cortisone acetate

cortisone (17-hydroxy-11-dehydrocorticosterone, Kendall's compound E) (kor´tisōn´),

n a hormone produced by the adrenal cortex; a glucocorticoid, 17-hydroxy-11-dehydrocorticosterone; useful in the treatment of rheumatoid arthritis, lupus erythematosus, and some allergic conditions. Has marked antiinflammatory properties. Excess production or administration produces signs of hyperadrenocorticalism (Cushing's syndrome) with hyperlipemia and obesity hyperglycemia and edema.

cortisone acetate,

n brand name: Cortone;
drug class: gluocorticoid, short acting;
action: decreases inflammation by suppression of macrophage and leukocyte migration, reduces capillary permeability;
uses: inflammation, severe allergy, adrenal insufficiency, collagen, and respiratory and dermatologic disorders.

---

cortisone acetate

Cortisyl (UK)

Pharmacologic class: Glucocorticoid

Therapeutic class: Adrenocorticoid

Pregnancy risk category C

Action

Unclear. Reduces inflammation, possibly by suppressing cell-mediated immune reactions; decreasing white blood cell, monocyte, and eosinophil counts; reducing binding of immunoglobulins to cell surface receptors; and inhibiting interleukin synthesis. Also stabilizes lysosomal membranes, curbs polymorphonuclear leukocyte migration, interrupts phagocytosis, and diminishes antibody formation in infected and injured tissues.

Availability

Injection: 50 mg/ml

Tablets: 5 mg, 10 mg, 25 mg

⊘Indications and dosages

➣ Asthma; adrenal insufficiency; chronic inflammatory, allergic, hematologic, neoplastic, and autoimmune disorders; prevention of organ rejection in organ transplant recipients (given with other immunosuppressants)

Adults: 25 to 300 mg P.O. daily, or 20 to 300 mg I.M. daily or on alternate days. Individualize dosage based on disease and patient response.

Dosage adjustment

• Renal impairment
• Elderly patients

Contraindications

• Hypersensitivity to drug
• Systemic fungal infections

Precautions

Use cautiously in:
• renal insufficiency, cirrhosis, diabetes mellitus, diverticulitis, nonspecific ulcerative colitis, recent intestinal anastomoses, peptic ulcer (active or latent), heart failure, hypertension, thromboembolic disorders, hypoprothrombinemia, hypothyroidism, myasthenia gravis, glaucoma, ocular herpes simplex, osteoporosis, seizures, underlying immunosuppression, systemic infections, active untreated infections
• emotional instability or psychotic tendency
• pregnant or breastfeeding patients
• children.

Administration

• To help prevent peptic ulcer, give large doses between meals with antacids.
• If possible, administer before 9 A.M. (Exogenous corticosteroids are less likely to suppress adrenocortical activity when given at time of maximal activity.)

Route	Onset	Peak	Duration
P.O.	Rapid	2 hr	1.25-1.5 days
I.M.	24-48 hr	Variable	Variable

Adverse reactions

CNS: depression, euphoria, psychosis, vertigo, headache, increased intracranial pressure, seizures

CV: hypertension, thrombophlebitis, thromboembolism

EENT: cataracts, glaucoma, exophthalmos, increased intraocular pressure

GI: nausea, abdominal distention, pancreatitis, peptic ulcers, ulcerative esophagitis

GU: menstrual irregularities

Metabolic: sodium retention, fluid retention, potassium loss, carbohydrate intolerance, negative nitrogen balance, hyperglycemia, cushingoid appearance (moon face, buffalo hump), hypokalemic acidosis

Musculoskeletal: muscle wasting, osteoporosis, aseptic joint necrosis, muscle pain or weakness, vertebral compression fractures, steroid myopathy, tendon rupture, decreased growth (in children)

Skin: decreased wound healing, bruising, fragile skin, petechiae, urticaria, facial erythema, diaphoresis, hirsutism

Other: weight gain or loss, facial edema, increased susceptibility to or masking of infection, hypersensitivity reactions

Interactions

Drug-drug. Anticoagulants: increased or decreased anticoagulant blood level

Barbiturates, phenytoin, rifampin: decreased cortisone effects

Digoxin: increased risk of digitalis toxicity

Estrogens, hormonal contraceptives: increased cortisone effects

Fluoroquinolones: increased risk of tendon rupture

Itraconazole, ketoconazole: increased cortisone blood level

Live-virus vaccines: decreased antibody response to vaccine, increased risk of adverse reactions

Somatrem, somatropin: inhibition of growth-promoting effect

Thiazide and loop diuretics: additive hypokalemia

Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, cholesterol, glucose: increased levels

Calcium, potassium: decreased levels

Nitroblue tetrazolium test: false-negative result

Drug-herbs. Echinacea: increased immune-stimulating effects

Ginseng: increased immune-modulating response

Patient monitoring

• Monitor patient closely for signs and symptoms of infection. Be aware that drug may mask these.
• Watch for weight gain, edema, and signs and symptoms of hypokalemia.
• Measure blood pressure regularly to detect hypertension.
☞ When discontinuing drug after long-term therapy, taper dosage gradually. Abrupt withdrawal may be fatal.
• With long-term therapy, evaluate patient for negative nitrogen balance; drug may cause protein catabolism. Also check vital signs and evaluate laboratory findings (including 2-hour postprandial blood glucose level, potassium level, and chest X-ray) at regular intervals.
• Monitor upper GI X-rays in patients with suspected peptic ulcer disease or significant dyspepsia or gastric distress.

Patient teaching

• Advise patient to take drug with meal or snack.
• Tell patient taking single daily dose or alternate-day doses to take drug in morning before 9 A.M. Instruct patient taking multiple daily doses to take doses at evenly spaced intervals throughout day.
• Instruct patient to carry identification stating that he's on long-term steroid therapy.
• Tell patient to report unusual weight gain, leg or foot swelling, muscle weakness, puffy face, cold, or infection.
☞ Caution patient never to stop therapy abruptly, because doing so may cause life-threatening adrenal insufficiency.
☞ Tell patient to contact prescriber immediately if signs or symptoms of adrenal insufficiency follow dosage reduction or drug discontinuation.
• Inform patient that he'll require continued supervision after discontinuing drug, because his disease or disorder may suddenly recur.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and herbs mentioned above.