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Corticosteroids (Systemic)

This monograph includes information on the following:

1) Betamethasone
2) Budesonide *
3) Cortisone
4) Dexamethasone
5) Hydrocortisone
6) Methylprednisolone
7) Prednisolone
8) Prednisone
9) Triamcinolone


INN:
Hydrocortisone— Cortisol
{107}2
BAN:
Hydrocortisone—Cortisol
{107}1

JAN:
Hydrocortisone—Cortisol
{107}0Prednisolone tebutate—Prednisolone butylacetate
{108}9
VA CLASSIFICATION
Betamethasone
Primary: HS051
Secondary: IM403

Budesonide
Primary: HS051

Cortisone
Primary: HS051
Secondary: IM403

Dexamethasone
Primary: HS051
Secondary: DX900; GA609; IM403

Hydrocortisone
Primary: HS051
Secondary: GA609; IM403

Methylprednisolone
Primary: HS051
Secondary: IM403

Prednisolone
Primary: HS051
Secondary: IM403

Prednisone
Primary: HS051
Secondary: GA609; IM403

Triamcinolone
Primary: HS051
Secondary: IM403


Commonly used brand name(s): A-Hydrocort5; A-MethaPred6; A-hydroCort5; Acetocot9; Amcort9; Apo-Prednisone8; Aristocort9; Aristocort Forte9; Aristocort Intralesional9; Aristopak9; Aristospan9; Articulose-507; Articulose-L.A.9; Betnesol1; Celestone1; Celestone Phosphate1; Celestone Soluspan1; Cinalone 409; Cinonide 409; Clinacort9; Clinalog9; Cordrol8; Cortastat4; Cortastat 104; Cortastat LA4; Cortef5; Cortisone Acetate-ICN3; Cortone3; Cortone Acetate3; Cotolone7; Dalalone4; Dalalone D.P.4; Dalalone L.A.4; Decadrol4; Decadron4; Decadron Elixir4; Decadron Phosphate4; Decadron-LA4; Decaject4; Decaject LA4; Delta-Cortef7; Deltasone8; DepMedalone 406; DepMedalone 806; Depo-Medrol6; Depo-Predate6; Depoject-406; Depoject-806; Depopred6; Deronil4; Dexacorten4; Dexacorten-LA4; Dexamethasone Intensol4; Dexasone4; Dexasone L.A.4; Dexone4; Dexone 0.754; Dexone 1.54; Dexone 44; Dexone LA4; Duralone-406; Duralone-806; Entocort2; Hexadrol4; Hexadrol Phosphate4; Hydrocortone5; Hydrocortone Acetate5; Hydrocortone Phosphate5; Ken-Jec 409; Kenacort9; Kenacort Diacetate9; Kenaject-409; Kenalog-109; Kenalog-409; Key-Pred7; Key-Pred SP7; Liquid Pred8; Med-Jec-406; Medralone 806; Medrol6; Meprolone6; Methacort 406; Methacort 806; Methylcotolone6; Meticorten8; Mymethasone4; Nor-Pred T.B.A.7; Oradexon4; Orasone 18; Orasone 108; Orasone 208; Orasone 58; Orasone 508; Pediapred7; Pred-Ject-507; Pred-Pak 458; Pred-Pak 798; Predacort 507; Predacorten6; Predacorten 806; Predalone 507; Predalone T.B.A.7; Predate S7; Predate TBA7; Predate-507; Predcor-257; Predcor-507; Predcor-TBA7; Predicort-RP7; Predisone Intensol8; Prednicot8; Prelone7; Primethasone4; Robalog9; Scheinpharm Triamcine-A9; Selestoject1; Solu-Cortef5; Solu-Medrol6; Solurex4; Solurex LA4; Sterapred8; Sterapred DS8; Tac-39; Tramacort-D9; Tri-Kort9; Triam-A9; Triam-Forte9; Triamolone 409; Triamonide 409; Trilog9; Trilone9; Tristoject9; Winpred8.

Note: For a listing of dosage forms and brand names by country availability, see Dosage Forms section(s).

*Not commercially available in the U.S.



Category:


Corticosteroid—Betamethasone; Budesonide; Cortisone; Dexamethasone; Hydrocortisone; Methylprednisolone; Prednisolone; Prednisone; Triamcinolone;

Anti-inflammatory (steroidal)—Betamethasone; Budesonide; Cortisone; Dexamethasone; Hydrocortisone; Methylprednisolone; Prednisolone; Prednisone; Triamcinolone;

Diagnostic aid (Cushing's syndrome)—Dexamethasone;

Immunosuppressant—Betamethasone; Cortisone; Dexamethasone; Hydrocortisone; Methylprednisolone; Prednisolone; Prednisone; Triamcinolone;

Antiemetic, in cancer chemotherapy—Dexamethasone; Hydrocortisone; Prednisone;

Diagnostic aid (endogenous depression)—Dexamethasone;

Indications

Accepted

Allergic disorders—Indicated for the treatment of severe or incapacitating allergic disorders intractable to adequate trials of conventional treatment
Allergic reactions, drug-induced (treatment)—Betamethasone (sodium phosphate and acetate injectable suspension, {108}8 syrup, {108}7 tablets {108}6); cortisone (acetate injectable suspension, {108}5 {108}4 tablets {108}3 {108}2); dexamethasone (acetate injectable suspension, {108}1 elixir, {108}0 oral solution, {109}9 sodium phosphate injection, {109}8 {109}7 tablets {109}6 {109}5 {109}4); hydrocortisone (cypionate oral suspension, {109}3 sodium phosphate injection, {109}2 sodium succinate for injection, {109}1 tablets {109}0 {110}9 {110}8); methylprednisolone (acetate injectable suspension, {110}7 sodium succinate for injection, {110}6 {110}5 {110}4 tablets {110}3 {110}2); prednisolone (sodium phosphate oral solution, {110}1 syrup {110}0); prednisone (tablets {111}9 {111}8 {111}7); and triamcinolone (tablets {111}6).

Anaphylactic or anaphylactoid reactions (treatment adjunct)—Dexamethasone (sodium phosphate injection {111}5); hydrocortisone (sodium succinate for injection {111}4); and methylprednisolone (sodium succinate for injection {111}3) are indicated as adjunctive treatment in prolonged reactions (those not responding to other forms of treatment within 1 hour), reactions requiring cardiovascular or respiratory resuscitation, or situations in which there is a significant risk of relapse.
—Epinephrine is the drug of choice for this indication. {111}2 {111}1

Angioedema (treatment adjunct)—Betamethasone (tablets {111}0) is indicated as an adjunct in the treatment of angioedema. Treatment should be initiated with intramuscular or intravenous administration of a rapid-acting preparation.

Edema, laryngeal, acute noninfectious (treatment adjunct)—Betamethasone (sodium phosphate and acetate injectable suspension {112}9); cortisone (acetate injectable suspension, {112}8 {112}7 tablets {112}6); dexamethasone (sodium phosphate injection {112}5 {112}4); hydrocortisone (sodium phosphate injection, {112}3 sodium succinate for injection {112}2); and methylprednisolone (acetate injectable suspension, {112}1 sodium succinate for injection {112}0 {113}9) are indicated as adjuncts in the treatment of acute noninfectious laryngeal edema. Treatment should be initiated with intramuscular or intravenous administration of a rapid-acting preparation.
—Epinephrine is the drug of choice for this indication. {113}8 {113}7 {113}6 {113}5 {113}4 {113}3 {113}2 {113}1 {113}0 {62}9

Rhinitis, allergic, perennial or seasonal, severe (treatment) —Betamethasone (sodium phosphate and acetate injectable suspension, {62}8 syrup, {62}7 tablets {62}6 {62}5 {62}4); cortisone (acetate injectable suspension, {62}3 {62}2 tablets {62}1 {62}0); dexamethasone (acetate injectable suspension, {08}9 elixir, {08}8 oral solution, {08}7 sodium phosphate injection, {08}6 {08}5 tablets {08}4 {08}3); hydrocortisone (cypionate oral suspension, {08}2 sodium phosphate injection, {08}1 sodium succinate for injection, {08}0 tablets {62}9 {62}8 {62}7); methylprednisolone (acetate injectable suspension, {62}6 sodium succinate for injection, {62}5 {62}4 tablets {62}3 {62}2); prednisolone (sodium phosphate oral solution, {62}1 syrup {62}0); prednisone (tablets {62}9 {62}8 {62}7); and triamcinolone (acetonide injectable suspension, {62}6 tablets {62}5).

Serum sickness (treatment)—Betamethasone (sodium phosphate and acetate injectable suspension, {62}4 syrup, {62}3 tablets {62}2 {62}1); cortisone (acetate injectable suspension, {62}0 {62}9 tablets {62}8 {62}7); dexamethasone (acetate injectable suspension, {62}6 elixir, {62}5 oral solution, {62}4 sodium phosphate injection, {62}3 {62}2 tablets {62}1 {62}0 {62}9); hydrocortisone (cypionate oral suspension, {62}8 sodium phosphate injection, {62}7 sodium succinate for injection, {62}6 tablets {62}5 {62}4 {62}3); methylprednisolone (acetate injectable suspension, {62}2 sodium succinate for injection, {62}1 {62}0 {62}9 tablets {62}8 {62}7); prednisolone (sodium phosphate oral solution, {62}6 syrup {62}5); prednisone (tablets {62}4 {62}3); and triamcinolone (tablets {62}2).

Transfusion reactions, urticarial (treatment)— Betamethasone (sodium phosphate and acetate injectable suspension {62}1); cortisone (acetate injectable suspension, {62}0 {62}9 tablets {62}8); dexamethasone (acetate injectable suspension, {62}7 sodium phosphate injection {62}6 {62}5); hydrocortisone (sodium phosphate injection, {62}4 sodium succinate for injection {62}3); and methylprednisolone (acetate injectable suspension, {62}2 sodium succinate for injection {62}1 {62}0) are indicated in the treatment of urticarial transfusion reactions. Treatment should be initiated with intramuscular or intravenous administration of a rapid-acting preparation.

Collagen disorders—Indicated during an acute exacerbation or as maintenance therapy
Arteritis, giant cell (treatment)—Methylprednisolone (tablets {08}9); and prednisone (tablets {08}8).

Carditis, rheumatic [or nonrheumatic ]1, acute (treatment)—Betamethasone (sodium phosphate and acetate injectable suspension, {08}7 syrup, {08}6 tablets {08}5 {08}4); cortisone (acetate injectable suspension, {08}3 {08}2 tablets {08}1 {08}0); dexamethasone (acetate injectable suspension, {33}9 elixir, {33}8 oral solution, {33}7 sodium phosphate injection, {33}6 {33}5 tablets {33}4 {33}3 {33}2); hydrocortisone (cypionate oral suspension, {33}1 sodium phosphate injection, {33}0 sodium succinate for injection, {60}9 tablets {60}8 {60}7 {60}6); methylprednisolone (acetate injectable suspension, {60}5 sodium succinate for injection, {60}4 {60}3 tablets {60}2 {60}1); prednisolone (sodium phosphate oral solution, {60}0 syrup {60}9); prednisone (oral solution, tablets {60}8 {60}7 {60}6); and triamcinolone (tablets {60}5).

Dermatomyositis, systemic (polymyositis) (treatment)—Cortisone (acetate injectable suspension, {60}4 {60}3 tablets {60}2 {60}1); hydrocortisone (cypionate oral suspension, {60}0 sodium phosphate injection, {08}9 sodium succinate for injection, {08}8 tablets {08}7 {08}6); methylprednisolone (acetate injectable suspension, {08}5 sodium succinate for injection, {08}4 {08}3 tablets {08}2 {08}1); prednisolone (sodium phosphate oral solution, {08}0 syrup {33}9); and prednisone (tablets {33}8 {33}7 {33}6).

Lupus erythematosus, systemic (treatment)—Betamethasone (sodium phosphate and acetate injectable suspension, {33}5 syrup, {33}4 tablets {33}3 {33}2); cortisone (acetate injectable suspension, {33}1 {33}0 tablets {57}9 {57}8); dexamethasone (acetate injectable suspension, {57}7 elixir, {57}6 oral solution, {57}5 sodium phosphate injection, {57}4 {57}3 tablets {57}2 {57}1 {57}0); hydrocortisone (cypionate oral suspension, {08}9 sodium phosphate injection, {08}8 sodium succinate for injection, {08}7 tablets {08}6 {08}5 {08}4); methylprednisolone (acetate injectable suspension, {08}3 sodium succinate for injection, {08}2 {08}1 {08}0 tablets {33}9 {33}8); prednisolone (sodium phosphate oral solution, {33}7 syrup {33}6); prednisone (tablets {33}5 {33}4 {33}3); and triamcinolone (tablets {33}2).

[Connective tissue disease, mixed (treatment)]1
[Polyarteritis nodosa (treatment) ]1
[Polychondritis, relapsing (treatment) ]1 and
[Vasculitis (treatment)]1—Betamethasone; cortisone; dexamethasone; hydrocortisone; methylprednisolone; prednisolone; prednisone; and triamcinolone.
[Depression, mental, endogenous (diagnosis) ]1—Dexamethasone is indicated to diagnose endogenous depression and to evaluate the efficacy of treatment. Dexamethasone reduces plasma cortisol to a greater extent in control subjects than in hospitalized patients with diagnosed depression; values return toward those of control subjects as the patient responds to therapy. However, the dexamethasone suppression test is less sensitive in patients with mild to moderate depression. Also, many medications, medical problems, and other psychiatric disorders have been reported to interfere with the test results. The Health and Public Policy Committee of the American College of Physicians recommends that the dexamethasone suppression test not be used as a screening test for depression.

Dermatologic disorders
Alopecia areata (treatment)—Betamethasone (sodium phosphate and acetate injectable suspension {33}1); dexamethasone (acetate injectable suspension, {33}0 sodium phosphate injection {08}9 {08}8); hydrocortisone (acetate injectable suspension {08}7); methylprednisolone (acetate injectable suspension {08}6); and triamcinolone (acetonide injectable suspension {08}5).

Dermatitis, atopic (treatment)—Betamethasone (sodium phosphate and acetate injectable suspension, {08}4 syrup, {08}3 tablets {08}2 {08}1); cortisone (acetate injectable suspension, {08}0 {33}9 tablets {33}8 {33}7); dexamethasone (acetate injectable suspension, {33}6 elixir, {33}5 oral solution, {33}4 sodium phosphate injection, {33}3 {33}2 tablets {33}1 {33}0 {08}9); hydrocortisone (cypionate oral suspension, {08}8 sodium phosphate injection, {08}7 sodium succinate for injection, {08}6 tablets {08}5 {08}4 {08}3); methylprednisolone (acetate injectable suspension, {08}2 sodium succinate for injection, {08}1 {08}0 tablets {33}9 {33}8); prednisolone (sodium phosphate oral solution, {33}7 syrup {33}6); prednisone (tablets {33}5 {33}4 {33}3); and triamcinolone (tablets {33}2).

Dermatitis, contact (treatment)—Betamethasone (sodium phosphate and acetate injectable suspension, {33}1 syrup, {33}0 tablets {08}9 {08}8); cortisone (acetate injectable suspension, {08}7 {08}6 tablets {08}5 {08}4); dexamethasone (acetate injectable suspension, {08}3 elixir, {08}2 oral solution, {08}1 sodium phosphate injection, {08}0 {33}9 tablets {33}8 {33}7 {33}6); hydrocortisone (cypionate oral suspension, {33}5 sodium phosphate injection, {33}4 sodium succinate for injection, {33}3 tablets {33}2 {33}1 {33}0); methylprednisolone (acetate injectable suspension, {08}9 sodium succinate for injection, {08}8 {08}7 {08}6 tablets {08}5 {08}4); prednisolone (sodium phosphate oral solution, {08}3 syrup {08}2); prednisone (tablets {08}1 {08}0 {11}9); and triamcinolone (tablets {11}8).

Dermatitis, exfoliative (treatment)—Betamethasone (sodium phosphate and acetate injectable suspension, {11}7 syrup, {11}6 tablets {11}5 {11}4); cortisone (acetate injectable suspension, {11}3 {11}2 tablets {11}1 {11}0); dexamethasone (acetate injectable suspension, {36}9 elixir, {36}8 oral solution, {36}7 sodium phosphate injection, {36}6 {36}5 tablets {36}4 {36}3 {36}2); hydrocortisone (cypionate oral suspension, {36}1 sodium phosphate injection, {36}0 sodium succinate for injection, {37}9 tablets {37}8 {37}7 {37}6); methylprednisolone (acetate injectable suspension, {37}5 sodium succinate for injection, {37}4 {37}3 {37}2 tablets {37}1 {37}0); prednisolone (sodium phosphate oral solution, {40}9 syrup {40}8); prednisone (tablets {40}7 {40}6 {40}5); and triamcinolone (tablets {40}4).

Dermatitis herpetiformis, bullous (treatment)— Betamethasone (sodium phosphate and acetate injectable suspension, {40}3 syrup, {40}2 tablets {40}1 {40}0); cortisone (acetate injectable suspension, {40}9 tablets {40}8); dexamethasone (acetate injectable suspension, {40}7 elixir, {40}6 oral solution, {40}5 sodium phosphate injection, {40}4 {40}3 tablets {40}2 {40}1 {40}0); hydrocortisone (cypionate oral suspension, {40}9 sodium phosphate injection, {40}8 sodium succinate for injection, {40}7 tablets {40}6 {40}5 {40}4); methylprednisolone (acetate injectable suspension, {40}3 sodium succinate for injection, {40}2 {40}1 tablets {40}0 {40}9); prednisolone (sodium phosphate oral solution, {40}8 syrup {40}7); prednisone (tablets {40}6 {40}5 {40}4); and triamcinolone (tablets {40}3).

Dermatitis, seborrheic, severe (treatment)—Betamethasone (sodium phosphate and acetate injectable suspension, {40}2 syrup, {40}1 tablets {40}0); cortisone (acetate injectable suspension, {11}9 {11}8 tablets {11}7 {11}6); dexamethasone (acetate injectable suspension, {11}5 elixir, {11}4 oral solution, {11}3 sodium phosphate injection, {11}2 {11}1 tablets {11}0 {37}9 {37}8); hydrocortisone (cypionate oral suspension, {37}7 sodium phosphate injection, {37}6 sodium succinate for injection, {37}5 tablets {37}4 {37}3 {37}2); methylprednisolone (acetate injectable suspension, {37}1 sodium succinate for injection, {37}0 {40}9 tablets {40}8 {40}7); prednisolone (sodium phosphate oral solution, {40}6 syrup {40}5); prednisone (tablets {40}4 {40}3 {40}2); and triamcinolone (tablets {40}1).

Dermatoses, inflammatory, severe (treatment)—Betamethasone (tablets {40}0) and triamcinolone (acetonide injectable suspension, {37}9 tablets {37}8).

Erythema multiforme, severe (Stevens-Johnson syndrome) (treatment) —Betamethasone (sodium phosphate and acetate injectable suspension, {37}7 syrup, {37}6 tablets {37}5 {37}4); cortisone (acetate injectable suspension, {37}3 {37}2 tablets {37}1 {37}0); dexamethasone (acetate injectable suspension, {36}9 elixir, {36}8 oral solution, {36}7 sodium phosphate injection, {36}6 {36}5 tablets {36}4 {36}3 {36}2); hydrocortisone (cypionate oral suspension, {36}1 sodium phosphate injection, {36}0 sodium succinate for injection, {36}9 tablets {36}8 {36}7 {36}6); methylprednisolone (acetate injectable suspension, {36}5 sodium succinate for injection, {36}4 {36}3 {36}2 tablets {36}1 {36}0); prednisolone (sodium phosphate oral solution, {37}9 syrup {37}8); prednisone (tablets {37}7 {37}6 {37}5); and triamcinolone (tablets {37}4).

Granuloma annulare (treatment)—Betamethasone (sodium phosphate and acetate injectable suspension {37}3); dexamethasone (acetate injectable suspension, {37}2 sodium phosphate injection {37}1 {37}0); hydrocortisone (acetate injectable suspension {57}9) methylprednisolone (acetate injectable suspension {57}8); and triamcinolone (acetonide injectable suspension {57}7).

Keloids (treatment)—Betamethasone (sodium phosphate and acetate injectable suspension {57}6); dexamethasone (acetate injectable suspension, {57}5 sodium phosphate injection {57}4 {57}3); hydrocortisone (acetate injectable suspension {57}2); methylprednisolone (acetate injectable suspension {57}1); and triamcinolone (acetonide injectable suspension {57}0).

Lichen planus (treatment)—Betamethasone (sodium phosphate and acetate injectable suspension {44}9); dexamethasone (acetate injectable suspension, {44}8 sodium phosphate injection {44}7 {44}6); hydrocortisone (acetate injectable suspension {44}5); methylprednisolone (acetate injectable suspension {44}4); and triamcinolone (acetonide injectable suspension {44}3).

Lichen simplex chronicus (neurodermatitis) (treatment)—Betamethasone (sodium phosphate and acetate injectable suspension {44}2); dexamethasone (acetate injectable suspension, {44}1 sodium phosphate injection {44}0 {44}9); hydrocortisone (acetate injectable suspension {44}8); methylprednisolone (acetate injectable suspension {44}7); and triamcinolone (acetonide injectable suspension {44}6).

Lupus erythematosus, discoid (treatment)—Betamethasone (sodium phosphate and acetate injectable suspension {44}5); dexamethasone (acetate injectable suspension, {44}4 sodium phosphate injection {44}3 {44}2); hydrocortisone (acetate injectable suspension {44}1); methylprednisolone (acetate injectable suspension {44}0); and triamcinolone (acetonide injectable suspension {44}9).

Mycosis fungoides (treatment)—Betamethasone (sodium phosphate and acetate injectable suspension, {44}8 syrup, {44}7 tablets {44}6 {44}5); cortisone (acetate injectable suspension, {44}4 {44}3 tablets {44}2 {44}1); dexamethasone (acetate injectable suspension, {44}0 elixir, {44}9 oral solution, {44}8 sodium phosphate injection, {44}7 {44}6 tablets {44}5 {44}4 {44}3); hydrocortisone (cypionate oral suspension, {44}2 sodium phosphate injection, {44}1 sodium succinate for injection, {44}0 tablets {15}9 {15}8 {15}7); methylprednisolone (acetate injectable suspension, {15}6 sodium succinate for injection, {15}5 {15}4 tablets {15}3 {15}2); prednisolone (sodium phosphate oral solution, {15}1 syrup {15}0); prednisone (tablets {15}9 {15}8 {15}7); and triamcinolone (tablets {15}6).

Necrobiosis lipoidica diabeticorum (treatment)— Betamethasone (sodium phosphate and acetate injectable suspension {15}5); dexamethasone (acetate injectable suspension, {15}4 sodium phosphate injection {15}3 {15}2); hydrocortisone (acetate injectable suspension {15}1); methylprednisolone (acetate injectable suspension {15}0); and triamcinolone (acetonide injectable suspension {10}9).

Pemphigus (treatment)—Betamethasone (sodium phosphate and acetate injectable suspension, {10}8 syrup, {10}7 tablets {10}6 {10}5); cortisone (acetate injectable suspension, {10}4 {10}3 tablets {10}2 {10}1); dexamethasone (acetate injectable suspension, {10}0 elixir, {10}9 oral solution, {10}8 sodium phosphate injection, {10}7 {10}6 tablets {10}5 {10}4 {10}3); hydrocortisone (cypionate oral suspension, {10}2 sodium phosphate injection, {10}1 sodium succinate for injection, {10}0 tablets {62}9 {62}8 {62}7); methylprednisolone (acetate injectable suspension, {62}6 sodium succinate for injection, {62}5 {62}4 {62}3 tablets {62}2 {62}1); prednisolone (sodium phosphate oral solution, {62}0 syrup {10}9); prednisone (tablets {10}8 {10}7 {10}6); and triamcinolone (tablets {10}5).

Psoriasis, severe (treatment)—Betamethasone (sodium phosphate and acetate injectable suspension, {10}4 syrup, {10}3 tablets {10}2 {10}1); cortisone (acetate injectable suspension, {10}0 {62}9 tablets {62}8 {62}7); dexamethasone (acetate injectable suspension, {62}6 elixir, {62}5 oral solution, {62}4 sodium phosphate injection, {62}3 {62}2 tablets {62}1 {62}0 {10}9); hydrocortisone (cypionate oral suspension, {10}8 sodium phosphate injection, {10}7 sodium succinate for injection, {10}6 tablets {10}5 {10}4 {10}3); methylprednisolone (acetate injectable suspension, {10}2 sodium succinate for injection, {10}1 {10}0 tablets {10}9 {10}8); prednisolone (sodium phosphate oral solution, {10}7 syrup {10}6); prednisone (tablets {10}5 {10}4 {10}3); and triamcinolone (tablets {10}2).

Psoriatic plaques (treatment)—Betamethasone (sodium phosphate and acetate injectable suspension {10}1); dexamethasone (acetate injectable suspension, {10}0 sodium phosphate injection {10}9 {10}8); hydrocortisone (acetate injectable suspension {10}7); methylprednisolone (acetate injectable suspension {10}6); and triamcinolone (acetonide injectable suspension {10}5).

[Eczema, severe (treatment)]—Betamethasone (tablets {10}4); cortisone 1; dexamethasone1; hydrocortisone1; methylprednisolone1; prednisolone1; prednisone1; and triamcinolone1.

[Pemphigoid (treatment)]1—Betamethasone; cortisone; dexamethasone; hydrocortisone; methylprednisolone; prednisolone; prednisone; and triamcinolone.

[Sarcoid, localized cutaneous (treatment) ]1—Betamethasone; dexamethasone; hydrocortisone; methylprednisolone; prednisolone; and triamcinolone.

Endocrine disorders
Adrenocortical insufficiency, acute (treatment) and
Adrenocortical insufficiency, chronic primary (Addison's disease) (treatment)—Betamethasone (sodium phosphate and acetate injectable suspension, {10}3 syrup, {10}2 tablets {10}1 {10}0); cortisone (acetate injectable suspension, {12}9 {12}8 tablets {12}7 {12}6); dexamethasone (elixir, {12}5 oral solution, {12}4 sodium phosphate injection, {12}3 {12}2 tablets {12}1 {12}0 {12}9); hydrocortisone (cypionate oral suspension, {12}8 sodium phosphate injection, {12}7 sodium succinate for injection, {12}6 tablets {12}5 {12}4 {12}3); methylprednisolone (acetate injectable suspension, {12}2 sodium succinate for injection, {12}1 {12}0 tablets {12}9 {12}8); prednisolone (sodium phosphate oral solution, {12}7 syrup {12}6); prednisone (tablets {12}5 {12}4 {12}3); and triamcinolone (tablets {12}2) are indicated in the treatment of adrenocortical insufficiency. However, hydrocortisone and cortisone are preferred as replacement therapy {12}1 {12}0 {12}9 {12}8 {12}7 {12}6 {12}5 {12}4 {12}3 {12}2 {12}1 {12}0 {12}9 {12}8 {12}7 {12}6 {12}5 {12}4 {12}3 {12}2 {12}1 {12}0 {12}9 {12}8 {12}7 {12}6 {12}5 {12}4 {12}3 {12}2 because of their significant mineralocorticoid activity. A rapid-acting preparation should be administered intramuscularly or intravenously initially. Administration of sodium (as dietary salt) and fluids also is required. In some patients, additional mineralocorticoid replacement also may be necessary. Rarely, a patient will have only a glucocorticoid deficiency and will not require mineralocorticoid or sodium supplementation.

Adrenocortical insufficiency, secondary (treatment)—Betamethasone (sodium phosphate and acetate injectable suspension, {12}1 syrup, {12}0 tablets {13}9 {13}8); cortisone (acetate injectable suspension, {13}7 {13}6 tablets {13}5 {13}4); dexamethasone (elixir, {13}3 oral solution, {13}2 sodium phosphate injection, {13}1 {13}0 tablets {13}9 {13}8 {13}7); hydrocortisone (cypionate oral suspension, {13}6 sodium phosphate injection, {13}5 sodium succinate for injection, {13}4 tablets {13}3 {13}2 {13}1); methylprednisolone (acetate injectable suspension, {13}0 sodium succinate for injection, {13}9 {13}8 tablets {13}7 {13}6); prednisolone (sodium phosphate oral solution, {13}5 syrup {13}4); prednisone (tablets {13}3 {13}2); and triamcinolone (tablets {13}1) are indicated in the treatment of secondary adrenocortical insufficiency. Glucocorticoid replacement usually is sufficient. Mineralocorticoid replacement is not always required.

Congenital adrenal hyperplasia (treatment)—Betamethasone (sodium phosphate and acetate injectable suspension, {13}0 syrup, {62}9 tablets {62}8 {62}7); cortisone (acetate injectable suspension, {62}6 {62}5 tablets {62}4 {62}3); dexamethasone (acetate injectable suspension, {62}2 elixir, {62}1 oral solution, {62}0 sodium phosphate injection, {62}9 tablets {62}8 {62}7 {62}6); hydrocortisone (cypionate oral suspension, {62}5 sodium phosphate injection, {62}4 sodium succinate for injection, {62}3 tablets {62}2 {62}1 {62}0); methylprednisolone (acetate injectable suspension, {62}9 sodium succinate for injection, {62}8 {62}7 tablets {62}6 {62}5); prednisolone (sodium phosphate oral solution, {62}4 syrup {62}3); and prednisone (oral solution, tablets {62}2 {62}1 {62}0) are indicated to reduce the virilization caused by enzyme deficiency–induced adrenal androgen hypersecretion. Corticosteroid and supplemental therapy depend upon the enzyme deficiency involved and the form of disease present. In salt-losing forms, hydrocortisone or cortisone plus increased sodium intake may be preferred. However, additional mineralocorticoid supplementation may be required. In salt-retaining or hypertensive forms, a glucocorticoid having minimal mineralocorticoid activity is preferred. However, long-acting glucocorticoids are best avoided because of the increased risk of growth retardation and difficulty in dosage adjustment.

Cushing's syndrome (diagnosis)—Dexamethasone (elixir, {62}9 oral solution, {62}8 sodium phosphate injection, {62}7 {62}6 {62}5 tablets {62}4 {62}3 {62}2) is indicated in the diagnosis of Cushing's syndrome and to distinguish Cushing's syndrome caused by excessive corticotropin secretion from that due to other causes.

Hypercalcemia associated with neoplasms [ or sarcoidosis]1 (treatment)— Betamethasone (sodium phosphate and acetate injectable suspension, {62}1 syrup, {62}0 tablets {67}9 {67}8); cortisone (acetate injectable suspension, {67}7 {67}6 tablets {67}5 {67}4); dexamethasone (acetate injectable suspension, {67}3 elixir, {67}2 oral solution, {67}1 sodium phosphate injection, {67}0 tablets {13}9 {13}8 {13}7); hydrocortisone (cypionate oral suspension, {13}6 sodium phosphate injection, {13}5 sodium succinate for injection, {13}4 tablets {13}3 {13}2 {13}1); methylprednisolone (sodium succinate for injection, {13}0 {67}9 tablets {67}8 {67}7); prednisolone (sodium phosphate oral solution, {67}6 syrup {67}5); prednisone (tablets {67}4 {67}3 {67}2); and trimacinolone (tablets {67}1).

Thyroiditis, nonsuppurative (treatment)—Betamethasone (sodium phosphate and acetate injectable suspension, {67}0 syrup, {13}9 tablets {13}8 {13}7); cortisone (acetate injectable suspension, {13}6 {13}5 tablets {13}4 {13}3); dexamethasone (acetate injectable suspension, {13}2 elixir, {13}1 oral solution, {13}0 sodium phosphate injection, {67}9 {67}8 tablets {67}7 {67}6 {67}5); hydrocortisone (cypionate oral suspension, {67}4 sodium phosphate injection, {67}3 tablets {67}2 {67}1 {67}0); methylprednisolone (sodium succinate for injection, {13}9 {13}8 tablets {13}7 {13}6); prednisolone (sodium phosphate oral solution, {13}5 syrup {13}4); prednisone (tablets {13}3 {13}2 {13}1); and triamcinolone (tablets {13}0).

Gastrointestinal disorders
Colitis, ulcerative (treatment)—Betamethasone (sodium phosphate and acetate injectable suspension, {67}9 syrup, {67}8 tablets {67}7 {67}6 {67}5); cortisone (acetate injectable suspension, {67}4 {67}3 tablets {67}2 {67}1); dexamethasone (acetate injectable suspension, {67}0 elixir, {13}9 oral solution, {13}8 sodium phosphate injection, {13}7 {13}6 tablets {13}5 {13}4 {13}3); hydrocortisone (cypionate oral suspension, {13}2 sodium phosphate injection, {13}1 sodium succinate for injection, {13}0 tablets {13}9 {13}8 {13}7); methylprednisolone (acetate injectable suspension, {13}6 sodium succinate for injection, {13}5 {13}4 {13}3 tablets {13}2 {13}1); prednisolone (sodium phosphate oral solution, {13}0 syrup {13}9); prednisone (tablets {13}8 {13}7 {13}6); and triamcinolone (tablets {13}5) are indicated when systemic therapy is required during a critical period of the disease. Long-term use is not recommended.

Crohn's disease (regional enteritis) (treatment)—Betamethasone (sodium phosphate and acetate injectable suspension, {13}4 syrup, {13}3 tablets {13}2 {13}1); cortisone (acetate injectable suspension, {13}0 {57}9 tablets {57}8 {57}7); dexamethasone (acetate injectable suspension, {57}6 elixir, {57}5 oral solution, {57}4 sodium phosphate injection, {57}3 {57}2 tablets {57}1 {57}0 {13}9); hydrocortisone (cypionate oral suspension, {13}8 sodium phosphate injection, {13}7 sodium succinate for injection, {13}6 tablets {13}5 {13}4 {13}3); methylprednisolone (acetate injectable suspension, {13}2 sodium succinate for injection, {13}1 {13}0 tablets {28}9 {28}8); prednisolone (sodium phosphate oral solution, {28}7 syrup {28}6); prednisone (tablets {28}5 {28}4 {28}3); and triamcinolone (tablets {28}2) are indicated when systemic therapy is required during a critical period of the disease. Long-term use is not recommended.
—Budesonide (capsules) is indicated for the induction and maintenance of remission in patients with mild to moderate Crohn's disease affecting the ileum and/or the ascending colon. {28}1

[Sprue, refractory (treatment)]—Betamethasone (tablets {28}0).

Hematologic disorders
Anemia, hemolytic, acquired (autoimmune) (treatment)—Betamethasone (sodium phosphate and acetate injectable suspension, {41}9 syrup, {41}8 tablets {41}7 {41}6); cortisone (acetate injectable suspension, {41}5 {41}4 tablets {41}3 {41}2); dexamethasone (acetate injectable suspension, {41}1 elixir, {41}0 oral solution, {42}9 sodium phosphate injection, {42}8 {42}7 tablets {42}6 {42}5 {42}4); hydrocortisone (cypionate oral suspension, {42}3 sodium phosphate injection, {42}2 sodium succinate for injection, {42}1 tablets {42}0 {28}9 {28}8); methylprednisolone (acetate injectable suspension, {28}7 sodium succinate for injection, {28}6 {28}5 tablets {28}4 {28}3); prednisolone (sodium phosphate oral solution, {28}2 syrup {28}1); prednisone (tablets {28}0 {41}9 {41}8); and triamcinolone (tablets {41}7).

Anemia, hypoplastic, congenital (erythroid) (treatment)—Betamethasone (sodium phosphate and acetate injectable suspension, {41}6 syrup, {41}5 tablets {41}4 {41}3); cortisone (acetate injectable suspension, {41}2 {41}1 tablets {41}0 {91}9); dexamethasone (acetate injectable suspension, {91}8 elixir, {91}7 oral solution, {91}6 sodium phosphate injection, {91}5 {91}4 tablets {91}3 {91}2 {91}1); hydrocortisone (cypionate oral suspension, {91}0 sodium phosphate injection, {91}9 sodium succinate for injection, {91}8 tablets {91}7 {91}6 {91}5); methylprednisolone (acetate injectable suspension, {91}4 sodium succinate for injection, {91}3 {91}2 tablets {91}1 {91}0); prednisolone (sodium phosphate oral solution, {16}9 syrup {16}8); prednisone (tablets {16}7 {16}6 {16}5); and triamcinolone (tablets {16}4).

Anemia, red blood cell (erythroblastopenia) (treatment)—Betamethasone (sodium phosphate and acetate injectable suspension, {16}3 syrup, {16}2 tablets {16}1 {16}0); cortisone (acetate injectable suspension, {16}9 {16}8 tablets {16}7 {16}6); dexamethasone (acetate injectable suspension, {16}5 elixir, {16}4 oral solution, {16}3 sodium phosphate injection, {16}2 {16}1 tablets {16}0 {28}9 {28}8); hydrocortisone (cypionate oral suspension, {28}7 sodium phosphate injection, {28}6 sodium succinate for injection, {28}5 tablets {28}4 {28}3 {28}2); methylprednisolone (acetate injectable suspension, {28}1 sodium succinate for injection, {28}0 {41}9 tablets {41}8 {41}7); prednisolone (sodium phosphate oral solution, {41}6 syrup {41}5); prednisone (tablets {41}4 {41}3 {41}2); and triamcinolone (tablets {41}1).

Thrombocytopenia, secondary, in adults (treatment)—Betamethasone (sodium phosphate and acetate injectable suspension, {41}0 syrup, {16}9 tablets {16}8 {16}7); cortisone (tablets {16}6); dexamethasone (acetate injectable suspension, {16}5 elixir, {16}4 oral solution, {16}3 sodium phosphate injection, {16}2 {16}1 tablets {16}0 {16}9 {16}8); hydrocortisone (cypionate oral suspension, {16}7 sodium phosphate injection, {16}6 sodium succinate for injection, {16}5 tablets {16}4 {16}3 {16}2); methylprednisolone (acetate injectable suspension, {16}1 sodium succinate for injection, {16}0 {16}9 tablets {16}8 {16}7); prednisolone (sodium phosphate oral solution, {16}6 syrup {16}5); prednisone (tablets {16}4 {16}3 {16}2); and triamcinolone (tablets {16}1).

Thrombocytopenic purpura, idiopathic, in adults (treatment)—Betamethasone (syrup, {16}0 tablets {16}9 {16}8); cortisone (tablets {16}7); dexamethasone (elixir, {16}6 oral solution, {16}5 sodium phosphate injection, {16}4 {16}3 tablets {16}2 {16}1 {16}0); hydrocortisone (cypionate oral suspension, {42}9 sodium phosphate injection, {42}8 sodium succinate for injection, {42}7 tablets {42}6 {42}5 {42}4); methylprednisolone (sodium succinate for injection, {42}3 {42}2 tablets {42}1 {42}0); prednisolone (sodium phosphate oral solution, {42}9 syrup {42}8); prednisone (tablets {42}7 {42}6 {42}5); and triamcinolone (tablets {42}4).

[Hemolysis (treatment)]1—Betamethasone; cortisone; dexamethasone; hydrocortisone; methylprednisolone; prednisolone; prednisone; and triamcinolone.

[Hepatic disease]1—Use is controversial
[Hepatitis, alcoholic, with encephalopathy (treatment)]1
[Hepatitis, chronic, active (treatment) ]1
[Hepatitis, nonalcoholic, in women (treatment)]1 and
[Necrosis, hepatic, subacute (treatment) ]1—Methylprednisolone; prednisolone; and prednisone.

Inflammatory disorders, nonrheumatic—Indicated during an acute episode or exacerbation. Local injections are preferred when only a few joints or areas are involved
Bursitis, acute or subacute (treatment)—Betamethasone (sodium phosphate and acetate injectable suspension, {42}3 {42}2 syrup, {42}1 tablets {42}0 {16}9); cortisone (acetate injectable suspension, {16}8 {16}7 tablets {16}6 {16}5); dexamethasone (acetate injectable suspension, {16}4 elixir, {16}3 oral solution, {16}2 sodium phosphate injection, {16}1 {16}0 tablets {28}9 {28}8 {28}7); hydrocortisone (acetate injectable suspension, {28}6 cypionate oral suspension, {28}5 sodium phosphate injection, {28}4 sodium succinate for injection, {28}3 tablets {28}2 {28}1 {28}0); methylprednisolone (acetate injectable suspension, {41}9 sodium succinate for injection, {41}8 {41}7 tablets {41}6 {41}5); prednisolone (sodium phosphate oral solution, {41}4 syrup {41}3); prednisone (tablets {41}2 {41}1 {41}0); and triamcinolone (acetonide injectable suspension, {57}9 {57}8 hexacetonide injectable suspension, {57}7 tablets {57}6).

Epicondylitis (treatment)—Betamethasone (sodium phosphate and acetate injectable suspension, {57}5 syrup, {57}4 tablets {57}3); cortisone (acetate injectable suspension, {57}2 {57}1 tablets {57}0 {15}9); dexamethasone (acetate injectable suspension, {15}8 elixir, {15}7 oral solution, {15}6 sodium phosphate injection, {15}5 {15}4 tablets {15}3 {15}2 {15}1); hydrocortisone (acetate injectable suspension, {15}0 cypionate oral suspension, {26}9 sodium phosphate injection, {26}8 sodium succinate for injection, {26}7 tablets {26}6 {26}5 {26}4); methylprednisolone (acetate injectable suspension, {26}3 sodium succinate for injection, {26}2 {26}1 tablets {26}0 {26}9); prednisolone (sodium phosphate oral solution, {26}8 syrup {26}7); prednisone (tablets {26}6 {26}5 {26}4); and triamcinolone (acetonide injectable suspension, {26}3 {26}2 hexacetonide injectable suspension, {26}1 tablets {26}0).

Tenosynovitis, acute nonspecific (treatment)—Betamethasone (sodium phosphate and acetate injectable suspension, {26}9 {26}8 syrup, {26}7 tablets {26}6 {26}5); cortisone (acetate injectable suspension, {26}4 {26}3 tablets {26}2 {26}1); dexamethasone (acetate injectable suspension, {26}0 elixir, {91}9 oral solution, {91}8 sodium phosphate injection, {91}7 {91}6 tablets {91}5 {91}4 {91}3); hydrocortisone (acetate injectable suspension, {91}2 cypionate oral suspension, {91}1 sodium phosphate injection, {91}0 sodium succinate for injection, {91}9 tablets {91}8 {91}7 {91}6); methylprednisolone (acetate injectable suspension, {91}5 sodium succinate for injection, {91}4 {91}3 tablets {91}2 {91}1); prednisolone (sodium phosphate oral solution, {91}0 syrup {17}9); prednisone (tablets {17}8 {17}7 {17}6); and triamcinolone (acetonide injectable suspension, {17}5 {17}4 hexacetonide injectable suspension, {17}3 tablets {17}2).

[Fibrositis (treatment)] and
[Myositis (treatment)]—Betamethasone (sodium phosphate and acetate injectable suspension {17}1) and dexamethasone (sodium phosphate injection {17}0).
[Nausea and vomiting, cancer chemotherapy–induced (prophylaxis)]—Dexamethasone (sodium phosphate injection, {62}9 tablets {62}8); [ hydrocortisone]1; and [ prednisone]1 are indicated to prevent nausea and vomiting induced by antineoplastic agents. The medication is administered prior to and following each course of chemotherapy. However, the advisability of administering a potent glucocorticoid to a cancer patient, unless indicated for palliation of the disease, has been questioned. Although an increased incidence of infection has not been reported in patients receiving such therapy, the possibility must be considered.
—The combination of dexamethasone plus ondansetron has been shown to provide better emetic control over cisplatin-induced emesis than ondansetron alone. {62}7 {62}6 {62}5 {62}4

Neoplastic disease—Indicated in conjunction with appropriate specific antineoplastic disease therapy for palliative management
Leukemia, acute or chronic lymphocytic (treatment) {62}3—Betamethasone (sodium phosphate and acetate injectable suspension, {62}2 syrup, {62}1 tablets {62}0 {62}9); cortisone (acetate injectable suspension, {62}8 {62}7 tablets {62}6 {62}5); dexamethasone (acetate injectable suspension, {62}4 elixir, {62}3 oral solution, {62}2 sodium phosphate injection, {62}1 {62}0 tablets {62}9 {62}8 {62}7); hydrocortisone (cypionate oral suspension, {62}6 sodium phosphate injection, {62}5 sodium succinate for injection, {62}4 tablets {62}3 {62}2 {62}1); methylprednisolone (acetate injectable suspension, {62}0 sodium succinate for injection, {17}9 {17}8 tablets {17}7 {17}6); prednisolone (sodium phosphate oral solution, {17}5 syrup {17}4); prednisone (oral solution, tablets {17}3 {17}2 {17}1); and triamcinolone (tablets {17}0).

Lymphomas, Hodgkin's or non-Hodgkin's (treatment) {62}9—Betamethasone (sodium phosphate and acetate injectable suspension, {62}8 syrup, {62}7 tablets {62}6 {62}5); cortisone (acetate injectable suspension, {62}4 {62}3 tablets {62}2 {62}1); dexamethasone (acetate injectable suspension, {62}0 elixir, {62}9 oral solution, {62}8 sodium phosphate injection, {62}7 {62}6 tablets {62}5 {62}4 {62}3); hydrocortisone (cypionate oral suspension, {62}2 sodium phosphate injection, {62}1 sodium succinate for injection, {62}0 tablets {62}9 {62}8 {62}7); methylprednisolone (acetate injectable suspension, {62}6 sodium succinate for injection, {62}5 {62}4 tablets {62}3 {62}2); prednisolone (sodium phosphate oral solution, {62}1 syrup {62}0); prednisone (tablets {62}9 {62}8 {62}7); and triamcinolone (tablets {62}6).

Waldenström's macroglobulinemia (treatment) {62}5 {62}4 {62}3—Prednisone. {62}2

[Carcinoma, breast (treatment)]1 {62}1
[Carcinoma, prostatic (treatment) ]1 {62}0
[Fever, due to malignancy (treatment adjunct)]1
[Multiple myeloma (treatment)]1 {62}9 and
[Tumors, brain, primary (treatment adjunct)]1 {62}8—Betamethasone; cortisone; dexamethasone; hydrocortisone; methylprednisolone; prednisolone; prednisone; and triamcinolone.
Nephrotic syndrome (treatment)—Betamethasone (sodium phosphate and acetate injectable suspension, {62}7 syrup, {62}6 tablets {62}5 {62}4); cortisone (acetate injectable suspension, {62}3 {62}2 tablets {62}1 {62}0); dexamethasone (acetate injectable suspension, {62}9 elixir, {62}8 oral solution, {62}7 sodium phosphate injection, {62}6 {62}5 tablets {62}4 {62}3 {62}2); hydrocortisone (cypionate oral suspension, {62}1 sodium phosphate injection, {62}0 sodium succinate for injection, {62}9 tablets {62}8 {62}7 {62}6); methylprednisolone (acetate injectable suspension, {62}5 sodium succinate for injection, {62}4 {62}3 tablets {62}2 {62}1); prednisolone (sodium phosphate oral solution, {62}0 syrup {62}9); prednisone (oral solution, tablets {62}8 {62}7 {62}6); and triamcinolone (tablets {62}5) are indicated to induce diuresis or remission of proteinuria in idiopathic nephrotic syndrome (without uremia), and to improve renal function in patients with lupus erythematosus. In idiopathic nephrotic syndrome, long-term therapy may be required to prevent frequent relapses.

Neurologic disease
Meningitis, tuberculous (treatment adjunct)—Betamethasone (sodium phosphate and acetate injectable suspension, {62}4 syrup, {62}3 tablets {62}2 {62}1); cortisone (acetate injectable suspension, {62}0 {62}9 tablets {62}8 {62}7); dexamethasone (elixir, {62}6 oral solution, {62}5 sodium phosphate injection, {62}4 {62}3 tablets {62}2 {62}1 {62}0); hydrocortisone (cypionate oral suspension, {17}9 sodium phosphate injection, {17}8 sodium succinate for injection, {17}7 tablets {17}6 {17}5 {17}4); methylprednisolone (acetate injectable suspension, {17}3 sodium succinate for injection, {17}2 {17}1 tablets {17}0 {62}9); prednisolone (sodium phosphate oral solution, {62}8 syrup {62}7); prednisone (tablets {62}6 {62}5 {62}4); and triamcinolone (tablets {62}3) are indicated in patients with concurrent or impending subarachnoid block.
—The corticosteroid should be administered concurrently with appropriate antituberculosis chemotherapy.

Multiple sclerosis (treatment)—Hydrocortisone (tablets {62}2 {62}1); methylprednisolone (acetate injectable suspension, {62}0 sodium succinate for injection, {62}9 {62}8 tablets {62}7 {62}6); prednisolone (sodium phosphate oral solution, {62}5 syrup); prednisone (oral solution, tablets {62}4 {62}3); and triamcinolone (tablets {62}2) are indicated in acute exacerbations of the disease.

[Myasthenia gravis (treatment)]1—Betamethasone; cortisone; dexamethasone; hydrocortisone; methylprednisolone; prednisolone; prednisone; and triamcinolone are indicated for treatment of severe cases not controlled by antimyasthenic agents alone. Glucocorticoid therapy may be more effective following thymectomy and in patients having disease onset after 40 years of age. Long-term therapy may be required.

Neurotrauma
Edema, cerebral, especially when associated with primary or metastatic brain tumor, craniotomy, or head injury ( [prophylaxis ]1 and treatment)Dexamethasone (elixir, oral solution, {62}1 sodium phosphate injection, {62}0 {62}9 tablets {62}8 {62}7 {62}6); methylprednisolone (sodium succinate for injection {62}5); and [prednisone ]1 are indicated to prevent neurosurgery-associated cerebral edema and to treat edema caused by glioblastomas or metastatic brain tumors. These medications may be less effective in treating edema caused by astrocytomas or meningiomas. Efficacy in closed head injury or ischemic brain edema has not been established. Because very high doses are required, only those glucocorticoids having little or no mineralocorticoid activity should be used.
[Ischemia, cerebral (treatment)]1—Dexamethasone.

[Pseudotumor cerebri (treatment)]1—Dexamethasone.

[Spinal cord injury, acute (treatment)]—Methylprednisolone (sodium succinate for injection {62}4) is indicated in the treatment of spinal cord injury. A large study concluded that patients receiving high-dose methylprednisolone therapy within 8 hours of acute spinal cord injury recover more motor and sensory function, as compared with those receiving naloxone or placebo. {62}3 {62}2 However, methylprednisolone did not improve patient prognosis when it was administered more than 8 hours after the spinal cord injury. {62}1 {62}0

Ophthalmic disorders—Indicated in the treatment of severe acute or chronic allergic and inflammatory ophthalmic conditions
Chorioretinitis (treatment)—Betamethasone (sodium phosphate and acetate injectable suspension, {62}9 syrup, {62}8 tablets {62}7 {62}6); cortisone (acetate injectable suspension, {62}5 tablets {62}4 {62}3); dexamethasone (acetate injectable suspension, {62}2 elixir, {62}1 oral solution, {62}0 sodium phosphate injection, {62}9 {62}8 tablets {62}7 {62}6 {62}5); hydrocortisone (cypionate oral suspension, {62}4 sodium phosphate injection, {62}3 sodium succinate for injection, {62}2 tablets {62}1 {62}0 {62}9); methylprednisolone (acetate injectable suspension, {62}8 sodium succinate for injection, {62}7 {62}6 tablets {62}5); prednisolone (sodium phosphate oral solution, {62}4 syrup {62}3); prednisone (tablets {62}2 {62}1 {62}0); and triamcinolone (tablets {62}9).

Choroiditis, posterior, diffuse (treatment)—Betamethasone (sodium phosphate and acetate injectable suspension, {62}8 syrup, {62}7 tablets {62}6 {62}5); cortisone (acetate injectable suspension, {62}4 {62}3 tablets {62}2 {62}1); dexamethasone (acetate injectable suspension, {62}0 elixir, {26}9 oral solution, {26}8 sodium phosphate injection, {26}7 {26}6 tablets {26}5 {26}4 {26}3); hydrocortisone (cypionate oral suspension, {26}2 sodium phosphate injection, {26}1 sodium succinate for injection, {26}0 tablets {26}9 {26}8 {26}7); methylprednisolone (sodium succinate for injection, {26}6 {26}5 tablets {26}4 {26}3); prednisolone (sodium phosphate oral solution, {26}2 syrup {26}1); prednisone (tablets {26}0 {26}9 {26}8); and triamcinolone (tablets {26}7).

Conjunctivitis, allergic (not controlled topically) (treatment) —Betamethasone (sodium phosphate and acetate injectable suspension, {26}6 syrup, {26}5 tablets {26}4 {26}3); cortisone (acetate injectable suspension, {26}2 {26}1 tablets {26}0 {17}9); dexamethasone (acetate injectable suspension, {17}8 elixir, {17}7 oral solution, {17}6 sodium phosphate injection, {17}5 {17}4 tablets {17}3 {17}2 {17}1); hydrocortisone (cypionate oral suspension, {17}0 sodium phosphate injection, {26}9 sodium succinate for injection, {26}8 tablets {26}7 {26}6 {26}5); methylprednisolone (acetate injectable suspension, {26}4 sodium succinate for injection, {26}3 {26}2 tablets {26}1 {26}0); prednisolone (sodium phosphate oral solution, {18}9 syrup {18}8); prednisone (tablets {18}7 {18}6 {18}5); and triamcinolone (tablets {18}4).

Herpes zoster ophthalmicus (treatment)—Betamethasone (sodium phosphate and acetate injectable suspension, {18}3 syrup, {18}2 tablets {18}1 {18}0); cortisone (acetate injectable suspension, {43}9 {43}8 tablets {43}7 {43}6); dexamethasone (acetate injectable suspension, {43}5 elixir, {43}4 oral solution, {43}3 sodium phosphate injection, {43}2 {43}1 tablets {43}0 {45}9 {45}8); hydrocortisone (cypionate oral suspension, {45}7 sodium phosphate injection, {45}6 sodium succinate for injection, {45}5 tablets {45}4 {45}3 {45}2); methylprednisolone (acetate injectable suspension, {45}1 sodium succinate for injection, {45}0 {18}9 tablets {18}8 {18}7); prednisolone (sodium phosphate oral solution, {18}6 syrup {18}5); prednisone (tablets {18}4 {18}3 {18}2); and triamcinolone (tablets {18}1).

Inflammation, anterior segment (treatment)—Betamethasone (sodium phosphate and acetate injectable suspension, {18}0 syrup, {43}9 tablets {43}8 {43}7); cortisone (acetate injectable suspension, {43}6 {43}5 tablets {43}4 {43}3); dexamethasone (acetate injectable suspension, {43}2 elixir, {43}1 oral solution, {43}0 sodium phosphate injection, {45}9 {45}8 tablets {45}7 {45}6 {45}5); hydrocortisone (cypionate oral suspension, {45}4 sodium phosphate injection, {45}3 sodium succinate for injection, {45}2 tablets {45}1 {45}0 {18}9); methylprednisolone (acetate injectable suspension, {18}8 sodium succinate for injection, {18}7 {18}6 tablets {18}5 {18}4); prednisolone (sodium phosphate oral solution, {18}3 syrup {18}2); prednisone (tablets {18}1 {18}0 {43}9); and triamcinolone (tablets {43}8).

Iridocyclitis (treatment)—Betamethasone (sodium phosphate and acetate injectable suspension, {43}7 syrup, {43}6 tablets {43}5 {43}4); cortisone (acetate injectable suspension, {43}3 {43}2 tablets {43}1 {43}0); dexamethasone (acetate injectable suspension, {45}9 elixir, {45}8 oral solution, {45}7 sodium phosphate injection, {45}6 {45}5 tablets {45}4 {45}3 {45}2); hydrocortisone (cypionate oral suspension, {45}1 sodium phosphate injection, {45}0 sodium succinate for injection, {18}9 tablets {18}8 {18}7 {18}6); methylprednisolone (acetate injectable suspension, {18}5 sodium succinate for injection, {18}4 {18}3 tablets {18}2 {18}1); prednisolone (sodium phosphate oral solution, {18}0 syrup {43}9); prednisone (tablets {43}8 {43}7 {43}6); and triamcinolone (tablets {43}5).

Iritis (treatment)—Betamethasone (sodium phosphate and acetate injectable suspension, {43}4 syrup, {43}3 tablets {43}2 {43}1); cortisone (acetate injectable suspension, {43}0 {68}9 tablets {68}8 {68}7); dexamethasone (acetate injectable suspension, {68}6 elixir, {68}5 oral solution, {68}4 sodium phosphate injection, {68}3 {68}2 tablets {68}1 {68}0 {70}9); hydrocortisone (cypionate oral suspension, {70}8 sodium phosphate injection, {70}7 sodium succinate for injection, {70}6 tablets {70}5 {70}4 {70}3); methylprednisolone (acetate injectable suspension, {70}2 sodium succinate for injection, {70}1 {70}0 tablets {71}9 {71}8); prednisolone (sodium phosphate oral solution, {71}7 syrup {71}6); prednisone (tablets {71}5 {71}4 {71}3); and triamcinolone (tablets {71}2).

Keratitis (not associated with herpes simplex or fungal infection) (treatment)—Betamethasone (sodium phosphate and acetate injectable suspension, {71}1 syrup, {71}0 tablets {77}9 {77}8); cortisone (acetate injectable suspension, {77}7 {77}6 tablets {77}5 {77}4); dexamethasone (acetate injectable suspension, {77}3 elixir, {77}2 oral solution, {77}1 sodium phosphate injection, {77}0 {45}9 tablets {45}8 {45}7 {45}6); hydrocortisone (cypionate oral suspension, {45}5 sodium phosphate injection, {45}4 sodium succinate for injection, {45}3 tablets {45}2 {45}1 {45}0); methylprednisolone (acetate injectable suspension, {55}9 sodium succinate for injection, {55}8 {55}7 tablets {55}6 {55}5); prednisolone (sodium phosphate oral solution, {55}4 syrup {55}3); prednisone (tablets {55}2 {55}1 {55}0); and triamcinolone (tablets {66}9).

Neuritis, optic (treatment)—Betamethasone (sodium phosphate and acetate injectable suspension, {66}8 syrup, {66}7 tablets {66}6 {66}5); cortisone (acetate injectable suspension, {66}4 tablets {66}3 {66}2); dexamethasone (acetate injectable suspension, {66}1 elixir, {66}0 oral solution, {45}9 sodium phosphate injection, {45}8 {45}7 tablets {45}6 {45}5 {45}4); hydrocortisone (cypionate oral suspension, {45}3 sodium phosphate injection, {45}2 sodium succinate for injection, {45}1 tablets {45}0 {91}9 {91}8); methylprednisolone (acetate injectable suspension, {91}7 sodium succinate for injection, {91}6 {91}5 tablets {91}4 {91}3); prednisolone (sodium phosphate oral solution, {91}2 syrup {91}1); prednisone (tablets {91}0 {91}9 {91}8); and triamcinolone (tablets {91}7).

Ophthalmia, sympathetic (treatment)—Betamethasone (sodium phosphate and acetate injectable suspension, {91}6 syrup, {91}5 tablets {91}4 {91}3); cortisone (acetate injectable suspension, {91}2 {91}1 tablets {91}0 {68}9); dexamethasone (acetate injectable suspension, {68}8 elixir, {68}7 oral solution, {68}6 sodium phosphate injection, {68}5 {68}4 tablets {68}3 {68}2 {68}1); hydrocortisone (cypionate oral suspension, {68}0 sodium phosphate injection, {77}9 sodium succinate for injection, {77}8 tablets {77}7 {77}6 {77}5); methylprednisolone (sodium succinate for injection, {77}4 {77}3 tablets {77}2 {77}1); prednisolone (sodium phosphate oral solution, {77}0 syrup {68}9); prednisone (tablets {68}8 {68}7 {68}6); and triamcinolone (tablets {68}5).

Ulcers, allergic, corneal marginal (treatment)— Betamethasone (sodium phosphate and acetate injectable suspension, {68}4 syrup, {68}3 tablets {68}2 {68}1); cortisone (acetate injectable suspension, {68}0 {77}9 tablets {77}8 {77}7); dexamethasone (acetate injectable suspension, {77}6 elixir, {77}5 oral solution, {77}4 sodium phosphate injection, {77}3 {77}2 tablets {77}1 {77}0 {55}9); hydrocortisone (cypionate oral suspension, {55}8 sodium phosphate injection, {55}7 sodium succinate for injection, {55}6 tablets {55}5 {55}4 {55}3); methylprednisolone (acetate injectable suspension, {55}2 sodium succinate for injection, {55}1 {55}0 tablets {66}9 {66}8); prednisolone (sodium phosphate oral solution, {66}7 syrup {66}6); prednisone (tablets {66}5 {66}4 {66}3); and triamcinolone (tablets {66}2).

Uveitis, posterior, diffuse (treatment)—Betamethasone (sodium phosphate and acetate injectable suspension, {66}1 syrup, {66}0 tablets {91}9 {91}8); cortisone (acetate injectable suspension, {91}7 {91}6 tablets {91}5 {91}4); dexamethasone (acetate injectable suspension, {91}3 elixir, {91}2 oral solution, {91}1 sodium phosphate injection, {91}0 {18}9 tablets {18}8 {18}7 {18}6); hydrocortisone (cypionate oral suspension, {18}5 sodium phosphate injection, {18}4 sodium succinate for injection, {18}3 tablets {18}2 {18}1 {18}0); methylprednisolone (acetate injectable suspension, {62}9 sodium succinate for injection, {62}8 {62}7 tablets {62}6 {62}5); prednisolone (sodium phosphate oral solution, {62}4 syrup {62}3); prednisone (tablets {62}2 {62}1 {62}0); and triamcinolone (tablets {18}9).

[Neuritis, retrobulbar (treatment)]—Betamethasone (tablets {18}8); and dexamethasone (sodium phosphate injection {18}7).

Oral disorders—Indicated for treatment of oral lesions unresponsive to topical therapy. The presence of an oral herpetic lesion must be ruled out prior to initiation of glucocorticoid therapy
[Gingivitis, desquamative (treatment) ]1—Betamethasone; cortisone; dexamethasone; hydrocortisone; methylprednisolone; prednisolone; prednisone; and triamcinolone are indicated when the diagnosis is confirmed via immunofluorescent biopsy assay.

[Inflammatory reactions, postoperative, dental (treatment) ]—Betamethasone (tablets {18}6).

[Lesions, oral, associated with corticosteroid-responsive disorders, such as discoid lupus erythematosus; erythema multiforme, severe (Stevens-Johnson syndrome); lichen planus; pemphigoid; pemphigus; and systemic lupus erythematosus (treatment)]1 and
[Stomatitis, aphthous, recurrent (treatment) ]1—Betamethasone; cortisone; dexamethasone; hydrocortisone; methylprednisolone; prednisolone; prednisone; and triamcinolone.
[Pericarditis (treatment)]1—Betamethasone; cortisone; dexamethasone; hydrocortisone; methylprednisolone; prednisolone; prednisone; and triamcinolone are indicated to relieve fever and inflammation.

[Polyps, nasal (treatment)]1—Betamethasone; dexamethasone; methylprednisolone; prednisolone; and triamcinolone.

Respiratory disorders—Indicated in the treatment [ and prophylaxis]1 of respiratory disorders. Prophylactic uses include administration prior to or during extracorporeal circulation in heart surgery if the patient has a pre-existing pulmonary disorder, and administration prior to, during, and following oral, facial, or neck surgery to prevent edema that may threaten the airway
Asthma, bronchial (treatment)—Betamethasone (sodium phosphate and acetate injectable suspension, {18}5 syrup, {18}4 tablets {18}3 {18}2 {18}1); cortisone (acetate injectable suspension, {18}0 {62}9 tablets {62}8 {62}7); dexamethasone (acetate injectable suspension, {62}6 elixir, {62}5 oral solution, {62}4 sodium phosphate injection, {62}3 {62}2 tablets {62}1 {62}0 {43}9); hydrocortisone (cypionate oral suspension, {43}8 sodium phosphate injection, {43}7 sodium succinate for injection, {43}6 tablets {43}5 {43}4 {43}3); methylprednisolone (acetate injectable suspension, {43}2 sodium succinate for injection, {43}1 {43}0 tablets {18}9 {18}8); prednisolone (sodium phosphate oral solution, {18}7 syrup {18}6); prednisone (tablets {18}5 {18}4 {18}3); and triamcinolone (tablets {18}2).

Berylliosis (treatment)—Betamethasone (sodium phosphate and acetate injectable suspension, {18}1 syrup, {18}0 tablets {62}9 {62}8); cortisone (acetate injectable suspension, {62}7 {62}6 tablets {62}5 {62}4); dexamethasone (acetate injectable suspension, {62}3 elixir, {62}2 oral solution, {62}1 sodium phosphate injection, {62}0 {43}9 tablets {43}8 {43}7 {43}6); hydrocortisone (cypionate oral suspension, {43}5 sodium phosphate injection, {43}4 sodium succinate for injection, {43}3 tablets {43}2 {43}1 {43}0); methylprednisolone (acetate injectable suspension, {18}9 sodium succinate for injection, {18}8 {18}7 tablets {18}6 {18}5); prednisolone (sodium phosphate oral solution, {18}4 syrup {18}3); prednisone (tablets {18}2 {18}1 {18}0); and triamcinolone (tablets {62}9).

[Croup (treatment)]1—Dexamethasone is indicated for the treatment of croup in children. Studies have indicated that treatment with dexamethasone may increase the rate of discharge from the hospital emergency department and shorten hospitalization.{62}8{62}7{62}6{62}5{62}4{62}3{62}2{62}1{62}0{18}9{18}8{18}7{18}6{18}5{18}4{18}3{18}2{18}1{18}0{45}9{45}8{45}7

Löeffler's syndrome (eosinophilic pneumonitis or hypereosinophilic syndrome) (treatment)—Betamethasone (sodium phosphate and acetate injectable suspension, {45}6 syrup, {45}5 tablets {45}4 {45}3); cortisone (acetate injectable suspension, {45}2 {45}1 tablets {45}0 {45}9); dexamethasone (acetate injectable suspension, {45}8 elixir, {45}7 oral solution, {45}6 sodium phosphate injection, {45}5 {45}4 tablets {45}3 {45}2 {45}1); hydrocortisone (cypionate oral suspension, {45}0 sodium phosphate injection, {45}9 sodium succinate for injection, {45}8 tablets {45}7 {45}6 {45}5); methylprednisolone (acetate injectable suspension, {45}4 sodium succinate for injection, {45}3 {45}2 tablets {45}1 {45}0); prednisolone (sodium phosphate oral solution, {45}9 syrup {45}8); prednisone (tablets {45}7 {45}6 {45}5); and triamcinolone (tablets {45}4).

Pneumonitis, aspiration (treatment)—Betamethasone (sodium phosphate and acetate injectable suspension, {45}3 syrup, {45}2 tablets {45}1); cortisone (acetate injectable suspension, {45}0 {18}9 tablets {18}8 {18}7); dexamethasone (acetate injectable suspension, {18}6 elixir, {18}5 oral solution, {18}4 sodium phosphate injection, {18}3 {18}2 tablets {18}1 {18}0 {18}9); hydrocortisone (cypionate oral suspension, {18}8 sodium phosphate injection, {18}7 sodium succinate for injection, {18}6 tablets {18}5 {18}4 {18}3); methylprednisolone (acetate injectable suspension, {18}2 sodium succinate for injection, {18}1 {18}0 tablets {45}9 {45}8); prednisolone (sodium phosphate oral solution, {45}7 syrup {45}6); prednisone (tablets {45}5 {45}4 {45}3); and triamcinolone (tablets {45}2).

Sarcoidosis, symptomatic (treatment)—Betamethasone (sodium phosphate and acetate injectable suspension, {45}1 syrup, {45}0 tablets {45}9 {45}8); cortisone (acetate injectable suspension, {45}7 {45}6 tablets {45}5 {45}4); dexamethasone (acetate injectable suspension, {45}3 elixir, {45}2 oral solution, {45}1 sodium phosphate injection, {45}0 {21}9 tablets {21}8 {21}7 {21}6); hydrocortisone (cypionate oral suspension, {21}5 sodium phosphate injection, {21}4 sodium succinate for injection, {21}3 tablets {21}2 {21}1 {21}0); methylprednisolone (acetate injectable suspension, {19}9 sodium succinate for injection, {19}8 {19}7 tablets {19}6 {19}5); prednisolone (sodium phosphate oral solution, {19}4 syrup {19}3); prednisone (tablets {19}2 {19}1 {19}0); and triamcinolone (tablets {21}9).

Tuberculosis, pulmonary, disseminated or fulminating (treatment adjunct)—Betamethasone (sodium phosphate and acetate injectable suspension, {21}8 syrup, {21}7 tablets {21}6 {21}5); cortisone (acetate injectable suspension, {21}4 {21}3 tablets {21}2 {21}1); dexamethasone (elixir, {21}0 oral solution, {21}9 sodium phosphate injection, {21}8 {21}7 tablets {21}6 {21}5 {21}4); hydrocortisone (cypionate oral suspension, {21}3 sodium phosphate injection, {21}2 sodium succinate for injection, {21}1 tablets {21}0 {84}9 {84}8); methylprednisolone (acetate injectable suspension, {84}7 sodium succinate for injection, {84}6 {84}5 tablets {84}4 {84}3); prednisolone (sodium phosphate oral solution, {84}2 syrup {84}1); prednisone (oral solution, tablets {84}0 {21}9 {21}8); and triamcinolone (tablets {21}7) are indicated as adjuncts in the treatment of tuberculosis. The corticosteroid should be administered concurrently with appropriate antituberculosis chemotherapy.

[Bronchitis, asthmatic, acute or chronic (treatment)]1 and
[Pulmonary disease, chronic obstructive (not controlled with theophylline and beta-adrenergic agonists) (treatment)]—Betamethasone; cortisone; dexamethasone; hydrocortisone; methylprednisolone; prednisolone; prednisone; and triamcinolone.

[Edema, pulmonary, noncardiogenic (protamine sensitivity–induced) (treatment)]1and
[Hemangioma, airway-obstructing, in infants (treatment)]1—Betamethasone; cortisone; dexamethasone; hydrocortisone; methylprednisolone; prednisolone; prednisone; and triamcinolone are indicated in the treatment of noncardiogenic pulmonary edema and airway-obstructing hemangioma in infants. Treatment should be initiated with intramuscular or intravenous administration of a rapid-acting preparation.

[Emphysema, pulmonary (treatment)]—Betamethasone (tablets {21}6) and triamcinolone (tablets {21}5) are indicated in the treatment of pulmonary emphysema when bronchospasm or bronchial edema plays a significant role. {21}4

[Fibrosis, idiopathic pulmonary (Hamman-Rich syndrome) (treatment)]—Betamethasone (tablets {21}3) and triamcinolone (tablets {21}2).

[Pneumonia, Pneumocystis carinii, associated with acquired immunodeficiency syndrome (AIDS) (treatment adjunct)]1—In a small number of studies, early use of corticosterioids (e.g., corticosteroid therapy begun within 24 to 72 hours of initial antipneumocystis therapy) as an adjunct to specific antipneumocystis therapy was shown to significantly reduce the risk of oxygenation deterioration, respiratory failure, and death in patients being treated for moderate-to-severe AIDS-associated pneumocystis pneumonia. {21}1 {21}0 {21}9 {21}8 {21}7 {21}6 {21}5 {21}4 The corticosteroids used in these studies were prednisone and intravenous methylprednisolone. {21}3 {21}2 {21}1 {21}0 No improvement in clinical outcome was shown in another study when adjunctive corticosteroid therapy was begun after the onset of respiratory failure and after the initiation of primary pneumocystis therapy. {57}9 {57}8 {57}7 {57}6 Therefore if adjunctive corticosteroid is used, it should be started at the initiation of primary therapy for pneumocystis pneumonia in adults and children older than 13 years of age who have documented or suspected human immunodeficiency virus (HIV) infection and documented or suspected pneumocystis pneumonia, accompanied by moderate-to-severe pulmonary dysfunction (PaO 2 < 70 mm Hg on room air or A-a gradient > 35 mm Hg). {57}5 {57}4 {57}3 The diagnosis of HIV infection and pneumocystis pneumonia should be confirmed as soon as possible. {57}2 {57}1 {57}0 {57}9 {57}8

[Respiratory distress syndrome, adult (treatment)]1—Dexamethasone is indicated in the treatment of respiratory distress syndrome in adults, especially those with post-traumatic pulmonary insufficiency or burns, and during or following massive blood transfusions. However, the benefit of such treatment has not been established.

[Respiratory distress syndrome, neonatal (prophylaxis) ]—Betamethasone1; dexamethasone (sodium phosphate injection {57}7); and hydrocortisone1 are indicated to reduce the incidence and severity of respiratory distress syndrome (hyaline membrane disease) in premature neonates. The medication is administered to the pregnant woman, preferably 24 to 48 hours prior to delivery, to allow time for it to produce an effect. Corticosteroids are not effective when delivery is imminent. If necessary, ritodrine may be administered to delay delivery. If delivery does not occur within several days to 1 week following corticosteroid administration, but the risk of premature delivery persists, administration of a second course of corticosteroid therapy may be necessary. Corticosteroids are not effective in the treatment of respiratory distress syndrome in the premature neonate.

[Status asthmaticus (treatment)]—Betamethasone (sodium phosphate and acetate injectable suspension, {57}6 tablets {57}5); cortisone1; dexamethasone (sodium phosphate injection {57}4); hydrocortisone (sodium succinate for injection {57}3); methylprednisolone (sodium succinate for injection {57}2); prednisolone 1; and triamcinolone1 are indicated in the treatment of status asthmaticus. Treatment should be initiated with intramuscular or intravenous administration of a rapid-acting preparation.

Rheumatic disorders—Indicated as adjunctive therapy during an acute episode or exacerbation. Local injections are preferred when only a few joints or areas are involved
Ankylosing spondylitis (treatment)—Betamethasone (sodium phosphate and acetate injectable suspension, {57}1 syrup, {57}0 tablets {21}9 {21}8); cortisone (acetate injectable suspension, {21}7 {21}6 tablets {21}5 {21}4); dexamethasone (acetate injectable suspension, {21}3 elixir, {21}2 oral solution, {21}1 sodium phosphate injection, {21}0 {21}9 tablets {21}8 {21}7 {21}6); hydrocortisone (cypionate oral suspension, {21}5 sodium phosphate injection, {21}4 sodium succinate for injection, {21}3 tablets {21}2 {21}1 {21}0); methylprednisolone (acetate injectable suspension, {62}9 sodium succinate for injection, {62}8 {62}7 tablets {62}6 {62}5); prednisolone (sodium phosphate oral solution, {62}4 syrup {62}3); prednisone (tablets {62}2 {62}1 {62}0); and triamcinolone (tablets {62}9).

Arthritis, gouty, acute (treatment)—Betamethasone (sodium phosphate and acetate injectable suspension, {62}8 syrup, {62}7 tablets {62}6 {62}5); cortisone (acetate injectable suspension, {62}4 {62}3 tablets {62}2 {62}1); dexamethasone (acetate injectable suspension, {62}0 elixir, {57}9 oral solution, {57}8 sodium phosphate injection, {57}7 {57}6 tablets {57}5 {57}4 {57}3); hydrocortisone (acetate injectable suspension, {57}2 cypionate oral suspension, {57}1 sodium phosphate injection, {57}0 sodium succinate for injection, {20}9 tablets {20}8 {20}7 {20}6); methylprednisolone (sodium succinate for injection, {20}5 {20}4 tablets {20}3 {20}2); prednisolone (acetate injectable suspension, {20}1 sodium phosphate oral solution, {20}0 syrup {19}9); prednisone (tablets {19}8 {19}7 {19}6); and triamcinolone (acetonide injectable suspension, {19}5 {19}4 hexacetonide injectable suspension, {19}3 tablets {19}2).

Arthritis, psoriatic (treatment)—Betamethasone (sodium phosphate and acetate injectable suspension, {19}1 syrup, {19}0 tablets {19}9 {19}8); cortisone (acetate injectable suspension, {19}7 tablets {19}6); dexamethasone (acetate injectable suspension, {19}5 elixir, {19}4 oral solution, {19}3 sodium phosphate injection, {19}2 {19}1 tablets {19}0 {20}9 {20}8); hydrocortisone (cypionate oral suspension, {20}7 sodium phosphate injection, {20}6 sodium succinate for injection, {20}5 tablets {20}4 {20}3 {20}2); methylprednisolone (acetate injectable suspension, {20}1 sodium succinate for injection, {20}0 {20}9 tablets {20}8 {20}7); prednisolone (sodium phosphate oral solution, {20}6 syrup {20}5); prednisone (tablets {20}4 {20}3 {20}2); and triamcinolone (tablets {20}1).

Arthritis, rheumatoid (including juvenile arthritis) (treatment) —Betamethasone (sodium phosphate and acetate injectable suspension, {20}0 {20}9 syrup, {20}8 tablets {20}7 {20}6 {20}5); cortisone (acetate injectable suspension, {20}4 {20}3 tablets {20}2 {20}1); dexamethasone (acetate injectable suspension, {20}0 elixir, {15}9 oral solution, {15}8 sodium phosphate injection, {15}7 {15}6 tablets {15}5 {15}4 {15}3); hydrocortisone (acetate injectable suspension, {15}2 cypionate oral suspension, {15}1 sodium phosphate injection, {15}0 sodium succinate for injection, {62}9 tablets {62}8 {62}7 {62}6); methylprednisolone (sodium succinate for injection, {62}5 {62}4 tablets {62}3 {62}2); prednisolone (sodium phosphate oral solution, {62}1 syrup {62}0); prednisone (tablets {62}9 {62}8 {62}7); and triamcinolone (acetonide injectable suspension, {62}6 {62}5 hexacetonide injectable suspension, {62}4 tablets {62}3).
—[Long-term use is controversial. It is recommended that such treatment be reserved for patients not responsive to other measures, such as aspirin or other nonsteroidal anti-inflammatory drugs, rest, and physical therapy.]1

Osteoarthritis, post-traumatic (treatment)—Betamethasone (sodium phosphate and acetate injectable suspension, {62}2 {62}1 syrup, {62}0 tablets {62}9); cortisone (acetate injectable suspension, {62}8 {62}7 tablets {62}6 {62}5); dexamethasone (acetate injectable suspension, {62}4 elixir, {62}3 oral solution, {62}2 sodium phosphate injection, {62}1 {62}0 tablets {62}9 {62}8 {62}7); hydrocortisone (acetate injectable suspension, {62}6 cypionate oral suspension, {62}5 sodium phosphate injection, {62}4 sodium succinate for injection, {62}3 tablets {62}2 {62}1 {62}0); methylprednisolone (acetate injectable suspension, {62}9 sodium succinate for injection, {62}8 {62}7 tablets {62}6 {62}5); prednisolone (sodium phosphate oral solution, {62}4 syrup {62}3); prednisone (tablets {62}2 {62}1 {62}0); and triamcinolone (acetonide injectable suspension, {62}9 {62}8 hexacetonide injectable suspension {62}7).

Polymyalgia rheumatica (treatment)—Methylprednisolone (tablets {62}6); and prednisone (tablets {62}5).

Synovitis of osteoarthritis (treatment)—Betamethasone (sodium phosphate and acetate injectable suspension, {62}4 syrup, {62}3 tablets {62}2); cortisone (acetate injectable suspension, {62}1 {62}0 tablets {62}9 {62}8); dexamethasone (acetate injectable suspension, {62}7 elixir, {62}6 oral solution, {62}5 sodium phosphate injection, {62}4 {62}3 tablets {62}2 {62}1 {62}0); hydrocortisone (acetate injectable suspension, {62}9 cypionate oral suspension, {62}8 sodium phosphate injection, {62}7 sodium succinate for injection, {62}6 tablets {62}5 {62}4 {62}3); methylprednisolone (acetate injectable suspension, {62}2 sodium succinate for injection, {62}1 {62}0 tablets {62}9 {62}8); prednisolone (sodium phosphate oral solution, {62}7 syrup {62}6); prednisone (tablets {62}5 {62}4 {62}3); and triamcinolone (acetonide injectable suspension, {62}2 {62}1 hexacetonide injectable suspension, {62}0 tablets {62}9).

[Calcium pyrophosphate deposition disease, acute (chondrocalcinosis articularis; pseudogout; synovitis, crystal-induced) (treatment)]1 and
[Reiter's disease (treatment)]1—Betamethasone; cortisone; dexamethasone; hydrocortisone; methylprednisolone; prednisolone; prednisone; and triamcinolone.

[Rheumatic fever (treatment)]—Betamethasone1; cortisone 1; dexamethasone1; hydrocortisone1; methylprednisolone (sodium succinate for injection {62}8); prednisolone1; prednisone1; and triamcinolone (tablets {62}7) are indicated in the treatment of rheumatic fever, especially if carditis is present.
Shock (treatment)—Betamethasone (sodium phosphate and acetate injectable suspension {62}6); cortisone (acetate injectable suspension, {62}5 {62}4 tablets {62}3); dexamethasone (sodium phosphate injection {62}2 {62}1); hydrocortisone (sodium phosphate injection, {62}0 sodium succinate for injection {62}9); and methylprednisolone (sodium succinate for injection {62}8 {62}7 {62}6) are indicated in the treatment of shock caused by adrenocortical insufficiency (Addisonian shock).
—Corticosteroids also are indicated as adjuncts in the treatment of shock associated with anaphylactic or anaphylactoid reactions. Treatment should be initiated with intramuscular or intravenous administration of a rapid-acting preparation.
—[Intravenous corticosteroids are being used as adjuncts in the treatment of septic shock. Such use is very controversial because efficacy has not been established and superimposition of new infections has been reported. Specifically, methylprednisolone has been shown to be ineffective and hazardous in the treatment of septic shock and is not recommended.]

[Transplant rejection, organ (prophylaxis and treatment) ]—Betamethasone1; cortisone1; dexamethasone1; hydrocortisone1; methylprednisolone (sodium succinate for injection, {62}5 tablets {62}4); prednisolone1; prednisone1; and triamcinolone1 are indicated concurrently with other immunosuppressants such as azathioprine or cyclosporine to reduce the risk of rejection of transplanted organs.
—[High doses of rapidly acting corticosteroids are indicated in the treatment of rejection reactions.]1

Trichinosis (treatment)—Betamethasone (sodium phosphate and acetate injectable suspension, {62}3 syrup, {62}2 tablets {62}1); cortisone (acetate injectable suspension, {62}0 {57}9 tablets {57}8 {57}7); dexamethasone (acetate injectable suspension, {57}6 elixir, {57}5 oral solution, {57}4 sodium phosphate injection, {57}3 {57}2 tablets {57}1 {57}0 {15}9); hydrocortisone (cypionate oral suspension, {15}8 sodium phosphate injection, {15}7 sodium succinate for injection, {15}6 tablets {15}5 {15}4 {15}3); methylprednisolone (acetate injectable suspension, {15}2 sodium succinate for injection, {15}1 {15}0 tablets {46}9 {46}8); prednisolone (sodium phosphate oral solution, {46}7 syrup {46}6); prednisone (tablets {46}5 {46}4 {46}3); and triamcinolone (tablets {46}2) are indicated in the treatment of trichinosis with neurological or myocardial involvement.

Tumors, cystic, of an aponeurosis or tendon (ganglia) (treatment) —Dexamethasone (acetate injectable suspension, {46}1 sodium phosphate injection {46}0 {47}9); hydrocortisone (acetate injectable suspension {47}8); and methylprednisolone (acetate injectable suspension {47}7).

Acceptance not established
There is currently not enough medical literature or clinical experience to recommend the use of prednisone for the treatment of edema associated with brain cancer.{47}6

1 Not included in Canadian product labeling.



Pharmacology/Pharmacokinetics

Table 1. Pharmacology/Pharmacokinetics *



  Drug and
Route
Onset
of Action
Peak
Effect
Duration
of Action
Betamethasone
     
    Oral
  1–2 hr
3.25 days
  Sodium phosphate
     
    IV
Rapid
   
    IM
Rapid
   
  Acetate/Sodium phosphate
     
    IM
1–3 hr
  1 wk
    IA, IS
    1–2 wk
    IL, ST
    1 wk
Cortisone acetate
     
    Oral
Rapid
2 hr
1.25–1.5 days
    IM
Slow
20–48 hr
 
Dexamethasone
     
    Oral
  1–2 hr
2.75 days
  Acetate
     
    IM
  8 hr
6 days
    IA, ST, IL
    1–3 wk
  Sodium phosphate
     
    IV
Rapid
   
    IM
Rapid
   
    IA, IS, IL, ST
    3 days–3 wk
Hydrocortisone
     
    Oral
  1 hr
1.25–1.5 days
    IM
  4–8 hr
 
  Acetate
     
    IA, IS, IB, IL, ST
  24–48 hr
3 days–4 wk
  Cypionate
     
    Oral
  1–2 hr
 
  Sodium phosphate
     
    IV
Rapid
   
    IM
Rapid
1 hr
 
  Sodium succinate
     
    IV
Rapid
   
    IM
Rapid
1 hr
Variable
Methylprednisolone
     
    Oral
  1–2 hr
1.25–1.5 days
  Acetate
     
    IM
Slow
6–48 hr
4–8 days
1–4 wk
    IA, IL, ST
Very slow
7 days
1–5 wk
  Sodium succinate
     
    IV
Rapid
   
    IM
Rapid
   
Prednisolone
     
    Oral
  1–2 hr
1.25–1.5 days
  Acetate
     
    IM
Slow
   
  Acetate/Sodium phosphate
     
    IM
    Up to 4 wk
    IB, IS, IA, ST
    3 days–4 wk
  Sodium phosphate
     
    IV
Rapid
1 hr
 
    IM
Rapid
1 hr
 
    IA, IL, ST
    3 days–3 wk
  Tebutate
     
    IA, IL, ST
Slow
1–2 days
  1–3 wk
Prednisone
     
    Oral
  1–2 hr
1.25–1.5 days
Triamcinolone
     
    Oral
  1–2 hr
2.25 days
  Acetonide
     
    IM
Slow
24–48 hr
  1–6 wk
    IB, IA, IS, IL, ST
    Several wk
  Diacetate
     
    Oral
  1–2 hr
 
    IM
Slow

 
4 days–4 wk
    IL
    1–2 wk
    IA, IS, ST

 
  1–8 wk
  Hexacetonide
     
    IA, IL
    3–4 wk
* Abbreviations: IA = intra-articular; IB = intrabursal; IL = intralesional; IM = intramuscular; IS = intrasynovial; ST = soft tissue.

Table 2. Pharmacology/Pharmacokinetics




 
Relative Potency
Protein
Binding §
Half-life (hr)
Glucocorticoid
Dose (mg) *
Glucocorticoid
Activity
Mineralocorticoid
Activity
Plasma
Biological
(Tissue)
Corticosteroids
           
Short-acting
 
           
Cortisone
25
0.8
2+
  0.5
8–12
Hydrocortisone
20
1
2+
Very high
1.5–2
8–12
Intermediate-acting
 
           
Methylprednisolone
4
5
0 #
  >3.5
18–36
Prednisolone
5
4
1+
High
2.1–3.5
18–36
Prednisone
5
4
1+
High to very high
3.4–3.8
18–36
Triamcinolone
4
5
0 #
High
2–>5
18–36
Long-acting
 
           
Betamethasone
0.6
20–30
0 #
High
3–5
36–54
Dexamethasone
0.5–0.75
20–30
0 #
High
3–4.5
36–54
* Approximate; applies to oral or intravenous administration only.
 Anti-inflammatory, immunosuppressant, metabolic effects.
 Sodium and water retention, potassium depletion.
§ Hydrocortisone binds to transcortin (corticosteroid-binding globulin [CBG]) and to albumin. Prednisone, but not betamethasone, dexamethasone, or triamcinolone, also binds to CBG.
# Although these glucocorticoids are considered not to have significant mineralocorticoid activity, hypokalemia and/or sodium and fluid retention may occur, depending on dosage and patient predisposition.

Physicochemical characteristics:
Molecular weight—


Betamethasone:
    392.47 {47}5


Acetate—
     434.51 {47}4



Sodium phosphate—
    516.41 {47}3




Budesonide:
    430.54 {47}2



Cortisone acetate:
    402.49 {47}1



Dexamethasone:
    392.47 {47}0


Acetate—
    452.52 {48}9



Sodium phosphate—
    516.41 {48}8




Hydrocortisone:
    362.47 {48}7


Acetate—
    404.51 {48}6



Cypionate—
    486.65 {48}5



Sodium phosphate—
    486.41 {48}4



Sodium succinate—
    484.52 {48}3




Methylprednisolone:
    374.48 {48}2


Acetate—
    416.52 {48}1



Sodium succinate—
    496.54 {48}0




Prednisolone:
    360.45 (anhydrous); {48}9 387.47 (sesquihydrate)


Acetate—
    402.49 {48}8



Sodium phosphate—
    484.4 {48}7



Tebutate—
    458.6 {48}6




Prednisone:
    358.44 {48}5



Triamcinolone:
    394.44 {48}4


Acetonide—
    434.51 {48}3



Diacetate—
    478.52 {48}2



Hexacetonide—
    532.65 {48}1



Mechanism of action/Effect:

Corticosteroids diffuse across cell membranes and complex with specific cytoplasmic receptors. These complexes then enter the cell nucleus, bind to DNA, and stimulate transcription of messenger RNA (mRNA) and subsequent protein synthesis of various enzymes thought to be ultimately responsible for two categories of effects of systemic corticosteroids. However, these agents may suppress transcription of mRNA in some cells (e.g., lymphocytes).


For glucocorticoid effects:

Anti-inflammatory (steroidal)—Glucocorticoids decrease or prevent tissue responses to inflammatory processes, thereby reducing development of symptoms of inflammation without affecting the underlying cause. Glucocorticoids inhibit accumulation of inflammatory cells, including macrophages and leukocytes, at sites of inflammation. They also inhibit phagocytosis, lysosomal enzyme release, and synthesis and/or release of several chemical mediators of inflammation. Although the exact mechanisms are not completely understood, actions that may contribute significantly to these effects include blockade of the action of macrophage inhibitory factor (MIF), leading to inhibition of macrophage localization; reduction of dilatation and permeability of inflamed capillaries and reduction of leukocyte adherence to the capillary endothelium, leading to inhibition of both leukocyte migration and edema formation; and increased synthesis of lipomodulin (macrocortin), an inhibitor of phospholipase A2–mediated arachidonic acid release from membrane phospholipids, with subsequent inhibition of the synthesis of arachidonic acid–derived mediators of inflammation (prostaglandins, thromboxanes, and leukotrienes). Immunosuppressant actions also may contribute significantly to the anti-inflammatory effect.

Immunosuppressant—Mechanisms of immunosuppressant action are not completely understood but may involve prevention or suppression of cell-mediated (delayed hypersensitivity) immune reactions as well as more specific actions affecting the immune response. {48}0 Glucocorticoids reduce the concentration of thymus-dependent lymphocytes (T-lymphocytes), monocytes, and eosinophils. They also decrease binding of immunoglobulin to cell surface receptors and inhibit the synthesis and/or release of interleukins, thereby decreasing T-lymphocyte blastogenesis and reducing expansion of the primary immune response. Glucocorticoids also may decrease passage of immune complexes through basement membranes and decrease concentrations of complement components and immunoglobulins.



For mineralocorticoid effects:

Water and electrolyte balance: Sodium reabsorption, and potassium and hydrogen excretion, along with subsequent water retention, are mediated through an action of mineralocorticoids on the area of the renal distal tubule that facilitates sodium transport. Cation transport in other secretory cells is similarly affected. Excretion of water and electrolytes by the large intestine and by salivary and sweat glands also is altered, but to a lesser extent. Only cortisone and hydrocortisone have clinically useful mineralocorticoid activity.



For specific indications:

Congenital adrenal hyperplasia: Glucocorticoids inhibit corticotropin (adrenocorticotropic hormone [ACTH]) secretion, leading to suppression of adrenal hypersecretion of androgens responsible for the androgenism associated with various enzyme deficiencies.

Hypercalcemia: Glucocorticoids reduce plasma calcium concentration by decreasing gastrointestinal absorption of calcium, probably by interfering with intestinal calcium transport (by decreasing the effect of vitamin D), and increasing calcium excretion.

Respiratory distress syndrome prophylaxis: Glucocorticoids may induce enzymes that accelerate or increase production of lung surfactant by type 2 pneumonocytes.



Other actions/effects:

Pharmacologic (supraphysiologic) doses of exogenous corticosteroids produce hypothalamic-pituitary-adrenal (HPA) axis suppression via a negative feedback mechanism, i.e., they inhibit pituitary ACTH secretion, thereby reducing ACTH-mediated production of corticosteroids and androgens in the adrenal cortex. The development of adrenocortical insufficiency and the time required for recovery of adrenal function depend primarily on the duration of corticosteroid therapy and, to a lesser extent, on dosage, timing, and frequency of administration, as well as on the potency and biologic (tissue) half-life of the specific agent. Adrenal insufficiency may occur in approximately 5 to 7 days with daily administration of doses equivalent to 20 to 30 mg of prednisone or in up to 30 days with lower doses. Following discontinuation of short-term (up to 5 days) high-dose use, adrenal recovery may occur within 1 week. Following prolonged high-dose use, complete recovery of adrenal function may require up to 1 year and, in some patients, may never occur.

Glucocorticoids stimulate protein catabolism and induce enzymes responsible for metabolism of amino acids. They decrease synthesis and increase degradation of protein in lymphoid tissue, connective tissue, muscle, and skin. With prolonged use, atrophy of these tissues may occur.

Glucocorticoids increase glucose availability by inducing hepatic enzymes involved in gluconeogenesis, stimulating protein catabolism (which increases hepatic concentrations of amino acids required for gluconeogenesis), and decreasing peripheral utilization of glucose. These actions lead to increased hepatic glycogen storage, increased blood glucose concentrations, and insulin resistance.

Glucocorticoids increase lipolysis and mobilize fatty acids from adipose tissues, leading to increased plasma fatty acid concentrations. With prolonged use, an abnormal redistribution of fat may occur.

Glucocorticoids decrease bone formation and increase bone resorption. They reduce plasma calcium concentration, leading to secondary hyperparathyroidism and subsequent stimulation of osteoclasts, and directly inhibit osteoblasts. These actions, together with a decrease in the protein matrix of bone secondary to increased protein catabolism, may lead to inhibition of bone growth in children and adolescents and the development of osteoporosis at any age.

Absorption:


Oral:

Rapidly and almost completely absorbed.



Parenteral:


Intramuscular—

Freely soluble esters (sodium phosphate, sodium succinate)—Rapidly absorbed.

Poorly soluble derivatives (acetate, acetonide, diacetate, hexacetonide, tebutate)—Slowly but completely absorbed.



Local—

Freely soluble esters—Less rapidly absorbed than with intramuscular injection.

Poorly soluble derivatives—Slowly but completely absorbed.



Biotransformation:

Primarily hepatic (rapid); also renal and tissue; mostly to inactive metabolites. Cortisone and prednisone are inactive until metabolized to the active metabolites hydrocortisone and prednisolone, respectively. Fluorinated corticosteroids are metabolized more slowly than other members of the group.

Duration of action:

Duration of action depends upon the route/site of administration, solubility of the dosage form, dose administered, and the condition being treated. Following oral or intravenous administration, the duration of action depends upon the biological (tissue) half-life. Following intramuscular administration, the duration of action depends upon the solubility of the dosage form as well as the biological (tissue) half-life. Following local injections, the duration of action depends upon the solubility of the dosage form and the specific route/site of administration.

Elimination:
    Primarily by renal excretion of inactive metabolites.


Precautions to Consider

Pregnancy/Reproduction
Fertility—
Corticosteroids have been reported to increase or decrease the number or motility of spermatozoa. {68}9 {68}8 {68}7 {68}6 {68}5 {68}4 {68}3 However, it is not known whether reproductive capacity in humans is adversely affected.

Pregnancy—

For corticosteroids

Corticosteroids cross the placenta. {68}2 {68}1 {68}0 {70}9 Although adequate studies have not been done in humans, there is some evidence that pharmacologic doses of corticosteroids may increase the risk of placental insufficiency, decreased birthweight, or stillbirth. However, teratogenic effects in humans have not been confirmed.

Prenatal administration of betamethasone or dexamethasone to the pregnant woman to prevent respiratory distress syndrome in the premature neonate has not been shown to affect the child's growth or development adversely. Physiologic replacement doses of corticosteroids administered for treatment of maternal adrenal insufficiency also are unlikely to adversely affect the fetus or neonate.

Studies in animals have shown that corticosteroids increase the incidence of cleft palate, {70}8 {70}7 placental insufficiency, spontaneous abortions, and intrauterine growth retardation.

FDA Pregnancy Category C (Prednisolone). {70}6



For budesonide

High doses of budesonide administered subcutaneously produced fetal malformations (primarily skeletal defects) in rabbits, rats, and mice. However, the relevance of these findings to humans has not been established. {70}5


Breast-feeding

For corticosteroids—Problems in humans have not been documented. Administration of physiologic doses or low pharmacologic doses (the equivalent or less of 25 mg of cortisone or 5 mg of prednisone per day) is not considered likely to affect the infant adversely. Less than 1% of the administered dose of prednisolone is distributed into breast milk. {70}4 However, breast-feeding during the use of higher pharmacologic doses is not recommended because corticosteroids are distributed into breast milk {70}3 {70}2 {70}1 {70}0 {71}9 {71}8 {71}7 {71}6 {71}5 {71}4 {71}3 and may cause unwanted effects, such as growth suppression and inhibition of endogenous steroid production, in the infant. {71}2 {71}1 {71}0 {77}9 {77}8 {77}7

Pediatrics

Infants born to women who have received substantial doses of corticosteroids during pregnancy should be carefully observed for signs of hypoadrenalism {77}6 {77}5 {77}4 {77}3 {77}2 {77}1 {77}0 {68}9 {68}8 {68}7 {68}6 {68}5 {68}4 {68}3 {68}2 {68}1 and replacement therapy should be administered as required. {68}0

Because infections such as chickenpox or measles may be more serious (or even fatal) in children receiving immunosuppressant doses of corticosteroids, extra care to avoid exposure to these infections is recommended. {77}9 {77}8 {77}7 {77}6 {77}5 {77}4 {77}3 {77}2 {77}1 {77}0 Prophylactic therapy with varicella zoster immune globulin (VZIG) or immune globulin intravenous (IGIV) or intramuscular (IGIM), as appropriate, may be indicated in exposed patients. {68}9 {68}8 {68}7 {68}6 {68}5 {68}4 {68}3 {68}2 {68}1 {68}0 {77}9 {77}8 {77}7 Therapy with an antiviral agent may be indicated if chickenpox develops. {77}6 {77}5 {77}4 {77}3 {77}2 {77}1 {77}0 {57}9 {57}8 {57}7 {57}6 {57}5

Chronic use of corticosteroids may suppress growth and development of the pediatric or adolescent patient and should be undertaken with caution. {57}4 {57}3 Use of long-acting glucocorticoids (betamethasone and dexamethasone) or daily doses of any corticosteroid that are larger than replacement therapy doses are especially likely to inhibit growth and are not recommended for any form of chronic therapy. For long-term therapy, a short-acting agent (cortisone or hydrocortisone) or an intermediate-acting agent (methylprednisolone, prednisolone, prednisone, or triamcinolone) is recommended. Alternate-day therapy with an oral intermediate-acting corticosteroid may decrease growth retardation effects. {57}2 {57}1 Some clinicians recommend that only cortisone, hydrocortisone, or prednisone be used for long-term replacement therapy. Also, pediatric patients may be at increased risk of developing osteoporosis, avascular necrosis of the femoral heads, glaucoma, or cataracts during prolonged therapy. Children and adolescents receiving prolonged therapy should be closely monitored.

Pediatric dosage is determined more by the severity of the condition and the response of the patient than by age or body weight. {57}0 Also, for treatment of adrenocortical insufficiency, pediatric dosage is preferably determined in terms of mg per square meter of body surface area. Determination of pediatric dosage in terms of mg per kg of body weight (mg/kg) increases the possibility of overdosage, especially in very young, short, or heavy children.


Geriatrics


Geriatric patients may be more likely to develop hypertension during corticosteroid therapy. {62}9 Geriatric patients, especially postmenopausal women, also may be more likely to develop glucocorticoid-induced osteoporosis.

Drug interactions and/or related problems
The following drug interactions and/or related problems have been selected on the basis of their potential clinical significance (possible mechanism in parentheses where appropriate)—not necessarily inclusive (» = major clinical significance):

See also Laboratory value alterations.

Note: Combinations containing any of the following medications, depending on the amount present, also may interact with this medication.
Interactions listed below involving alterations in serum potassium concentration and/or changes in sodium or fluid balance are especially likely to occur with corticosteroids having significant mineralocorticoid activity. However, these interactions also may occur with other corticosteroids, depending on dosage and patient predisposition.

Acetaminophen    (induction of hepatic enzymes by corticosteroids may increase the formation of a hepatotoxic acetaminophen metabolite, thereby increasing the risk of hepatotoxicity, when they are used concurrently with chronic or high-dose acetaminophen therapy)


Alcohol or
Anti-inflammatory drugs, nonsteroidal (NSAIDs)    (risk of gastrointestinal ulceration or hemorrhage may be increased when these substances are used concurrently with glucocorticoids; however, concurrent use of NSAIDs in the treatment of arthritis may provide additive therapeutic benefit and permit glucocorticoid dosage reduction)


» Aminoglutethimide    (aminoglutethimide suppresses adrenal function so that glucocorticoid supplementation may be required; however, aminoglutethimide accelerates the metabolism of dexamethasone so that the half-life of dexamethasone may be reduced twofold; hydrocortisone is recommended instead because its metabolism is not known to be altered by aminoglutethimide and because its mineralocorticoid activity also may be required)


» Amphotericin B, parenteral {62}8 {62}7 or
Carbonic anhydrase inhibitors    (concurrent use with corticosteroids may result in severe hypokalemia and should be undertaken with caution; {62}6 serum potassium concentrations and cardiac function should be monitored during concurrent use)

    (the use of hydrocortisone to control adverse reactions to amphotericin B has resulted in cases of cardiac enlargement and congestive heart failure {62}5 {62}4)

    (concurrent use of corticosteroids with acetazolamide sodium may increase the risk of hypernatremia and/or edema because corticosteroids cause sodium and fluid retention; the risk with corticosteroids may depend on the patient's sodium requirement as determined by the condition being treated)

    (the possibility should be considered that concurrent chronic use of both carbonic anhydrase inhibitors and corticosteroids may increase the risk of hypocalcemia and osteoporosis because carbonic anhydrase inhibitors also increase calcium excretion)


Anabolic steroids or
Androgens    (concurrent use with glucocorticoids may increase the risk of edema; also, concurrent use may promote the development of severe acne)


» Antacids    (concurrent chronic use with prednisone or dexamethasone may decrease absorption of these glucocorticoids; efficacy may be decreased sufficiently to require dosage adjustment in patients receiving small doses, but probably not in those receiving large doses, of the corticosteroid)


Anticholinergics, especially atropine and related compounds    (concurrent long-term use with glucocorticoids may increase intraocular pressure)


Anticoagulants, coumarin- or indanedione-derivative {62}3 {62}2 {62}1 {62}0 {57}9 {57}8 {57}7 {57}6 {57}5 {57}4 {57}3 or
Heparin or
Streptokinase or
Urokinase    (effects of coumarin or indanedione derivatives usually are decreased [but may be increased in some patients] when these medications are used concurrently with glucocorticoids; {57}2 {57}1 {57}0 {62}9 {62}8 {62}7 {62}6 {62}5 {62}4 {62}3 dosage adjustments based on prothrombin time determinations may be necessary during and after glucocorticoid therapy)

    (the potential occurrence of gastrointestinal ulceration or hemorrhage during glucocorticoid therapy, and the effects of glucocorticoids on vascular integrity, may cause increased risk to patients receiving anticoagulant or thrombolytic therapy)


Antidepressants, {62}2 tricyclic    (these medications do not relieve, and may exacerbate, corticosteroid-induced mental disturbances; they should not be used for treatment of these adverse effects {62}1)


» Antidiabetic agents, oral {62}0 {62}9 {62}8 {62}7 {62}6 {62}5 {62}4 {62}3 {62}2 {62}1 {62}0 {48}9 {48}8 {48}7 {48}6 or
» Insulin {48}5 {48}4 {48}3 {48}2 {48}1 {48}0 {48}9 {48}8 {48}7 {48}6 {48}5 {48}4 {48}3 {48}2    (glucocorticoids may increase blood glucose concentration; {48}1 {48}0 dosage adjustment of one or both agents may be necessary during concurrent use; {62}9 {62}8 {62}7 {62}6 {62}5 {62}4 {62}3 {62}2 {62}1 {62}0 {62}9 {62}8 {62}7 dosage readjustment of the hypoglycemic agent also may be required when glucocorticoid therapy is discontinued)


Antithyroid agents or
Thyroid hormones {62}6    (changes in the thyroid status of the patient that may occur as a result of administration, changes in dosage, or discontinuation of thyroid hormones or antithyroid agents may necessitate adjustment of corticosteroid dosage because metabolic clearance of corticosteroids is decreased in hypothyroid patients and increased in hyperthyroid patients; {62}5 dosage adjustment should be based on results of thyroid function tests {62}4)


Asparaginase    (glucocorticoids, especially prednisone, may increase the hyperglycemic effect of asparaginase and the risk of neuropathy and disturbances in erythropoiesis; the toxicity appears to be less pronounced when asparaginase is administered following, rather than before or with, these medications)


Contraceptives, oral, estrogen-containing {62}3 or
Estrogens {62}2 {62}1    (estrogens may alter the metabolism and protein binding of glucocorticoids, leading to decreased clearance, increased elimination half-life, and increased therapeutic and toxic effects of the glucocorticoid; glucocorticoid dosage adjustment may be required during and following concurrent use {62}0)


» Cyclosporine {62}9 {62}8 {62}7 {62}6 {62}5    (seizures have been observed in patients receiving cyclosporine and high doses of methylprednisolone {62}4 {62}3 {62}2)


» Digitalis glycosides {62}1 {62}0    (concurrent use with glucocorticoids may increase the possibility of arrhythmias or digitalis toxicity {62}9 {62}8 associated with hypokalemia)


» Diuretics {62}7 {62}6 {62}5 {62}4 {62}3 {62}2    (natriuretic and diuretic effects of these medications may be decreased by sodium- and fluid-retaining actions of corticosteroids, and vice versa )

    (concurrent use of potassium-depleting diuretics with corticosteroids may result in severe hypokalemia; {62}1 {62}0 {62}9 {62}8 {62}7 {62}6 monitoring of serum potassium concentration and cardiac function is recommended )

    (effects of potassium-sparing diuretics and/or corticosteroids on serum potassium concentration may be decreased during concurrent use; monitoring of serum potassium concentration is recommended)


Ephedrine {62}5 {62}4 {62}3 {62}2 {62}1 {62}0 or
Phenobarbital {48}9 {48}8 {48}7 {48}6 {48}5 {48}4 {48}3 {48}2 {48}1 {48}0 {62}9 or
Phenytoin {62}8 {62}7 {62}6 {62}5 {62}4 {62}3 {62}2 {62}1 {62}0 {62}9 {62}8 {62}7 or
Rifampin {62}6 {62}5 {62}4 {62}3 {62}2 {62}1 {62}0 {62}9 {62}8 {62}7 {62}6    (concurrent use may increase the metabolic clearance of corticosteroids; {62}5 corticosteroid dosage adjustment may be required during and following concurrent use {62}4 {62}3 {62}2 {62}1 {62}0 {62}9 {62}8 {62}7 {62}6 {62}5 {62}4 {62}3)


Folic acid    (requirements may be increased in patients receiving long-term corticosteroid therapy)


» Hepatic enzyme-inducing agents (see Appendix II)    (concurrent use may decrease the corticosteroid effect because of increased corticosteroid metabolism resulting from induction of hepatic microsomal enzymes )


Immunosuppressant agents, other    (concurrent use with immunosuppressant doses of glucocorticoids may increase the risk of infection and possibly the development of lymphomas or other lymphoproliferative disorders; these neoplasms may be associated with Epstein-Barr virus infections; a few studies in organ transplant patients receiving immunosuppressant therapy indicate that progression of the neoplasm may be reversed after immunosuppressant dosage is decreased or therapy is discontinued)


Iophendylate or
Metrizamide    (concurrent intrathecal administration of metrizamide or iophendylate with intrathecal administration of glucocorticoids may increase the risk of arachnoiditis )


Isoniazid {62}2 {62}1    (glucocorticoids, especially prednisolone, may increase hepatic metabolism and/or excretion of isoniazid, leading to decreased plasma concentration and effectiveness of isoniazid, {62}0 {48}9 especially in patients who are rapid acetylators; isoniazid dosage adjustment may be required during and following concurrent use)


Mexiletine    (concurrent use with glucocorticoids may accelerate metabolism of mexiletine, leading to decreased mexiletine plasma concentration)


» Mitotane    (mitotane suppresses adrenocortical function; glucocorticoid supplementation usually is required during mitotane administration, but higher doses than those generally used for replacement therapy may be required because mitotane alters glucocorticoid metabolism)


Neuromuscular blocking agents, nondepolarizing    (hypokalemia induced by glucocorticoids may enhance the blockade of nondepolarizing neuromuscular blocking agents, possibly leading to increased or prolonged respiratory depression or paralysis [apnea]; serum potassium determinations may be necessary prior to administration of these agents)

    (hydrocortisone and prednisone also have been reported to decrease the efficacy of pancuronium by an unknown mechanism; increased dosage of pancuronium or use of an alternate neuromuscular blocking agent may be necessary)


» Potassium supplements    (effects of these medications and/or corticosteroids on serum potassium concentration may be decreased when these medications are used concurrently; monitoring of serum potassium concentration is recommended)


» Ritodrine    (concurrent use may cause pulmonary edema in the pregnant woman; maternal death has been reported; both medications should be discontinued at the first sign of pulmonary edema)


Salicylates {48}8 {48}7 {48}6 {48}5 {48}4 {48}3 {48}2 {48}1 {48}0 {62}9 {62}8 {62}7 {62}6 {62}5 {62}4    (although concurrent use with glucocorticoids in the treatment of arthritis may provide additive therapeutic benefit and permit glucocorticoid dosage reduction, glucocorticoids may increase salicylate excretion and reduce salicylate plasma concentrations so that the salicylate dosage requirement may be increased; {62}3 {62}2 {62}1 {62}0 {62}9 salicylism may occur when glucocorticoid dosage is subsequently decreased or discontinued, especially in patients receiving large [antirheumatic] doses of salicylates; {62}8 {62}7 {62}6 {62}5 {62}4 also, the risk of gastrointestinal ulceration or hemorrhage may be increased during concurrent use)

    (caution is recommended when salicylates are used concurrently with corticosteroids in patients with hypoprothrombinemia {62}3 {62}2 {62}1 {62}0 {48}9 {48}8 {48}7 {48}6 {48}5 {48}4 {48}3)


» Sodium-containing medications or foods    (concurrent use with pharmacologic doses of glucocorticoids may result in edema and increased blood pressure, possibly to hypertensive levels)

    (although patients receiving replacement doses of glucocorticoids may require sodium supplementation, adjustment of dietary sodium intake may be required when a medication having a high sodium content is administered concurrently )


» Somatrem {48}2 or
» Somatropin    (inhibition of the growth response to somatrem {48}1 or somatropin may occur with chronic therapeutic use of daily doses [per square meter of body surface area] in excess of:

    Oral
Parenteral
  Betamethasone
300–450 mcg
150–225 mcg
  Cortisone
12.5–18.8 mg
6.25–9.4 mg
  Dexamethasone
375–563 mcg
187.5–281.5 mcg
  Hydrocortisone
10–15 mg
5–7.5 mg
  Methylprednisolone
2–3 mg
1–1.5 mg
  Prednisolone
2.5–3.75 mg
1.25–1.88 mg
  Prednisone
2.5–3.75 mg
 
  Triamcinolone
2–3 mg
1–1.5 mg
(It is recommended that these doses not be exceeded during somatrem or somatropin therapy; if larger doses are required, administration of somatrem or somatropin should be postponed)


Streptozocin    (concurrent use with glucocorticoids may increase the risk of hyperglycemia )


Troleandomycin {48}0 {62}9 {62}8 {62}7    (troleandomycin may decrease metabolism of methylprednisolone and possibly other glucocorticoids, leading to increased plasma concentration, elimination half-life, and therapeutic and toxic effects; {62}6 {62}5 {62}4 {62}3 glucocorticoid dosage adjustment may be required during and following concurrent use {62}2 {62}1 {62}0 {85}9)


» Vaccines, live virus, or other immunizations {85}8 {85}7 {85}6 {85}5 {85}4 {85}3 {85}2 {85}1 {85}0 {86}9 {86}8 {86}7 {86}6 {86}5 {86}4    (administration of live virus vaccines to patients receiving pharmacologic [immunosuppressant] doses of glucocorticoids may potentiate replication of the vaccine virus, thereby increasing the risk of the patient's developing the viral disease, and/or decreasing the patient's antibody response to the vaccine and is not recommended; {86}3 {86}2 the patient's immunologic status should be evaluated prior to administration of a live virus vaccine; also, immunization with oral poliovirus vaccine should be postponed in persons in close contact with the patient, especially family members)

    (other immunizations are not recommended in patients receiving pharmacologic [immunosuppressant] doses of glucocorticoids because of the increased risk of neurological complications and the possibility of decreased or absent antibody response {86}1 {86}0 {85}9 {85}8 {85}7 {85}6)

    (immunizations may be administered to patients receiving glucocorticoids via routes or in quantities that are not likely to cause immunosuppression, for example, those receiving local injections, short-term [less than 2 weeks] therapy, or physiologic doses {85}5 {85}4 {85}3 {85}2 {85}1)



Laboratory value alterations
The following have been selected on the basis of their potential clinical significance (possible effect in parentheses where appropriate)—not necessarily inclusive (» = major clinical significance):



With results of dexamethasone suppression tests

Due to other medications
Alcohol (chronic abuse) or
Glutethimide or
Meprobamate or
Methaqualone or
Methyprylon    (may cause false-positive results in test for endogenous depression)


Benzodiazepines (high doses) or
Cyproheptadine (high doses) or
Glucocorticoid therapy, long-term or
Indomethacin {85}0 {47}9    (may cause false-negative results in test for endogenous depression {47}8 {47}7)


Ephedrine {47}6 {47}5 or
Estrogens (high doses) or
Hepatic enzyme–inducing agents {47}4 {47}3 (see Appendix II)    (may cause false-positive results in tests for Cushing's disease or endogenous depression)


Due to medical problems or conditions
Adrenal hyperfunction (Cushing's disease) or
Anorexia nervosa or malnutrition leading to extreme weight loss, recent or
Carcinoma, disseminated, with concurrent serious infection or
Cardiac failure or
Dehydration or
Diabetes mellitus, unstable or
Fever or
Hypertension or
Pregnancy or
Renal failure or
Temporal lobe disease    (may cause false-positive results in test for endogenous depression)


Adrenal insufficiency or
Hypopituitarism    (may cause false-negative results in test for endogenous depression)


Psychiatric disorders such as acute psychosis, mania, chronic schizophrenia, and primary degenerative dementia    (may interfere with results of test for endogenous depression)

With other diagnostic test results
Brain imaging using sodium pertechnetate Tc 99m, technetium Tc 99m gluceptate, or technetium Tc 99m pentetate    (uptake of these diagnostic aids into cerebral tumors may be decreased in patients receiving large doses of glucocorticoids because of glucocorticoid-induced reduction of peritumor edema)


Gonadorelin test for hypothalamic-pituitary-gonadal axis function     (glucocorticoids may alter the results of the gonadorelin test by affecting pituitary secretion of gonadotropins through a complicated feedback mechanism )


Nitroblue-tetrazolium test {47}2 {47}1 {47}0 {85}9 {85}8 {85}7    (false-negative test results may occur {85}6 {85}5 {85}4 {85}3 {85}2 {85}1)


Protirelin test for thyroid function    (physiologic doses of corticosteroids have no effect, but pharmacologic doses may reduce the thyroid-stimulating hormone [TSH] response to protirelin; however, withdrawal of corticosteroids in patients with known hypopituitarism is generally not recommended)


Skeletal imaging using technetium Tc 99m medronate, technetium Tc 99m oxidronate, or technetium Tc 99m pyrophosphate    (long-term use of glucocorticoids may induce bone calcium depletion, thus causing decreased bone uptake of these diagnostic aids)


Skin tests, {85}0 {47}9 {47}8 {47}7 {47}6 {47}5 {47}4 {47}3 {47}2 {47}1 {47}0 {48}9 {48}8 {48}7 {48}6 including tuberculin and histoplasmin skin tests and patch tests for allergy    (reactions may be suppressed, {48}5 {48}4 {48}3 {48}2 {48}1 {48}0 {57}9 {57}8 {57}7 {57}6 {57}5 {57}4 {57}3 {57}2 {57}1 especially with daily administration of large doses of corticosteroids )


Thyroid 123I or 131I uptake {57}0    (may be decreased {49}9)

With physiology/laboratory test values
Calcium, serum {49}8 {49}7 {49}6 {49}5 {49}4 {49}3 {49}2 {49}1 {49}0 {49}9 {49}8 {49}7 {49}6    (concentrations may be decreased {49}5 {49}4 {49}3 {49}2 {49}1 {49}0 {49}9 {49}8 {49}7 {49}6 {49}5 {49}4 {49}3)


Glucose, blood and urine    (concentrations may be increased because of intrinsic hyperglycemic activity )


» Hypothalamic-pituitary-adrenal (HPA) axis function as assessed by:
Adrenocorticotropic hormone (ACTH, corticotropin) or
Cortisol, blood or
Cortisol, urine or
17-Hydroxycorticosteroids, urine (17-OHCS) or
17-Ketosteroids, total, urine (17-KS)    (may be decreased with pharmacologic doses of glucocorticoids, especially in children)


Lipid profile    (concentrations may be increased)


Platelet count    (may be increased or decreased)


Polymorphonuclear leukocyte count    (may be increased)


Potassium, serum {49}2 {49}1 {49}0 {49}9 {49}8 {49}7 {49}6 {49}5 {49}4 {49}3 {49}2 {49}1 {49}0 {49}9 {49}8    (concentrations may be decreased because of increased potassium excretion, {49}7 {49}6 {49}5 {49}4 {49}3 {49}2 {49}1 {49}0 {49}9 {49}8 {49}7 {49}6 {49}5 {49}4 {49}3 especially with agents having significant mineralocorticoid activity)


Sodium, blood {49}2 {49}1 {49}0 {49}9 {49}8 {49}7 {49}6 {49}5 {49}4 {49}3 {49}2 {49}1 {49}0 {49}9 {49}8    (concentrations may be increased because of sodium retention, {49}7 {49}6 {49}5 {49}4 {49}3 {49}2 {49}1 {49}0 {49}9 {49}8 {49}7 {49}6 {49}5 {49}4 {49}3 especially with glucocorticoids having significant mineralocorticoid activity)


Uric acid, serum    (concentrations may be increased in patients with acute leukemia but may be decreased in other patients because of weak uricosuric effect)


White blood count    (may be decreased)


Medical considerations/Contraindications
The medical considerations/contraindications included have been selected on the basis of their potential clinical significance (reasons given in parentheses where appropriate)— not necessarily inclusive (» = major clinical significance).

See also Laboratory value alterations.

Note: The medical problems listed below apply only to pharmacologic (supraphysiologic) doses of glucocorticoids, unless otherwise stated.


Except under special circumstances, these medications should not be used when the following medical problems exist:

For intra-articular injection:
» Arthroplasty of joint, prior    (increased risk of infection)


» Blood clotting disorders    (risk of intra- and extra-articular hemorrhage)


» Fracture, intra-articular    (healing may be retarded)


» Infection, periarticular, current {49}2 {49}1 or history of {49}0    (may be exacerbated or reactivated)


» Osteoporosis, juxta-articular, non-arthritic    (may be exacerbated)


» Unstable joint {49}9 {49}8 {49}7
For neonatal respiratory distress syndrome prophylaxis:
» Amnionitis
» Bleeding, uterine
» Febrile illness or infection, especially tuberculosis, maternal or
» Herpes simplex type 2 infection, active, maternal or
» Keratitis, viral, maternal    (may be exacerbated; if corticosteroid administration is essential, appropriate antimicrobial therapy must be administered concurrently)


» Placental insufficiency
» Premature membrane rupture    (increased risk of maternal infection; the glucocorticoid should be administered immediately if this occurs, since the risk of infection increases with time )


Risk-benefit should be considered when the following medical problems exist

For all indications:
» Acquired immunodeficiency syndrome (AIDS) or {49}6
» Human immunodeficiency virus (HIV) infection {49}5 {49}4    (although pharmacologic doses of corticosteroids can be effective in the treatment of certain HIV-related diseases, careful medical evaluation of the risks and benefits of this therapy must be done, due to the possible increased risk of severe uncontrollable infections and/or neoplasms; {49}3 {49}2 {49}1 in one study in patients given tapering doses of intravenous methylprednisolone starting with 60 mg every 6 hours for 8 days as an adjunct to antipneumocystis therapy, an increase in frequency or severity of life-threatening opportunistic infections was observed; {49}0 {49}9 {49}8 in a study of similar patients given tapering doses of prednisone starting at 40 mg two times a day for 21 days, no increase in the incidence of Kaposi's sarcoma or life-threatening opportunistic infections was observed, though the incidence of oral candidiasis and mucocutaneous herpes simplex infection did increase {49}7 {49}6 {49}5)


» Anastomoses, intestinal, recent {49}4 {49}3 {49}2 {49}1 {49}0 {49}9 {49}8 {49}7 {49}6 {49}5 {49}4 {49}3 {49}2 {49}1 {49}0 {49}9    (corticosteroids should be used with caution {49}8 {49}7 {49}6 {49}5 {49}4 {49}3 {49}2 {49}1 {49}0 {49}9 {49}8 {49}7 {49}6 {49}5 {49}4 {49}3)


» Cardiac disease {49}2 {49}1 or
» Congestive heart failure {49}0 {49}9 or
Hypertension {49}8 {49}7 {49}6 {49}5 {49}4 {49}3 {49}2 {49}1 {49}0 {49}9 {49}8 {49}7 {49}6 {49}5 {49}4 {49}3 or
» Renal function impairment or disease, severe    (edema may be hazardous, especially with agents having significant mineralocorticoid activity)

    (patients undergoing dialysis may have increased risk of avascular necrosis with long-term corticosteroid use)


» Chickenpox, existing or recent (including recent exposure) {49}2 {49}1 {49}0 {49}9 {49}8 {49}7 {49}6 {49}5 {49}4 {49}3 {49}2 {49}1 {49}0 or
» Measles, existing or recent (including recent exposure) {49}9 {49}8 {49}7 {49}6 {49}5 {49}4 {49}3 {49}2 {49}1 {49}0 {62}9 {62}8    (risk of severe, potentially fatal, generalized disease; {62}7 {62}6 {62}5 {62}4 {62}3 {62}2 {62}1 {62}0 {62}9 {62}8 extra care to avoid exposure to these infections is recommended; {62}7 {62}6 {62}5 {62}4 {62}3 {62}2 {62}1 {62}0 {62}9 prophylactic therapy with varicella zoster immune globulin [VZIG] or immune globulin intravenous [IGIV] or intramuscular [IGIM], as appropriate, may be indicated in exposed patients; {62}8 {62}7 {62}6 {62}5 {62}4 {62}3 {62}2 {62}1 {62}0 {62}9 {62}8 {62}7 {62}6 therapy with an antiviral agent may be indicated if chickenpox develops {62}5 {62}4 {62}3 {62}2 {62}1 {62}0 {62}9 {62}8 {62}7 {62}6 {62}5 {62}4)


Colitis, ulcerative, nonspecific, with possibility of impending perforation, abscess, or other infection {62}3 {62}2 {62}1 {62}0 {49}9 {49}8 {49}7 {49}6 {49}5 {49}4 {49}3 {49}2 {49}1 {49}0 {49}9 {49}8 or
Diverticulitis {49}7 {49}6 {49}5 {49}4 {49}3 {49}2 {49}1 {49}0 {15}9 {15}8 {15}7 {15}6 {15}5 {15}4 {15}3 {15}2 or
» Esophagitis, gastritis, or peptic ulcer, active or latent {15}1 {15}0 {50}9 {50}8 {50}7 {50}6 {50}5 {50}4 {50}3 {50}2 {50}1 {50}0 {51}9 {51}8 {51}7 {51}6    (symptoms of progression or reactivation may be masked; {51}5 {51}4 {51}3 {51}2 hemorrhage and/or perforation may occur without warning {51}1 {51}0 {51}9 {51}8)


» Diabetes mellitus or predisposition to {51}7 {51}6 {51}5 {51}4 {51}3 {51}2    (may be exacerbated or activated {51}1 {51}0 {50}9 {50}8 {50}7)


» Fungal infections, systemic {50}6 {50}5 {50}4 {50}3 {50}2 {50}1 {50}0 {51}9 {51}8 {51}7 {51}6 {51}5    (may be exacerbated; pharmacologic doses of corticosteroids should not be given unless the patient is concurrently receiving an antifungal agent)


Glaucoma, {51}4 {51}3 {51}2 {51}1 {51}0 open-angle    (intraocular pressure may be increased {51}9 {51}8 {51}7 {51}6 {51}5)


Hepatic function impairment or disease {51}4    (increased risk of glucocorticoid toxicity, especially if hypoalbuminemia is present; possibility of impaired conversion of cortisone or prednisone to their active metabolites, although this effect may be offset by decreased protein binding or clearance and/or conversion in other tissues)


» Herpes simplex, ocular {51}3 {51}2 {51}1 {51}0 {51}9 {51}8 {51}7 {51}6 {51}5 {51}4 {51}3 {51}2 {51}1 {51}0 {51}9    (possible corneal perforation {51}8 {51}7 {51}6 {51}5 {51}4 {51}3 {51}2 {51}1 {51}0 {23}9 {23}8 {23}7 {23}6 {23}5 {23}4)


Herpetic lesions, oral
Hyperlipidemia    (concentrations of fatty acids or cholesterol may be increased)


Hypersensitivity to corticosteroids {23}3 {23}2 {23}1 {23}0 {62}9
Hyperthyroidism {62}8    (glucocorticoid effect may be impaired because of accelerated metabolism; this may be especially important with physiologic doses or low pharmacologic doses)


Hypoalbuminemia or conditions predisposing to, including hepatic cirrhosis {62}7 {62}6 {62}5 {62}4 {62}3 {62}2 {62}1 {62}0 {62}9 {62}8 {62}7 {62}6 {62}5 {62}4 {62}3 {62}2 or nephrotic syndrome    (increased risk of toxicity because reduced availability of albumin for glucocorticoid binding leads to increased serum concentration of unbound drug; reduction in initial dosage is recommended)


Hypothyroidism {62}1 {62}0 {62}9 {62}8 {62}7 {62}6 {62}5 {62}4 {62}3 {62}2 {62}1 {62}0 {62}9 {62}8 {62}7 {62}6    (decreased metabolism of corticosteroid may result)


Infections, viral or bacterial, uncontrolled, local or systemic {62}5 {62}4 {62}3 {62}2 {62}1 {62}0 {62}9 {62}8 {62}7 {62}6 {62}5 {62}4 {62}3     (symptoms of infection may be masked; new infection may develop; resistance and ability to localize infection may be decreased; if infection occurs during therapy, appropriate antimicrobial therapy should be instituted {62}2 {62}1 {62}0 {62}9 {62}8 {62}7 {62}6 {62}5 {62}4 {62}3 {62}2 {62}1 {62}0 {62}9 {62}8)


» Myasthenia gravis {62}7 {62}6 {62}5 {62}4 {62}3 {62}2 {62}1 {62}0 {62}9 {62}8 {62}7 {62}6 {62}5 {62}4 {62}3 {62}2    (muscle weakness may be increased initially, possibly leading to respiratory distress; {62}1 {62}0 the patient should be hospitalized, and respiratory support should be immediately available, when glucocorticoid therapy is initiated)


» Myocardial infarction, recent {50}9 {50}8 {50}7 {50}6 {50}5    (possible risk of left ventricular free wall rupture; extreme caution is recommended {50}4 {50}3 {50}2 {50}1 {50}0)


Osteoporosis {51}9 {51}8 {51}7 {51}6 {51}5 {51}4 {51}3 {51}2 {51}1 {51}0 {22}9 {22}8 {22}7 {22}6 {22}5    (may be exacerbated {22}4 {22}3)


» Psychosis, acute {22}2 {22}1 {22}0 {22}9 {22}8 {22}7 {22}6 {22}5 {22}4 {22}3 {22}2 {22}1 {22}0 {50}9    (may be aggravated {50}8 {50}7 {50}6 {50}5 {50}4 {50}3 {50}2 {50}1 {50}0 {51}9 {51}8 {51}7 {51}6)


Renal function impairment, {51}5 {51}4 {51}3 mild to moderate, or stones    (fluid retention may exacerbate these conditions; increased risk of edema, especially with agents having mineralocorticoid activity)

    (patients receiving dialysis may have increased risk of avascular necrosis with long-term corticosteroid use)


» Strongyloides infestation, confirmed or suspected {51}2 {51}1 {51}0 {15}9 {15}8 {15}7 {15}6 {15}5    (corticosteroid-induced immunosuppression may lead to hyperinfection and dissemination with widespread larval migration, often accompanied by severe enterocolitis and potentially fatal gram-negative septicemia {15}4 {15}3 {15}2 {15}1 {15}0 {50}9 {50}8)


Systemic lupus erythematosus (SLE)    (cautious use is recommended because of an increased risk of aseptic necrosis )


» Tuberculosis, active, {50}7 {50}6 {50}5 {50}4 {50}3 {50}2 {50}1 {50}0 {51}9 {51}8 {51}7 positive skin test, latent, or history of {51}6 {51}5 {51}4 {51}3 {51}2 {51}1    (may be exacerbated or reactivated; appropriate antitubercular chemotherapy or prophylaxis should be administered concurrently {51}0 {50}9 {50}8 {50}7 {50}6 {50}5 {50}4 {50}3 {50}2 {50}1 {50}0 {51}9 {51}8 {51}7 {51}6)



Patient monitoring
The following may be especially important in patient monitoring (other tests may be warranted in some patients, depending on condition; » = major clinical significance):

Adrenal function assessment, {51}5 may include adrenocorticotropic hormone (ACTH) stimulation test, blood or urine cortisol concentrations, urine 17-hydroxycorticosteroids concentration, or urine 17-ketosteroids concentration    (may be required during, and following withdrawal of high-dose or long-term [more than 3 weeks] therapy to assess adrenal function; complete recovery of adrenal function may require up to 1 year following prolonged use, especially with high doses; in some patients receiving prolonged, high-dose therapy, complete recovery may never occur)


Electrolytes, serum and
Occult blood, stool    (may be required during long-term therapy)


Glucose concentrations, blood or urine {51}4 {51}3 {51}2 {51}1 or
Glucose tolerance test    (may be required for patients with diabetes mellitus or a predisposition to diabetes mellitus {51}0)


Growth and development determinations {50}9 {50}8 {50}7 {50}6 {50}5 {50}4 {50}3 {50}2 {50}1 {50}0 {51}9 {51}8    (recommended in children and adolescents receiving prolonged therapy {51}7 {51}6 {51}5 {51}4 {51}3 {51}2 {51}1 {51}0 {15}9 {15}8 {15}7 {15}6)


Ophthalmologic examinations    (may be required at periodic intervals for adults or children receiving therapy for more than 6 weeks to detect the presence of cataracts, glaucoma, increased intraocular pressure, or ocular infections)


Prothrombin time (PT) {15}5 {15}4 {15}3 {15}2 {15}1    (frequent monitoring recommended in patients receiving coumarin anticoagulants concurrently {15}0 {52}9 {52}8 {52}7 {52}6)




Side/Adverse Effects

Note: The risk of adverse effects with pharmacologic doses of corticosteroids generally increases with the duration of therapy and frequency of administration and, to a lesser extent, with dosage.
Chronic administration of physiologic replacement doses of corticosteroids rarely causes adverse effects.
Administration of glucocorticoids via local injection reduces the risk of systemic effects. The risk of both systemic and local adverse effects is still present to a degree, however, and increases with the frequency of injections.
Pharmacologic doses of glucocorticoids lower resistance to infection; the patient may be predisposed to systemic infections during, and for a time following, therapy. Increased susceptibility to infection may occur with short-term high-dose use (“pulse” therapy) as well as with more prolonged use. Also, symptoms of onset or progression of infections may be masked.

The following side/adverse effects have been selected on the basis of their potential clinical significance (possible signs and symptoms in parentheses where appropriate)—not necessarily inclusive:

Those indicating need for medical attention
Incidence less frequent
    
Diabetes mellitus (decreased or blurred vision; frequent urination; increased thirst){52}5{52}4{52}3{52}2{52}1{52}0{62}9{62}8{62}7{62}6{62}5{62}4{62}3{62}2{62}1

Incidence rare
    
Burning, numbness, pain, or tingling at or near injection site {62}0{62}9
    
congestive heart failure —in susceptible individuals{62}8{62}7{62}6{62}5{62}4{62}3{62}2{62}1{62}0
    
generalized allergic reaction (skin rash or hives){53}9{53}8{53}7{53}6{53}5{53}4{53}3{53}2
    
local allergic reaction or infection at injection site (redness, swelling, pain, or other signs of infection or allergic reaction)
    
psychic disturbances such as delirium (confusion; excitement; restlessness), disorientation
euphoria (false sense of well-being), hallucinations (seeing, hearing, or feeling things that are not there), manic-depressive episodes ( sudden, wide mood swings), mental depression, or paranoia ( mistaken feelings of self-importance or being mistreated){53}1{53}0{62}9{62}8{62}7{62}6{62}5{62}4{62}3{62}2{62}1{62}0{62}9{62}8
    
sudden blindness {62}7{62}6{62}5{62}4{62}3{62}2{62}1{62}0

Note: Psychic disturbances are more likely to occur in patients with chronic debilitating illnesses that predispose them to psychic disturbances and in patients receiving higher daily dosages. Psychic disturbances may be related to dose rather than duration of therapy; symptoms may appear within a few days to 2 weeks after initiation of therapy and usually are associated with doses equivalent to 40 mg or more of prednisone per day. Additionally, euphoria or fear of relapse may lead to psychological dependence or abuse of corticosteroids.
Sudden blindness following injection into sites in the head or neck area, {62}9 {62}8 {62}7 {62}6 {62}5 {62}4 such as nasal turbinates or scalp, is due to possible entry of drug crystals into ocular blood vessels.


With intravenous administration
    
Anaphylaxis, generalized (hives; shortness of breath ; swelling of face, nasal membranes, and eyelids; tightness in chest; troubled breathing; wheezing){62}3{62}2{62}1{62}0{62}9{62}8{62}7
    
cardiac arrythmias {62}6{62}5
    
flushing of face or cheeks
    
seizures {62}4{62}3{62}2{62}1{62}0{62}9{62}8{62}7{62}6{62}5

Note: Rapid intravenous administration of high doses of corticosteroids has been reported to cause angioedema and/or anaphylactic reactions, seizures, and sudden death associated with cardiac arrhythmias. {62}4 Monitoring of the electrocardiogram (ECG) is recommended. Equipment, medications, and trained personnel necessary for treating these complications should be immediately available.




Those occurring principally during long-term use indicating need for medical attention
    
Acne {62}3
    
adrenal suppression {62}2{62}1{62}0{62}9{62}8{62}7{62}6{62}5{62}4{62}3{62}2{62}1{62}0
    
avascular necrosis (hip or shoulder pain)
    
cataracts, posterior subcapsular (gradual blurring or loss of vision){52}9{52}8{52}7{52}6{52}5{52}4{52}3{52}2{52}1{52}0{53}9{53}8{53}7{53}6{53}5
    
Cushing's syndrome effects including filling or rounding out of the face
hirsutism (unusual increase in hair growth), hypertension
menstrual irregularities
muscle weakness
or striae (reddish purple lines on arms, face, legs, trunk, or groin){53}4{53}3{53}2{53}1{53}0{52}9{52}8{52}7{52}6{52}5{52}4{52}3{52}2{52}1{52}0{53}9
    
cutaneous or subcutaneous tissue atrophy (thin, shiny skin; pitting or depression of skin at injection site)—with frequent repository injections{53}8{53}7{53}6{53}5{53}4{53}3{53}2{53}1
    
ecchymosis (unusual bruising){53}0{52}9{52}8{52}7{52}6{52}5{52}4{52}3{52}2{52}1{52}0{53}9{53}8{53}7
    
fluid and sodium retention (rapid weight gain; swelling of feet or lower legs){53}6{53}5{53}4{53}3{53}2{53}1{53}0{15}9{15}8{15}7{15}6{15}5{15}4{15}3{15}2
    
glaucoma with possible damage to optic nerves (blurred vision or other change in vision; eye pain){15}1{15}0{54}9{54}8{54}7{54}6{54}5{54}4{54}3{54}2{54}1{54}0{24}9{24}8{24}7
    
growth suppression —in children{24}6{24}5{24}4{24}3{24}2{24}1{24}0{54}9{54}8{54}7{54}6{54}5{54}4{54}3{54}2
    
hypokalemic syndrome (irregular heartbeat; muscle cramps or pain; unusual tiredness or weakness){54}1{54}0{24}9{24}8{24}7{24}6{24}5{24}4{24}3{24}2{24}1{24}0{24}9{24}8
    
impaired wound healing {24}7{24}6{24}5{24}4{24}3{24}2{24}1{24}0{54}9{54}8{54}7{54}6{54}5{54}4{54}3
    
increased intracranial pressure (headache; insomnia; papilledema; unusual tiredness or weakness){54}2{54}1{54}0{54}9{54}8{54}7{54}6{54}5{54}4{54}3{54}2{54}1{54}0{50}{58}
    
ocular infection, secondary, fungal or viral (blurred vision or other change in vision; eye pain ; redness of eyes; sensitivity of eyes to light; tearing){04}{06}{10}{18}{20}{21}{30}{33}{36}{42}{46}{47}{50}{58}
    
osteoporosis or bone fractures ( pain in back, ribs, arms, or legs)—includes vertebral compression and long bone pathologic fractures {03}{04}{06}{10}{18}{20}{21}{30}{33}{36}{42}{46}{47}{50}{58}
    
pancreatitis (continuing abdominal or stomach pain or burning; nausea; vomiting ){03}{04}{06}{10}{18}{21}{30}{33}{36}{42}{46}{47}{50}{58}
    
peptic ulceration or intestinal perforation (bloody or black, tarry stools; continuing abdominal or stomach pain or burning){03}{04}{06}{10}{18}{20}{21}{29}{30}{33}{36}{42}{46}{47}{50}{58}
    
scarring at injection site
    
steroid myopathy (muscle weakness ){03}{06}{10}{18}{20}{21}{30}{33}{36}{42}{46}{47}{50}{58}
    
tendon rupture {06}{10}{18}{33}{36}{42}{47}
    
thin, fragile skin {03}{04}{06}{10}{18}{20}{21}{30}{33}{36}{42}{46}{47}{50}{58}


Those indicating need for medical attention only if they continue or are bothersome
Incidence more frequent
    
Gastrointestinal irritation (nausea; vomiting){06}{10}{18}{30}{33}
    
increased appetite {04}{06}{10}{30}{33}
    
indigestion {29}
    
nervousness or restlessness
    
trouble in sleeping {50}
    
weight gain {10}

For triamcinolone
    
Loss of appetite

Incidence less frequent or rare
    
Changes in skin color or hypopigmentation (darkening or lightening of skin color){04}{09}{10}{18}{30}{33}{50}
    
dizziness or lightheadedness
    
flushing of face or cheeks {20}{46}{47}{50}
    
headache {03}{04}{06}{10}{18}{20}{21}{30}{33}{36}{46}{47}{50}{58}
    
hiccups {06}{09}{33}
    
increased joint pain —following intra-articular injection
    
increased sweating {01}{03}{04}{05}{06}{07}{08}{09}{10}{11}{12}{16}{18}{19}{20}{21}{30}{33}{36}{42}{46}{47}{50}{58}
    
nosebleeds —following intranasal injection
    
vertigo (dizziness; sensation of spinning ){04}{06}{10}{18}{20}{21}{30}{33}{36}{46}{47}{50}{58}

Note: Hypopigmentation is more likely at the injection site.
Flushing of face or cheeks may persist for 24 to 48 hours.
Increased joint pain may occur within a few hours postinjection and persist for up to 48 hours.




Those occurring principally after medication is discontinued, indicating a corticosteroid withdrawal syndrome and the need for medical attention
    
Withdrawal syndrome (abdominal or back pain; dizziness ; fainting; frequent or continuing unexplained headaches; low-grade fever {04} {06} {10} {20} {30} {33}; muscle or joint pain {04} {06} {10} {20} {30} {33}; nausea; prolonged loss of appetite; rapid weight loss; reappearance of disease symptoms; shortness of breath; unusual tiredness or weakness {04} {06} {10} {20} {30} {33}; vomiting)

Note: Too-rapid withdrawal of therapy, especially after prolonged use, may cause acute, possibly life-threatening, adrenal insufficiency and/or a withdrawal syndrome not related to hypothalamic-pituitary-adrenal (HPA) axis suppression.





Patient Consultation
As an aid to patient consultation, refer to Advice for the Patient, Corticosteroids—Glucocorticoid Effects (Systemic) .

In providing consultation, consider emphasizing the following selected information (» = major clinical significance):

Before using this medication
»   Conditions affecting use, especially:
Hypersensitivity to corticosteroids

Pregnancy—Pharmacologic doses in animals show some evidence of increased risk of placental insufficiency, decreased birthweight, or stillbirths; other animal studies show increased incidence of cleft palate, placental insufficiency, spontaneous abortions, and intrauterine growth retardation





Breast-feeding—Breast-feeding is not recommended during use of higher pharmacologic doses





Use in children—Infants born to women who received corticosteroids during pregnancy should be monitored for signs of hypoadrenalism; close monitoring also is required during chronic therapy because suppression of growth and development may result; possible increased severity of chickenpox or measles in children receiving immunosuppressant doses; increased risk for developing osteoporosis, avascular necrosis of the femoral heads, glaucoma, or cataracts during prolonged therapy






Use in the elderly—Increased risk for developing osteoporosis (especially in postmenopausal females) or hypertension
Other medications, especially aminoglutethimide; amphotericin B, parenteral; antacids; antidiabetic agents, oral; cyclosporine; digitalis glycosides; diuretics; hepatic enzyme–inducing agents; insulin; mitotane; potassium supplements; ritodrine; sodium-containing medications; somatrem; somatropin; or vaccines, live virus, or other immunizations
Other medical problems, especially

• For all uses—Acquired immunodeficiency syndrome (AIDS); anastomoses, intestinal, recent; cardiac disease; chickenpox; congestive heart failure; diabetes mellitus; esophagitis, gastritis, or peptic ulcer; fungal infections, systemic; herpes simplex, ocular; human immunodeficiency virus (HIV) infection; measles; myasthenia gravis; myocardial infarction, recent; psychosis, acute; renal function impairment or disease; Strongyloides infestation; or tuberculosis


• For intra-articular injection only—Arthroplasty of joint, blood clotting disorders, intra-articular fracture, osteoporosis, periarticular infection, or unstable joint


• For neonatal respiratory distress syndrome prophylaxis only—Amnionitis, febrile illness or infection, herpes simplex type 2 infection, maternal viral keratitis, placental insufficiency, premature membrane rupture, or uterine bleeding


Proper use of this medication

For oral dosage forms
» Taking with food to minimize gastrointestinal irritation

Possibility that alcohol may enhance ulcerogenic effects of medication

For budesonide capsules (micronized)
Swallowing capsules whole without breaking, crushing, or chewing {29}
» Importance of not using more medication than the amount prescribed

» Proper dosing
Missed dose: If dosing schedule is—

• Every other day: Taking as soon as possible if remembered same morning; if remembered later, not taking until next morning, then skipping a day


• Once a day: Taking as soon as possible; not taking if almost time for next dose; not doubling doses


• Several times a day: Taking as soon as possible; doubling if time for next dose


» Proper storage

Precautions while using this medication
» Regular visits to physician to check progress during and following therapy

» Checking with physician before discontinuing medication; gradual dosage reduction may be necessary

Checking with physician if symptoms recur or worsen when dose decreased or therapy discontinued

For patients on long-term therapy
» Possible need for sodium restriction or potassium supplementation

Possible need for calorie restriction

Possible need for increased protein intake

Possible need for ophthalmologic examinations

Carrying medical identification card indicating use of corticosteroids
» Caution in receiving skin tests

» Caution if any kind of surgery or emergency treatment is required

» Caution if serious infections or injuries occur

» Avoiding exposure to chickenpox or measles (especially for children); telling physician right away if exposure occurs

» Caution in receiving vaccinations or other immunizations or coming in contact with persons receiving oral poliovirus vaccine

For patients with diabetes: May increase blood glucose concentrations

For parenteral dosage forms
Restricting use of joint following intra-articular injection

Checking with physician if redness or swelling occurs and continues or becomes worse following local injection


Side/adverse effects
Signs of potential side effects, especially diabetes mellitus; burning, numbness, pain, or tingling at or near injection site; congestive heart failure (in susceptible individuals); generalized allergic reaction; local allergic reaction or infection at injection site; psychic disturbances; sudden blindness; anaphylaxis, generalized; cardiac arrythmias; flushing of face or cheeks; seizures; acne; adrenal suppression; avascular necrosis; cataracts, posterior subcapsular; Cushing's syndrome effects; cutaneous or subcutaneous tissue atrophy; ecchymosis; fluid and sodium retention; glaucoma with possible damage to optic nerves; growth suppression (in children); hypokalemic syndrome; impaired wound healing; increased intracranial pressure; ocular infection, secondary, fungal or viral; osteoporosis or bone fractures; pancreatitis; peptic ulceration or intestinal perforation; scarring at injection site; steroid myopathy; tendon rupture; and thin, fragile skin


General Dosing Information

Table 3. General Dosing Information *



Drug
Parenteral Routes of Administration

Systemic

Local

IM
IV
SC
IA
IB
IL
IS
ST
[IT] 1
Betamethasone
Sodium phosphate


 
 
 
 
Sodium phosphate/Acetate

   
 


 
Cortisone Acetate

               
Dexamethasone
Acetate

   
 
 
 
Sodium phosphate


 
 


 
Hydrocortisone
Sterile suspension

               
Acetate
     




 
Sodium phosphate



           
Sodium succinate


             
Methylprednisolone
Acetate

   
 


 
Sodium succinate


             
Prednisolone
Acetate

               
Acetate/Sodium phosphate

   

 

 
Sodium phosphate


 
 
 
 
Tebutate
     
 
 
[]1
Triamcinolone
Acetonide

   


    []1
Diacetate

   
 


[]1
Hexacetonide
     
 
    [] 1
* Bracketed information refers to routes of administration that are not included in U.S. product labeling.
 Abbreviations: Systemic—IM = intramuscular; IV = intravenous; SC = subcutaneous. Local—IA = intra-articular; IB = intrabursal; IL = intralesional; IS = intrasynovial; ST = soft tissue; IT = intraturbinal.
1 Not included in Canadian product labeling.
For replacement therapy in chronic adrenocortical insufficiency states, corticosteroid therapy must be continued for the life of the patient. It is recommended that dosage of cortisone or hydrocortisone be timed to simulate endogenous corticosteroid secretion, with two thirds of the daily dose administered in the morning and one third in the evening. Other corticosteroids usually are given once a day.

For treatment of congenital adrenal hyperplasia, suppression of corticotropin secretion is required to decrease hypersecretion of adrenal androgens. This usually is achieved by administering one third of the daily dose of cortisone or hydrocortisone in the morning and two thirds in the evening or giving one third of the daily dose three times a day at evenly spaced intervals. Other corticosteroids usually are given once a day.

Except in severe conditions or emergency situations, it is recommended that therapy be instituted with low doses that are increased as necessary to provide the desired effect. {03} {04} {06} {11} {12} {20} {21} {30} {46} {47} For most conditions, administration in the lowest effective dose for the shortest time possible is recommended. Dosage requirements are variable and should be individualized according to the disease being treated and patient response {06} {07} {08} {09} {10} {11} {12} {19} {20} {21} {25} {27} {28} {30} {31} {33} {34} {36} {40} {41} {42} {44} {46} {47} {48} {50} {51} {59} rather than by age or body weight. Whenever possible, local administration is recommended in order to concentrate the medication at the affected site and reduce the risk of systemic effects. After a favorable response is obtained, the dosage should be decreased gradually to the lowest dose that will maintain an adequate clinical response. {03} {04} {11} {25} {28} {36} {40} {41} {42} {44} {46} {47} {48} {51} {58}

Frequent monitoring of drug effect is required. {19} {20} {46} {40} {44} {47} {48} {51} Situations that may necessitate dosage adjustments include remissions or exacerbations of the disease process and the patient's response to the medication. {20} {25} {44} {47} {48} {51}

Clinically significant hypothalamic-pituitary-adrenal (HPA) axis suppression leading to adrenal insufficiency may occur more readily with multiple daily doses or evening administration than with single doses given every morning or every other morning. Administration of a single daily dose of a short- or intermediate-acting corticosteroid prior to 9 a.m. may reduce the risk of HPA axis suppression (because maximum endogenous corticosteroid secretion occurs in the morning) and is recommended for daily administration whenever possible. However, some disease conditions may require multiple daily doses.

Following discontinuation of short-term (up to 5 days) high-dose use, adrenal recovery may occur within 1 week. However, following prolonged high-dose administration, complete recovery of adrenal function may require up to 1 year. Following very prolonged suppression, complete recovery may never occur. During the recovery period, monitoring of adrenal function may be required to assess the patient's ability to respond to stress.

Patients with confirmed or suspected adrenal insufficiency, including those already receiving replacement therapy, require an increase in dosage or reinstitution of therapy prior to, during, and for a time following, exposure to emotional stress or physical stress such as severe infection, surgery (including dental surgery), or injury. {03} {04} {06} {10} {11} {18} {19} {20} {21} {25} {28} {29} {30} {33} {36} {40} {41} {42} {46} {47} {50} {58} Administration of sodium and/or a mineralocorticoid also may be required. {10} {18} {20} {21} {33} {36} {42} {46} {47} {50} Dosage and duration of such therapy are dependent on the severity of the stress.

When medication is to be discontinued, dosage should be reduced gradually. {04} {06} {10} {11} {18} {19} {20} {21} {25} {28} {30} {33} {36} {40} {41} {42} {43} {44} {46} {47} {48} {59} The rate at which dosage can be decreased and the time required for complete withdrawal of therapy are variable, depending on the specific agent used; dose, frequency, and route of administration; duration of therapy; condition being treated; and patient response.

For oral dosage forms only
If oral long-term use is required for disease therapy, an alternate-day regimen using an intermediate-acting corticosteroid is recommended to minimize HPA axis suppression and possibly other adverse effects. An intermediate-acting corticosteroid is one that suppresses HPA axis activity for 12 to 36 hours following a single dose. Administration of longer-acting corticosteroids on an alternate-day schedule does not reduce the risk of HPA axis suppression and is not recommended.

Alternate-day therapy utilizes a single dose administered every other morning, usually in a quantity equivalent to, or somewhat higher than, twice the usual or pre-established daily dose. The patient should have a normal or moderately responsive HPA axis.

If treatment has been initiated with daily administration, changes to alternate-day therapy should be made gradually, after the patient's condition has stabilized. However, for some diseases, such as childhood nephrotic syndrome, therapy may be initiated with alternate-day dosing.

Alternate-day therapy may not be effective in treating hematologic disorders, malignancies, ulcerative colitis, or severe conditions. Also, some patients, such as those with asthma or rheumatoid arthritis, may experience exacerbation of symptoms on the second day. Administration of (or increasing the dosage of) suitable supplemental therapy on the second day may provide sufficient symptomatic relief to permit alternate-day dosing in some patients.

For parenteral dosage forms only
For acute adrenocortical insufficiency, initiation of corticosteroid therapy by intravenous injection followed by slow intravenous infusion or intramuscular administration is recommended. Certain other acute conditions also may require initiation of therapy with intramuscular or intravenous administration of a rapidly acting formulation.

In severe or life-threatening conditions, single-dose or short-term intravenous administration of a very high dose (“pulse” therapy) may produce the required therapeutic response with a minimum risk of prolonged HPA axis suppression or other adverse effects. Such therapy has been recommended for treating conditions such as organ transplant rejection reactions, acute nephritis associated with systemic lupus erythematosus, vasculitis, adult respiratory distress syndrome, and shock. However, rapid intravenous administration of high doses of corticosteroids has been reported to cause potentially life-threatening side effects and appropriate precautions should be observed.

When the suspension dosage forms are administered intramuscularly, they should be injected deeply into the gluteal muscle to prevent local tissue atrophy. It is recommended that the deltoid muscle not be used because of a higher incidence of local atrophy. In addition, do not inject repeatedly into the same site.

A standard textbook should be consulted for specific techniques and procedures applicable to local injection of corticosteroids for various indications.

Following intra-articular injection, the injected joint should not be overused, even if pain is relieved, because of the increased risk of joint damage or deterioration. {26} {50} It is recommended that weight-bearing joints be rested for 24 to 48 hours postinjection.

Administration of a local anesthetic concurrently with intra-articular or soft tissue injection of a corticosteroid may reduce the pain of injection and provide immediate relief of symptoms. However, a postinjection flare of pain may occur when the local anesthetic effect subsides.

Dosages for local injections (e.g., intra-articular, intrabursal, intradermal, intralesional) are given as ranges only. The actual dosage depends upon the size of the joint or lesion and the severity of the condition being treated. {10}

Diet/Nutrition
Administration of oral dosage forms with food may relieve the indigestion or mild gastrointestinal irritation that may occur. {06}

Patients receiving prolonged therapy with pharmacologic doses of corticosteroids, especially those with significant mineralocorticoid activity, may require sodium restriction and/or potassium supplementation during therapy. {03} {04} {06} {10} {18} {21} {30} {33} {36} {42} {50} {58}

Because corticosteroids promote protein catabolism, increased protein intake may be necessary during prolonged therapy.

Administration of calcium and vitamin D and, if the patient's condition permits, exercise or physical therapy may reduce the risk of corticosteroid-induced osteoporosis during prolonged therapy.

For treatment of adverse effects
Recommended treatment consists of the following:

   • For gastrointestinal effects—Administration of antacids between meals may relieve indigestion or mild gastrointestinal irritation that may occur during parenteral, as well as oral, corticosteroid therapy. However, the efficacy of antacids or other antiulcer medications in preventing severe gastrointestinal problems, such as ulceration, hemorrhage, and/or bowel perforation, during corticosteroid therapy has not been established.
   • For mental depression or psychoses—If possible, decrease corticosteroid dosage or discontinue therapy. A phenothiazine may be administered if necessary; lithium also has been recommended. Some patients may require electroconvulsive therapy if severe depression persists. Tricyclic antidepressants should not be used since they do not relieve, and may exacerbate, corticosteroid-induced mental disturbances. Prophylactic administration of an antipsychotic agent may be indicated if additional courses of corticosteroid therapy are required by a patient with a history of corticosteroid-induced psychosis.
   • For withdrawal effects (non-HPA axis suppression)—Administration of aspirin or another nonsteroidal anti-inflammatory drug may alleviate some of the symptoms of this condition.

BETAMETHASONE

Summary of Differences
Precautions: Pediatrics—Not recommended for chronic use; especially likely to inhibit growth.


Oral Dosage Forms

BETAMETHASONE SYRUP USP

Usual adult and adolescent dose
Corticosteroid
Oral, 0.6 to 7.2 mg a day as a single dose or in divided doses. {01} {27}


Usual pediatric dose
Adrenocortical insufficiency
Oral, 0.018 mg per kg of body weight or 0.5 mg per square meter of body surface area a day in three divided doses.

Other indications
Oral, 0.063 to 0.25 mg per kg of body weight or 1.88 to 7.5 mg per square meter of body surface area a day in three or four divided doses.


Strength(s) usually available
U.S.—


0.6 mg per 5 mL (Rx) [Celestone (alcohol <1%) (sodium chloride) (sorbitol) (sugar){01}]

Canada—
Not commercially available.

Packaging and storage:
Store between 2 and 30 °C (36 and 86 °F), {01} protected from light. {01} Store in a well-closed container. {57} Protect from freezing.


BETAMETHASONE TABLETS USP

Usual adult and adolescent dose
See Betamethasone Syrup USP.

Usual pediatric dose
See Betamethasone Syrup USP.

Strength(s) usually available
U.S.—


0.6 mg (Rx) [Celestone (scored){27}]

Canada—
Not commercially available. {38}

Packaging and storage:
Store between 2 and 30 °C (36 and 86 °F) {27} in a well-closed container. {57}

Note: Protect the 21-tablet pack from excessive moisture. {27}



BETAMETHASONE SODIUM PHOSPHATE EFFERVESCENT TABLETS

Usual adult and adolescent dose
Corticosteroid
Oral, 0.25 to 1 mg three or four times a day. {58}


Usual pediatric dose
See Betamethasone Syrup USP.

Strength(s) usually available
U.S.—
Not commercially available.

Canada—


0.5 mg (Rx) [Betnesol (scored){58}]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), in a well-closed container, unless otherwise specified by manufacturer. Protect from moisture.

Preparation of dosage form:
Dissolve in water immediately prior to ingestion.

Note: When dispensing, explain dissolution requirement to patient.



BETAMETHASONE SODIUM PHOSPHATE EXTENDED-RELEASE TABLETS

Usual adult and adolescent dose
Corticosteroid
Oral, 2 to 6 mg a day initially, then adjusted according to patient response.


Usual pediatric dose
See Betamethasone Syrup USP.

Strength(s) usually available
U.S.—
Not commercially available.

Canada—
Not commercially available. {38}

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), in a well-closed container, unless otherwise specified by manufacturer.



Parenteral Dosage Forms

BETAMETHASONE SODIUM PHOSPHATE INJECTION USP

Note: The dosing and strengths of the dosage forms available are expressed in terms of betamethasone base (not the sodium phosphate salt).


Usual adult and adolescent dose
Corticosteroid
Intra-articular, intralesional, or soft-tissue injection, up to 9 mg (base), repeated as needed. {02}

Intramuscular or intravenous, up to 9 mg a day. {02}


Usual pediatric dose
Adrenocortical insufficiency
Intramuscular, 0.018 mg (base) per kg of body weight or 0.5 mg per square meter of body surface area a day (in three divided doses) every third day; or 0.0058 to 0.0088 mg per kg of body weight or 0.17 to 0.25 mg per square meter of body surface area once a day.

Other indications
Intramuscular, 0.021 to 0.13 mg per kg of body weight or 0.63 to 3.75 mg per square meter of body surface area every twelve to twenty-four hours.


Strength(s) usually available
U.S.—


3 mg (base) (4 mg sodium phosphate) per mL (Rx) [Celestone Phosphate (sodium bisulfite 3.2 mg)] [Selestoject (sodium bisulfite)][Generic]

Canada—
Not commercially available.

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), protected from light, unless otherwise specified by manufacturer. Protect from freezing.


BETAMETHASONE SODIUM PHOSPHATE AND BETAMETHASONE ACETATE INJECTABLE SUSPENSION USP{15}

Usual adult and adolescent dose
Arthritis, gouty, acute or
Bursitis, acute or subacute or
Tenosynovitis, nonspecific acute
Intrabursal or intramuscular, 1.5 to 6 mg, repeated every three to seven days, {03} or as needed. {03} {39}

Arthritis, rheumatoid or
Osteoarthritis, post-traumatic
Intra-articular, 1.5 to 12 mg, depending upon the size of the affected joint, repeated as needed. {03} {39}

Asthma, bronchial or
Rhinitis, allergic, perennial or seasonal
Intramuscular, 6 to 12 mg once a week. {39}

Dermatologic disorders
Intradermal, 1.2 mg per square centimeter of affected skin {03} {39} every three to seven days. {39}

Status asthmaticus or
Lupus erythematosis, disseminated
Intramuscular, initially 12 mg. {39}


Usual adult and adolescent prescribing limits
Dermatologic disorders
6 mg per week. {03} {39}


Usual pediatric dose
Dosage has not been established.

Strength(s) usually available
U.S.—


6 mg (3 mg of betamethasone acetate and 3 mg of betamethasone base) per mL (Rx) [Celestone Soluspan{03}]

Canada—


6 mg (3 mg of betamethasone acetate and 3 mg of betamethasone base) per mL (Rx) [Celestone Soluspan{39}]

Packaging and storage:
Store between 2 and 25 °C (36 and 77 °F), protected from light, {03} {39} unless otherwise specified by manufacturer. Protect from freezing.

Incompatibilities:
This medication should not be mixed with parenteral-local anesthetic formulations containing parabens, phenol, or other such preservatives, because flocculation of the corticosteroid may occur. {03} The required quantity of corticosteroid suspension should be drawn into the syringe first, then the local anesthetic added. Do not introduce the local anesthetic directly into the multiple-dose vial. {03}

Auxiliary labeling:
   • Shake well. {03} {39}

Additional information:
For administration of injections, see manufacturer's labeling.

Do not administer this medication intravenously. {03}


BUDESONIDE


Oral Dosage Forms

BUDESONIDE EXTENDED-RELEASE CAPSULES (MICRONIZED)

Usual adult dose
Crohn's disease
Active disease: Oral, 9 mg once a day in the morning before breakfast for up to eight weeks. {29}

Maintenance of remission: Oral, 6 mg once a day in the morning before breakfast. {29}


Usual pediatric dose
Safety and efficacy have not been established. {29}

Usual geriatric dose
See Usual adult dose.

Strength(s) usually available
U.S.—
Not commercially available.

Canada—


3 mg (Rx) [Entocort{29}]

Packaging and storage:
Store between 15 and 30 °C (59 and 86 °F), {29} unless otherwise specified by manufacturer. Store in a tight container. {29}

Auxiliary labeling:
Store in original container. {29}

Note: Dispense in original container. {29}



CORTISONE


Oral Dosage Forms

CORTISONE ACETATE TABLETS USP

Usual adult and adolescent dose
Corticosteroid
Oral, 25 to 300 mg a day as a single dose or in divided doses. {05} {31} {59}


Usual pediatric dose
Adrenocortical insufficiency
Oral, 0.7 mg per kg of body weight or 20 to 25 mg per square meter of body surface area a day in divided doses.

Other indications
Oral, 2.5 to 10 mg per kg of body weight or 75 to 300 mg per square meter of body surface area a day as a single dose or in divided doses.


Strength(s) usually available
U.S.—


5 mg (Rx)[Generic] ( scored)(lactose)


10 mg (Rx)[Generic] ( scored)


25 mg (Rx) [Cortone Acetate (scored){05}][Generic] (scored){59}

Canada—


5 mg (Rx) [Cortone{31}]


25 mg (Rx) [Cortisone Acetate-ICN (scored){56}] [Cortone (scored ){31}][Generic]

Packaging and storage:
Store between 15 and 30 °C (59 and 86 °F) {59}, unless otherwise specified by manufacturer. Store in a well-closed container. {57} Protect from light. {59}



Parenteral Dosage Forms

CORTISONE ACETATE INJECTABLE SUSPENSION USP{15}

Usual adult and adolescent dose
Corticosteroid
Intramuscular, 20 to 300 mg a day. {04} {30}


Usual pediatric dose
Adrenocortical insufficiency
Intramuscular, 0.7 mg per kg of body weight or 37.5 mg per square meter of body surface area a day every third day; or 0.23 to 0.35 mg per kg of body weight or 12.5 mg per square meter of body surface area once a day.

Other indications
Intramuscular, 0.83 to 5 mg per kg of body weight or 25 to 150 mg per square meter of body surface area every twelve to twenty-four hours.


Strength(s) usually available
U.S.—


25 mg per mL (Rx)[Generic]


50 mg per mL (Rx) [Cortone Acetate (benzyl alcohol 9 mg ){04}][Generic]

Canada—


50 mg per mL (Rx) [Cortone (benzyl alcohol){30}]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Protect from freezing. {04}

Stability:
Dilutions or admixtures of this medication with other products are not recommended because the state of suspension or the rate of absorption may be affected.

This medication is heat-sensitive and should not be autoclaved. {04} {30}

Auxiliary labeling:
   • Shake well.


Caution:
Use of preparations containing benzyl alcohol is not recommended in neonates. A fatal toxic syndrome consisting of metabolic acidosis, central nervous system (CNS) depression, respiratory problems, renal failure, hypotension, and possibly seizures and intracranial hemorrhages has been associated with this use.

Additional information:
Do not administer this medication intravenously.


DEXAMETHASONE

Summary of Differences
Category: Also, diagnostic aid (Cushing's syndrome and endogenous depression) and antiemetic (in cancer chemotherapy).

Precautions: Pediatrics—Not recommended for chronic use; especially likely to inhibit growth.


Oral Dosage Forms

Note: Bracketed uses in the Dosage Forms section refer to categories of use and/or indications that are not included in U.S. product labeling.

DEXAMETHASONE ELIXIR USP

Usual adult and adolescent dose
Corticosteroid
Oral, 0.75 to 9 mg a day as a single dose or in divided doses. {06} {07}

[Dexamethasone suppression test]1
Test for Cushing's syndrome: Oral, 1 mg as a single dose at 11:00 p.m. or 0.5 mg every six hours for forty-eight hours. {06} {07} {25} {34}

Test to distinguish Cushing's syndrome due to pituitary ACTH excess from Cushing's syndrome due to other causes: Oral, 2 mg every six hours for forty-eight hours. {06} {07} {25} {34}

[Depression, mental, endogenous, diagnosis of]1: Oral, 1 mg as a single dose at 11:00 p.m.

Edema, cerebral, associated with recurrent or inoperable brain tumor
Oral, 2 mg two or three times a day, administered as maintenance therapy after cerebral edema has initially been controlled using parenteral dexamethasone sodium phosphate. {07} {25} {34}


Usual pediatric dose
Adrenocortical insufficiency
Oral, 0.023 mg per kg of body weight or 0.67 mg per square meter of body surface area a day in three divided doses.

Other indications
Oral, 0.083 to 0.33 mg per kg of body weight or 2.5 to 10 mg per square meter of body surface area a day in three or four divided doses.


Strength(s) usually available
U.S.—


0.5 mg per 5 mL (Rx) [Decadron Elixir (alcohol 5%){06}] [Hexadrol (alcohol 5%)] [Mymethasone (alcohol 5%)][Generic]

Canada—
Not commercially available.

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a tight container. {57} Protect from freezing.

Auxiliary labeling:
   • Keep container tightly closed. {06}


DEXAMETHASONE ORAL SOLUTION USP{32}

Usual adult and adolescent dose
See Dexamethasone Elixir USP.

Usual pediatric dose
See Dexamethasone Elixir USP.

Strength(s) usually available
U.S.—


0.5 mg per 5 mL (Rx)[Generic]{25}


1 mg per mL (Rx) [Dexamethasone Intensol (alcohol 30%){25}]

Canada—
Not commercially available.

Packaging and storage:
Store between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer, in a tight container. {32} Protect from freezing.

Preparation of dosage form:
Dexamethasone Intensol should be mixed with water, juice, soft drink, applesauce, or pudding before administration. {25}

Stability:
Dexamethasone Intensol should be consumed immediately after it is mixed with a beverage or a semi-solid food. {25} Any unused portion should be discarded. {25}


DEXAMETHASONE TABLETS USP

Usual adult and adolescent dose
Corticosteroid or
Dexamethasone suppression test or
Edema, cerebral, associated with recurrent or inoperable brain tumor
See Dexamethasone Elixir USP.

Allergic disorders
Therapy should be initiated with dexamethasone sodium phosphate injection (see Dexamethasone Sodium Phosphate Injection USP). Then, beginning on the second day, oral, 3 mg in two divided doses for two days, 1.5 mg in two divided doses for one day, 0.75 mg for two days, and a follow-up visit on the eighth day. {08} {25}

Allergic disorders, severe or
Carditis, rheumatic [or nonrheumatic ]1 or
Neoplastic disease or
Pemphigus, acute or
Lupus erythmatosus, systemic, crisis of
Oral, initially 4 to 10 mg a day in divided doses. {34}

Congenital adrenal hyperplasia
Oral, 0.5 to 1.5 mg a day. {34}

Lupus erythematosus, systemic or
Pemphigus, chronic or
Sarcoidosis, symptomatic
Oral, initially 2 to 4.5 mg a day. {34}

[Nausea and vomiting, cancer chemotherapy–induced]
Therapy should be initiated with dexamethasone sodium phosphate injection (see Dexamethasone Sodium Phosphate Injection USP). Then, oral, 4 mg every four to six hours, or 8 mg every eight hours with the dosage being reduced gradually over two to three days. {34} Duration of therapy should not exceed five days beyond administration of chemotherapy. {34}


Usual pediatric dose
Congenital adrenal hyperplasia
Oral, 0.5 to 1.5 mg a day. {34}

Adrenocortical insufficiency or
Other indications
See Dexamethasone Elixir USP.

[Croup]1
Oral, 0.15 to 0.6 mg per kg of body weight given once.{92}{93}{94}{95}{96}{97}{98}{99}{100}{101}{102}{103}{104}{105}{106}{107}{108}{109}{110}{111}{112}{113}


Strength(s) usually available
U.S.—


0.25 mg (Rx) [Decadron (scored){07}][Generic]


0.5 mg (Rx) [Decadron (scored){07}] [Hexadrol (scored)][Generic] (scored){25}


0.75 mg (Rx) [Decadron (scored){07}] [Dexone 0.75 ( scored){62}] [Hexadrol (scored)][Generic] (scored){25}


1 mg (Rx)[Generic] ( scored){25}


1.5 mg (Rx) [Decadron (scored){07}] [Dexone 1.5 (scored){62}] [Hexadrol (scored)][Generic] (scored){25}


2 mg (Rx)[Generic] ( scored){25}


4 mg (Rx) [Decadron (scored){07}] [Dexone 4 (scored){62}] [Hexadrol (scored)][Generic] (scored){25}


6 mg (Rx) [Decadron (scored){07}][Generic] (scored){25}

Canada—


0.5 mg (Rx) [Decadron (scored){34}] [Deronil (scored)] [Dexasone (scored){35}]


0.75 mg (Rx) [Deronil (scored)] [Dexasone (scored){35}]


4 mg (Rx) [Decadron (scored){34}] [Deronil (scored)] [Dexasone (scored){35}] [Oradexon ( scored)]

Packaging and storage:
Store between 15 and 30 °C (59 and 86 °F), {34} unless otherwise specified by manufacturer. Store in a well-closed container. {57}

Preparation of dosage form:
Tablets should be crushed and dissolved in liquid prior to administration to pediatric patients.{92}



Parenteral Dosage Forms

Note: Bracketed uses in the Dosage Forms section refer to categories of use and/or indications that are not included in U.S. product labeling.

DEXAMETHASONE ACETATE INJECTABLE SUSPENSION USP{63}

Note: The dosing and strengths of the dosage forms available are expressed in terms of dexamethasone base (not the acetate salt).


Usual adult and adolescent dose
Corticosteroid
Intra-articular or soft-tissue injection, 4 to 16 mg of dexamethasone (base), repeated at one- to three-week intervals, if necessary. {09}

Intralesional, 0.8 to 1.6 mg per injection site, repeated as needed. {09}

Intramuscular, 8 to 16 mg, repeated at one- to three-week intervals, if necessary. {09}


Usual pediatric dose
Dosage has not been established. {09}
[Croup]1
Intramuscular, 0.6 mg per kg of body weight as a single injection.{92}{93}{94}{95}{96}{97}{98}{99}{100}{101}{102}{103}{104}{105}{106}{107}{108}{109}{110}{111}{112}{113}


Strength(s) usually available
U.S.—


8 mg (base) per mL (Rx) [Cortastat LA{62}] [Dalalone L.A. (sodium bisulfite) (benzyl alcohol )] [Decadron-LA ( sodium bisulfite 1 mg) (benzyl alcohol 9 mg){09}] [Decaject LA (sodium bisulfite) (benzyl alcohol ){62}] [Dexacorten-LA{62}] [Dexasone L.A.{62}] [Dexone LA (sodium bisulfite) (benzyl alcohol){62}] [Solurex LA (sodium bisulfite ) (benzyl alcohol){62}][Generic]


16 mg (base) per mL (Rx) [Dalalone D.P. (sodium bisulfite 1 mg ) (benzyl alcohol 9 mg){64}]

Canada—
Not commercially available.

Packaging and storage:
Store between 15 and 30 °C (59 and 86 °F), {64} unless otherwise specified by manufacturer. Protect from freezing. {09} Protect from light. {64}

Stability:
This medication is heat-sensitive and should not be autoclaved. {09} {64}

Auxiliary labeling:
   • Shake well. {64}

Additional information:
For administration of injections, see manufacturer's labeling.

Do not administer this medication intravenously.

The suspension containing the equivalent of 16 mg of dexamethasone per mL is not for intralesional use.


DEXAMETHASONE SODIUM PHOSPHATE INJECTION USP

Note: The dosing and strength of the dosage forms available are expressed in terms of dexamethasone phosphate.


Usual adult and adolescent dose
Corticosteroid
Intra-articular, intralesional, or soft-tissue injection, 0.2 to 6 mg (dexamethasone phosphate), repeated at three-day to three-week intervals, if necessary. {08}

Intramuscular or intravenous, 0.5 to 9 mg a day. {08} {33}

Edema, cerebral
Initial: Intravenous, 10 mg, followed by 4 mg intramuscularly every six hours until symptoms subside. {08} {33} {60} Dosage may be reduced after two to four days and gradually discontinued over a period of five to seven days, {33} unless a brain tumor, which must be treated before dexamethasone can be discontinued, is present. {08}

Maintenance (for recurrent or inoperable brain tumors): Intramuscular, 2 mg two or three times a day initially, then adjusted according to patient response. {08} {33}

Shock


The following regimens have been utilized:
Intravenous, 20 mg as a single dose initially, followed by 3 mg per kg of body weight per twenty-four hours via continuous intravenous infusion, {08} {33} {60} or

Intravenous, 2 to 6 mg per kg of body weight as a single injection, {08} {33} or

Intravenous, 40 mg as a single dose, administered every two to six hours as needed, {08} {33} {60} or

Intravenous, 1 mg per kg of body weight as a single injection. {08} {33}


Note: Administration of high-dose therapy for shock should be discontinued after the patient's condition has stabilized and usually is continued for no longer than two to three days. {08} {33}


Allergic disorders
Intramuscular, initially 4 or 8 mg as a single dose. Maintenance therapy should be continued with dexamethasone tablets {08} {33} {34} (see Dexamethasone Tablets USP).

[Nausea and vomiting, cancer chemotherapy–induced]
Intravenous, 8 to 20 mg administered over five to fifteen minutes beginning just prior to chemotherapy. Therapy should be continued with dexamethasone tablets {33} (see Dexamethasone Tablets USP).

[Respiratory distress syndrome, neonatal (prophylaxis)]
Intramuscular, 5 mg every twelve hours up to a total of four doses beginning seven days to twenty-four hours before the estimated delivery date. {33}


Usual adult prescribing limits
80 mg daily. {33}

Usual pediatric dose
Adrenocortical insufficiency
Intramuscular, 0.023 mg (dexamethasone phosphate) per kg of body weight or 0.67 mg per square meter of body surface area a day (in three divided doses) every third day; or 0.0078 to 0.012 mg per kg of body weight or 0.23 to 0.34 mg per square meter of body surface area once a day.

Other indications
Intramuscular, 0.028 to 0.17 mg per kg of body weight or 0.83 to 5 mg per square meter of body surface area every twelve to twenty-four hours.

[Croup]1
Intramuscular, 0.6 mg per kg of body weight as a single injection.{92}{93}{94}{95}{96}{97}{98}{99}{100}{101}{102}{103}{104}{105}{106}{107}{108}{109}{110}{111}{112}{113}


Strength(s) usually available
U.S.—


4 mg (phosphate) per mL (Rx) [Cortastat{62}] [Dalalone (sodium bisulfite)] [Decadrol] [Decadron Phosphate (sodium bisulfite 1 mg){08}] [Decaject (sodium bisulfite){62}] [Dexacorten{62}] [Dexasone{62}] [Dexone (sodium bisulfite)] [Hexadrol Phosphate ( sodium sulfite 1 mg) (benzyl alcohol 10 mg)] [Primethasone{62}] [Solurex (sodium bisulfite)][Generic]( sodium metabisulfite)


10 mg (phosphate) per mL (Rx) [Cortastat 10{62}] [Dexasone{62}] [Hexadrol Phosphate (sodium sulfite 1.5 mg) (benzyl alcohol 10 mg)][Generic](sodium metabisulfite)( benzyl alcohol 9 mg)


20 mg (phosphate) per mL (Rx) [Hexadrol Phosphate (sodium sulfite 1.75 mg) (benzyl alcohol 10 mg)][Generic](sodium metabisulfite)(benzyl alcohol 9 mg)


24 mg (phosphate) per mL (Rx) [Decadron Phosphate (sodium bisulfite 1 mg){08}][Generic](sodium metabisulfite)

Canada—


4 mg (phosphate) per mL (Rx) [Decadron Phosphate (sodium bisulfite){33}] [Hexadrol Phosphate (benzyl alcohol 10 mg) ( sodium sulfite){60}][Generic](sodium metabisulfite )


10 mg (phosphate) per mL (Rx) [Hexadrol Phosphate (benzyl alcohol 10 mg) (sodium sulfite){60}][Generic](sodium metabisulfite)

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Protect from light. {08} {33} {57} Protect from freezing. {08} {33}

Preparation of dosage form:
Dexamethasone sodium phosphate injection may be admixed with dextrose injection or sodium chloride injection and administered via intravenous infusion. {08}

For use in cancer chemotherapy–induced nausea and vomiting, 20 mg of dexamethasone sodium phosphate injection may be admixed with 8 mg of ondansetron hydrochloride injection in 50 mL of 5% dextrose injection. {33}

Stability:
This medication is heat-sensitive and should not be autoclaved. {08} {33}

When dexamethasone sodium phosphate injection is admixed with dextrose injection or sodium chloride injection, the solution must be used within 24 hours. {08}

When dexamethasone sodium phosphate injection is admixed with ondansetron hydrochloride injection in 5% dextrose injection, the resulting solution is stable for up to two days when stored at room temperature or for up to 7 days when stored at a temperature between 2 and 8 °C (36 and 46 °F). {33}


Caution:
Use of preparations containing benzyl alcohol is not recommended in neonates. A fatal toxic syndrome consisting of metabolic acidosis, central nervous system (CNS) depression, respiratory problems, renal failure, hypotension, and possibly seizures and intracranial hemorrhages has been associated with this use.

Additional information:
For administration of injections, see manufacturer's labeling.

Dosage forms containing 24 mg (dexamethasone phosphate) per mL are for intravenous use only. {08}


HYDROCORTISONE


Oral Dosage Forms

HYDROCORTISONE TABLETS USP

Usual adult and adolescent dose
Corticosteroid
Oral, 20 to 240 mg a day as a single dose or in divided doses. {11} {36} {37} {40}

Multiple sclerosis, acute exacerbations of
Oral, 800 mg a day for one week, followed by 320 mg every other day for one month. {40}


Usual pediatric dose
Adrenocortical insufficiency
Oral, 0.56 mg per kg of body weight or 15 to 20 mg per square meter of body surface area a day as a single dose or in divided doses.

Other indications
Oral, 2 to 8 mg per kg of body weight or 60 to 240 mg per square meter of body surface area a day as a single dose or in divided doses.


Strength(s) usually available
U.S.—


5 mg (Rx) [Cortef (scored){40}]


10 mg (Rx) [Cortef (scored){40}] [Hydrocortone (scored){11}][Generic]{37}


20 mg (Rx) [Cortef (scored){40}][Generic] (scored){37}

Canada—


10 mg (Rx) [Cortef (scored){36}]


20 mg (Rx) [Cortef (scored){36}]

Packaging and storage:
Store between 15 and 30 °C (59 and 86 °F), {37} unless otherwise specified by manufacturer. Store in a well-closed container. {57}


HYDROCORTISONE CYPIONATE ORAL SUSPENSION

Note: The dosing and strength of the dosage forms available are expressed in terms of hydrocortisone base (not the cypionate salt).


Usual adult and adolescent dose
Corticosteroid
Oral, 20 to 240 mg (base) a day as a single dose or in divided doses. {44}


Usual pediatric dose
Adrenocortical insufficiency
Oral, 0.56 mg (base) per kg of body weight or 15 to 20 mg per square meter of body surface area a day as a single dose or in divided doses.

Other indications
Oral, 2 to 8 mg per kg of body weight or 60 to 240 mg per square meter of body surface area a day as a single dose or in divided doses.


Strength(s) usually available
U.S.—


10 mg (base) per 5 mL (Rx) [Cortef{44}]

Canada—
Not commercially available.

Packaging and storage:
Store between 20 and 25 °C (68 and 77 °F), {44} unless otherwise specified by manufacturer. Store in a tight, light-resistant container. {44} Protect from freezing.

Auxiliary labeling:
   • Shake well.



Parenteral Dosage Forms

HYDROCORTISONE INJECTABLE SUSPENSION USP{15}

Usual adult and adolescent dose
Corticosteroid
Intramuscular, 15 to 240 mg a day.


Usual pediatric dose
Adrenocortical insufficiency
Intramuscular, 0.56 mg per kg of body weight or 30 to 37.5 mg per square meter of body surface area a day every third day; or 0.19 to 0.28 mg per kg of body weight or 10 to 12.5 mg per square meter of body surface area once a day.

Other indications
Intramuscular, 0.67 to 4 mg per kg of body weight or 20 to 120 mg per square meter of body surface area every twelve to twenty-four hours.


Strength(s) usually available
U.S.—


25 mg per mL (Rx)[Generic]


50 mg per mL (Rx)[Generic]

Canada—
Not commercially available.

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Protect from freezing.

Auxiliary labeling:
   • Shake well.

Additional information:
Do not administer this medication intravenously.


HYDROCORTISONE ACETATE INJECTABLE SUSPENSION USP{15}

Usual adult and adolescent dose
Corticosteroid
Intra-articular, intralesional, or soft-tissue injection, 5 to 75 mg, repeated at two- to three-week intervals. {10}


Note: Severe conditions may require doses at one-week intervals. {10}


Usual pediatric dose
Dosage has not been established.

Strength(s) usually available
U.S.—


25 mg per mL (Rx)[Generic]{62}


50 mg per mL (Rx) [Hydrocortone Acetate (benzyl alcohol 9 mg){10}][Generic]{62}

Canada—
Not commercially available.

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Protect from freezing.

Stability:
For concurrent use of a parenteral-local anesthetic, withdraw the required quantity of corticosteroid suspension into a syringe, then add the local anesthetic. {10} Do not introduce the local anesthetic directly into the multiple-dose vial. Also, the mixture must be used immediately and any unused portion discarded. {10}

This medication is heat-sensitive and should not be autoclaved. {10}

Auxiliary labeling:
   • Shake well.


Caution:
Use of preparations containing benzyl alcohol is not recommended in neonates. A fatal toxic syndrome consisting of metabolic acidosis, central nervous system (CNS) depression, respiratory problems, renal failure, hypotension, and possibly seizures and intracranial hemorrhages has been associated with this use.

Additional information:
For administration of injections, see manufacturer's labeling.

Do not administer this medication intravenously.


HYDROCORTISONE SODIUM PHOSPHATE INJECTION USP

Note: The dosing and strength of the dosage form available is expressed in terms of hydrocortisone base (not the sodium phosphate salt).


Usual adult and adolescent dose
Corticosteroid
Intramuscular, intravenous, or subcutaneous, 15 to 240 mg (base) a day in divided doses. {12}


Usual pediatric dose
Adrenocortical insufficiency
Intramuscular or intravenous, 0.19 to 0.28 mg (base) per kg of body weight or 10 to 12 mg per square meter of body surface area a day in three divided doses.

Other indications
Intramuscular, 0.67 to 4 mg per kg of body weight or 20 to 120 mg per square meter of body surface area every twelve to twenty-four hours.


Strength(s) usually available
U.S.—


50 mg (base) per mL (Rx) [Hydrocortone Phosphate (sodium bisulfite 3.2 mg){12}][Generic]( Quad—sodium metabisulfite 2 mg)

Canada—
Not commercially available.

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Protect from freezing.

Preparation of dosage form:
Hydrocortisone sodium phosphate injection may be admixed with dextrose injection or sodium chloride injection and administered via intravenous infusion. {12}

Stability:
This medication is heat-sensitive and should not be autoclaved. {12}

When hydrocortisone sodium phosphate injection is admixed with dextrose injection or sodium chloride injection, the solution must be used within 24 hours. {12}


Caution:
Use of preparations containing benzyl alcohol is not recommended in neonates. A fatal toxic syndrome consisting of metabolic acidosis, central nervous system (CNS) depression, respiratory problems, renal failure, hypotension, and possibly seizures and intracranial hemorrhages has been associated with this use. {12}

Additional information:
For administration of injections, see manufacturer's labeling.


HYDROCORTISONE SODIUM SUCCINATE FOR INJECTION USP

Note: The dosing and strength of the dosage forms available are expressed in terms of hydrocortisone base (not the sodium succinate salt).


Usual adult and adolescent dose
Corticosteroid
Intramuscular or intravenous, 100 to 500 mg (base); may be repeated every two to six hours, depending upon patient condition and response. {13}


Note: Initial intravenous dosage should be administered over a period of thirty seconds (100-mg dose) to ten minutes (doses 500 mg or higher). {13}
Maintenance dosage (if required) should be no less than 25 mg per day. {13}


Usual pediatric dose
Adrenocortical insufficiency
Intramuscular or intravenous, 0.19 to 0.28 mg (base) per kg of body weight or 10 to 12 mg per square meter of body surface area a day in three divided doses.

Other indications
Intramuscular, 0.67 to 4 mg per kg of body weight or 20 to 120 mg per square meter of body surface area every twelve to twenty-four hours.


Size(s) usually available:
U.S.—


100 mg (base) (Rx) [A-hydroCort (benzyl alcohol 18 mg per 2 mL—Univial)] [Solu-Cortef (benzyl alcohol 18.1 mg per 2 mL—Act-O-Vial, Mix-O-Vial)][Generic]{62}


250 mg (base) (Rx) [A-hydroCort (benzyl alcohol 18 mg per 2 mL—Univial)] [Solu-Cortef (benzyl alcohol 16.4 mg per 2 mL—Act-O-Vial, Mix-O-Vial)][Generic]{62}


500 mg (base) (Rx) [A-hydroCort (benzyl alcohol 36 mg per 4 mL—Univial)] [Solu-Cortef (benzyl alcohol 33.4 mg per 4 mL—Act-O-Vial, Mix-O-Vial)][Generic]{62}


1 gram (base) (Rx) [A-hydroCort (benzyl alcohol 72 mg per 8 mL—Univial)] [Solu-Cortef (benzyl alcohol 66.9 mg per 8 mL—Act-O-Vial, Mix-O-Vial)][Generic]{62}

Canada—


100 mg (base) (Rx) [A-Hydrocort (benzyl alcohol 18 mg){67}] [Solu-Cortef (benzyl alcohol 18.1 mg){13}]


250 mg (base) (Rx) [A-Hydrocort (benzyl alcohol 18 mg){67}] [Solu-Cortef (benzyl alcohol 16.4 mg){13}]


500 mg (base) (Rx) [A-Hydrocort (benzyl alcohol 36 mg){67}] [Solu-Cortef (benzyl alcohol 33.4 mg){13}]


1 gram (base) (Rx) [A-Hydrocort (benzyl alcohol 72 mg){67}] [Solu-Cortef (benzyl alcohol 66.9 mg){13}]

Packaging and storage:
Store between 15 and 30 °C (59 and 86 °F), {13} unless otherwise specified by manufacturer.

Stability:
Reconstituted solution should be used only if it is clear and should be discarded after 3 days. {13} {57}

After reconstitution, protect the solution from light. {13}


Caution:
Use of preparations containing benzyl alcohol is not recommended in neonates. A fatal toxic syndrome consisting of metabolic acidosis, central nervous system (CNS) depression, respiratory problems, renal failure, hypotension, and possibly seizures and intracranial hemorrhages has been associated with this use.

Additional information:
For preparation and administration of injections, see manufacturer's labeling.


METHYLPREDNISOLONE


Oral Dosage Forms

METHYLPREDNISOLONE TABLETS USP

Usual adult and adolescent dose
Corticosteroid
Oral, 4 to 48 mg a day as a single dose or in divided doses. {28} {41} {42}

Multiple sclerosis, acute exacerbations of
Oral, 160 mg a day for one week, followed by 64 mg every other day for one month. {28} {41}


Usual pediatric dose
Adrenocortical insufficiency
Oral, 0.18 mg per kg of body weight or 3.33 mg per square meter of body surface area a day in three divided doses.{91}

Other indications
Oral, 0.42 to 1.67 mg per kg of body weight or 12.5 to 50 mg per square meter of body surface area a day in three or four divided doses.{91}


Strength(s) usually available
U.S.—


2 mg (Rx) [Medrol (scored){16}]


4 mg (Rx) [Medrol (scored){16}] [Meprolone][Generic]{28}{41}


8 mg (Rx) [Medrol (scored){16}]


16 mg (Rx) [Medrol (scored){16}][Generic]


24 mg (Rx) [Medrol (scored){16}][Generic]


32 mg (Rx) [Medrol (scored){16}][Generic]

Canada—


4 mg (Rx) [Medrol (scored){42}]


16 mg (Rx) [Medrol (scored){42}]

Packaging and storage:
Store between 20 and 25 °C (68 and 77 °F), {16} unless otherwise specified by manufacturer. Store in a tight container. {28} {41} {57}



Parenteral Dosage Forms

Note: Bracketed uses in the Dosage Forms section refer to categories of use and/or indications that are not included in U.S. product labeling.

METHYLPREDNISOLONE ACETATE INJECTABLE SUSPENSION USP{15}

Usual adult and adolescent dose
Corticosteroid
Intra-articular, intralesional, or soft-tissue injection, 4 to 80 mg, repeated at one- to five-week intervals, if necessary. {26}

Intramuscular, 40 to 120 mg, repeated at one-day to two-week intervals, if necessary.

Congenital adrenal hyperplasia
Intramuscular, 40 mg at two-week intervals. {26}

Multiple sclerosis, acute exacerbations of
Intramuscular, 160 mg a day for one week, followed by 64 mg every other day for one month. {26}


Usual pediatric dose
Adrenocortical insufficiency
Intramuscular, 0.12 mg per kg of body weight or 3.33 mg per square meter of body surface area a day (in three divided doses) every third day; or 0.039 to 0.059 mg per kg of body weight or 1.11 to 1.66 mg per square meter of body surface area once a day.{91}

Other indications
Intramuscular, 0.14 to 0.84 mg per kg of body weight or 4.16 to 25 mg per square meter of body surface area every twelve to twenty-four hours.{91}


Strength(s) usually available
U.S.—


20 mg per mL (Rx) [Depo-Medrol (benzyl alcohol 9.3 mg){17}][Generic]{62}


40 mg per mL (Rx) [DepMedalone 40{62}] [Depoject-40{62}] [Depo-Medrol (benzyl alcohol 9.16 mg){17}] [Depopred{62}] [Depo-Predate{62}] [Duralone-40] [Med-Jec-40{62}] [Methacort 40{62}] [Methylcotolone{62}] [Predacorten{62}][Generic]{62}


80 mg per mL (Rx) [DepMedalone 80{62}] [Depoject-80{62}] [Depo-Medrol (benzyl alcohol 8.8 mg){17}] [Depopred{62}] [Depo-Predate{62}] [Duralone-80] [Medralone 80{62}] [Methacort 80{62}] [Methylcotolone{62}] [Predacorten 80{62}][Generic]{62}

Canada—


20 mg per mL (Rx) [Depo-Medrol (benzyl alcohol){26}]


40 mg per mL (Rx) [Depo-Medrol (benzyl alcohol){26}]


80 mg per mL (Rx) [Depo-Medrol (benzyl alcohol){26}]

Packaging and storage:
Store between 20 and 25 °C (68 and 77 °F), {17} unless otherwise specified by manufacturer. Protect from freezing.

Preparation of dosage form:
For preparation and administration of injections, see manufacturer's labeling.

Incompatibilities:
It is recommended that this medication not be diluted or mixed with other solutions because of possible physical incompatibility. {26}

Auxiliary labeling:
   • Shake well.


Caution:
Use of preparations containing benzyl alcohol is not recommended in neonates. A fatal toxic syndrome consisting of metabolic acidosis, central nervous system (CNS) depression, respiratory problems, renal failure, hypotension, and possibly seizures and intracranial hemorrhages has been associated with this use.

Additional information:
Do not administer this medication intrathecally or intravenously.


METHYLPREDNISOLONE SODIUM SUCCINATE FOR INJECTION USP

Note: The dosing and strength of the dosage form available is expressed in terms of methylprednisolone base (not the sodium succinate salt).


Usual adult and adolescent dose
Corticosteroid
Intramuscular or intravenous, 10 to 40 mg (base), repeated as needed. {18} {43}

Colitis, ulcerative
Intravenous, 40 to 120 mg three to seven times a week for two or more weeks. {45}

High-dose (“pulse”) therapy
Intravenous, 30 mg per kg of body weight administered over at least thirty minutes. {18} {43} {45} This dose may be repeated every four to six hours for forty-eight hours. {18} {43} {45}

Multiple sclerosis, acute exacerbations of
Intramuscular or intravenous, 160 mg a day for one week, followed by 64 mg every other day for one month. {18} {43}

[Pneumonia, Pneumocystis carinii, associated with AIDS, adjunctive treatment]1
Intravenous, 30 mg two times a day on days one through five, 30 mg once a day on days six through ten, and 15 mg once a day on days eleven through twenty-one. {68} {70} {71} {77}

[Spinal cord injury, acute ]
Intravenous, 30 mg per kg of body weight administered over fifteen minutes, followed after forty-five minutes by a continuous infusion of 5.4 mg per kg of body weight per hour, for twenty-three hours. {45} {55} {66}

Note: Treatment should begin within eight hours of the injury. {45}



Usual pediatric dose
Adrenocortical insufficiency
Intramuscular, 0.18 mg (base) per kg of body weight or 3.33 mg per square meter of body surface area a day (in three divided doses) every third day; or 0.039 to 0.059 mg per kg of body weight or 1.11 to 1.66 mg per square meter of body surface area once a day.{91}

[High-dose ("pulse") therapy]1
Intravenous, 30 (base) mg/kg (to a maximum of 1 gram) administered over thirty minutes to one hour once a day for three consecutive days.{91}

[Pneumonia, Pneumocystis carinii, associated with AIDS, adjunctive treatment]1
Children up to 14 years of age: Dosage has not been established. {68} {77}

Children 14 years of age or older: See Usual adult and adolescent dose. {68} {77}

[Spinal cord injury, acute]1
Intravenous, 30 mg per kg of body weight administered over fifteen minutes, followed after forty-five minutes by a continuous infusion of 5.4 mg per kg of body weight per hour, for twenty-three hours. {55} {66}

Other indications
Intramuscular, 0.14 to 0.84 mg per kg of body weight or 4.16 to 25 mg per square meter of body surface area every twelve to twenty-four hours.{91}


Size(s) usually available:
U.S.—


40 mg (base) (Rx) [Solu-Medrol (benzyl alcohol 8.8 mg){18}][Generic]{62}


125 mg (base) (Rx) [Solu-Medrol (benzyl alcohol 17.6 mg ){18}][Generic]{62}


500 mg (base) (Rx) [A-MethaPred{43}] [Solu-Medrol (benzyl alcohol 70.2 mg —vial with diluent; 33.7 mg—single-dose vial){18}][Generic]{62}


1 gram (base) (Rx) [A-MethaPred{43}] [Solu-Medrol (benzyl alcohol 66.8 mg—single-dose vial){18}][Generic]{62}


2 grams (base) (Rx) [Solu-Medrol (benzyl alcohol 273 mg—vial with diluent){18}]

Canada—


40 mg (base) (Rx) [Solu-Medrol (diluent—benzyl alcohol 8.8 mg){45}]


125 mg (base) (Rx) [Solu-Medrol (diluent—benzyl alcohol 17.6 mg){45}]


500 mg (base) (Rx) [Solu-Medrol (diluent—benzyl alcohol 33.7 mg){45}]


1 gram (base) (Rx) [Solu-Medrol (diluent—benzyl alcohol 66.8 mg){45}]

Packaging and storage:
Store between 20 and 25 °C (68 and 77 °F), {18} unless otherwise specified by manufacturer. Protect from light. {18} {45}

Preparation of dosage form:
For preparation and administration of injections, see manufacturer's labeling.

Stability:
Use reconstituted solution within 48 hours. {45} Do not use if solution is cloudy or contains a precipitate.


Caution:
Use of diluents or preparations containing benzyl alcohol is not recommended in neonates. A fatal toxic syndrome consisting of metabolic acidosis, central nervous system (CNS) depression, respiratory problems, renal failure, hypotension, and possibly seizures and intracranial hemorrhages has been associated with this use.

Additional information:
When used intravenously, Methylprednisolone Sodium Succinate for Injection USP should be administered over a period of 1 to several minutes.


PREDNISOLONE


Oral Dosage Forms

PREDNISOLONE SYRUP USP

Usual adult and adolescent dose
Corticosteroid
Oral, 5 to 60 mg a day as a single dose or in divided doses. {21}

Multiple sclerosis, acute exacerbations of
Oral, 200 mg a day for one week, followed by 80 mg every other day for one month. {19}


Usual adult prescribing limits
250 mg a day.

Usual pediatric dose
Adrenocortical insufficiency
Oral, 0.14 mg per kg of body weight or 4 mg per square meter of body surface area a day in three divided doses.

Other indications
Oral, 0.5 to 2 mg per kg of body weight or 15 to 60 mg per square meter of body surface area a day in three or four divided doses.


Strength(s) usually available
U.S.—


5 mg per 5 mL (Rx) [Prelone (alcohol £0.4%){21}]


15 mg per 5 mL (Rx) [Prelone (alcohol 5%){21}][Generic]{84}

Canada—
Not commercially available.

Packaging and storage:
Store between 15 and 30 °C (59 and 86 °F), {21} unless otherwise specified by manufacturer. Store in a tight container. {21} {57} Protect from light {57} and from freezing.

Auxiliary labeling:
   • Do not refrigerate. {21}

Note: Dispense with a calibrated measuring device. {21}



PREDNISOLONE TABLETS USP

Usual adult and adolescent dose
See Prednisolone Syrup USP.

Usual adult prescribing limits
See Prednisolone Syrup USP.

Usual pediatric dose
See Prednisolone Syrup USP.

Strength(s) usually available
U.S.—


5 mg (Rx) [Cotolone{62}] [Delta-Cortef (scored)][Generic]{62}

Canada—
Not commercially available.

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F). Store in a well-closed container. {57}


PREDNISOLONE SODIUM PHOSPHATE ORAL SOLUTION

Note: The dosing and strength of the dosage form available is expressed in terms of prednisolone base (not the sodium phosphate salt).


Usual adult and adolescent dose
Corticosteroid
Oral, 5 to 60 mg (base) a day as a single dose or in divided doses. {20}

Multiple sclerosis, acute exacerbations of
Oral, 200 mg a day for one week, followed by 80 mg every other day for one month. {19}


Usual adult prescribing limits
250 mg a day.

Usual pediatric dose
Adrenocortical insufficiency
Oral, 0.14 mg (base) per kg of body weight or 4 mg per square meter of body surface area a day in three divided doses.

Other indications
Oral, 0.5 to 2 mg per kg of body weight or 15 to 60 mg per square meter of body surface area a day in three or four divided doses.


Strength(s) usually available
U.S.—


5 mg (base) per 5 mL (Rx) [Pediapred (sorbitol){19}]

Canada—


5 mg (base) per 5 mL (Rx) [Pediapred (sorbitol){20}]

Packaging and storage:
Store between 15 and 30 °C (59 and 86 °F), {20} unless otherwise specified by manufacturer. Protect from freezing.

Auxiliary labeling:
   • Keep container tightly closed. {20}



Parenteral Dosage Forms

PREDNISOLONE ACETATE INJECTABLE SUSPENSION USP{15}

Usual adult and adolescent dose
Corticosteroid
Intra-articular, intralesional, or soft-tissue injection, 4 to 100 mg, repeated as needed.

Intramuscular, 4 to 60 mg a day.


Usual pediatric dose
Adrenocortical insufficiency
Intramuscular, 0.14 mg per kg of body weight or 4 mg per square meter of body surface area a day (in three divided doses) every third day; or 0.046 to 0.07 mg per kg of body weight or 1.33 to 2 mg per square meter of body surface area once a day.

Other indications
Intramuscular, 0.17 to 1 mg per kg of body weight or 5 to 30 mg per square meter of body surface area every twelve to twenty-four hours.


Strength(s) usually available
U.S.—


25 mg per mL (Rx) [Cotolone{62}] [Key-Pred{62}] [Predcor-25][Generic]{62}


50 mg per mL (Rx) [Articulose-50 (benzyl alcohol)] [Cotolone{62}] [Key-Pred{62}] [Predacort 50{62}] [Pred-Ject-50{62}] [Predalone 50{62}] [Predate-50{62}] [Predcor-50][Generic]{62}

Canada—
Not commercially available.

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Protect from freezing.

Auxiliary labeling:
   • Shake well.

Additional information:
Do not administer this medication intravenously.


PREDNISOLONE ACETATE AND PREDNISOLONE SODIUM PHOSPHATE INJECTABLE SUSPENSION

Usual adult and adolescent dose
Corticosteroid
Intra-articular, intramuscular, or intrasynovial, 20 to 80 mg of prednisolone acetate and 5 to 20 mg of prednisolone sodium phosphate, repeated at three-day to four-week intervals, if necessary.


Usual pediatric dose
Dosage has not been established.

Strength(s) usually available
U.S.—


80 mg of prednisolone acetate and 20 mg of prednisolone sodium phosphate per mL (Rx)[Generic]

Canada—
Not commercially available.

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Protect from light. Protect from freezing.

Auxiliary labeling:
   • Shake well.

Additional information:
Do not administer this medication intravenously.


PREDNISOLONE SODIUM PHOSPHATE INJECTION USP

Note: The dosing and strength of the dosage form available is expressed in terms of prednisolone phosphate.


Usual adult and adolescent dose
Corticosteroid
Intra-articular, intralesional, or soft-tissue injection, 2 to 30 mg (prednisolone phosphate), repeated at three-day to three-week intervals, if necessary.

Intramuscular or intravenous, 4 to 60 mg a day.


Usual pediatric dose
Adrenocortical insufficiency
Intramuscular, 0.14 mg (prednisolone phosphate) per kg of body weight or 4 mg per square meter of body surface area a day (in three divided doses) every third day; or 0.046 to 0.07 mg per kg of body weight or 1.33 to 2 mg per square meter of body surface area once a day.

Other indications
Intramuscular, 0.17 to 1 mg per kg of body weight or 5 to 30 mg per square meter of body surface area every twelve to twenty-four hours.


Strength(s) usually available
U.S.—


20 mg (phosphate) per mL (Rx) [Key-Pred SP (sodium bisulfite )] [Predate S] [Predicort-RP (sodium bisulfite)][Generic]{62}

Canada—
Not commercially available.

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Protect from light. {57} Protect from freezing.

Preparation of dosage form:
For preparation and administration of injections, see manufacturer's labeling.

Stability:
This medication is heat-sensitive and should not be autoclaved.


PREDNISOLONE TEBUTATE INJECTABLE SUSPENSION USP{15}

Usual adult and adolescent dose
Corticosteroid
Intra-articular, intralesional, or soft-tissue injection, 4 to 40 mg, repeated at two- to three-week intervals, if necessary.


Note: Severe conditions may require doses at one-week intervals.


Usual pediatric dose
Dosage has not been established.

Strength(s) usually available
U.S.—


20 mg per mL (Rx) [Nor-Pred T.B.A. (benzyl alcohol)] [Predalone T.B.A. ( benzyl alcohol)] [Predate TBA] [Predcor-TBA (benzyl alcohol)]

Canada—
Not commercially available.

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), protected from light, unless otherwise specified by manufacturer. Protect from freezing.

Preparation of dosage form:
For preparation and administration of injections, see manufacturer's labeling.

Stability:
For concurrent use of a parenteral-local anesthetic, withdraw the required quantity of corticosteroid suspension into a syringe, then add the local anesthetic. Do not introduce the local anesthetic directly into the multiple-dose vial. Also, the mixture should be injected immediately and any unused portion discarded.

This medication is heat-sensitive and should not be autoclaved.

Auxiliary labeling:
   • Shake well.


Caution:
Use of preparations containing benzyl alcohol is not recommended in neonates. A fatal toxic syndrome consisting of metabolic acidosis, central nervous system (CNS) depression, respiratory problems, renal failure, hypotension, and possibly seizures and intracranial hemorrhages has been associated with this use.

Additional information:
Do not administer this medication intravenously.


PREDNISONE


Oral Dosage Forms

Note: Bracketed uses in the Dosage Forms section refer to categories of use and/or indications that are not included in U.S. product labeling.

PREDNISONE ORAL SOLUTION USP

Usual adult and adolescent dose
Corticosteroid
Oral, 5 to 60 mg a day as a single dose or in divided doses. {46} {47} {48}

Congenital adrenal hyperplasia
Oral, 5 to 10 mg a day as a single dose.

Multiple sclerosis, acute exacerbations of
Oral, 200 mg a day for one week, followed by 80 mg every other day for one month. {48}

[Pneumonia, Pneumocystis carinii, associated with AIDS, adjunctive treatment]1
Oral, 40 mg two times a day on days one through five, 40 mg once a day on days six through ten, and 20 mg once a day on days eleven through twenty-one. {68} {70} {71} {77}


Usual adult prescribing limits
250 mg a day.

Usual pediatric dose
Carditis, rheumatic [ or nonrheumatic]1, acute or
Leukemia or
Tumors
Oral, 0.5 mg per kg of body weight or 15 mg per square meter of body surface area four times a day for two to three weeks; then 0.38 mg per kg of body weight or 11.25 mg per square meter of body surface area four times a day for four to six weeks.

Congenital adrenal hyperplasia
Oral, 5 mg per square meter of body surface area a day in two divided doses.

Nephrotic syndrome
Children up to 18 months of age: Dosage has not been established.

Children 18 months to 4 years of age: Oral, initially 7.5 to 10 mg four times a day.

Children 4 to 10 years of age: Oral, initially 15 mg four times a day.

Children 10 years of age or older: Oral, initially 20 mg four times a day.

Tuberculosis (with concurrent antitubercular therapy)
Oral, 0.5 mg per kg of body weight or 15 mg per square meter of body surface area four times a day for two months.

[Pneumonia, Pneumocystis carinii, associated with AIDS, adjunctive treatment]1
Children up to 14 years of age: Dosage has not been established. {68} {77}

Children 14 years of age or older: See Usual adult and adolescent dose. {68} {77}


Strength(s) usually available
U.S.—


5 mg per 5 mL (Rx)[Generic](alcohol 5%)


5 mg per mL (Rx) [Predisone Intensol (alcohol 30%)]

Canada—
Not commercially available.

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), in a light-resistant container, unless otherwise specified by manufacturer. Store in a tight container. {57} Protect from freezing.


PREDNISONE SYRUP USP

Usual adult and adolescent dose
See Prednisone Oral Solution USP.

Usual adult prescribing limits
See Prednisone Oral Solution USP.

Usual pediatric dose
See Prednisone Oral Solution USP.

Strength(s) usually available
U.S.—


5 mg per 5 mL (Rx) [Liquid Pred (alcohol 5%) (saccharin) (sorbitol){62}]

Canada—
Not commercially available.

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), in a light-resistant container, unless otherwise specified by manufacturer. Store in a tight container. {57} Protect from freezing.


PREDNISONE TABLETS USP

Usual adult and adolescent dose
See Prednisone Oral Solution USP.

Usual adult prescribing limits
See Prednisone Oral Solution USP.

Usual pediatric dose
See Prednisone Oral Solution USP.

Strength(s) usually available
U.S.—


1 mg (Rx) [Meticorten{62}] [Orasone 1 (scored){62}][Generic] (scored)


2.5 mg (Rx) [Deltasone (scored){48}][Generic] (scored)


5 mg (Rx) [Deltasone (scored){48}] [Orasone 5 (scored){62}] [Prednicot{62}] [Pred-Pak 45{62}] [Pred-Pak 79{62}] [Sterapred{62}][Generic] (scored)


10 mg (Rx) [Deltasone (scored){48}] [Orasone 10 (scored){62}] [Prednicot{62}] [Sterapred DS (scored){62}][Generic] (scored)


20 mg (Rx) [Cordrol{62}] [Deltasone ( scored){48}] [Orasone 20 (scored){62}] [Prednicot{62}][Generic] (scored)


50 mg (Rx) [Deltasone (scored){48}] [Orasone 50 (scored){62}][Generic] (scored)

Canada—


1 mg (Rx) [Apo-Prednisone{85}] [Winpred{86}]


5 mg (Rx) [Apo-Prednisone (scored){85}] [Deltasone (scored){47}][Generic] ( scored)


50 mg (Rx) [Apo-Prednisone (scored){85}] [Deltasone (scored){47}]

Packaging and storage:
Store between 20 and 25 °C (68 and 77 °F), {48} unless otherwise specified by manufacturer. Store in a well-closed container. {57}


TRIAMCINOLONE


Oral Dosage Forms

Note: Bracketed uses in the Dosage Forms section refer to categories of use and/or indications that are not included in U.S. product labeling.

TRIAMCINOLONE TABLETS USP

Usual adult and adolescent dose
Allergic disorders
Oral, 8 to 16 mg a day to achieve control within twenty-four to forty-eight hours. {49}

Arthritis, rheumatoid
Initial: Oral, 8 to 16 mg a day for two to seven days. {49}

Maintenance: Oral, 2 to 16 mg a day. {49}

Bursitis, acute
Oral, initially 2 to 16 mg a day; dosage may then be adjusted based on patient response. {49}

Dermatoses, inflammatory
Initial: Oral, 8 to 16 mg a day. {49}

Maintenance: Oral, 1 to 2 mg a day. {49}

Lupus erythematosus, disseminated
Initial: Oral, 20 to 30 mg a day. {49}

Maintenance: Oral, 3 to 30 mg a day {49}.

Neoplastic disease
Oral, initially 16 to 40 mg a day; dosage may then be adjusted based on patient response. {49}

Nephrotic syndrome
Oral, 16 to 20 mg a day until diuresis occurs. Dosage should be gradually tapered and discontinued when remission occurs. {49}

Rhinitis, allergic, perennial or seasonal, severe
Initial: Oral, 8 to 12 mg a day. {49}

Maintenance: Oral, 2 to 6 mg a day. {49}

[Emphysema, pulmonary] or
[Fibrosis, idiopathic pulmonary (Hamman-Rich syndrome)]
Initial: Oral, 8 to 12 mg a day. {49}

Maintenance: 2 to 4 mg a day. {49}

[Rheumatic fever]
Initial: Oral, 16 to 20 mg a day. {49}

Maintenance: Oral, 6 to 20 mg a day. {49}

Other indications
Oral, initially 8 to 20 mg a day in three or four divided doses. When a satisfactory response is obtained, the dose should be reduced by decrements of 2 mg every two to three days until the lowest dose that maintains the desired effect is reached. {49}


Usual pediatric dose
Adrenocortical insufficiency
Oral, 0.12 mg per kg of body weight or 3.3 mg per square meter of body surface area a day as a single dose or in divided doses.

Neoplastic disease
Oral, initially 1 to 2 mg per kg of body weight a day; dosage may then be adjusted based on patient response. {49}

Other indications
Oral, 0.42 to 1.7 mg per kg of body weight or 12.5 to 50 mg per square meter of body surface area a day as a single dose or in divided doses.

Note: Some pediatric patients with neoplastic disease (acute leukemia) may require initial doses as high as 2 mg per kg of body weight per day.



Strength(s) usually available
U.S.—


1 mg (Rx) [Aristocort (scored){62}]


4 mg (Rx) [Aristocort (scored){62}] [Aristopak{62}] [Kenacort][Generic]{62}


8 mg (Rx) [Aristocort (scored){62}] [Kenacort ( scored) (tartrazine)]


16 mg (Rx) [Aristocort (scored)]

Canada—


2 mg (Rx) [Aristocort (scored){49}]


4 mg (Rx) [Aristocort (scored){49}] [Kenacort ( scored)]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F). Store in a well-closed container.


TRIAMCINOLONE DIACETATE SYRUP USP

Note: The dosing and strength of the dosage forms available are expressed in terms of triamcinolone base (not the diacetate salt).


Usual adult and adolescent dose
Adrenocortical insufficiency
Oral, 4 to 12 mg (base) a day as a single dose or in divided doses.

Other indications
Oral, 4 to 48 mg a day as a single dose or in divided doses.

Note: After an initial response has been attained, this medication may be administered on an intermittent schedule. An example of this schedule is as follows: three or four days of medication followed by three medication-free days.
In some patients (e.g., those with systemic lupus erythematosus, acute rheumatic carditis, or certain hematologic disorders), initial doses as high as 60 mg per day may be required.



Usual pediatric dose
Adrenocortical insufficiency
Oral, 0.12 mg (base) per kg of body weight or 3.3 mg per square meter of body surface area a day as a single dose or in divided doses.

Other indications
Oral, 0.42 to 1.7 mg per kg of body weight or 12.5 to 50 mg per square meter of body surface area a day as a single dose or in divided doses.

Note: Some pediatric patients with neoplastic disease (acute leukemia) may require initial doses as high as 2 mg per kg of body weight per day.



Strength(s) usually available
U.S.—


2 mg (diacetate) per 5 mL (Rx) [Aristocort]


4.85 mg anhydrous diacetate (4 mg base) per 5 mL (Rx) [Kenacort Diacetate]

Canada—


2 mg (diacetate) per 5 mL (Rx) [Aristocort]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a tight, light-resistant container. Protect from freezing.



Parenteral Dosage Forms

TRIAMCINOLONE ACETONIDE INJECTABLE SUSPENSION USP{15}

Usual adult and adolescent dose
Corticosteroid
Intra-articular, intrabursal, or tendon-sheath injection, 2.5 to 15 mg. {50} {51} Dosage may then be adjusted to 10 to 80 mg a day, as necessary. {51}

Intradermal or intralesional, up to 1 mg per injection site, repeated at one-week or less frequent intervals, if necessary. {50}

Intramuscular, initially 2.5 to 60 mg a day. Dosage may then be adjusted to 20 to 80 mg a day, as necessary. {51}

Rhinitis, allergic, perennial or seasonal
Intramuscular, 40 to 100 mg as a single dose. {51}


Usual pediatric dose
Corticosteroid


Children up to 6 years of age:
Use is not recommended. {51}



Children 6 to 12 years of age:
Intra-articular, intrabursal, or tendon-sheath injection, 2.5 to 15 mg, repeated as needed.

Intramuscular, 40 mg, {51} repeated at four-week intervals if necessary; or 0.03 to 0.2 mg per kg of body weight or 1 to 6.25 mg per square meter of body surface area, repeated at one- to seven-day intervals.



Strength(s) usually available
U.S.—


3 mg per mL (Rx) [Tac-3{23}]


10 mg per mL (Rx) [Kenalog-10 (benzyl alcohol 0.9%){62}]


40 mg per mL (Rx) [Clinalog{62}] [Cinonide 40] [Kenaject-40 (benzyl alcohol ){62}] [Kenalog-40 (benzyl alcohol 0.9%){62}] [Ken-Jec 40{62}] [Robalog{62}] [Triam-A (benzyl alcohol){62}] [Triamonide 40 (benzyl alcohol)] [Tri-Kort (benzyl alcohol)] [Trilog (benzyl alcohol)][Generic]{62}

Canada—


10 mg per mL (Rx) [Kenalog-10 (benzyl alcohol){50}]


40 mg per mL (Rx) [Kenalog-40 (benzyl alcohol){51}] [Scheinpharm Triamcine-A (benzyl alcohol 0.9%){22}]

Packaging and storage:
Store between 15 and 30 °C (59 and 86 °F), {22} {50} {51} unless otherwise specified by manufacturer. Protect from light. {15} {50} {51} Protect from freezing. {50} {51}

Preparation of dosage form:
For preparation and administration of injections, see manufacturer's labeling.

Auxiliary labeling:
   • Shake well. {50} {51}


Caution:
Use of preparations containing benzyl alcohol is not recommended in neonates. A fatal toxic syndrome consisting of metabolic acidosis, central nervous system (CNS) depression, respiratory problems, renal failure, hypotension, and possibly seizures and intracranial hemorrhages has been associated with this use.

Additional information:
Do not administer this medication intravenously.

Do not administer the 10-mg-per-mL strength intramuscularly.

Do not administer the 40-mg-per-mL strength intradermally or intralesionally.


TRIAMCINOLONE DIACETATE INJECTABLE SUSPENSION USP{15}

Usual adult and adolescent dose
Corticosteroid
Intra-articular, intrasynovial, intralesional, sublesional, or soft-tissue injection, 3 to 48 mg, repeated at one- to eight-week intervals, if necessary.

Intramuscular, 40 mg once a week. Alternatively, a dose equal to four to seven times the predetermined oral daily dose may be administered as a single injection and repeated at four-day to four-week intervals as required.


Usual pediatric dose
Corticosteroid
Children up to 6 years of age—Use is not recommended.

Children 6 to 12 years of age—Intramuscular, 40 mg once a week.


Strength(s) usually available
U.S.—


25 mg per mL (Rx) [Aristocort (benzyl alcohol 0.9%){52}]


40 mg per mL (Rx) [Acetocot{62}] [Amcort (benzyl alcohol){62}] [Aristocort Forte (benzyl alcohol 0.9%){53}] [Articulose-L.A. (benzyl alcohol )] [Cinalone 40{62}] [Clinacort{62}] [Tramacort-D{62}] [Triam-Forte (benzyl alcohol){62}] [Triamolone 40 (benzyl alcohol)] [Trilone] [Tristoject (benzyl alcohol){62}][Generic]{62}

Canada—


25 mg per mL (Rx) [Aristocort Intralesional]


40 mg per mL (Rx) [Aristocort Forte][Generic]

Packaging and storage:
Store between 15 and 30 °C (59 and 86 °F), {52} {53} unless otherwise specified by manufacturer. Protect from freezing. {52} {53}

Preparation of dosage form:
For preparation and administration of injections, see manufacturer's labeling.

Stability:
Admixtures containing local anesthetics will retain their potency for one full week.

Incompatibilities:
This medication should not be mixed with parenteral-local anesthetic formulations containing preservatives such as parabens or phenol because flocculation of the corticosteroid may occur.

Auxiliary labeling:
   • Shake well.


Caution:
Use of preparations containing benzyl alcohol is not recommended in neonates. A fatal toxic syndrome consisting of metabolic acidosis, central nervous system (CNS) depression, respiratory problems, renal failure, hypotension, and possibly seizures and intracranial hemorrhages has been associated with this use.

Additional information:
Do not administer this medication intravenously. {52} {53}


TRIAMCINOLONE HEXACETONIDE INJECTABLE SUSPENSION USP{15}

Usual adult and adolescent dose
Corticosteroid
Intra-articular, 2 to 20 mg, repeated at three- or four-week intervals, if necessary. {54}

Intralesional or sublesional, up to 0.5 mg per square inch of affected skin, repeated as needed.


Usual pediatric dose
Dosage has not been established.

Strength(s) usually available
U.S.—


20 mg per mL (Rx) [Aristospan (benzyl alcohol 0.9%){24}]

Canada—


20 mg per mL (Rx) [Aristospan (benzyl alcohol 0.9%){54}]

Packaging and storage:
Store between 15 and 30 °C (59 and 86 °F), {24} unless otherwise specified by manufacturer. Protect from freezing. {24}

Preparation of dosage form:
For preparation and administration of injections, see manufacturer's labeling.

Stability:
Admixtures containing local anesthetics will retain their potency for one full week.

Incompatibilities:
This medication should not be mixed with parenteral-local anesthetic formulations containing parabens, phenol, or other such preservatives because flocculation of the corticosteroid may occur.

Auxiliary labeling:
   • Shake well. {54}


Caution:
Use of preparations containing benzyl alcohol is not recommended in neonates. A fatal toxic syndrome consisting of metabolic acidosis, central nervous system (CNS) depression, respiratory problems, renal failure, hypotension, and possibly seizures and intracranial hemorrhages has been associated with this use.

Additional information:
Do not administer this medication intravenously. {54}

The 5-mg-per-mL strength is recommended for intralesional and sublesional injections only.

The 20-mg-per-mL strength is recommended for intra-articular injection only.



Revised: 02/20/2003



References
  1. Betamethasone syrup package insert (Celestone, Schering), Rev 10/95, Rec 04/08/99.
  1. PI Celestone Phosphate injection Rev. 7/83. PDR 87-same as 88.
  1. Betamethasone sodium phosphate and betamethasone acetate injectable suspension package insert (Celestone Soluspan, Schering), Rev 03/96, Rec 04/08/99.
  1. Cortisone acetate injectable suspension (Cortone, Merck). In: PDR Physicians' desk reference. 53rd ed. 1999. Montvale, NJ: Medical Economics Company; 1999. p. 1753-4.
  1. Corticsone acetate tablets (Cortone, Merck). In: PDR Physicians' desk reference. 53rd ed. 1999. Montvale, NJ: Medical Economics Company; 1999. p. 1754-6.
  1. Dexamethasone elixir (Decadron Elixir, Merck). In: PDR Physicians' desk reference. 53rd ed. 1999. Montvale, NJ: Medical Economics Company; 1999. p. 1769-71.
  1. Dexamethasone tablets (Decadron Tablets, Merck). In: PDR Physicians' desk reference. 53rd ed. 1999. Montvale, NJ: Medical Economics Company; 1999. p. 1771-3.
  1. Dexamethasone sodium phosphate injection (Decadron Phosphate Injection, Merck). In: PDR Physicians' desk reference. 53rd ed. 1999. Montvale, NJ: Medical Economics Company; 1999. p. 1773-5.
  1. Dexamethasone acetate injectable suspension (Decadron-LA, Merck). In: PDR Physicians' desk reference. 53rd ed. 1999. Montvale, NJ: Medical Economics Company; 1999. p. 1779-80.
  1. Hydrocortisone acetate injectable suspension (Hydrocortone, Merck). In: PDR Physicians' desk reference. 53rd ed. 1999. Montvale, NJ: Medical Economics Company; 1999. p. 1800-1.
  1. Hydrocortisone tablets (Hydrocortone, Merck). In: PDR Physicians' desk reference. 53rd ed. 1999. Montvale, NJ: Medical Economics Company; 1999. p. 1803-5.
  1. Hydrocortisone sodium phosphate injection (Hydrocortone Phosphate, Merck). In: PDR Physicians' desk reference. 53rd ed. 1999. Montvale, NJ: Medical Economics Company; 1999. p. 1801-3.
  1. Hydrocortisone sodium succinate for injection (Solu-Cortef, Pharmacia & Upjohn). In: Gillis MC, editor. CPS Compendium of pharmaceuticals and specialties. 34th ed. Ottawa: Canadian Pharmacists Association; 1999. p. 1669-71.
  1. Canada JR, editor. USP dictionary of USAN and international drug names 1998. Rockville, MD: The United States Pharmacopeial Convention Inc; 1997. p. 94, 112-3, 194, 222, 361-2, 465-6, 598-9, 753.
  1. The United States pharmacopeia. The national formulary. USP 23rd revision (January 1, 1995). NF 18th ed (January 1, 1995). Rockville, MD: The United States Pharmacopeial Convention, Inc; 1995 (6th supplement, 1997). p. 3654-5, 3667, 3679-80, 3698-9, 3725-6, 3735-6.
  1. Methylprednisolone tablets (Medrol, Pharmacia & Upjohn). In: PDR Physicians' desk reference. 53rd ed. 1999. Montvale, NJ: Medical Economics Company; 1999. p. 2495.
  1. Methylprednisolone acetate injectable suspension (Depo-Medrol, Pharmacia & Upjohn). In: PDR Physicians' desk reference. 53rd ed. 1999. Montvale, NJ: Medical Economics Company; 1999. p. 2472.
  1. Methylpredisolone sodium succinate for injection (Solu-Medrol, Pharmacia & Upjohn). In: PDR Physicians' desk reference. 53rd ed. 1999. Montvale, NJ: Medical Economics Company; 1999. p. 2511-3.
  1. Prednisolone sodium phosphate oral solution package insert (Pediapred, Medeva—US), Rev 08/96, Rec 04/15/99.
  1. Prednisolone sodium phosphate oral solution (Pediapred, Rhône-Poulenc Rorer). In: Gillis MC, editor. CPS Compendium of pharmaceuticals and specialties. 34th ed. Ottawa: Canadian Pharmacists Association; 1999. p. 1358-60.
  1. Prednisolone syrup package insert (Prelone, Muro), Rev 05/98, Rec 08/20/98.
  1. Triamcinolone acetonide injectable suspension (Scheinpharm Triamcine-A, Schein). In: Gillis MC, editor. CPS Compendium of pharmaceuticals and specialties. 34th ed. Ottawa: Canadian Pharmacists Association; 1999. p. 1617.
  1. Triamcinolone acetonide injectable suspension (Tac-3, Parnell). In: PDR Physicians' desk reference. 53rd ed. 1999. Montvale, NJ: Medical Economics Company; 1999. p. 2315-6.
  1. Triamcinolone hexacetonide injectable suspension (Aristospan, Fujisawa). In: PDR Physicians' desk reference. 53rd ed. 1999. Montvale, NJ: Medical Economics Company; 1999. p. 1040-1.
  1. Dexamethasone tablets/oral solution package insert (Roxane—US), Rev 03/98, Rec 04/19/99.
  1. Methylprednisolne acetate injectable suspension (Depo-Medrol, Pharmacia & Upjohn). In: Gillis MC, editor. CPS Compendium of pharmaceuticals and specialties. 34th ed. Ottawa: Canadian Pharmacists Association; 1999. p. 482-4.
  1. Betamethasone tablets package insert (Celestone, Schering—US), Rev 10/95, Rec 04/08/99.
  1. Methylprednisolone tablets package insert (Duramed—US), Rev 09/96, Rec 08/15/97.
  1. Budesonide capsules product monograph (Entocort, Astra Pharma—Canada), Rev 06/22/98, Rec 07/21/98.
  1. Cortisone acetate injectable suspension (Cortone Suspension, Merck Sharp & Dohme Canada). In: Gillis MC, editor. CPS Compendium of pharmaceuticals and specialties. 34th ed. Ottawa: Canadian Pharmacists Association; 1999. p. 409-10.
  1. Cortisone acetate tablets (Cortone Tablets, Merck Sharp & Dohme Canada). In: Gillis MC, editor. CPS Compendium of pharmaceuticals and specialties. 34th ed. Ottawa: Canadian Pharmacists Association; 1999. p. 410-2.
  1. The United States pharmacopeia. The national formulary. USP 23rd revision (January 1, 1995). NF 18th ed (January 1, 1995). Rockville, MD: The United States Pharmacopeial Convention, Inc; 1995 (10th supplement, 1999). p. 4809.
  1. Dexamethasone sodium phosphate injection (Decadron Phosphate, Merck Sharp & Dohme). In: Gillis MC, editor. CPS Compendium of pharmaceuticals and specialties. 34th ed. Ottawa: Canadian Pharmacists Association; 1999. p. 463-6.
  1. Dexamethasone tablets (Decadron Tablets, Merck Sharp & Dohme). In: Gillis MC, editor. CPS Compendium of pharmaceuticals and specialties. 34th ed. Ottawa: Canadian Pharmacists Association; 1999. p. 466-7.
  1. Dexamethasone tablets (Dexasone, ICN). In: Gillis MC, editor. CPS Compendium of pharmaceuticals and specialties. 34th ed. Ottawa: Canadian Pharmacists Association; 1999. p. 494.
  1. Hydrocortisone tablets (Cortef, Pharmacia & Upjohn). In: Gillis MC, editor. CPS Compendium of pharmaceuticals and specialties. 34th ed. Ottawa: Canadian Pharmacists Association; 1999. p. 399-400.
  1. Hydrocortisone tablets package insert (West-ward—US), Rev 06/94, Rec 09/01/98.
  1. Personal communication, 04/05/99.
  1. Betamethasone sodium phosphate and betamethasone acetate injectable suspension (Celestone Soluspan, Schering). In: Gillis MC, editor. CPS Compendium of pharmaceuticals and specialties. 34th ed. Ottawa: Canadian Pharmacists Association; 1999. p. 316.
  1. Hydrocortisone tablets package insert (Cortef, Pharmacia & Upjohn—US), Rev 09/97, Rec 04/21/99.
  1. Methylprednisolone tablets package insert (Invamed—US), Rev 09/97, Rec 10/15/98.
  1. Methylprednisolone (Medrol, Pharmacia & Upjohn). In: Gillis MC, editor. CPS Compendium of pharmaceuticals and specialties. 34th ed. Ottawa: Canadian Pharmacists Association; 1999. p. 1013-4.
  1. Methylprednisolone sodium succinate for injection package insert (A-MethaPred, Abbott—US), Rev 1994, Rec 04/15/99.
  1. Hydrocortisone cypionate oral suspension package insert (Cortef, Pharmacia & Upjohn—US), Rev 02/98, Rec 04/21/99.
  1. Methylprednisolone sodium succinate for injection (Solu-Medrol, Pharmacia & Upjohn). In: Gillis MC, editor. CPS Compendium of pharmaceuticals and specialties. 34th ed. Ottawa: Canadian Pharmacists Association; 1999. p. 1671-3.
  1. Prednisone tablets package insert (Lannett—US), Rev 10/95, Rec 12/16/96.
  1. Prednisone tablets (Deltasone, Pharmacia & Upjohn). In: Gillis MC, editor. CPS Compendium of pharmaceuticals and specialties. 34th ed. Ottawa: Canadian Pharmacists Association; 1999. p. 471-2.
  1. Prednisone tablets package insert (Deltasone, Pharmacia & Upjohn—US), Rev 08/97, Rec 04/21/99.
  1. Triamcinolone tablets (Aristocort, Stiefel/Glades). In: Gillis MC, editor. CPS Compendium of pharmaceuticals and specialties. 34th ed. Ottawa: Canadian Pharmacists Association; 1999. p. 155-6.
  1. Triamcinolone acetonide injectable suspension (Kenalog-10, Westwood-Squibb). In: Gillis MC, editor. CPS Compendium of pharmaceuticals and specialties. 34th ed. Ottawa: Canadian Pharmacists Association; 1999. p. 887-9.
  1. Triamcinolone acetonide injectable suspension (Kenalog-40, Westwood-Squibb). In: Gillis MC, editor. CPS Compendium of pharmaceuticals and specialties. 34th ed. Ottawa: Canadian Pharmacists Association; 1999. p. 889-90.
  1. Triamcinolone diacetate injectable suspension (Aristocort, Fujisawa). In: PDR Physicians' desk reference. 53rd ed. 1999. Montvale, NJ: Medical Economics Company; 1999. p. 1039.
  1. Triamcinolone diacetate injectable suspension (Aristocort Forte, Fujisawa). In: PDR Physicians' desk reference. 53rd ed. 1999. Montvale, NJ: Medical Economics Company; 1999. p. 1039-40.
  1. Triamcinolone hexacetonide injectable suspension (Aristospan, Stiefel/Glades). In: Gillis MC, editor. CPS Compendium of pharmaceuticals and specialties. 34th ed. Ottawa: Canadian Pharmacists Association; 1999. p. 156-7.
  1. Panel ballot, 06/06/90.
  1. Cortisone acetate tablets (Cortisone Acetate-ICN, ICN). In: Gillis MC, editor. CPS Compendium of pharmaceuticals and specialties. 34th ed. Ottawa: Canadian Pharmacists Association; 1999. p. 407.
  1. The United States pharmacopeia. The national formulary. USP 23rd revision (January 1, 1995). NF 18th ed (January 1, 1995). Rockville, MD: The United States Pharmacopeial Convention Inc; 1995. p. 187-8, 429-30, 469-75, 756-7, 764-5, 1004, 1278-9, 1282-3, 1285-6.
  1. Betamethasone sodium phosphate enema/eye and ear drops/tablets (Betnesol, Roberts). In: Gillis MC, editor. CPS Compendium of pharmaceuticals and specialties. 34th ed. Ottawa: Canadian Pharmacists Association; 1999. p. 226-7.
  1. Cortisone acetate tablets package insert (West-ward—US), Rev 03/95, Rec 09/01/98.
  1. Dexamethasone sodium phosphate injection (Hexadrol Phosphate Injection, Organon Teknika). In: Gillis MC, editor. CPS Compendium of pharmaceuticals and specialties. 34th ed. Ottawa: Canadian Pharmacists Association; 1999. p. 763-4.
  1. Betamethasone tablets (Celestone, Schering). In: Gillis MC, editor. CPS Compendium of pharmaceuticals and specialties. 34th ed. Ottawa: Canadian Pharmacists Association; 1999. p. 315-6.
  1. Cardinale V, editor. 1998 drug topics red book. Montvale, NJ: Medical Economics Company Inc; 1997. p. 136, 150, 171, 233, 236, 246, 248, 256, 258-9, 262, 265, 352, 376-8, 388, 404, 409, 412, 414-5, 454, 491-2, 496, 517, 539, 568, 571-3, 578.
  1. The United States pharmacopeia. The national formulary. USP 23rd revision (January 1, 1995). NF 18th ed (January 1, 1995). Rockville, MD: The United States Pharmacopeial Convention, Inc; 1995 (7th supplement, 1997). p. 3880.
  1. Dexamethasone acetate injectable suspension (Dalalone D.P., Forest). In: PDR Physicians' desk reference. 53rd ed. 1999. Montvale, NJ: Medical Economics Company; 1999. p. 1020.
  1. Markham A, Sorkin EM. Ondansetron: an update of its therapeutic use in chemotherapy-induced and postoperative nausea and vomiting. Drugs 1993; 45: 931-52.
  1. Bracken MD, et al. A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury: results of the second national acute spinal cord injury study. New Engl J Med 1990; 322(20): 405-11.
  1. Hydrocortisone sodium succinate for injection (A-Hydrocort, Abbott). In: Gillis MC, editor. CPS Compendium of pharmaceuticals and specialties. 34th ed. Ottawa: Canadian Pharmacists Association; 1999. p. 50.
  1. NIH-University of California Expert Panel for Corticosteroids as Adjunctive Therapy for Pneumocystis Pneumonia. Consensus statement on the use of corticosteroids as adjunctive therapy for pneumocystis pneumonia in the acquired immunodeficiency syndrome. New Engl J Med 1990 Nov 22; 323(21): 1500-4.
  1. Bozzette SA. The use of corticosteroids in Pneumocystis carinii pneumonia [commentary]. J Inf Dis 1990; 162: 1365-9.
  1. Gagnon S, Boota AM, Fischl MA, et al. Corticosteroids as adjunctive therapy for severe Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. New Engl J Med 1990 Nov 22; 323(21): 1444-50.
  1. Bozzette SA, et al. A controlled trial of early adjunctive treatment with corticosteroids for Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. New Engl J Med 1990 Nov 22; 323(21): 1451-7.
  1. Montaner JSG, Lawson LM, Levitt N, et al. Corticosteroids prevent early deterioration in patients with moderately severe Pneumocystis carinii pneumonia and the acquired immunodeficiency syndrome (AIDS). Ann Intern Med 1990; 113(1): 14-20.
  1. Kovacs JA. Are corticosteroids beneficial as adjunctive therapy for pneumocystis pneumonia in AIDS? [editorial]. Ann Intern Med 1990; 113(1):1-3.
  1. Mason GR. Corticosteroids for pneumocystis pneumonia [letter]. Ann Intern Med 1990; 113(10): 803-4.
  1. Montaner JSG, Schechter MT, Ruedy J. Corticosteroids for pneumocystis pneumonia [letter]. Ann Intern Med 1990; 113(10): 804.
  1. Clement M, Edison R, Turner J, et al. Corticosteroids as adjunctive therapy in severe Pneumocystis carinii pneumonia: a prospective placebo-controlled trial. Am Rev Respir Dis 1989; 139: Suppl; A250.
  1. Panel comments, 02/12/91.
  1. Panel comment, 02/12/91.
  1. Panel comment, 02/12/91.
  1. Reviewers' responses to Hematologic-Oncologic Advisory Panel Memo #9 of 01/30/97.
  1. Salmon SE, Cassady JR. Leukemias. Plasma cell neoplasms. In: DeVita VT, Hellman S, Rosenberg SA, editors. Cancer: principles and practice of oncology. 5th ed. Philadelphia: Lippincott-Raven Publishers; 1997. p. 2375-7.
  1. Plasma cell neoplasm. National Cancer Institute. Available from: URL: http://cancernet.nci.nih.gov
  1. Louis DN, Cavenee WK. Neoplasms of the central nervous system. In: DeVita VT, Hellman S, Rosenberg SA, editors. Cancer: principles and practice of oncology. 5th ed. Philadelphia: Lippincott-Raven Publishers; 1997. p. 2034-5.
  1. Prednisolone syrup (WE Pharmaceuticals). In: PDR Physicians' desk reference. 53rd ed. 1999. Montvale, NJ: Medical Economics Company; 1999. p. 3242.
  1. Prednisone tablets (Apo-Prednisone, Apotex). In: Gillis MC, editor. CPS Compendium of pharmaceuticals and specialties. 34th ed. Ottawa: Canadian Pharmacists Association; 1999. p. 137.
  1. Prednisone tablets (Winpred, ICN). In: Gillis MC, editor. CPS Compendium of pharmaceuticals and specialties. 34th ed. Ottawa: Canadian Pharmacists Association; 1999. p. 1966.
  1. Smith DB, Newlands ES, Rustin GJS, et al. Comparison of ondansetron and ondansetron plus dexamethasone as antiemetic prophylaxis during cisplatin-containing chemotherapy. Lancet 1991; 338: 487-90.
  1. Roila F, Tonato M, Cognetti F, et al. Prevention of cisplatin-induced emesis: a double-blind multicenter randomized crossover study comparing ondansetron and ondansetron plus dexamethasone. J Clin Oncol 1991; 9: 675-8.
  1. Smyth JF, Coleman RE, Nicolson M, et al. Does dexamethasone enhance control of cisplatin induced emesis by ondansetron? BMJ 1991; 303: 1423-6.
  1. Reviewers' consensus on the use of prednisone for the treatment of edema associated with brain cancer, 06/02/00.
  1. USP Expert Committees consensus on review of the ballot, 01/2002.
  1. Reviewers' consensus on ballot 1/18/2003.
  1. Sumboonnanonda A, Suwanjutha S, Sirinavin S. Randomized controlled trial of dexamethasone in infectious croup. J Med Assoc Thai 1997;80:262-5.
  1. Geelhoed GC, Turner J, Macdonald WBG. Efficacy of a small single dose of oral dexamethasone for outpatient croup: a double blind, placebo controlled clinical trial. BMJ 1996;313:140-2.
  1. Kunkel NC, Baker MD. Use of racemic epinephrine, dexamethasone, and mist in the outpatient management of croup. Pediatr Emerg Care 1996;12:156-9.
  1. Cruz MN, Stewart G, Rosenberg N. Use of dexamethasone in the outpatient management of acute laryngotracheitis. Pediatrics 1995;96:220-23.
  1. Geelhoed GC, Macdonald WBG. Oral dexamethasone in the treatment of croup: 0.15 mg/kg versus 0.3 mg/kg versus 0.6 mg/kg. Pediatr Pulmonol 1995;20:362-8.
  1. Super DM, Cartelli NA, Brooks LJ, et al. A prospective randomized double-blind study to evaluate the effect of dexamethasone in acute laryngotracheitis. J Pediatr 1989;115:323-9.
  1. Kuusela AL, Vesikari T. A randomized double-blind, placebo-controlled trail of dexamethasone and racemic epinephrine in the treatment of croup. Acta Paediatr Scand 1988;77:99-104.
  1. Roberts GW, Master VV, Staugas RE, et al. Repeated dose inhaled budesonide versus placebo in the treatment of croup. J Paediatr Child Health 1999;35:170-74.
  1. Godden CW, Campbell MJ, Hussey M, et al. Double blind placebo controlled trial of nebulized budesonide for croup. Arch Dis Child 1997;76:155-58.
  1. Johnson DW, Schuh S, Koren G, et al. Outpatient treatment of croup with nebulized dexamethasone. Arch Pediatr Adolesc Med 1996;150:349-55.
  1. Fitzgerald D, Mellis C, Johnson M, et al. Nebulized budesonide is as effective as nebulized adrenaline in moderately severe croup. Pediatrics 1996;97:722-25.
  1. Klassen TP, Watters LK, Feldman ME, et al. The efficacy of nebulized budesonide in dexamethasone-treated outpatients with croup. Pediatrics 19966;97:463-66.
  1. Klassen TP, Feldman ME, Watters LK. Nebulized budesonide for children with mild-to-moderate croup. N Engl J Med 1994;331:285-89.
  1. Husby S, Agertoft L, Mortensen S, et al. Treatment of croup with nebulized steroid (budesonide): a double blind, placebo controlled study. Arch Dis Child 1993;68:352-55.
  1. Luria JW, Gonzalez-del-Rey JA, DiGiulio GA, et al. Effectiveness of oral or nebulized dexamethasone for children with mild croup. Arch Pediatr Adolesc Med 2001;155:1340-45.
  1. Johnson DW, Jacobson S, Edney PC, et al. A comparison of nebulized budesonide, intramuscular dexamethasone, and placebo for moderately severe croup. N Engl J Med 1998;339:498-503.
  1. Rittichier KK, Ledwith CA. Outpatient treatment of moderate croup with dexamethasone: intramuscular versus oral dosing. Pediatrics 2000;106:1344-48.
  1. Klassen TP, Craig WR, Moher D, et al. Nebulized budesonide and oral dexamethasone for treatment of croup. JAMA 1998;279:1629-32.
  1. Geelhoed GC, Macdonald WBG. Oral and inhaled steroids in croup: a randomized, placebo-controlled trial. Pediatr Pulmonol 1995;20:355-61.
  1. Ausejo M, Saena A, Pham B, et al. The effectiveness of glucocorticoids in treating croup: meta-analysis. BMJ 1999;319:595-600.
  1. Kairys SW, Olmstead EM, O'Connor GT. Steroid treatment of laryngotracheitis: a meta-analysis f the evidence from randomized trials. Pediatrics 1989;83:683-93.
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