Adult Dosing
Ulcerative Colitis
Enema (Colocort, Cortenema, generic hydrocortisone)
- 100 mg enema PR qhs x 3 wks; retain enema at least 60 min, preferably overnight
- Discontinue if no clinical improvement within 3 wks; may extend treatment for 2-3 months if some clinical improvement
- Note: Taper gradually to discontinue if treatment >3 wks
Ulcerative proctitis
Aerosol foam (Cortifoam)
- 1 applicatorful (90 mg) PR qd-bid x 2-3 wks, then every other day thereafter
- Taper gradually to discontinue if prolonged treatment
SUPP (generic hydrocortisone)
- 2-4 SUPP/day PR divided bid-tid x 2 wks
- May use for 6-8 wks if post radiation proctitis
- Taper gradually to discontinue if prolonged treatment
Pediatric Dosing
- Safety and effectiveness in pediatric population have not been established
[Outline]
- In severe ulcerative colitis, do not delay surgery while awaiting response to medical treatment
- Improper insertion of applicator tip can result in damage to the rectal wall
- Corticosteroids can mask signs of infection; new infections appear during use
- Corticosteroids can produce reversible hypothalamic-pituitary adrenal (HPA) axis suppression; potential for glucocorticosteroid insufficiency after treatment withdrawal
- Increase dosage of rapidly acting corticosteroids before, during and after the stressful situations
- Long term therapy can cause posterior subcapsular cataracts, glaucoma, secondary ocular infections
- Elevation of blood pressure, salt and water retention, and increased excretion of potassium, calcium may occur on average and large doses of hydrocortisone
- Patients should be refrained against smallpox vaccination and other live immunization procedures while undergoing corticosteroid therapy
- Non-immune pediatric patients or adults on corticosteroids are more susceptible to chicken pox and measles
- Patients with latent tuberculosis or tuberculin reactivity treated with corticosteriods should be closely monitored as reactivation of the disease may occur
- Monitor serum electrolytes, BP, serum glucose, chest x-ray if prolonged therapy desired; ophthalmological examination if treatment >6 wks
- Monitor renal function
- Monitor BMD if prolonged therapy or if >65 yrs; Upper GI x-ray if history of PUD or significant dyspepsia
- Monitor growth and development in pediatric patients
Cautions: Use cautiously in
- Renal impairment
- Hypertension
- CHF
- Recent MI
- Hypothyroidism
- Diabetes Mellitus
- Diverticulitis
- Peptic ulcer disease
- Osteoporosis
- Myasthenia gravis
- Seizure disorder
- Glaucoma
- Concurrent aspirin in hypoprothrombinemia
- Immunocompromised patients
Pregnancy Category:C
Breastfeeding: Safety unknown; a better studied alternate corticosteroid should be preferred. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 12 October 2010). Neonates born of mothers who have received corticosteroid therapy during pregnancy should be carefully observed for signs of hypoadrenalism.
Pricing data from www.DrugStore.com in U.S.A.
- Cortifoam 90 MG FOAM [Can] (MEDA PHARMACEUTICALS)
15 mg = $260
45 mg = $759.99 - Colocort 100 MG/60ML ENEM [Bottle] (PADDOCK)
60 60ml = $15.99
180 60ml = $35.97
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.
