corticosteroids (systemic)

hydrocortisone: hye-droe-KOR-ti-sone

methylPREDNISolone: meth-ill-pred-NISS-oh-lone

prednisoLONE: pred-NISS-oh-lone

predniSONE: PRED-ni-sone

triamcinolone: trye-am-SIN-oh-lone

betamethasone: bay-ta-METH-a-sone

budesonide: byoo-DESS-oh-nide

dexAMETHasone: dex-a-METH-a-sone

Therapeutic Classification: antiasthmatics, corticosteroids

Pharmacologic Classification: corticosteroids (systemic)

REMS

Hydrocortisone

Adrenocortical insufficiency.

Betamethasone, dexamethasone, hydrocortisone, prednisolone, prednisone, methylprednisolone, triamcinolone

Used systemically and locally in a wide variety of chronic diseases, including:
- Inflammatory,
- Allergic,
- Hematologic,
- Neoplastic,
- Autoimmune disorders.

Methylprednisolone, prednisone

With other immunosuppressants in the prevention of organ rejection in transplantation surgery.
Asthma.

Dexamethasone

Cerebral edema,
- Diagnostic agent in adrenal disorders,
- Multiple myeloma (in combination with other anti-myeloma agents).

Budesonide (3-mg Delayed-Release Capsules and Ortikos)

Mild to moderate Crohn disease involving ileum and/or ascending colon.

Budesonide (3-mg Delayed-Release Capsules and Ortikos)

Maintenance of clinical remission for up to 3 mo of mild to moderate Crohn disease involving ileum and/or ascending colon.

Budesonide (Uceris)

Induction of remission of active, mild to moderate ulcerative colitis.

Budesonide (Tarpeyo)

Reduction of proteinuria in patients with primary immunoglobulin A nephropathy who are at risk of rapid disease progression (i.e., a urine protein-to-creatinine ratio [UPCR] ≥ 1.5 g/g).

Unlabeled Use:

Short-term administration to high-risk mothers before delivery to prevent respiratory distress syndrome in the newborn (betamethasone, dexamethasone).
Adjunctive therapy of hypercalcemia (prednisone, prednisolone, methylprednisolone).
Acute spinal cord injury (methylprednisolone).
Adjunctive management of nausea and vomiting from chemotherapy (dexamethasone, prednisone, prednisolone, methylprednisolone).
Croup (dexamethasone).
Airway edema prior to extubation (dexamethasone).
Facilitation of ventilator weaning in neonates with bronchopulmonary dysplasia (dexamethasone).

In pharmacologic doses, all agents suppress inflammation and the normal immune response.
All agents have numerous intense metabolic effects (see Adverse Reactions/Side Effects).
Suppress adrenal function at chronic doses of betamethasone: 0.6 mg/day; hydrocortisone: 20 mg/day; dexamethasone: 0.75 mg/day; methylprednisolone, triamcinolone: 4 mg/day; prednisone/prednisolone: 5 mg/day.

Hydrocortisone

Replace endogenous cortisol in deficiency states.

Hydrocortisone

Have potent mineralocorticoid (sodium-retaining) activity.

Prednisolone, prednisone

Have minimal mineralocorticoid activity.

Betamethasone, dexamethasone, methylprednisolone, triamcinolone

Have negligible mineralocorticoid activity.

Budesonide

Local anti-inflammatory activity in the lumen of the GI tract in Crohn disease and ulcerative colitis; modulates activity of B cells in ileum to decrease production of galactose-deficient IgA1 antibodies, which cause IgA nephropathy.

Therapeutic effects:

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

Budesonide

Improvement in symptoms/sequelae of Crohn disease, induction of remission of ulcerative colitis, and reduction in UPCR.

Absorption: Well absorbed after oral administration (except budesonide). Sodium phosphate and sodium succinate salts are rapidly absorbed after IM administration. Acetate and acetonide salts are slowly but completely absorbed after IM administration. Absorption from local sites (intra-articular, intralesional) is slow but complete. Bioavailability of budesonide is 9–21%.

Distribution: All are widely distributed.

Metabolism/Excretion: All are metabolized mostly by the liver to inactive metabolites. Prednisone is converted by the liver to prednisolone, which is then metabolized by the liver.

Half-Life: Betamethasone: 3–5 hr (plasma), 36–54 hr (tissue). budesonide: 2.0–3.6 hr (3-mg delayed-release capsules, Ortikos, Uceris); 5–6.8 hr (Tarpeyo). dexamethasone: 3–4.5 hr (plasma), 36–54 hr (tissue). hydrocortisone: 1.5–2 hr (plasma), 8–12 hr (tissue). methylprednisolone: >3.5 hr (plasma), 18–36 hr (tissue). prednisolone: 2.1–3.5 hr (plasma), 18–36 hr (tissue). prednisone: 3.4–3.8 hr (plasma), 18–36 hr (tissue). triamcinolone: 2–5 hr (plasma), 18–36 hr (tissue).

( anti-inflammatory activity)

ROUTE	ONSET	PEAK	DURATION
Betamethasone IM (acetate/sodium phosphate)	1–3 hr	unknown	1 wk
Budesonide PO	unknown	unknown	unknown
Dexamethasone PO	unknown	1–3 hr	2.75 days
Dexamethasone IM, IV (sodium phosphate)	rapid	unknown	2.75 days
Hydrocortisone PO	unknown	1–2 hr	1.25–1.5 days
Hydrocortisone IM (sodium succinate)	rapid	1 hr	variable
Hydrocortisone IV (sodium succinate)	rapid	unknown	unknown
Methylprednisolone PO	unknown	1–2 hr	1.25–1.5 days
Methylprednisolone IM (acetate)	6–48 hr	4–8 days	1–4 wk
Methylprednisolone IM, IV (sodium succinate)	rapid	unknown	unknown
Prednisolone PO	unknown	1–2 hr	1.25–1.5 days
Prednisone PO	unknown	1–2 hr	1.25–1.5 days
Triamcinolone IM (acetonide)	24–48 hr	unknown	1–6 wk
Triamcinolone Intralesional (hexacetonide)	slow	unknown	4 days–4 wk

Contraindicated in:

Active untreated infections (may be used in patients being treated for some forms of meningitis);
Lactation: Avoid chronic use;
Known alcohol, bisulfite, cow’s milk, or tartrazine hypersensitivity or intolerance (some products contain these and should be avoided in susceptible patients);
Administration of live-virus vaccines.

Use Cautiously in:

Chronic treatment (will lead to adrenal suppression; use lowest possible dose for shortest period of time);
Hypothyroidism;
Immunosuppression;
Cirrhosis;
Stress (surgery, infections); supplemental doses may be needed;
Potential infections may mask signs (fever, inflammation);
Traumatic brain injury (high doses may be associated with ↑ mortality);
OB: Safety not established in pregnancy;
Pedi: Chronic use in children will result in ↓ growth; use lowest possible dose for shortest period of time;
Pedi: Neonates (avoid use of benzyl alcohol containing injectable preparations; use preservative-free formulations).

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

CV: hypertension

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

EENT: ↑intraocular pressure, cataracts

Endo: adrenal suppression, cushingoid appearance (moon face, buffalo hump), hyperglycemia, PHEOCHROMOCYTOMA

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

GI: anorexia, nausea, PEPTIC ULCERATION, vomiting

Hemat: leukocytosis, THROMBOEMBOLISM, thrombophlebitis

Metab: weight gain

MS: muscle wasting, osteoporosis, avascular necrosis of joints, muscle pain

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

Misc: ↑susceptibility to infection

Drug-drug:

↑risk of hypokalemia with thiazide and loop diuretics, or amphotericin B.
Hypokalemia may ↑ risk of digoxin toxicity.
May ↑ requirement for insulin or oral hypoglycemic agents.
Phenytoin, phenobarbital, and rifampin may ↓ levels and effectiveness.
Hormonal contraceptives may ↓ levels and effectiveness.
↑risk of adverse GI effects with NSAIDs (including aspirin).
At chronic doses that suppress adrenal function, may ↓ antibody response to and ↑ risk of adverse reactions from live-virus vaccines.
May ↑ levels and risk of toxicity of cyclosporine and tacrolimus.
May ↑ risk of tendon rupture from fluoroquinolones.
Antacids↓ absorption of prednisone and dexamethasone.
CYP3A4 inhibitors, including clarithromycin, cobicistat, itraconazole, ketoconazole, or ritonavir, may ↑ levels and risk of toxicity.
May ↓ levels and effectiveness of isoniazid.
May antagonize the effects of anticholinergic agents in myasthenia gravis.

Drug-Food:

Grapefruit juice↑ levels and risk of toxicity of budesonide; avoid concurrent use.

Betamethasone

IM (Adults ): 0.5–9 mg as betamethasone sodium phosphate/acetate suspension. Prevention of respiratory distress syndrome in newborn: 12 mg once daily for 2–3 days before delivery (unlabeled).
IM (Children ): Adrenocortical insufficiency: 17.5 mcg/kg/day (500 mcg/m²/day) in 3 divided doses every 3rd day or 5.8–8.75 mcg/kg (166–250 mcg/m²)/day as a single dose.

Budesonide

PO (Adults ): Active Crohn disease: 9 mg once daily in the morning for up to 8 wk; may repeat 8-wk course for recurring episodes. Maintenance of remission of Crohn disease: 6 mg once daily for up to 3 mo; once symptoms are controlled, taper to complete cessation; Induction of remission of ulcerative colitis: 9 mg once daily for up to 8 wk; once symptoms are controlled, taper to complete cessation; Reduction in proteinuria associated with primary immunoglobulin A nephropathy: 16 mg once daily in the morning for 9 mo, then 8 mg once daily in the morning for 2 wk.
PO (Children 8–17 yr and >25 kg): Active Crohn disease: 9 mg once daily in the morning for up to 8 wk, then 6 mg once daily in the morning for 2 wk.

Hepatic Impairment

(Adults ): Moderate hepatic impairment: 3 mg once daily in the morning.

Dexamethasone

PO IM IV (Adults ): Anti-inflammatory: 0.75–9 mg/day divided every 6–12 hr. Airway edema or extubation: 0.5–2 mg/kg/day divided every 6 hr; begin 24 hr prior to extubation and continue for 24 hr postextubation. Cerebral edema: 10 mg IV initially, then 4 mg IM or IV every 6 hr until maximal response achieved; then switch to PO regimen and taper over 5–7 days.
PO IM IV (Children ): Airway edema or extubation: 0.5–2 mg/kg/day divided every 6 hr; begin 24 hr prior to extubation and continue for 24 hr postextubation. Anti-inflammatory: 0.08–0.3 mg/kg/day or 2.5–10 mg/m²/day divided every 6–12 hr. Physiologic replacement: 0.03–0.15 mg/kg/day or 0.6–0.75 mg/m²/day divided every 6–12 hr.
PO (Adults ): Suppression test: 1 mg at 11 pm or 0.5 mg every 6 hr for 48 hr. Multiple myeloma: 20–40 mg once daily on specific days (based on protocol being used).
IV (Children ): Chemotherapy-induced emesis: 5–20 mg given 15–30 min before treatment; Cerebral edema: Loading dose of 1–2 mg/kg followed by 1–1.5 mg/kg/day divided every 4–6 hr for 5 days (not to exceed 16 mg/day); then taper over 1–6 wk; Bacterial meningitis: 0.6 mg/kg/day divided every 6 hr for 4 days (start at time of 1st antibiotic dose).
IV PO (Adults ): Chemotherapy-induced emesis: 10–20 mg given 15–30 min before each treatment or 10 mg every 12 hr on each treatment day; Delayed nausea/vomiting: 4–10 mg PO 1–2 times/day for 2–4 days or 8 mg PO every 12 hr for 2 days, then 4 mg PO every 12 hr for 2 days or 20 mg PO 1 hr before chemotherapy, then 10 mg PO every 12 hr after chemotherapy, then 8 mg PO every 12 hr for 2 days, then 4 mg PO every 12 hr for 2 days.
IS (Adults ): 0.4–6 mg/day.

Hydrocortisone

PO (Adults ): 20–240 mg/day in 1–4 divided doses.
PO (Children ): Adrenocortical insufficiency/replacement therapy: 8–10 mg/m²/day in 2–3 divided doses; Anti-inflammatory or immunosuppressive: 2.5–10 mg/kg/day or 75–300 mg/m²/day in 3–4 divided doses.
IM IV (Adults ): 100–500 mg every 2–6 hr (range 100–8000 mg/day).
IM IV (Children ): Adrenocortical insufficiency: 0.186–0.28 mg/kg/day (10–12 mg/m²/day) in 3 divided doses. Other uses: 0.666–4 mg/kg (20–120 mg/m²) every 12–24 hr.
Rect (Adults ): Retention enema: 100 mg nightly for 21 days or until remission occurs.

Methylprednisolone

PO (Adults ): Multiple sclerosis: 160 mg/day for 7 days, then 64 mg every other day for 1 mo. Other uses: 2–60 mg/day as a single dose or in 2–4 divided doses. Asthma exacerbations: 120–180 mg/day in divided doses 3–4 times/day for 48 hr, then 60–80 mg/day in 2 divided doses.
PO (Children ): Anti-inflammatory/Immunosuppressive: 0.5–1.7 mg/kg/day (5–25 mg/m²/day) in divided doses every 6–12 hr. Asthma exacerbations: 1 mg/kg every 6 hr for 48 hr, then 1–2 mg/kg/day (maximum: 60 mg/day) divided twice daily.
IM IV (Adults ): Most uses: methylprednisolone sodium succinate: 40–250 mg every 4–6 hr. High-dose “pulse” therapy (methylprednisolone sodium succinate): 30 mg/kg IV every 4–6 hr for up to 72 hr. Status asthmaticus (methylprednisolone sodium succinate): 2 mg/kg IV, then 0.5–1 mg/kg IV every 6 hr for up to 5 days. Multiple sclerosis (methylprednisolone sodium succinate): 160 mg/day for 7 days, then 64 mg every other day for 1 mo. Adjunctive therapy of Pneumocystis jiroveci pneumonia in patients with AIDS (methylprednisolone sodium succinate): 30 mg twice daily for 5 days, then 30 mg once daily for 5 days, then 15 mg once daily for 10 days. Acute spinal cord injury (methylprednisolone sodium succinate): 30 mg/kg IV over 15 min initially, followed in 45 min with a continuous infusion of 5.4 mg/kg/hr for 23 hr (unlabeled).
IM IV (Children ): Anti-inflammatory/Immunosuppressive: 0.5–1.7 mg/kg/day (5–25 mg/m²/day) in divided doses every 6–12 hr. Acute spinal cord injury (methylprednisolone sodium succinate): 30 mg/kg IV over 15 min initially, followed in 45 min with a continuous infusion of 5.4 mg/kg/hr for 23 hr (unlabeled). Status asthmaticus: 2 mg/kg IV, then 0.5–1 mg/kg IV every 6 hr. Lupus nephritis: 30 mg/kg IV every other day for 6 doses.
IM (Adults ): Methylprednisolone acetate: 40–120 mg daily, weekly, or every 2 wk.

Prednisolone

PO (Adults ): Most uses: 5–60 mg/day as a single dose or in divided doses. Multiple sclerosis: 200 mg/day for 7 days, then 80 mg every other day for 1 mo. Asthma exacerbations: 120–180 mg/day in divided doses 3–4 times/day for 48 hr, then 60–80 mg/day in 2 divided doses.
PO (Children ): Anti-inflammatory/Immunosuppressive: 0.1–2 mg/kg/day in 1–4 divided doses; Nephrotic syndrome: 2 mg/kg/day (60 mg/m²/day) in 1–3 divided doses daily (maximum dose: 80 mg/day) until urine is protein-free for 4–6 wk, followed by 2 mg/kg/dose (40 mg/m²/dose) every other day in the morning; gradually taper off over 4–6 wk; Asthma exacerbations: 1 mg/kg every 6 hr for 48 hr, then 1–2 mg/kg/day (maximum: 60 mg/day) divided twice daily.

Prednisone

PO (Adults ): Most uses: 5–60 mg/day as a single dose or in divided doses (delayed-release tablets should be administered once daily). Multiple sclerosis: 200 mg/day for 1 wk; then 80 mg every other day for 1 mo. Adjunctive therapy of Pneumocystis jiroveci pneumonia in patients with AIDS: 40 mg twice daily for 5 days; then 40 mg once daily for 5 days; then 20 mg once daily for 10 days.
PO (Children ): Nephrotic syndrome: 2 mg/kg/day initially given in 1–3 divided doses (maximum 80 mg/day; delayed-release tablets should be administered once daily) until urine is protein-free for 4–6 wk. Maintenance dose of 2 mg/kg/day every other day in the morning; gradually taper off after 4–6 wk. Asthma exacerbation: 1 mg/kg every 6 hr for 48 hr; then 1–2 mg/kg/day (maximum 60 mg/day) in divided doses twice daily.

Triamcinolone

IM (Adults ): Triamcinolone acetonide: 40–80 mg every 4 wk.
Intra-articular(Adults ): Triamcinolone hexacetonide: 2–20 mg every 3–4 wk (dose depends on size of joint to be injected, amount of inflammation, and amount of fluid present); Triamcinolone acetonide: 32 mg as a single dose into the knee joint.
IM (Children ): Triamcinolone acetonide: 40 mg every 4 wk or 30–200 mcg/kg (1–6.25 mg/m²) every 1–7 days.

Betamethasone

(Generic available)

Suspension for injection (sodium phosphate and acetate): 6 mg (total)/mL

Budesonide

(Generic available)

Delayed-release capsules: 3 mg
Delayed-release capsules (Tarpeyo): 4 mg
Extended-release capsules (Ortikos): 6 mg; 9 mg
Extended-release tablets (Uceris): 9 mg
Orally disintegrating tablets (Jorveza): 1 mg

Dexamethasone

(Generic available)

Tablets: 0.5 mg; 0.75 mg; 1 mg; 1.5 mg; 2 mg; 4 mg; 6 mg; 20 mg
Elixir raspberry flavor: 0.5 mg/5 mL
Oral solution cherry flavor: 0.5 mg/5 mL; 1 mg/mL
Solution for injection (sodium phosphate): 4 mg/mL; 10 mg/mL

Hydrocortisone

(Generic available)

Tablets: 5 mg; 10 mg; 20 mg
Oral granules (Alkindi Sprinkle): 0.5 mg; 1 mg; 2 mg; 5 mg
Enema: 100 mg/60 mL
Lyophilized powder for injection (sodium succinate): 100 mg/vial; 250 mg/vial; 500 mg/vial; 1 g

Methylprednisolone

(Generic available)

Tablets: 2 mg; 4 mg; 8 mg; 16 mg; 32 mg
Powder for injection (sodium succinate): 40 mg/vial; 125 mg/vial; 500 mg/vial; 1 g/vial; 2 g/vial
Suspension for injection (acetate): 20 mg/mL; 40 mg/mL; 80 mg/mL

Prednisolone

(Generic available)

Tablets: 5 mg
Orally disintegrating tablets grape flavor: 10 mg; 15 mg; 30 mg
Oral solution: 5 mg/5 mL; 10 mg/5 mL; 15 mg/5 mL; 20 mg/5 mL; 25 mg/5 mL

Prednisone

(Generic available)

Tablets: 1 mg; 2.5 mg; 5 mg; 10 mg; 20 mg; 50 mg
Delayed-release tablets: 1 mg; 2 mg; 5 mg
Oral solution: 5 mg/5 mL; 5 mg/mL

Triamcinolone

(Generic available)

Extended-release suspension for intra-articular injection (acetonide) (requires reconstitution) (Zilretta): 32 mg/vial
Suspension for intra-articular injection (hexacetonide): 20 mg/mL
Suspension for intramuscular injection (acetonide): 10 mg/mL; 40 mg/mL; 80 mg/mL

Assess for signs/symptoms of adrenal insufficiency (hypotension, weight loss, weakness, nausea, vomiting, anorexia, lethargy, confusion, restlessness) before and periodically during therapy. When switching other oral hydrocortisone formulations to Alkindi Sprinkle, use the same total daily hydrocortisone dose. Closely monitor patient after switching to Alkindi Sprinkle for signs/symptoms of adrenocortical insufficiency. If signs/symptoms of adrenal insufficiency occur after switching, ↑ total daily dose of Alkindi Sprinkle.
Monitor intake, output, and daily weights. Observe for peripheral edema, steady weight gain, rales/crackles, or dyspnea. Notify health care provider if these occur.
Pedi: Children should have periodic evaluations of growth; may slow growth.
Cerebral Edema: Assess for changes in level of consciousness and headache during therapy.
Budesonide: Assess signs of Crohn disease and ulcerative colitis (diarrhea, crampy abdominal pain, fever, bleeding from rectum) during therapy. Monitor frequency and consistency of bowel movements periodically during therapy.
Assess symptoms of ulcerative colitis (diarrhea, bleeding, weight loss, anorexia, fever, leukocytosis) periodically during therapy.

Lab Test Considerations:

Verify negative pregnancy test before starting therapy with Hemady. Monitor serum electrolytes, CBC, and glucose. May cause hyperglycemia, especially in patients with diabetes. May ↓ WBCs. May ↓ potassium and calcium and ↑ sodium.
- Guaiac-test stools. Promptly report presence of guaiac-positive stools.
- May ↑ cholesterol. May ↓ uptake of thyroid ¹²³I or ¹³¹I.
- May suppress reactions to allergy skin tests.
- Periodic adrenal function tests may be ordered to assess degree of hypothalamic-pituitary-adrenal axis suppression in systemic and chronic topical therapy.
Dexamethasone Suppression Test: To diagnose Cushing syndrome: Obtain baseline cortisol level; administer dexamethasone at 11 pm and obtain cortisol levels at 8 am the next day. Normal response is a ↓ cortisol level. Alternative method: Obtain baseline 24-hr urine for 17-hydroxycorticosteroid concentrations; then begin 48-hr administration of dexamethasone. Second 24-hr urine for 17-hydroxycorticosteroid is obtained after 24 hr of dexamethasone.

Do not confuse prednisone with prednisolone. Do not confuse dexamethasone with dexmedetomidine. Do not confuse methylprednisolone with medroxyprogesterone or methyltestosterone. Do not confuse Solu-Cortef with Solu-Medrol. Do not confuse Depo-Medrol with Solu-Medrol.
- If dose is ordered daily or every other day, administer in the morning to coincide with the body’s normal secretion of cortisol.
Periods of stress, such as surgery, may require supplemental systemic corticosteroids.
Patients with mild to moderate Crohn disease may be switched from oral prednisolone without adrenal insufficiency by gradually ↓ prednisolone doses and adding budesonide.
PO: Administer with meals to minimize GI irritation.
- DNC: Swallow Ortikos (budesonide) tablets whole; do not crush or chew. Other tablets may be crushed and administered with food or fluids for patients with difficulty swallowing. DNC: Capsules and extended-release tablets should be swallowed whole; do not open, crush, break, or chew.
- Entocort EC (budesonide) capsules can be opened and contents sprinkled onto 1 tablespoon (15 mL) of applesauce for patients unable to swallow capsule. Applesauce must not be hot and must be soft enough to swallow without chewing. Mix granules with applesauce and consume entire contents within 30 min of mixing. Do not chew or crush the granules. Do not save the applesauce and granules for future use. Follow with 8 ounces of cool water to ensure complete swallowing of granules.
- Alkindi Sprinkle (hydrocortisone) are granules in capsules. Do not swallow capsules; do not crush or chew granules. Do not use with nasogastric or gastric tubes; may cause blockage of tube. To open capsule, hold capsule so that printed strength is at the top and tap to ensure all granules are in the lower half of the capsule. Squeeze bottom of capsule gently and twist off top of capsule. Granules may be poured directly onto patient’s tongue, poured onto a spoon and placed in patient’s mouth, or sprinkled onto a spoonful of cold or room temperature soft food (yogurt or fruit puree). Swallow granules within 5 min to avoid bitter taste, as the outer taste-masking cover can dissolve. Tap capsule to ensure all granules are removed. Avoid wetting capsule on the tongue or soft food; may result in granules remaining in capsule. Immediately follow administration with fluids (water, milk, breast milk, formula) to ensure all granules are swallowed. Do not add granules to liquid; may result in ↓ of dose administered and may result in a bitter taste.
- Use calibrated measuring device to ensure accurate dose of liquid forms.
- For orally disintegrating tablets, remove tablet from blister just prior to dosing. Peel blister pack open, and place tablet on tongue; may be swallowed whole or allowed to dissolve in mouth, with or without water. Tablets are friable; do not cut, split, or break.
- Avoid consumption of grapefruit juice during therapy with budesonide or methylprednisolone.
IM: SUBQ: Shake suspension well before drawing up. IM doses should not be administered when rapid effect is desirable. Do not dilute with other solution or admix. Do not administer suspensions IV.

Y-Site Compatibility:
- acetaminophen
- acyclovir
- allopurinol
- amikacin
- aminocaproic acid
- aminophylline
- amphotericin B liposomal
- anidulafungin
- argatroban
- arsenic trioxide
- ascorbic acid
- atracurium
- atropine
- azithromycin
- aztreonam
- benztropine
- bivalirudin
- bleomycin
- bumetanide
- buprenorphine
- butorphanol
- cangrelor
- carboplatin
- carmustine
- cefazolin
- cefepime
- cefiderocol
- cefotaxime
- cefotetan
- cefoxitin
- ceftaroline
- ceftazidime
- ceftobiprole
- ceftolozane/tazobactam
- ceftriaxone
- chlorothiazide
- cisatracurium
- cisplatin
- cladribine
- clindamycin
- cyanocobalamin
- cyclophosphamide
- cyclosporine
- cytarabine
- dacarbazine
- dactinomycin
- daptomycin
- dexmedetomidine
- digoxin
- diltiazem
- dimenhydrinate
- docetaxel
- dopamine
- doxorubicin hydrochloride
- doxorubicin liposomal
- edetate calcium disodium
- enalaprilat
- ephedrine
- epinephrine
- epoetin alfa
- eptifibatide
- ertapenem
- etoposide
- etoposide phosphate
- famotidine
- fentanyl
- filgrastim
- fluconazole
- fludarabine
- fluorouracil
- folic acid
- fosaprepitant
- foscarnet
- fosphenytoin
- furosemide
- ganciclovir
- gemcitabine
- glycopyrrolate
- granisetron
- heparin
- hydrocortisone
- hydromorphone
- ifosfamide
- imipenem/cilastatin
- imipenem/cilastatin/relebactam
- indomethacin
- insulin, regular
- irinotecan
- isoproterenol
- ketorolac
- leucovorin
- levofloxacin
- lidocaine
- linezolid
- lorazepam
- mannitol
- melphalan
- meropenem
- meropenem/vaborbactam
- mesna
- methadone
- methohexital
- methylprednisolone
- metoclopramide
- metoprolol
- metronidazole
- milrinone
- mitomycin
- morphine
- moxifloxacin
- multivitamins
- nafcillin
- nalbuphine
- naloxone
- nitroglycerin
- nitroprusside
- norepinephrine
- octreotide
- ondansetron
- oxaliplatin
- oxytocin
- paclitaxel
- palonosetron
- pamidronate
- pemetrexed
- penicillin G
- pentobarbital
- phenobarbital
- phenylephrine
- phytonadione
- piperacillin/tazobactam
- plazomicin
- potassium acetate
- potassium chloride
- procainamide
- prochlorperazine
- propofol
- propranolol
- pyridoxine
- remifentanil
- rituximab
- sargramostim
- sodium acetate
- sodium bicarbonate
- succinylcholine
- sufentanil
- tacrolimus
- tedizolid
- telavancin
- theophylline
- thiamine
- thiotepa
- tigecycline
- tirofiban
- trastuzumab
- vancomycin
- vasopressin
- vecuronium
- verapamil
- vinblastine
- vincristine
- vinorelbine
- voriconazole
- zidovudine
- zoledronic acid
Y-Site Incompatibility:
- alemtuzumab
- amiodarone
- amphotericin deoxycholate
- blinatumomab
- caspofungin
- cefuroxime
- ciprofloxacin
- dacarbazine
- dantrolene
- daunorubicin
- diazepam
- diphenhydramine
- dobutamine
- doxycycline
- epirubicin
- esmolol
- gemtuzumab ozogamicin
- haloperidol
- idarubicin
- labetalol
- magnesium sulfate
- midazolam
- minocycline
- mitoxantrone
- mycophenolate
- nicardipine
- pantoprazole
- papaverine
- pentamidine
- phenytoin
- prochlorperazine
- protamine
- tobramycin
- topotecan
- trimethoprim/sulfamethoxazole

Y-Site Compatibility:
- acetaminophen
- acyclovir
- alemtuzumab
- allopurinol
- amikacin
- aminophylline
- amphotericin B liposomal
- anidulafungin
- argatroban
- ascorbic acid
- atracurium
- atropine
- azithromycin
- aztreonam
- benztropine
- bivalirudin
- bleomycin
- bumetanide
- buprenorphine
- butorphanol
- cangrelor
- carboplatin
- carmustine
- caspofungin
- cefazolin
- cefepime
- cefiderocol
- cefotaxime
- cefotetan
- cefoxitin
- ceftaroline
- ceftazidime
- ceftobiprole
- ceftolozane/tazobactam
- ceftriaxone
- cefuroxime
- chloramphenicol
- chlorothiazide
- chlorpromazine
- cisatracurium
- cisplatin
- cladribine
- clindamycin
- cyanocobalamin
- cyclophosphamide
- cyclosporine
- cytarabine
- dactinomycin
- daptomycin
- daunorubicin
- defibrotide
- dexamethasone
- dexmedetomidine
- dexrazoxane
- digoxin
- docetaxel
- dopamine
- doxorubicin hydrochloride
- doxorubicin liposomal
- droperidol
- edetate calcium disodium
- enalaprilat
- ephedrine
- epinephrine
- epirubicin
- epoetin alfa
- eptifibatide
- ertapenem
- erythromycin
- estrogens, conjugated
- etoposide
- famotidine
- fentanyl
- filgrastim
- fluconazole
- fludarabine
- fluorouracil
- folic acid
- foscarnet
- fosphenytoin
- furosemide
- gemcitabine
- glycopyrrolate
- granisetron
- heparin
- hydromorphone
- ifosfamide
- imipenem/cilastatin
- imipenem/cilastatin/relebactam
- indomethacin
- insulin, regular
- irinotecan
- isoproterenol
- ketamine
- ketorolac
- leucovorin
- levofloxacin
- lidocaine
- linezolid
- lorazepam
- mannitol
- melphalan
- meropenem/vaborbactam
- mesna
- methadone
- methohexital
- methotrexate
- methylergonovine
- metoclopramide
- metoprolol
- metronidazole
- milrinone
- mitoxantrone
- morphine
- moxifloxacin
- multivitamins
- nafcillin
- naloxone
- neostigmine
- nitroglycerin
- nitroprusside
- norepinephrine
- octreotide
- ondansetron
- oxacillin
- oxaliplatin
- oxytocin
- paclitaxel
- palonosetron
- pamidronate
- pantoprazole
- pemetrexed
- penicillin G
- pentobarbital
- phenobarbital
- phentolamine
- phenylephrine
- phytonadione
- piperacillin/tazobactam
- plazomicin
- potassium acetate
- potassium chloride
- procainamide
- prochlorperazine
- propofol
- propranolol
- pyridostigmine
- remifentanil
- rituximab
- scopolamine
- sodium acetate
- sodium bicarbonate
- succinylcholine
- sufentanil
- tacrolimus
- tedizolid
- telavancin
- theophylline
- thiotepa
- tigecycline
- tirofiban
- topotecan
- trastuzumab
- vasopressin
- vecuronium
- verapamil
- vinblastine
- vincristine
- vinorelbine
- voriconazole
- zoledronic acid
Y-Site Incompatibility:
- amphotericin B deoxycholate
- ampicillin/sulbactam
- azathioprine
- ciprofloxacin
- dantrolene
- diazepam
- diazoxide
- dobutamine
- doxycycline
- ganciclovir
- gemtuzumab ozogamicin
- haloperidol
- idarubicin
- labetalol
- midazolam
- mycophenolate
- nalbuphine
- pentamidine
- phenytoin
- protamine
- pyridoxine
- rocuronium
- sargramostim
- thiamine
- trimethoprim/sulfamethoxazole

Y-Site Compatibility:
- acetaminophen
- acyclovir
- alprostadil
- amikacin
- aminophylline
- amphotericin B liposomal
- anidulafungin
- argatroban
- arsenic trioxide
- ascorbic acid
- atracurium
- atropine
- azithromycin
- aztreonam
- benztropine
- bivalirudin
- bleomycin
- bumetanide
- buprenorphine
- butorphanol
- cangrelor
- carboplatin
- carmustine
- cefazolin
- cefepime
- cefotetan
- ceftaroline
- ceftazidime
- ceftobiprole
- ceftolozane/tazobactam
- ceftriaxone
- cefuroxime
- chloramphenicol
- chlorpromazine
- cisplatin
- cladribine
- clindamycin
- cyanocobalamin
- cyclophosphamide
- cyclosporine
- cytarabine
- dactinomycin
- daptomycin
- dexamethasone
- dexmedetomidine
- digoxin
- dobutamine
- dopamine
- doxorubicin liposomal
- enalaprilat
- ephedrine
- epinephrine
- epoetin alfa
- eptifibatide
- ertapenem
- erythromycin
- etoposide
- fentanyl
- fluconazole
- fludarabine
- fluorouracil
- folic acid
- fosaprepitant
- furosemide
- gentamicin
- glycopyrrolate
- granisetron
- hydromorphone
- ifosfamide
- imipenem/cilastatin
- imipenem/cilastatin/relebactam
- insulin, regular
- isoproterenol
- ketorolac
- labetalol
- levofloxacin
- linezolid
- lorazepam
- mannitol
- melphalan
- meropenem/vaborbactam
- mesna
- methadone
- methotrexate
- metoclopramide
- metoprolol
- metronidazole
- milrinone
- mitomycin
- morphine
- moxifloxacin
- multivitamins
- nafcillin
- naloxone
- nitroglycerin
- nitroprusside
- norepinephrine
- octreotide
- oxaliplatin
- oxytocin
- pamidronate
- pemetrexed
- penicillin G
- pentobarbital
- phenobarbital
- phenylephrine
- piperacillin/tazobactam
- potassium acetate
- procainamide
- prochlorperazine
- propranolol
- remifentanil
- rituximab
- sodium acetate
- sodium bicarbonate
- succinylcholine
- sufentanil
- tacrolimus
- tedizolid
- theophylline
- thiotepa
- tirofiban
- tobramycin
- topotecan
- trastuzumab
- vasopressin
- verapamil
- vincristine
- voriconazole
- zoledronic acid
Y-Site Incompatibility:
- alemtuzumab
- allopurinol
- amphotericin B deoxycholate
- ampicillin/sulbactam
- blinatumomab
- calcium chloride
- calcium gluconate
- caspofungin
- cefotaxime
- cefoxitin
- ciprofloxacin
- dacarbazine
- dantrolene
- daunorubicin
- dexrazoxane
- diazepam
- diazoxide
- diphenhydramine
- docetaxel
- doxycycline
- epirubicin
- etoposide phosphate
- filgrastim
- foscarnet
- ganciclovir
- gemcitabine
- gemtuzumab ozogamicin
- haloperidol
- hydralazine
- idarubicin
- irinotecan
- isavuconazonium
- leucovorin
- magnesium sulfate
- mitoxantrone
- mycophenolate
- nalbuphine
- paclitaxel
- palonosetron
- pantoprazole
- papaverine
- pentamidine
- phenytoin
- promethazine
- propofol
- protamine
- pyridoxine
- rocuronium
- sargramostim
- thiamine
- trimethoprim/sulfamethoxazole
- vancomycin
- vecuronium
- vinorelbine

Dexamethasone

IV Administration:

Intermittent Infusion: Diluent: High-dose therapy should be added to D5W or 0.9% NaCl solution. Solution is clear and colorless to light yellow; use diluted solution within 24 hr. Concentration: 10 mg/mL. Rate: Infuse over 15–30 min.

Hydrocortisone Sodium Succinate

IV Administration:

Methylprednisolone Sodium Succinate

IV Administration:

Explain purpose and side effects of medication to patient. Advise patient to read Patient Information before starting therapy.
Advise patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care provider before taking other medications.
Advise patient to take medication as directed. Take missed doses as soon as remembered unless almost time for next dose. Do not double doses. If full dose is not administered due to regurgitating or vomiting of granules, instruct patients and/or caregivers to contact their health care provider. A repeat dose may be required to avoid adrenal insufficiency. Stopping the medication suddenly may result in adrenal insufficiency (anorexia, nausea, weakness, fatigue, dyspnea, hypotension, hypoglycemia). If these signs appear, notify health care provider immediately. This can be life-threatening.
- Advise patient to avoid consumption of grapefruit juice during therapy with budesonide or methylprednisolone.
- Corticosteroids cause immunosuppression and may mask symptoms of infection. Advise patient to avoid people with known contagious illnesses and to report possible infections immediately.
- Pediapred solution may be refrigerated.
- Advise patient to avoid vaccinations without first consulting health care provider.
- Advise patient to inform health care provider 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 provider if signs and symptoms of hypercorticism (acne; thicker or more hair on body and face; bruise easily; fatty pad or hump between shoulders [buffalo hump], rounding of face [moon face], pink or purple stretch marks on skin of abdomen, thighs, breasts, and arms; ankle swelling), adrenal suppression (tiredness, weakness, nausea and vomiting, low blood pressure), worsening of allergies (eczema, rhinitis), and infection (fever, chills, pain, feeling tired, aches, nausea, and vomiting). May worsen existing tuberculosis, fungal, bacterial, viral, or parasitic infections or ocular herpes simplex.
- Advise patient to notify health care provider immediately if exposed to chickenpox or measles.
- Advise patient to notify health care provider of medication regimen before treatment or surgery.
- Discuss possible effects on body image. Explore coping mechanisms.
- Advise patient to inform health care provider 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.
Long-Term Therapy: Encourage patient to eat a diet high in protein, calcium, and potassium and low in sodium and carbohydrates (see Food Sources for Specific Nutrients). Alcohol should be avoided during therapy; may ↑ risk of GI irritation.
- If rectal dose used 21 days, ↓ to every other night for 2–3 wk to ↓ gradually.
- Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected or if breastfeeding. Hemady may cause fetal harm. Advise women taking Hemady to use effective contraception during and for ≥1 mo after last dose. Monitor infants born to mothers who have received substantial doses of corticosteroids during pregnancy for signs of hypoglycemia and hypoadrenalism. Advise women to avoid breastfeeding during and for 2 wk after last dose. May impair male fertility.

Suppression of inflammation and modification of the normal immune response.
Replacement therapy in adrenal insufficiency.
Budesonide: Improvement in symptoms/sequelae of Crohn disease, induction of remission of ulcerative colitis, and reduction in UPCR.

hydrocortisone: Alkindi Sprinkle, Cortef, Cortenema, Solu-CORTEF,

methylPREDNISolone: Depo-Medrol, Medrol, Solu-MEDROL,

prednisoLONE: ~~Orapred,~~ Orapred ODT,

predniSONE: ~~Rayos,~~

triamcinolone: Hexatrione, Kenalog, Zilretta,

betamethasone: Celestone Soluspan, ~~Celestone,~~

budesonide: ~~Entocort EC,~~ Ortikos, Tarpeyo, Uceris,

dexAMETHasone: ~~Decadron,~~ Hemady

predniSONE: Winipred,

triamcinolone: Trispan,

betamethasone: ~~Betaject,~~

budesonide: Cortiment, Entocort, Jorveza

section name header

Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇

Interactions ⬆ ⬇

Route/Dosage ⬆ ⬇

Availability ⬆ ⬇

Assessment ⬆ ⬇

Implementation ⬆ ⬇

Patient/Family Teaching ⬆ ⬇

Evaluation/Desired Outcomes ⬆ ⬇

US Brand Names ⬆ ⬇

Canadian Brand Names ⬆