may range from 0.25 to 7.2 milligrams (mg) a day, as a single dose or divided into several doses.
    • Children—Dose is based on body weight or size and must be determined by your doctor
  • For long-acting oral dosage form (extended-release tablets):
    • Adults and teenagers—Dose may range from 1.2 to 12 mg injected into a joint, lesion, muscle, or vein as often as necessary, as determined by your doctor.
    • Children—Dose is based on body weight or size and must be determined by your doctor.
  • For injection dosage form:
    • Adults and teenagers—2 to 6 mg a day.
    • Children—Dose is based on body weight or size and must be determined by your doctor.
  • For budesonide
  • For long-acting oral dosage form (extended-release capsules):
    • Adults—At first, the dose is 9 milligrams (mg) a day for up to eight weeks. Then your doctor may decrease the dose to 6 mg a day. Each dose should be taken in the morning before breakfast.
    • Children—Use and dose must be determined by your doctor.
  • For cortisone
  • For oral dosage form (tablets):
    • Adults and teenagers—25 to 300 milligrams (mg) a day, as a single dose or divided into several doses.
    • Children—Dose is based on body weight or size and must be determined by your doctor.
  • For injection dosage form:
    • Adults and teenagers—20 to 300 mg a day, injected into a muscle.
    • Children—Dose is based on body weight or size and must be determined by your doctor.
  • For dexamethasone
  • For oral dosage forms (elixir, oral solution, tablets):
    • Adults and teenagers—0.5 to 10 milligrams (mg) taken as often as necessary, as determined by your doctor.
    • Children—Dose is based on body weight or size and must be determined by your doctor.
  • For injection dosage form:
    • Adults and teenagers—20.2 to 40 mg injected into a joint, lesion, muscle, or vein as often as necessary, as determined by your doctor.
    • Children—Dose is based on body weight or size and must be determined by your doctor.
  • For hydrocortisone
  • For oral dosage forms (oral suspension, tablets):
    • Adults and teenagers—20 to 800 milligrams (mg) every one or two days, as a single dose or divided into several doses.
    • Children—Dose is based on body weight or size and must be determined by your doctor.
  • For injection dosage form:
    • Adults and teenagers—5 to 500 mg injected into a joint, lesion, muscle, or vein, or under the skin as often as necessary, as determined by your doctor.
    • Children—Dose is based on body weight or size and must be determined by your doctor.
  • For methylprednisolone
  • For oral dosage form (tablets):
    • Adults and teenagers—4 to 160 milligrams (mg) every one or two days, as a single dose or divided into several doses.
    • Children—Dose is based on body weight or size and must be determined by your doctor.
  • For injection dosage form:
    • Adults and teenagers—4 to 160 mg injected into a joint, lesion, muscle, or vein as often as necessary, as determined by your doctor.
    • Children—Dose is based on body weight or size and must be determined by your doctor.
  • For prednisolone
  • For oral dosage forms (oral solution, syrup, tablets):
    • Adults and teenagers—5 to 200 milligrams (mg) taken as often as necessary, as determined by your doctor.
    • Children—Dose is based on body weight or size and must be determined by your doctor.
  • For injection dosage form:
    • Adults and teenagers—2 to 100 mg injected into a joint, lesion, muscle, or vein as often as necessary, as determined by your doctor.
    • Children—Dose is based on body weight or size and must be determined by your doctor.
  • For prednisone
  • For oral dosage forms (oral solution, syrup, tablets):
    • Adults and teenagers—5 to 200 milligrams (mg) every one or two days, as a single dose or divided into several doses.
    • Children—Dose is based on body weight or size and must be determined by your doctor.
  • For triamcinolone
  • For oral dosage forms (syrup, tablets):
    • Adults and teenagers—2 to 60 milligrams (mg) a day, as a single dose or divided into several doses.
    • Children—Dose is based on body weight or size and must be determined by your doctor.
  • For injection dosage form:
    • Adults and teenagers—0.5 to 100 mg injected into a joint, lesion, or muscle, or under the skin as often as necessary, as determined by your doctor.
    • Children—Dose is based on body weight or size and must be determined by your doctor.

Missed Dose

Call your doctor or pharmacist for instructions.

If you miss a dose of this medicine and your dosing schedule is:

  • One dose every other day—Take the missed dose as soon as possible if you remember it the same morning, then go back to your regular dosing schedule. If you do not remember the missed dose until later, wait and take it the following morning. Then skip a day and start your regular dosing schedule again.
  • One dose a day—Take the missed dose as soon as possible, then go back to your regular dosing schedule. If you do not remember until the next day, skip the missed dose and do not double the next one.
  • Several doses a day—Take the missed dose as soon as possible, then go back to your regular dosing schedule. If you do not remember until your next dose is due, double the next dose.

If you have any questions about this, check with your health care professional.

Storage

Keep out of the reach of children.

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Do not keep outdated medicine or medicine no longer needed.

Precautions While Using This Medicine

Your doctor should check your progress at regular visits. Also, your progress may have to be checked after you have stopped using this medicine, since some of the effects may continue.

Do not stop using this medicine without first checking with your doctor. Your doctor may want you to reduce gradually the amount you are using before stopping the medicine completely.

Check with your doctor if your condition reappears or worsens after the dose has been reduced or treatment with this medicine is stopped.

If you will be using corticosteroids for a long time:

  • Your doctor may want you to follow a low-salt diet and/or a potassium-rich diet.
  • Your doctor may have you take a bisphosphonate (alendronate [e.g., Fosamax], risedronate [e.g., Actonel]) to help prevent and treat bone problems while you are taking a corticosteroid.
  • Your doctor may want you to watch your calories to prevent weight gain.
  • Your doctor may want you to add extra protein to your diet.
  • Your doctor may want you to have your eyes examined by an ophthalmologist (eye doctor) before, and also sometime later during treatment.
  • Your doctor may want you to carry a medical identification card stating that you are using this medicine.

Tell the doctor in charge that you are using this medicine:

  • Before having skin tests
  • Before having any kind of surgery (including dental surgery) or emergency treatment
  • If you get a serious infection or injury

Avoid close contact with anyone who has chickenpox or measles. This is especially important for children. Tell your doctor right away if you think you have been exposed to chickenpox or measles.

While you are being treated with this medicine, and after you stop taking it, do not have any immunizations without your doctor's approval. Also, other people living in your home should not receive the oral polio vaccine, since there is a chance they could pass the polio virus on to you. In addition, you should avoid close contact with other people at school or work who have recently taken the oral polio vaccine.

For patients with diabetes:

  • This medicine may affect blood glucose (sugar) levels. If you notice a change in the results of your blood or urine sugar tests or if you have any questions, check with your doctor.

For patients having this medicine injected into their joints:

  • If this medicine is injected into one of your joints, you should be careful not to put too much stress or strain on that joint for a while, even if it begins to feel better. Make sure your doctor has told you how much you are allowed to move this joint while it is healing.
  • If redness or swelling occurs at the place of injection, and continues or gets worse, check with your doctor.

Side Effects of This Medicine

Corticosteroids may lower your resistance to infections. Also, any infection you get may be harder to treat. Always check with your doctor as soon as possible if you notice any signs of a possible infection, such as sore throat, fever, sneezing, or coughing.

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

Less common
  • Decreased or blurred vision
  • frequent urination
  • increased thirst
Rare
  • Blindness (sudden, when injected in the head or neck area)
  • burning, numbness, pain, or tingling at or near place of injection
  • confusion
  • excitement
  • false sense of well-being
  • hallucinations (seeing, hearing, or feeling things that are not there)
  • mental depression
  • mistaken feelings of self-importance or being mistreated
  • mood swings (sudden and wide)
  • redness, swelling, or other sign of allergy or infection at place of injection
  • restlessness
  • skin rash or hives

Additional side effects may occur if you take this medicine for a long time. Check with your doctor if any of the following side effects occur:

  • Abdominal or stomach pain or burning (continuing)
  • acne
  • bloody or black, tarry stools
  • changes in vision
  • eye pain
  • filling or rounding out of the face
  • headache
  • irregular heartbeat
  • menstrual problems
  • muscle cramps or pain
  • muscle weakness
  • nausea
  • pain in arms, back, hips, legs, ribs, or shoulders
  • pitting, scarring, or depression of skin at place of injection
  • reddish purple lines on arms, face, groin, legs, or trunk
  • redness of eyes
  • sensitivity of eyes to light
  • stunting of growth (in children)
  • swelling of feet or lower legs
  • tearing of eyes
  • thin, shiny skin
  • trouble in sleeping
  • unusual bruising
  • unusual increase in hair growth
  • unusual tiredness or weakness
  • vomiting
  • weight gain (rapid)
  • wounds that will not heal

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common
  • Increased appetite
  • indigestion
  • loss of appetite (for triamcinolone only)
  • nervousness or restlessness
Less common or rare
  • Darkening or lightening of skin color
  • dizziness or lightheadedness
  • flushing of face or cheeks
  • hiccups
  • increased joint pain (after injection into a joint)
  • increased sweating
  • nosebleeds (after injection into the nose)
  • sensation of spinning

After you stop using this medicine, your body may need time to adjust. The length of time this takes depends on the amount of medicine you were using and how long you used it. If you have taken large doses of this medicine for a long time, your body may need one year to adjust. During this time, check with your doctor immediately if any of the following side effects occur:

  • Abdominal, stomach, or back pain
  • dizziness
  • fainting
  • fever
  • loss of appetite (continuing)
  • muscle or joint pain
  • nausea
  • reappearance of disease symptoms
  • shortness of breath
  • unexplained headaches (frequent or continuing)
  • unusual tiredness or weakness
  • vomiting
  • weight loss (rapid)

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

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