Corticosteroides

Replacement therapy

The adrenal cortex normally secretes hydrocortisone (cortisol) which has glucocorticoid activity and weak mineralocorticoid activity. It also secretes the mineralocorticoid aldosterone. In deficiency states, physiological replacement is best achieved with a combination of hydrocortisone and the mineralocorticoid fludrocortisone; hydrocortisone alone does not usually provide sufficient mineralocorticoid activity for complete replacement.

FLUDROCORTISONE ACETATE:

Indications: mineralocorticoid replacement in adrenocortical insufficiency. Adrenogenital Disorder, Primary Adrenocortical Insufficiency, Symptomatic Orthostatic Hypotension.

Contraindications: Chronic Heart Failure, Acute Tuberculosis, Cataracts, Diabetes Mellitus, Disease of Liver, Epilepsy, Glaucoma, Hypercortisolism, Hypertension, Hypokalemia, Hypothyroidism, Inactive Tuberculosis, Myasthenia Gravis, Osteoporosis, Peptic Ulcer, Peripheral Edema, Renal Disease.

Dose and Administration: 50–300 micrograms daily; child 5 micrograms/kg daily.

Glucocorticoid therapy

BETAMETHASONE:

Indications: suppression of inflammatory and allergic disorders; congenital adrenal hyperplasia. Acquired Thrombocytopenia, Acute Lymphoid Leukemia, Adrenocortical Insufficiency, Adrenogenital Disorder, Allergic Rhinitis, Angioedema, Ankylosing Spondylitis, Aspiration Pneumonitis, Atopic Dermatitis, Autoimmune Disease, Autoimmune Hemolytic Anemia, Berylliosis, Bronchial Asthma, Bursitis, Congenital Adrenal Hyperplasia, Congenital Hypoplastic Anemia, Contact Dermatitis, Crohn’s Disease.

Contraindications: Arginase Deficiency, Arginosuccinate Lyase Deficiency, Carbamyl Phosphate Synthetase Deficiency, Cerebral Malaria, Citrullinemia, Fungal Infections, and Ornithine Carbamyltransferase Deficiency.

Dose and Administration: By mouth, usual range 0.5–5 mg daily.

BETAMETHASONE DIPROPIONATE & SODIUM PHOSPHATE:  Indications: suppression of inflammatory and allergic disorders; congenital adrenal hyperplasia. Acquired Thrombocytopenia, Acute Lymphoid Leukemia, Adrenocortical Insufficiency, Adrenogenital Disorder, Allergic Rhinitis, Angioedema, Ankylosing Spondylitis, Aspiration Pneumonitis, Atopic Dermatitis, Autoimmune Disease, Autoimmune Hemolytic Anemia, Berylliosis, Bronchial Asthma, Bursitis, Congenital Adrenal Hyperplasia, Congenital Hypoplastic Anemia, Contact Dermatitis, Crohn’s Disease.

Contraindications: Arginase Deficiency, Arginosuccinate Lyase Deficiency, Carbamyl Phosphate Synthetase Deficiency, Cerebral Malaria, Citrullinemia, Fungal Infections, and Ornithine Carbamyltransferase Deficiency.

Dose and Administration: dosing must be individualized on the basis of the specific disease.

DEXAMETHASONE:

Indications: suppression of inflammatory and allergic disorders; diagnosis of Cushing’s disease, congenital adrenal hyperplasia; cerebral oedema associated with malignancy; croup; nausea and vomiting with chemotherapy; rheumatic disease

Contraindications: Arginase Deficiency, Arginosuccinate Lyase Deficiency, Carbamyl Phosphate Synthetase Deficiency, Cerebral Malaria, Citrullinemia, Fungal Infections, and Ornithine Carbamyltransferase Deficiency.

Dose and Administration: By mouth, usual range 0.5–10 mg daily; child 10– 100 micrograms/kg daily, By intramuscular injection or slow intravenous injection or infusion (as dexamethasone phosphate), initially 0.5–24 mg; child 200– 400 micrograms/kg daily, Cerebral oedema associated with malignancy (as

dexamethasone phosphate), by intravenous injection, 10 mg initially, then 4 mg by intramuscular injection every 6 hours as required for 2–4 days then gradually reduced and stopped over 5–7 days.

HYDROCORTISONE:

Indications: adrenocortical insufficiency; shock; hypersensitivity reactions e.g. anaphylactic shock and angioedema; asthma; severe inflammatory bowel disease; haemorrhoids; rheumatic disease

Contraindications: Fungal Infections, Cataracts, Chronic Heart Failure, Duodenal Ulcer, Esophagitis, Gastric Ulcer, Inactive Tuberculosis, Infection, Intestinal Abscess, Intestinal Anastomosis, Measles, Measles Contact, Ocular Infection, Osteoporosis, Peptic Ulcer, Psychotic Disorder, Renal Disease, Varicella Contact, Viral Ocular Infection.

Dose and Administration: By mouth, replacement therapy, 20–30 mg daily in divided doses; child 10–30 mg. By intramuscular injection or slow intravenous injection or infusion, 100–500 mg, 3–4 times in 24 hours or as required; child by slow intravenous injection up to 1 year 25 mg, 1–5 years 50 mg, 6–12 years 100 mg.

METHYLPREDNISOLONE SODIUM SUCCINATE:

Indications: suppression of inflammatory and allergic disorders; severe inflammatory bowel disease; cerebral oedema associated with malignancy; rheumatic disease.

Contraindications: Arginase Deficiency, Arginosuccinate Lyase Deficiency, Carbamyl Phosphate Synthetase Deficiency, Cerebral Malaria, Citrullinemia, Fungal Infections, and Ornithine Carbamyltransferase Deficiency.

Dose and Administration: By intramuscular injection or slow intravenous injection or infusion, initially 10–500 mg; graft rejection, up to 1 g daily by

intravenous infusion for up to 3 days.

METHYLPREDNISOLONE ACETATE:

Indications: suppression of inflammatory and allergic disorders; severe inflammatory bowel disease; cerebral oedema associated with malignancy; rheumatic disease.

Contraindications: Arginase Deficiency, Arginosuccinate Lyase Deficiency, Carbamyl Phosphate Synthetase Deficiency, Cerebral Malaria, Citrullinemia, Fungal Infections, and Ornithine Carbamyltransferase Deficiency.

Dose and Administration: By deep intramuscular injection into gluteal muscle, 40–120 mg, a second injection may be given after 2–3 weeks if required.

PREDNISOLONE:

Indications: suppression of inflammatory and allergic disorders; see also notes above; inflammatory bowel disease; asthma, and; immunosuppression; rheumatic disease.

Contraindications: Arginase Deficiency, Arginosuccinate Lyase Deficiency, Carbamyl Phosphate Synthetase Deficiency, Cerebral Malaria, Citrullinemia, Fungal Infections, and Ornithine Carbamyltransferase Deficiency.

Dose and Administration: By mouth, initially, up to 10–20 mg daily (severe disease, up to 60 mg daily), preferably taken in the morning after breakfast; can often be reduced within a few days but may need to be continued for several weeks or months. Maintenance, usual range, 2.5–15 mg daily, but higher doses may be needed; cushingoid side-effects increasingly likely with doses above 7.5 mg daily.

TRIAMCINOLONE:

Indications: suppression of inflammatory and allergic disorders and rheumatic disease. Acquired Thrombocytopenia, Acute Lymphoid Leukemia, Adrenocortical Insufficiency, Adrenogenital Disorder, Allergic Rhinitis, Alopecia Areata, Angioedema, Ankylosing Spondylitis, Aspiration Pneumonitis, Atopic Dermatitis, Autoimmune Disease, Autoimmune Hemolytic Anemia, Berylliosis, Bronchial Asthma, Bursitis, Cerebral Edema, Contact Dermatitis, Crohn’s Disease, Cystic Aponeurosis Tumor, Dermatitis Herpetiformis.

Contraindications: Arginase Deficiency, Arginosuccinate Lyase Deficiency, Carbamyl Phosphate Synthetase Deficiency, Cerebral Malaria, Citrullinemia, Fungal Infections, and Ornithine Carbamyltransferase Deficiency.

Dose and Administration: By deep intramuscular injection, into gluteal muscle, 40 mg of acetonide for depot effect, repeated at intervals according to the patient’s response; max. single dose 100 mg.