• Management of adrenocortical insufficiency; chronic use in other situations is limited because of mineralocorticoid activity.
• Replacement therapy in adrenal insufficiency.

Contraindicated in:

• Active untreated infections (may be used in patients being treated for tuberculous meningitis)
• Lactation: Avoid chronic use.

Use Cautiously in:

• Chronic treatment (will lead to adrenal suppression; use lowest possible dose for shortest period of time), unless being used to treat adrenal insufficiency
• Stress (surgery, infections); supplemental doses may be needed
• Hypothyroidism
• Cirrhosis
• Ulcerative colitis
• Potential infections may mask signs (fever, inflammation)
• OB: Safety not established
• Pedi: Chronic use will result in ↓ growth; use lowest possible dose for shortest period of time.

Adverse reactions/side effects are much more common with high-dose/long-term therapy

CNS: depression, euphoria, headache, ↑ intracranial pressure (children only), personality changes, psychoses, restlessness.

EENT: cataracts, ↑ intraocular pressure.

CV: hypertension.

GI: PEPTIC ULCERATION, anorexia, nausea, vomiting.

Derm: acne, ↓wound healing, ecchymoses, fragility, hirsutism, petechiae.

Endo: adrenal suppression, hyperglycemia.

F and E: fluid retention (long-term high doses), hypokalemia, hypokalemic alkalosis.

Hemat: THROMBOEMBOLISM, thrombophlebitis.

Metab: weight gain, weight loss.

MS: avascular necrosis of joints, muscle wasting, osteoporosis, muscle pain.
Misc: cushingoid appearance (moon face, buffalo hump), ↑ susceptibility to infection.

Drug-Drug:

• Additive hypokalemia with thiazide or loop diuretics, or amphotericin B.
• Hypokalemia may ↑ risk of digoxin toxicity.
• May ↑ requirement for insulins or oral hypoglycemic agents.
• Phenytoin,phenobarbital, and rifampin stimulate metabolism; may ↓ effectiveness.
• Oral contraceptives may ↓ metabolism.
• ↑risk of adverse GI effects with NSAIDs (including aspirin).
• At chronic doses that suppress adrenal function, may ↓ antibody response to and ↑ the risk of adverse reactions from live-virus vaccines.

(Generic available)

• Tablets: 25 mg;

• PO (Adults): 25–300 mg/day in divided doses every 12–24 hr.
• PO (Children): Adrenocortical insufficiency — 0.7 mg/kg/day (20–25 mg/m²/day) in divided doses every 8 hr. Other uses — 2.5–10 mg/kg/day (75–300 mg/m²/day) in divided doses every 6–8 hr.

• In pharmacologic doses, suppresses inflammation and the normal immune response.
• Has numerous intense metabolic effects (see Adverse Reactions and Side Effects).
• Suppresses adrenal function at chronic doses of 20 mg/day.
• Replaces endogenous cortisol in deficiency states.
• Also has potent mineralocorticoid (sodium-retaining) activity.

• Suppression of inflammation and modification of the normal immune response.
• Replacement therapy in adrenal insufficiency.

Therapeutic Classification: corticosteroids

Pharmacologic Classification: corticosteroids

Absorption: Well absorbed after oral administration.

Distribution: Widely distributed; crosses the placenta and enters breast milk.

Metabolism/Excretion: Metabolized mostly by the liver to inactive metabolites.

Half-life: 0.5–2 hr (plasma), 8–12 hr (tissue).

Cortone

(anti-inflammatory activity)

• Instruct patient on correct technique of medication administration. Advise patient to take medication as directed. Take missed doses as soon as remembered unless almost time for next dose. Do not double doses. Stopping the medication suddenly may result in adrenal insufficiency (anorexia, nausea, weakness, fatigue, dyspnea, hypotension, hypoglycemia). If these signs appear, notify health care professional immediately. This can be life threatening.
  • Glucocorticoids cause immunosuppression and may mask symptoms of infection. Instruct patient to avoid people with known contagious illnesses and to report possible infections immediately.
  • Caution patient to avoid vaccinations without first consulting health care professional.
  • Review side effects with patient. Instruct patient to inform health care professional promptly if severe abdominal pain or tarry stools occur Patient should also report unusual swelling, weight gain, tiredness, bone pain, bruising, nonhealing sores, visual disturbances, or behavior changes.
  • Advise patient to notify health care professional of medication regimen before treatment or surgery.
  • Discuss possible effects on body image. Explore coping mechanisms.
  • Instruct patient to inform health care professional if symptoms of underlying disease return or worsen.
  • Advise patient to carry identification describing disease process and medication regimen in the event of emergency in which patient cannot relate medical history.
  • Explain need for continued medical follow-up to assess effectiveness and possible side effects of medication. Periodic lab tests and eye exams may be needed.
• Long-term Therapy: Encourage patient to eat a diet high in protein, calcium, and potassium, and low in sodium and carbohydrates (see Appendix M). Alcohol should be avoided during therapy.

KOR-ti-sone