Adult Dosing
Corticosteroid-responsive conditions
- Oral dosage requirements are variable and must be individualized depending on the disease and the patient's response
- Initial dosage ranges from 25-300 mg PO qd, as per severity of the disease
Notes:
- Maintain or adjust initial dosage to achieve satisfactory patient response; if satisfactory response does not occur in reasonable time, discontinue use and consider an alternative agent
- After achieving a favorable initial response, reduce the dose in small amounts until the lowest dosage that maintains an adequate clinical response is reached
- After a long-term treatment, drug should be tapered gradually to discontinue
Pediatric Dosing
Corticosteroid-responsive conditions
- Oral dosage requirements are variable and must be individualized depending on the disease and the patient's response
- 0.7-10 mg/kg/day PO or 20-300 mg/m2/day in 4 divided doses
Notes:
- Maintain or adjust initial dosage to achieve satisfactory patient response; if satisfactory response does not occur in reasonable time, discontinue use and consider an alternative agent
- After achieving a favorable initial response, reduce the dose in small amounts until the lowest dosage that maintains an adequate clinical response is reached
- After a long-term treatment, drug should be tapered gradually to discontinue
[Outline]
See Supplemental Patient Information
- Increased dosage of rapidly acting corticosteroids before, during, and after stressful situation is indicated in patients subjected to unusual stress
- Avoid rapid withdrawal of the drug as it may cause secondary adrenocortical insufficiency; this may be minimized by gradually tapering the dose. If stress situation occurs after discontinuation of therapy; hormone therapy should be re instituted
- Corticosteroids may mask some signs of infection which may lead to decrease in resistance and inability to localize infection
- Therapy may be associated with prolongation of coma and an increased incidence of GI bleeding and pneumonia in patients with cerebral malaria
- Rule out latent or active amebiasis before starting corticosteroid therapy in any patient with unexplained diarrhea or who has time in the tropics because therapy may activate latent amebiasis
- Long-term use may cause posterior subcapsular cataracts, glaucoma with possible damage to the optic nerves, and secondary ocular infections due to fungi or viruses
- Elevation of blood pressure, salt and water retention, and increased potassium and calcium excretion may occur on average and large doses of cortisone; monitor serum electrolyte levels during prolonged therapy
- Administration of live virus vaccines, such as smallpox, is contraindicated in patients receiving immunosuppressive doses of cortisone. Patients receiving drugs that suppress the immune system are more prone to infections than the healthy individuals
- Chickenpox and measles may have more serious, sometimes fatal, course in non-immune children and adults on cortisone; avoid exposure in these patients. Start prophylaxis with varicella zoster immune globulin (VZIG) if exposed to chickenpox and with pooled intramuscular immunoglobulin (IG) if exposed to measles
- Use the lowest possible dose of cortisone to control the condition under treatment; gradually taper the dose when dose reduction is possible
- When large doses are indicated, cortisone should be taken with meals and antacids taken between meals to help prevent peptic ulcer
- Closely observe the patients for signs that might indicate dose adjustment, such as changes in clinical status resulting from disease exacerbations or remissions, individual drug responsiveness, and the effect of stress
- Carefully monitor growth and development of infants and children on prolonged corticosteroid therapy
- Check prothrombin time frequently in patients receiving cortisone and coumarin anticoagulants
- Observe closely for development of hypokalemia during concomitant administration with potassium-depleting diuretics
- If indicated in patients with latent tuberculosis or tuberculin reactivity, observe closely as reactivation of the disease may occur
- Following long-term use, discontinuation of cortisone may result in symptoms of the corticosteroid withdrawal syndrome including fever, myalgia, arthralgia, and malaise
- Psychic derangement, ranging from euphoria, insomnia, mood swings, and severe depression, to frank psychotic manifestations may occur during treatment; existing emotional instability or psychotic tendencies may be aggravated
- Steroids may increase or decrease motility and number of spermatozoa in some patients
Cautions: Use cautiously in
- Hepatic impairment
- Recent MI
- Congestive heart failure
- Tuberculosis infection
- Nonspecific ulcerative colitis
- Impending perforation, abscess, or pyogenic infection
- Patients with hypothyroidism
- Cirrhosis
- Hypertension
- Ocular herpes simplex infections
- Concomitant use of aspirin in patients with hypoprothrombinemia
- Seizure disorder
- Diabetes Mellitus
- Diverticulitis
- Fresh intestinal anastomoses
- Active or latent peptic ulcers
- Renal insufficiency
- Osteoporosis
- Myasthenia gravis
Supplemental Patient Information
- Caution patients on immunosuppressant doses of cortisone against exposure to chickenpox or measles; advise these patients to seek immediate medical advise if exposed
Pregnancy Category:C
Breastfeeding: Safety unknown. Cortisone has not been studied during breastfeeding. An alternate drug is preferred, although it is unlikely that a large amount of the drug reaches the infant. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin /sis/htmlgen?LACT last accessed 17 January 2011). Manufacturer recommends mothers taking pharmacologic doses of corticosteroids to avoid nursing.
Pricing data from www.DrugStore.com in U.S.A.
- Cortisone Acetate 25 MG TABS [Bottle] (WEST-WARD)
30 mg = $27.99
90 mg = $64.97
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
