Cortisone, tablets 25 mg 80 pcs

GCS. It has a significant effect on carbohydrate metabolism and, to a lesser extent, on water and electrolyte metabolism. It has mineralocorticoid activity: sodium retention, potassium loss, fluid retention in the body. Promotes glycogen accumulation in the liver, increases blood glucose content, increases urinary excretion of nitrogen. It has anti-inflammatory, desensitizing and anti-allergic effects, has immunosuppressive activity.

Inflammatory activity is caused by inhibition of phospholipase A2 which leads to inhibition of prostaglandin synthesis, decrease of macrophage chemotactic factor release, decrease of macrophages and lymphocytes migration to inflammation focus, stabilization of lysosomal membranes and prevention of lysosomal enzymes release.

The immunosuppressive action is associated with decrease of the number of immunocompetent cells, decrease of immunoglobulin binding to cell receptors, suppression of blast-transformation of B-lymphocytes, decrease of interleukins, lymphokines, circulating immunocomplexes, complement fractions.

increases excretion of calcium with urine, activates bone tissue lysis by mediated increase of calcitonin amount, increases osteoclast activity, decreases osteoblast function.

It has a catabolic effect, increases protein breakdown. Has a lipolytic effect and increases the content of fatty acids in the blood. It reduces the production of ACTH in the anterior pituitary lobe, which leads to suppression of activity and subsequent atrophy of the adrenal cortex.

Indications

Addison’s disease, secondary chronic insufficiency of the adrenal cortex (in hypopituitarism).

Allergic, inflammatory, infectious-allergic, autoimmune diseases.

Active ingredient

Cortisone

Composition

Active ingredient:

cortisone acetate 25 mg.

Associates:

sugar,

potato starch,

stearic acid.

How to take, the dosage

Internal.

In chronic adrenal insufficiency:

The usual average maintenance dose is 25-50 mg per day. The daily dose of the drug is administered in 2 doses, reproducing the daily rhythm of cortisone secretion -2/3 of the daily dose in the morning (at 6-8 hours) and 1/3 of the daily dose in the evening (at 5-18 hours). At the threat of stress, the daily dose is increased 2-3 times and administered in 3-4 doses (6-8 hours later).

In congenital dysfunction of the adrenal cortex

The dose of 25 mg daily in combination with other glucocorticosteroid drugs (prednisolone, dexamethasone).

The maximum doses for adults are single-150 mg and 300 mg daily.

In children, Cortisone is prescribed in lower doses, depending on age.

Maximum doses for children:

Under 5 years: single – 25 mg, daily – 75 mg.

From 5 to 10 years: single 50 mg, daily -150 mg.

After 10 years of age: single 75 mg, daily 225 mg.

If it is necessary to replace Cortisone with other drugs with glucocorticosteroid activity, remember that 25 mg of cortisone is equivalent in action to 20 mg of hydrocortisone ; 5 mg of prednisolone or prednisone ; 4 mg of methylprednisolone or triamcinolone ; 0.75 mg of dexamethasone.

Interaction

Simultaneous administration of Cortisone with:

The inducers of “hepatic “microsomal enzymes ( phenobarbital , rifampicin , phenytoin , theophylline , ephedrine ) lead to a decrease in its concentration.

Diuretics (especially “thiazide” and carboenhydrase inhibitors) and amphotericin B can lead to increased excretion of K+ , with sodium-containing drugs – edema and increased blood pressure.

Amphotericin B increases the risk of heart failure.

The cardiac glycosides impair tolerance and increase the risk of ventricular extrasystole (due to hypokalemia).

With indirect anticoagulants, it weakens (less often increases) their effect (dose adjustment is required).

Anticoagulants and thrombolytics increase the risk of bleeding from ulcers in the gastrointestinal tract.

Ethanol and nonsteroidal anti-inflammatory drugs (NSAIDs) increase the risk of gastrointestinal ulcers and bleeding (in combination with NSAIDs, treatment of arthritis may decrease the dose of glucocorticosteroids due to summation of therapeutic effect).

Paracetamol increases the risk of hepatotoxicity (induction of liver enzymes and formation of the toxic metabolite of paracetamol).

Acetylsalicylic acid accelerates its excretion and reduces its concentration in the blood (when Cortisone is withdrawn, the level of salicylates in the blood increases and the risk of side effects increases).

Insulin and oral hypoglycemic drugs and hypotensive agents decrease their effectiveness.

Vitamin D reduces its effect on Ca 2+ absorption in the intestine.

Somatotropic hormone reduces the effectiveness of the latter, and with praziquantel reduces its concentration.

M-cholinoblockers (including antihistamines and tricyclic antidepressants) and nitrates contribute to increased intraocular pressure.

Isoniazid and mexelitin increase their metabolism (especially in “slow” acetylators), which leads to a decrease in their plasma concentrations.

Carboanhydrase inhibitors and “loop” diuretics may increase the risk of osteoporosis.

Indomethacin, by displacing Cortisone from binding to albumin, increases the risk of its side effects.

ACTH increases the effects of Cortisone.

Ergocalciferol and parathormone inhibit Cortisone-induced osteopathy.

Cyclosporine and ketoconazole, by slowing the metabolism of Cortisone, may in some cases increase its toxicity.

The simultaneous administration of androgens and steroidal anabolic drugs with Cortisone promotes the development of peripheral edema and hirsutism and the appearance of acne.

Estrogens and oral estrogen-containing contraceptives decrease the clearance of Cortisone, which may be accompanied by an increase in the severity of its effects.

Mitotan and other inhibitors of adrenal cortex function may necessitate increasing the dose of Cortisone.

The concomitant use with live antiviral vaccines and other immunizations increases the risk of virus activation and infections.

Antipsychotics (neuroleptics) and azathioprine increase the risk of cataracts when Cortisone is prescribed.

The concomitant administration of antacids decreases absorption of Cortisone.

Concomitant use with antithyroid drugs decreases and with thyroid hormones increases Cortisone clearance.

Special Instructions

During treatment with Cortisone (especially long-term), monitoring of ophthalmologist, control of blood pressure, water-electrolyte balance, as well as peripheral blood picture and blood glucose level is necessary.

In order to reduce side effects, antacids may be prescribed, and the intake of K + in the body may be increased (diet, potassium preparations). The food should be rich in proteins, vitamins, and restriction of fats, carbohydrates, and table salt.

The action of the drug is increased in patients with hypothyroidism and cirrhosis.

The drug may aggravate existing emotional instability or psychotic disorders. If a history of psychosis is indicated, Cortisone in high doses is prescribed under close medical supervision.

In stressful situations during maintenance treatment (e.g., surgery, trauma, or infectious diseases), an adjustment of the drug dose should be made due to the increased need for glucocorticosteroids.

In abrupt withdrawal, especially if high doses were previously used, withdrawal syndrome (anorexia, nausea, lethargy, generalized musculoskeletal pain, generalized weakness) and exacerbation of the condition for which Cortisone was prescribed may occur.

Vaccination should not be performed during treatment with Cortisone due to a decrease in its effectiveness (immune response).

When prescribed for intercurrent infections, septic conditions and tuberculosis, bactericidal antibiotics must be treated at the same time.

In children during long-term treatment with Cortisone the growth and development dynamics should be closely monitored. Children who have been in contact with patients with measles or chickenpox during treatment are given specific immunoglobulins prophylactically.

According to the insufficiently pronounced mineralocorticoid effect for replacement therapy in adrenal insufficiency Cortisone is used in combination with mineralocorticoids.

In diabetic patients, blood glucose levels should be monitored and therapy should be adjusted if necessary.

The radiological control of the bone and joint system (pictures of the spine, hand) is indicated.

Cortisone in patients with latent renal and urinary tract infections may cause leukocyturia, which may be of diagnostic value.

Cortisone increases metabolites of 11- and 17-oxyketocorticosteroids.

Contraindications

For short-term use for vital indications the only contraindication is hypersensitivity to cortisone acetate or drug components.
In children during growth, GCS should be used only for absolute indications and under special close supervision of the attending physician. The drug should be prescribed with caution in the following diseases and conditions:

• Gastrointestinal diseases – gastric and duodenal ulcer, esophagitis, gastritis, acute or latent peptic ulcer, newly created intestinal anastomosis, non-specific ulcerative colitis with threat of perforation or abscessing, diverticulitis.
• Parasitic and infectious diseases of viral, fungal or bacterial nature (current or recent, including recent contact with a patient) – herpes simplex, herpes zoster (viremic phase), varicella, measles; amebiasis, strongyloidosis; systemic mycosis; active and latent tuberculosis. Administration in case of severe infectious diseases is permitted only against the background of specific therapy.
• Pre- and post-vaccination period (8 weeks before and 2 weeks after vaccination), lymphadenitis after BCG vaccination. Immunodeficiency states (including AIDS or HIV infection).
• Diseases of the cardiovascular system, including. Recent myocardial infarction (patients with acute and subacute myocardial infarction may have disseminated necrosis, delayed scar tissue formation and thereby rupture of the heart muscle), severe chronic heart failure, arterial hypertension, hyperlipidemia.
• Endocrine disorders – diabetes (including impaired carbohydrate tolerance), thyrotoxicosis, hypothyroidism, Icenko-Cushing’s disease, obesity (III-IV stage). Hypoalbuminemia and conditions predisposing to its occurrence.
• Systemic osteoporosis, myasthenia gravis, acute psychosis, poliomyelitis (except for bulbar encephalitis), open and closed angle glaucoma
• Pregnancy.

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Side effects

The frequency and severity of side effects depend on the duration of use, the amount of dose used, and the ability to observe the circadian rhythm of Cortisone administration.

In the endocrine system:

Decreased glucose tolerance , steroid diabetes mellitus or manifestation of latent diabetes mellitus, depressed adrenal function, Icenko-Cushing’s syndrome (moon-shaped face, pituitary-type obesity, hirsutism, increased blood pressure , dysmenorrhea, amenorrhea, muscle weakness, stretch marks), delayed sexual development in children.

The digestive system:

Nausea, vomiting , pancreatitis , steroid gastric and duodenal ulcer, erosive esophagitis, bleeding and perforation of the GI tract, increased or decreased appetite, digestive disorders, flatulence, hiccups . In rare cases – increased activity of “liver” transaminases and alkaline phosphatase.

The cardiovascular system:

Arrhythmias, bradycardia (up to cardiac arrest), development (in predisposed patients) or worsening the severity of heart failure, ECG – changes characteristic of hypokalemia, increased blood pressure, hypercoagulation, thrombosis. In patients with acute and subacute myocardial infarction – expansion of the focus of necrosis, delayed formation of scar tissue, which may lead to rupture of the heart muscle.

Nervous system side:

Delirium, disorientation, euphoria, hallucinations, manic-depressive psychosis, Depression , paranoia, increased Intracranial pressure , nervousness or anxiety, Insomnia , Vertigo , Vertigo , cerebellar pseudotum, headache, seizures.

Senses:

Posterior subcapsular cataracts, increased intraocular pressure with possible damage to the optic nerve, tendency to develop secondary bacterial, fungal or viral eye infections, trophic changes of the cornea, exophthalmos.

Metabolism disorders:

Elevated calcium excretion, hypocalcemia, weight gain, negative nitrogen balance (increased protein breakdown), increased sweating.

The mineralocorticoid-induced fluid and sodium retention (peripheral edema), hypernatremia, hypokalemic syndrome (hypokalemia, arrhythmia, Myalgia or muscle spasm, unusual weakness and fatigue).

Musculoskeletal disorders:

Delayed growth and ossification processes in children (premature closure of epiphyseal growth zones), osteoporosis (very rare, abnormal bone fractures, aseptic necrosis of the head of the humerus and femur), muscle tendon rupture, steroid myopathy, reduced muscle mass (atrophy).

Skin and mucous membranes:

Delayed wound healing, petechiae, ecchymosis, skin thinning, hyper- or hypopigmentation, acne, stretch marks, tendency to develop pyoderma and candidiasis.

Allergic reactions:

Skin rash, itching, anaphylactic shock.

Other:

The development or exacerbation of infections (the appearance of this side effect is promoted by co-administration of immunosuppressants and vaccination), leukocyturia, withdrawal syndrome.

Overdose

Symptoms: increased side effects.

Treatment: symptomatic.