Dosing and uses of Cortisone
Adult dosage forms and strengths
tablet
- 5mg
- 10mg
- 25mg
Anti-inflammatory/Immunosuppressive
2.5-10 mg/kg/day PO divided q8hr or 25-300 mg/day PO qDay or divided q12hr
1-5 mg/kg IM qDay
Physiologic Replacement
0.5-0.75 mg/kg/day PO divided q8hr or 25-35 mg/day
0.25-0.35 mg/kg IM qDay
Other Indications & Uses
Adrenal insufficiency, conditions treated with immunosuppression, corticosteroid responsive dermatoses, inflammatory conditions
Pediatric dosage forms and strengths
tablet
- 5mg
- 10mg
- 25mg
Anti-inflammatory/Immunosuppressive
2.5 mg-10 mg/kg/day PO or 20-300 mg/sq.meter/day PO divided q6-8hr
Physiologic Replacement
0.5-0.75 mg/kg/day PO or 20-25 mg/sq.meter/day PO divided q8hr
Cortisone adverse (side) effects
>10%
Insomnia
Indigestion
Incr appetite
1-10%
Hirsutism
Arthragia
Cataract
Epistaxis
Dm
Warnings
Contraindications
Systemic fungal infection
Hypersensitivity to cortisone
Cautions
Short acting agent
Cirrhosis, ocular herpes simplex, HTN, diverticulitis, hypothyroidism, myasthenia gravis, PUD, osteoporosis, ulcerative colitis, psychotic tendencies, untreated systemic infections, renal insufficiency, pregnancy
Hydroxylated to active compound hydrocortisone
When used to treat adrenocortical insufficiency may need to use additional mineralocorticoid
Not indicated for IV use
DM, thromboembolic disorders
Long-term treatment: Risk of osteoporosis, myopathy, delayed wound healing
Patients receiving corticosteroids should avoid chickenpox or measles-infected persons if unvaccinated
Latent TB may be reactivated
Monitor patients with positive tuberculin test
Some suggestion of slightly increase cleft palate risk if corticosteroids used in pregnancy, but not fully substantiated
Pregnancy and lactation
Pregnancy category: not available
Lactation: excretion in milk unknown; use with caution
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Cortisone
Mechanism of action
Glucocorticoid; elicits mild mineralocorticoid activity and moderate anti-inflammatory effects; controls or prevents inflammation by controling the rate of protein synthesis, suppressing migration of PMNs and fibroblasts, and reversing capillary permeability
Absorption
Duration: 10 days (IM); 30-36 hr (PO)
Onset: PO: 24 hr (IM); within 2 hr (PO)
Distribution
Protein Bound: 90%
Metabolism
Extensively and rapidly in the liver to hydrocortisone (active metabolite) which is then metabolized in tissues and the liver to inactive glucuronide & sulfate metabolites
Metabolites: Hydrocortisone (active), glucuronide and sulfate metabolites (inactive)
Elimination
Half-life: 0.4-2 hr
Excretion: Mainly in urine, minimally in bile
