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CORTICOSTEROIDS Glucocorticoid Effects (Systemic)

Some commonly used brand names are:

In the U.S.—

• Acetocot ⁹
• A-hydroCort ⁵
• Amcort ⁹
• A-MethaPred ⁶
• Aristocort ⁹
• Aristocort Forte ⁹
• Aristopak ⁹
• Aristospan ⁹
• Articulose-50 ⁷
• Articulose-L.A. ⁹
• Celestone ¹
• Celestone Phosphate ¹
• Celestone Soluspan ¹
• Cinalone 40 ⁹
• Cinonide 40 ⁹
• Clinacort ⁹
• Clinalog ⁹
• Cordrol ⁸
• Cortastat ⁴
• Cortastat 10 ⁴
• Cortastat LA ⁴
• Cortef ⁵
• Cortone Acetate ³
• Cotolone ⁷
• Decadron ⁴
• Delta-Cortef ⁷
• Deltasone ⁸
• Depo-Medrol ⁶
• Dexamethasone Intensol ⁴
• Dexasone ⁴
• Dexasone L.A. ⁴
• Hydrocortone ⁵
• Hydrocortone Acetate ⁵
• Hydrocortone Phosphate ⁵
• Kenacort ⁹
• Kenacort Diacetate ⁹
• Kenaject-40 ⁹
• Kenalog-10 ⁹
• Kenalog-40 ⁹
• Ken-Jec 40 ⁹
• Key-Pred ⁷
• Key-Pred SP ⁷
• Liquid Pred ⁸
• Medrol ⁶
• Meprolone ⁶
• Meticorten ⁸
• Nor-Pred T.B.A. ⁷
• Orasone 1 ⁸
• Orasone 5 ⁸
• Orasone 10 ⁸
• Orasone 20 ⁸
• Orasone 50 ⁸
• Pediapred ⁷
• Predacort 50 ⁷
• Predalone 50 ⁷
• Predalone T.B.A. ⁷
• Predate-50 ⁷
• Predate S ⁷
• Predate TBA ⁷
• Predcor-25 ⁷
• Predcor-50 ⁷
• Predcor-TBA ⁷
• Predicort-RP ⁷
• Pred-Ject-50 ⁷
• Prednicot ⁸
• Prednisone Intensol ⁸
• Pred-Pak 45 ⁸
• Pred-Pak 79 ⁸
• Prelone ⁷
• Robalog ⁹
• Selestoject ¹
• Solu-Cortef ⁵
• Solu-Medrol ⁶
• Solurex ⁴
• Solurex LA ⁴
• Sterapred ⁸
• Sterapred DS ⁸
• Tac-3 ⁹
• Tramacort-D ⁹
• Triam-A ⁹
• Triam-Forte ⁹
• Triamolone 40 ⁹
• Triamonide 40 ⁹
• Tri-Kort ⁹
• Trilog ⁹
• Trilone ⁹
• Tristoject ⁹

In Canada—

• A-Hydrocort ⁵
• Apo-Prednisone ⁸
• Aristocort ⁹
• Aristocort Forte ⁹
• Aristocort Intralesional ⁹
• Aristospan ⁹
• Betnesol ¹
• Celestone Soluspan ¹
• Cortef ⁵
• Cortisone Acetate-ICN ³
• Cortone ³
• Decadron ⁴
• Decadron Phosphate ⁴
• Deltasone ⁸
• Depo-Medrol ⁶
• Deronil ⁴
• Dexasone ⁴
• Entocort ²
• Hexadrol Phosphate ⁴
• Kenacort ⁹
• Kenalog-10 ⁹
• Kenalog-40 ⁹
• Medrol ⁶
• Oradexon ⁴
• Pediapred ⁷
• Scheinpharm Triamcine-A ⁹
• Solu-Cortef ⁵
• Solu-Medrol ⁶
• Winpred ⁸

Another commonly used name for hydrocortisone is cortisol

Category

• Anti-inflammatory, steroidal—Betamethasone; Budesonide; Cortisone; Dexamethasone; Hydrocortisone; Methylprednisolone; Prednisolone; Prednisone; Triamcinolone
• Antiemetic, in cancer chemotherapy—Dexamethasone; Hydrocortisone; Prednisone
• Corticosteroid—Betamethasone; Budesonide; Cortisone; Dexamethasone; Hydrocortisone; Methylprednisolone; Prednisolone; Prednisone; Triamcinolone
• Diagnostic aid, Cushing"s syndrome—Dexamethasone
• Diagnostic aid, endogenous depression—Dexamethasone
• Immunosuppressant—Betamethasone; Cortisone; Dexamethasone; Hydrocortisone; Methylprednisolone; Prednisolone; Prednisone; Triamcinolone

Description

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

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

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

These medicines are available only with your doctor"s prescription, in the following dosage forms:

• Oral
• Betamethasone
  • Syrup (U.S.)
  • Tablets (U.S.)
  • Effervescent tablets (Canada)
  • Extended-release tablets
• Budesonide
  • Extended-release capsules (Canada)
• Cortisone
  • Tablets (U.S. and Canada)
• Dexamethasone
  • Elixir (U.S.)
  • Oral solution (U.S.)
  • Tablets (U.S. and Canada)
• Hydrocortisone
  • Oral suspension (U.S.)
  • Tablets (U.S. and Canada)
• Methylprednisolone
  • Tablets (U.S. and Canada)
• Prednisolone
  • Oral solution (U.S. and Canada)
  • Syrup (U.S.)
  • Tablets (U.S.)
• Prednisone
  • Oral solution (U.S.)
  • Syrup (U.S.)
  • Tablets (U.S. and Canada)
• Triamcinolone
  • Syrup (U.S. and Canada)
  • Tablets (U.S. and Canada)

• Parenteral
• Betamethasone
  • Injection (U.S. and Canada)
• Cortisone
  • Injection (U.S. and Canada)
• Dexamethasone
  • Injection (U.S. and Canada)
• Hydrocortisone
  • Injection (U.S. and Canada)
• Methylprednisolone
  • Injection (U.S. and Canada)
• Prednisolone
  • Injection (U.S.)
• Triamcinolone
  • Injection (U.S. and Canada)

Before Using This Medicine

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For corticosteroids, the following should be considered:

Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to corticosteroids. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

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

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

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

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

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

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

Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking corticosteroids, it is especially important that your health care professional know if you are taking any of the following:

• Ambenonium (e.g., Mytelase) or
• Neostigmine (e.g., Prostigmin) or
• Pyridostigmine (e.g., Mestinon)—May produce severe weakness in patients with myasthenia gravis.

• Aminoglutethimide (e.g., Cytadren) or
• Antacids (in large amounts) or
• Barbiturates, except butalbital, or
• Carbamazepine (e.g., Tegretol) or
• Griseofulvin (e.g., Fulvicin) or
• Mitotane (e.g., Lysodren) or
• Phenylbutazone (e.g., Butazolidin) or
• Phenytoin (e.g., Dilantin) or
• Primidone (e.g., Mysoline) or
• Rifampin (e.g., Rifadin)—Use of these medicines may make certain corticosteroids less effective

• Amphotericin B by injection (e.g., Fungizone)—Using corticosteroids with this medicine may decrease the amount of potassium in the blood. Serious side effects could occur if the level of potassium gets too low

• Antidiabetic agents, oral (diabetes medicine taken by mouth) or
• Insulin—Corticosteroids may increase blood glucose (sugar) levels

• Clarithromycin (e.g., Biaxin) or
• Erythromycin (e.g., E-Mycin, Erythrocin)—These medications may increase the amount of corticosteroid removed from your body.

• Cyclosporine (e.g., Sandimmune)—Use of this medicine with high doses of methylprednisolone may cause convulsions (seizures)

• Digitalis glycosides (heart medicine)—Corticosteroids decrease the amount of potassium in the blood. Digitalis can increase the risk of having an irregular heartbeat or other problems if the amount of potassium in the blood gets too low

• Diuretics (water pills) or
• Medicine containing potassium—Using corticosteroids with diuretics may cause the diuretic to be less effective. Also, corticosteroids may increase the risk of low blood potassium, which is also a problem with certain diuretics. Potassium supplements or a different type of diuretic is used in treating high blood pressure in those people who have problems keeping their blood potassium at a normal level. Corticosteroids may make these medicines less able to do this

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

• Ketoconazole (e.g., Nizoral)—May increase your risk of steroid side effects.

• Ritodrine (e.g., Yutopar)—Serious side effects could occur

• Skin test injections—Corticosteroids may cause false results in skin tests

• Sodium-containing medicine—Corticosteroids cause the body to retain (keep) more sodium (salt) and water. Too much sodium may cause high blood sodium, high blood pressure, and excess body water

• Somatrem (e.g., Protropin) or
• Somatropin (e.g., Humatrope)—Corticosteroids can interfere with the effects of these medicines

There are many other medicines that may interact with corticosteroids. Tell your health care professional if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine.

Other medical problems—The presence of other medical problems may affect the use of corticosteroids. Make sure you tell your doctor if you have any other medical problems, especially:

• Acquired immunodeficiency syndrome (AIDS) or
• Fungus infection or
• Herpes simplex infection of the eye or
• Human immunodeficiency virus (HIV) infection or
• Infection at the place of treatment or
• Other infection or
• Recent surgery or serious injury or
• Strongyloides (worm) infestation or
• Tuberculosis (active TB, nonactive TB, or past history of)—Corticosteroids can cause slower healing, worsen existing infections, or cause new infections

• Chickenpox (including recent exposure) or
• Measles (including recent exposure)—Risk of severe disease affecting other parts of the body

• Diabetes mellitus (sugar diabetes)—Corticosteroids may cause a loss of control of diabetes by increasing blood glucose (sugar)

• Diverticulitis or
• Stomach ulcer or other stomach or intestine problems or
• Ulcerative colitis, severe—Corticosteroids may cover up symptoms of a worsening stomach or intestinal condition. A patient would not know if his or her condition was getting worse and would not get medical help when needed

• Glaucoma—Corticosteroids may cause the pressure within the eye to increase

• Heart disease or
• High blood pressure or
• Kidney disease (especially if you are receiving dialysis) or
• Kidney stones—Corticosteroids cause the body to retain (keep) more salt and water. These conditions may be made worse by this extra body water

• High cholesterol levels—Corticosteroids may increase blood cholesterol levels

• Liver disease or
• Overactive thyroid or
• Underactive thyroid—With these conditions, the body may not eliminate the corticosteroid at the usual rate, which may change the medicine"s effect

• Myasthenia gravis—When you first start taking corticosteroids, muscle weakness may occur. Your doctor may want to take special precautions because this could cause problems with breathing

• Osteoporosis (bone disease)—Corticosteroids may worsen bone disease because they cause the body to lose more calcium

• Psychosis—This condition may be made worse

• Systemic lupus erythematosus (SLE)—This condition may cause certain side effects of corticosteroids to occur more easily

Proper Use of This Medicine

For patients taking this medicine by mouth:

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

For patients taking budesonide extended-release capsules :

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

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

Dosing—The dose of these medicines will be different for different patients. Follow your doctor"s orders or the directions on the label . The following information gives the range of doses of these medicines for all uses, which can vary widely. The dose that you are receiving may be very different. If your dose is different, do not change it unless your doctor tells you to do so.

The number of capsules, tablets, teaspoonfuls of liquid or amount of injection that you use depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are taking the corticosteroid. In addition, your doctor may need to change the dose from time to time .

• For betamethasone
• For oral dosage forms:
  • Syrup, tablets, effervescent tablets:
    • Adults and teenagers—Dose may range from 0.25 to 7.2 milligrams (mg) a day, as a single dose or divided into several doses.
    • Children—Dose is based on body weight or size and must be determined by your doctor.
  • Extended-release tablets:
    • Adults and teenagers—2 to 6 mg a day.
    • Children—Dose is based on body weight or size and must be determined by your doctor.
• For injection dosage form:
  • Adults and teenagers: Dose may range from 1.2 to 12 mg injected into a joint, lesion, muscle, or vein as often as necessary, as determined by your doctor.
  • Children: Dose is based on body weight or size and must be determined by your doctor.

• For budesonide
• For oral dosage form (extended-release capsules):
  • Adults: At first, the dose is 9 milligrams (mg) a day for up to eight weeks. Then your doctor may decrease the dose to 6 mg a day. Each dose should be taken in the morning before breakfast.
  • Children: Use and dose must be determined by your doctor.

• For cortisone
• For oral dosage form (tablets):
  • Adults and teenagers: 25 to 300 milligrams (mg) a day, as a single dose or divided into several doses.
  • Children: Dose is based on body weight or size and must be determined by your doctor.
• For injection dosage form:
  • Adults and teenagers: 20 to 300 mg a day, injected into a muscle.
  • Children: Dose is based on body weight or size and must be determined by your doctor.

• For dexamethasone
• For oral dosage forms (elixir, oral solution, tablets):
  • Adults and teenagers: 0.5 to 10 milligrams (mg) taken as often as necessary, as determined by your doctor.
  • Children: Dose is based on body weight or size and must be determined by your doctor.
• For injection dosage form:
  • Adults and teenagers: 0.2 to 40 mg injected into a joint, lesion, muscle, or vein as often as necessary, as determined by your doctor.
  • Children: Dose is based on body weight or size and must be determined by your doctor.

• For hydrocortisone
• For oral dosage forms (oral suspension, tablets):
  • Adults and teenagers: 20 to 800 milligrams (mg) every one or two days, as a single dose or divided into several doses.
  • Children: Dose is based on body weight or size and must be determined by your doctor.
• For injection dosage form:
  • Adults and teenagers: 5 to 500 mg injected into a joint, lesion, muscle, or vein, or under the skin as often as necessary, as determined by your doctor.
  • Children: Dose is based on body weight or size and must be determined by your doctor.

• For methylprednisolone
• For oral dosage form (tablets):
  • Adults and teenagers: 4 to 160 milligrams (mg) every one or two days, as a single dose or divided into several doses.
  • Children: Dose is based on body weight or size and must be determined by your doctor.
• For injection dosage form:
  • Adults and teenagers: 4 to 160 mg injected into a joint, lesion, muscle, or vein as often as necessary, as determined by your doctor.
  • Children: Dose is based on body weight or size and must be determined by your doctor.

• For prednisolone
• For oral dosage forms (oral solution, syrup, tablets):
  • Adults and teenagers: 5 to 200 milligrams (mg) taken as often as necessary, as determined by your doctor.
  • Children: Dose is based on body weight or size and must be determined by your doctor.
• For injection dosage form:
  • Adults and teenagers: 2 to 100 mg injected into a joint, lesion, muscle, or vein as often as necessary, as determined by your doctor.
  • Children: Dose is based on body weight or size and must be determined by your doctor.

• For prednisone
• For oral dosage forms (oral solution, syrup, tablets):
  • Adults and teenagers: 5 to 200 milligrams (mg) every one or two days, as a single dose or divided into several doses.
  • Children: Dose is based on body weight or size and must be determined by your doctor.

• For triamcinolone
• For oral dosage forms (syrup, tablets):
  • Adults and teenagers: 2 to 60 milligrams (mg) a day, as a single dose or divided into several doses.
  • Children: Dose is based on body weight or size and must be determined by your doctor.
• For injection dosage form:
  • Adults and teenagers: 0.5 to 100 mg injected into a joint, lesion, or muscle, or under the skin as often as necessary, as determined by your doctor.
  • Children: Dose is based on body weight or size and must be determined by your doctor.

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

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

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

Storage—To store this medicine:

• Keep out of the reach of children.
• Store away from heat and direct light.
• Do not store capsules or tablets in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down.
• Keep the liquid dosage forms of this medicine from freezing.
• Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.

Precautions While Using This Medicine

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

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

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

If you will be using corticosteroids for a long time:

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

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

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

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

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

For patients with diabetes :

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

For patients having this medicine injected into their joints :

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

Side Effects of This Medicine

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

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention. When this medicine is used for short periods of time, side effects usually are rare. However, check with your doctor as soon as possible if any of the following side effects occur:

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

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

Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome:

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

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

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

Additional Information

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

• Croup in children (dexamethasone)

Revised: 03/25/2005

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