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Cortisone

Pronunciation
Cortisone Acetate

Pronunciation: CORE-tih-sone
Class: Glucocorticoids

Trade Names

Cortone Acetate
- Tablets 25 mg
- Injection 50 mg/mL

Pharmacology

As short-acting glucocorticoid; depresses formation, release, and activity of endogenous mediators of inflammation; has some salt-retaining properties.

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Pharmacokinetics

Distribution

Crosses the placenta and is excreted in breast milk.

Elimination

The t ½ is 30 min.

Indications and Usage

Treatment of primary or secondary adrenal cortex insufficiency; rheumatic disorders; collagen diseases; dermatologic diseases; allergic states; allergic and inflammatory ophthalmic processes; respiratory diseases; hematologic disorders; neoplastic diseases; edematous states (caused by nephrotic syndrome); GI diseases; multiple sclerosis; tuberculous meningitis; trichinosis with neurologic or myocardial involvement.

Contraindications

Systemic fungal infections; administration of live virus vaccines in patients receiving immunosuppressive doses.

Dosage and Administration

Adults

PO 25 to 300 mg/day. Use lowest possible effective dose.

Alternate-day therapy

Provides at least twice usual daily dosage of short- to intermediate-acting medication.

Adults

IM 20 to 300 mg/day. In less severe cases, less than 20 mg/day may be sufficient; in severe cases, more than 300 mg/day may be required.

Storage/Stability

Store at room temperature in tightly closed container. Protect from heat and freezing.

Drug Interactions

Anticholinesterases

Drug may antagonize anticholinesterase effects in myasthenia gravis.

Anticoagulants, oral

Drug may increase or decrease anticoagulant dose requirements.

Barbiturates

May decrease pharmacologic effect of cortisone.

Phenytoin

May decrease therapeutic efficacy of cortisone.

Rifampin

May decrease therapeutic efficacy of cortisone.

Salicylates

Drug may reduce serum levels and efficacy of salicylates.

Troleandomycin

May increase effects of cortisone.

Laboratory Test Interactions

False-negative nitroblue tetrazolium test.

Adverse Reactions

Cardiovascular

Thromboembolism or fat embolism; thrombophlebitis; necrotizing angiitis; cardiac arrhythmias or ECG changes; syncopal episodes; hypertension; myocardial rupture after recent MI; CHF.

CNS

Convulsions; increased intracranial pressure with papilledema; vertigo; headache; neuritis/paresthesias; psychosis; fatigue; insomnia.

Dermatologic

Impaired wound healing; petechiae and ecchymoses; erythema; lupus erythematosus–like lesions; suppression of skin test reactions; subcutaneous fat atrophy; purpura; hirsutism; acneiform eruptions; allergic dermatitis; urticaria; angioneurotic edema; perineal irritation; hyperpigmentation or hypopigmentation.

EENT

Cataracts; increased IOP; glaucoma; exophthalmos.

GI

Pancreatitis; abdominal distention; ulcerative esophagitis; nausea; vomiting; increased appetite and weight gain; peptic ulcer; small bowel and large bowel perforation, especially in inflammatory bowel disease.

Genitourinary

Increased or decreased motility and number of spermatozoa.

Hematologic

Leukocytosis.

Metabolic

Sodium and fluid retention; hypokalemia; hypokalemic alkalosis; metabolic alkalosis; increased serum cholesterol; hypocalcemia; hypothalamicpituitary-axis suppression; endocrine abnormalities (decreased T 3 , T 4 and 131 I uptake, menstrual irregularities, cushingoid state, growth suppression in children, increased sweating, decreased carbohydrate tolerance, hyperglycemia, glycosuria, increased insulin or sulfonylurea requirements, manifestations of latent diabetes mellitus, negative nitrogen balance because of protein catabolism, hirsutism).

Miscellaneous

Musculoskeletal effects (eg, muscle weakness, myopathy, tendon rupture, osteoporosis, aseptic necrosis of femoral and humeral heads, spontaneous fractures; anaphylactoid reactions; aggravation or masking of infections; malaise.

Precautions

Monitor

Adrenal insufficiency

Report signs of adrenal insufficiency to health care provider: fatigue, anorexia, nausea, vomiting, diarrhea, weight loss, weakness, and dizziness.

Cushingoid symptoms

Report signs of cushingoid symptoms to health care provider.

Need for dosage adjustment

Monitor patient closely for signs that might require dosage adjustments, including changes as a result of remissions or exacerbations of the disease, individual drug responsiveness, and the effect of stress.


Pregnancy

Pregnancy category undetermined.

Lactation

Excreted in breast milk.

Children

Observe growth and development of infants and children undergoing prolonged therapy.

Elderly

May require lower doses.

Hypersensitivity

Anaphylactoid reactions have occurred rarely.

Hepatic Function

Use cautiously.

Adrenal suppression

Prolonged therapy may lead to HPA suppression. Withdraw gradually after prolonged therapy.

CV disease

Use with caution in patients with recent MI.

Fluid and electrolyte balance

Drug can cause elevated BP, salt and water retention, increased potassium and calcium excretion. Dietary salt restriction and potassium supplementation may be necessary.

Hepatitis

Drug may be harmful in chronic active hepatitis that is positive for hepatitis B surface antigen.

Infections

Drug may mask signs of infection and decrease host-defense mechanisms that prevent dissemination of infection.

Ocular effects

Use cautiously in ocular herpes simplex because of possible corneal perforation.

Peptic ulcer

Drug may contribute to peptic ulceration, especially in large doses.

Stress

Increased dosage of rapid-acting corticosteroid may be needed before, during, and after stressful situations.

Overdosage

Symptoms

Acute adrenal insufficiency caused by too rapid withdrawal: fever, myalgia, arthralgia, malaise, anorexia, nausea, desquamation of skin, orthostatic hypotension, dizziness, fainting, dyspnea, hypoglycemia. Cushingoid changes from chronic use of too large dose: moonface, central obesity, striae, hirsutism, acne, ecchymoses, fluid and electrolyte imbalance, hypertension, osteoporosis, myopathy, sexual dysfunction, diabetes, hyperlipidemia, peptic ulcer.

Patient Information

  • Instruct patient to take with meals to avoid GI upset.
  • Tell patient to take single daily dose before 9 AM.
  • Instruct patient to monitor weight daily and to report steady gain to health care provider.
  • Inform patients with diabetes to monitor blood glucose regularly.
  • Instruct elderly patients undergoing long-term therapy to have BP, blood glucose, and electrolytes checked every 6 mo.
  • Advise patient to avoid receiving live virus vaccine during therapy.
  • Instruct patients undergoing long-term therapy to have an annual eye examination and to carry ID card.
  • For discontinuation after long-term therapy, instruct patient to adhere to tapering schedule.
  • Advise patient to notify health care provider before discontinuing medication.
  • Instruct patient to report these symptoms to health care provider: cold, infection or prolonged sore throat; change in vision; swelling of extremities; weakness; black tarry stools; irregular heartbeat; menstrual irregularities; changes in mood or behavior; fatigue; anorexia; nausea; vomiting; diarrhea; weight loss.

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