Drug Info: C: Corticosteroids Glucocorticoid Effects (Systemic)

Some commonly used brand names are:

In the U.S.—

In Canada—

Another commonly used name for hydrocortisone iscortisol

• Anti-inflammatory, steroidal--Betamethasone; Budesonide ; Cortisone; Dexamethasone;Hydrocortisone; Methylprednisolone; Prednisolone;Prednisone; Triamcinolone
• Antiemetic, in cancer chemotherapy--Dexamethasone; Hydrocortisone; Prednisone
• Corticosteroid -- Betamethasone;Budesonide; Cortisone; Dexamethasone ; Hydrocortisone;Methylprednisolone; Prednisolone; Prednisone;Triamcinolone
• Diagnostic aid, Cushing's syndrome--Dexamethasone
• Diagnostic aid, endogenous depression--Dexamethasone
• Immunosuppressant --Betamethasone ;Cortisone; Dexamethasone; Hydrocortisone;Methylprednisolone; Prednisolone; Prednisone;Triamcinolone

Corticosteroids (kor-ti-koe-STER-oyds) (cortisone-likemedicines) are used to provide relief for inflamed areas ofthe body. They lessen swelling, redness, itching, andallergic reactions. They are often used as part of thetreatment for a number of different diseases, such as severeallergies or skin problems, asthma, or arthritis.Corticosteroids may also be used for other conditions asdetermined by your doctor.

Your body naturally produces certain cortisone-likehormones that are necessary to maintain good health. If yourbody does not produce enough, your doctor may have prescribedthis medicine to help make up the difference.

Corticosteroids are very strong medicines. In addition totheir helpful effects in treating your medical problem, theyhave side effects that can be very serious. If your adrenalglands are not producing enough cortisone-like hormones,taking this medicine is not likely to cause problems unlessyou take too much of it. If you are taking this medicine totreat another medical problem, be sure that you discuss therisks and benefits of this medicine with your doctor.

These medicines are available only with your doctor'sprescription, in the following dosage forms:

• Oral
• Betamethasone
  • Syrup (U.S.)
  • Tablets (U.S.)
  • Effervescent tablets (Canada)
  • Extended-release tablets
• Budesonide
  • Extended-release capsules (Canada)
• Cortisone
  • Tablets (U.S. and Canada)
• Dexamethasone
  • Elixir (U.S.)
  • Oral solution (U.S.)
  • Tablets (U.S. and Canada)
• Hydrocortisone
  • Oral suspension (U.S.)
  • Tablets (U.S. and Canada)
• Methylprednisolone
  • Tablets (U.S. and Canada)
• Prednisolone
  • Oral solution (U.S. and Canada)
  • Syrup (U.S.)
  • Tablets (U.S.)
• Prednisone
  • Oral solution (U.S.)
  • Syrup (U.S.)
  • Tablets (U.S. and Canada)
• Triamcinolone
  • Syrup (U.S. and Canada)
  • Tablets (U.S. and Canada)

• Parenteral
• Betamethasone
  • Injection (U.S. and Canada)
• Cortisone
  • Injection (U.S. and Canada)
• Dexamethasone
  • Injection (U.S. and Canada)
• Hydrocortisone
  • Injection (U.S. and Canada)
• Methylprednisolone
  • Injection (U.S. and Canada)
• Prednisolone
  • Injection (U.S.)
• Triamcinolone
  • Injection (U.S. and Canada)

In deciding to use a medicine, the risks of taking themedicine must be weighed against the good it will do. This is adecision you and your doctor will make. For corticosteroids,the following should be considered:

Allergies—Tell your doctor if you haveever had any unusual or allergic reaction to corticosteroids.Also tell your health care professional if you are allergic toany other substances, such as foods, preservatives, ordyes.

Diet—If you will be using this medicinefor a long time, your doctor may want you to:

• Follow a low-salt diet and/or a potassium-rich diet.
• Watch your calories to prevent weight gain.
• Add extra protein to your diet.

Pregnancy—Studies on birth defects withcorticosteroids have not been done in humans. However, studiesin animals have shown that corticosteroids cause birthdefects.

Breast-feeding—Corticosteroids pass intobreast milk and may cause problems with growth or otherunwanted effects in nursing babies. Depending on the amount ofmedicine you are taking every day, it may be necessary for youto take another medicine or to stop breast-feeding duringtreatment.

Children—Corticosteroids may causeinfections such as chickenpox or measles to be more serious inchildren who catch them. These medicines can also slow or stopgrowth in children and in growing teenagers, especially whenthey are used for a long time. Before this medicine is given tochildren or teenagers, you should discuss its use with yourchild's doctor and then carefully follow the doctor'sinstructions.

Older adults—Older patients may be morelikely to develop high blood pressure or osteoporosis (bonedisease) from corticosteroids. Women are especially at risk ofdeveloping bone disease.

Other medicines—Although certainmedicines should not be used together at all, in other casestwo different medicines may be used together even if aninteraction might occur. In these cases, your doctor may wantto change the dose, or other precautions may be necessary. Whenyou are taking corticosteroids, it is especially important thatyour health care professional know if you are taking any of thefollowing:

• Aminoglutethimide (e.g., Cytadren) or
• Antacids (in large amounts) or
• Barbiturates, except butalbital, or
• Carbamazepine (e.g., Tegretol) or
• Griseofulvin (e.g., Fulvicin) or
• Mitotane (e.g., Lysodren) or
• Phenylbutazone (e.g., Butazolidin) or
• Phenytoin (e.g., Dilantin) or
• Primidone (e.g., Mysoline) or
• Rifampin (e.g., Rifadin)—Use of these medicines maymake certain corticosteroids less effective

• Amphotericin B by injection (e.g., Fungizone)—Usingcorticosteroids with this medicine may decrease the amount ofpotassium in the blood. Serious side effects could occur ifthe level of potassium gets too low

• Antidiabetic agents, oral (diabetes medicine taken bymouth) or
• Insulin—Corticosteroids may increase blood glucose(sugar) levels

• Cyclosporine (e.g., Sandimmune)—Use of thismedicine with high doses of methylprednisolone may causeconvulsions (seizures)

• Digitalis glycosides (heartmedicine)—Corticosteroids decrease the amount ofpotassium in the blood. Digitalis can increase the risk ofhaving an irregular heartbeat or other problems if the amountof potassium in the blood gets too low

• Diuretics (water pills) or
• Medicine containing potassium—Using corticosteroidswith diuretics may cause the diuretic to be less effective.Also, corticosteroids may increase the risk of low bloodpotassium, which is also a problem with certain diuretics.Potassium supplements or a different type of diuretic is usedin treating high blood pressure in those people who haveproblems keeping their blood potassium at a normal level.Corticosteroids may make these medicines less able to dothis

• Immunizations (vaccinations)—While you are beingtreated with this medicine, and even after you stop takingit, do not have any immunizations without your doctor'sapproval. Also, other people living in your home should notreceive the oral polio vaccine, since there is a chance theycould pass the polio virus on to you. In addition, you shouldavoid close contact with other people at school or work whohave recently taken the oral polio vaccine

• Ritodrine (e.g., Yutopar)—Serious side effectscould occur

• Skin test injections—Corticosteroids may causefalse results in skin tests

• Sodium-containing medicine—Corticosteroids causethe body to retain (keep) more sodium (salt) and water. Toomuch sodium may cause high blood sodium, high blood pressure,and excess body water

• Somatrem (e.g., Protropin) or
• Somatropin (e.g., Humatrope)—Corticosteroids caninterfere with the effects of these medicines

• Acquired immunodeficiency syndrome (AIDS) or
• Fungus infection or
• Herpes simplex infection of the eye or
• Human immunodeficiency virus (HIV) infection or
• Infection at the place of treatment or
• Other infection or
• Recent surgery or serious injury or
• Strongyloides (worm) infestation or
• Tuberculosis (active TB, nonactive TB, or past historyof)—Corticosteroids can cause slower healing, worsenexisting infections, or cause new infections

• Chickenpox (including recent exposure) or
• Measles (including recent exposure)—Risk of severedisease affecting other parts of the body

• Diabetes mellitus (sugar diabetes)—Corticosteroidsmay cause a loss of control of diabetes by increasing bloodglucose (sugar)

• Diverticulitis or
• Stomach ulcer or other stomach or intestine problemsor
• Ulcerative colitis, severe—Corticosteroids maycover up symptoms of a worsening stomach or intestinalcondition. A patient would not know if his or her conditionwas getting worse and would not get medical help whenneeded

• Glaucoma—Corticosteroids may cause the pressurewithin the eye to increase

• Heart disease or
• High blood pressure or
• Kidney disease (especially if you are receiving dialysis)or
• Kidney stones—Corticosteroids cause the body toretain (keep) more salt and water. These conditions may bemade worse by this extra body water

• High cholesterol levels—Corticosteroids mayincrease blood cholesterol levels

• Liver disease or
• Overactive thyroid or
• Underactive thyroid—With these conditions, the bodymay not eliminate the corticosteroid at the usual rate, whichmay change the medicine's effect

• Myasthenia gravis—When you first start takingcorticosteroids, muscle weakness may occur. Your doctor maywant to take special precautions because this could causeproblems with breathing

• Osteoporosis (bone disease)—Corticosteroids mayworsen bone disease because they cause the body to lose morecalcium

• Psychosis—This condition may be made worse

• Systemic lupus erythematosus (SLE)—This conditionmay cause certain side effects of corticosteroids to occurmore easily

For patients taking this medicine by mouth:

• Take this medicine with food to help prevent stomachupset. If stomach upset, burning, or pain continues, checkwith your doctor.
• Stomach problems may be more likely to occur if youdrink alcoholic beverages while being treated with thismedicine. You should not drink alcoholic beverages whiletaking this medicine, unless you have first checked withyour doctor.

For patients taking budesonide extended-release capsules :

• Swallow the capsule whole, without breaking, crushing,or chewing it.

Use this medicine only as directed by your doctor.Do not use more or less of it, do not use it more often, anddo not use it for a longer time than your doctor ordered. Todo so may increase the chance of side effects.

Dosing—

The dose of these medicines will be different fordifferent patients. Follow your doctor's orders or the directions on thelabel. The following information gives the range ofdoses of these medicines for all uses, which can vary widely.The dose that you are receiving may be very different. If your dose is different, do not change it unlessyour doctor tells you to do so.

The number of capsules, tablets, teaspoonfuls of liquid oramount of injection that you use depends on the strength ofthe medicine. Also, the number of doses you take each day, the time allowedbetween doses, and the length of time you take the medicinedepend on the medical problem for which you are taking thecorticosteroid. In addition, your doctor may need to changethe dose from time to time.

• For betamethasone
• For oral dosage forms:
  • Syrup, tablets, effervescent tablets:
    • Adults and teenagers—Dose may range from 0.25to 7.2 milligrams (mg) a day, as a single dose ordivided into several doses.
    • Children—Dose is based on body weight or sizeand must be determined by your doctor.
  • Extended-release tablets:
    • Adults and teenagers—2 to 6 mg a day.
    • Children—Dose is based on body weight or sizeand must be determined by your doctor.
• For injection dosage form:
  • Adults and teenagers: Dose may range from 1.2 to 12mg injected into a joint, lesion, muscle, or vein asoften as necessary, as determined by your doctor.
  • Children: Dose is based on body weight or size andmust be determined by your doctor.

• For budesonide
• For oral dosage form (extended-release capsules):
  • Adults: At first, the dose is 9 milligrams (mg) a dayfor up to eight weeks. Then your doctor may decrease thedose to 6 mg a day. Each dose should be taken in themorning before breakfast.
  • Children: Use and dose must be determined by yourdoctor.

• For cortisone
• For oral dosage form (tablets):
  • Adults and teenagers: 25 to 300 milligrams (mg) aday, as a single dose or divided into several doses.
  • Children: Dose is based on body weight or size andmust be determined by your doctor.
• For injection dosage form:
  • Adults and teenagers: 20 to 300 mg a day, injectedinto a muscle.
  • Children: Dose is based on body weight or size andmust be determined by your doctor.

• For dexamethasone
• For oral dosage forms (elixir, oral solution, tablets):
  • Adults and teenagers: 0.5 to 10 milligrams (mg) takenas often as necessary, as determined by your doctor.
  • Children: Dose is based on body weight or size andmust be determined by your doctor.
• For injection dosage form:
  • Adults and teenagers: 0.2 to 40 mg injected into ajoint, lesion, muscle, or vein as often as necessary, asdetermined by your doctor.
  • Children: Dose is based on body weight or size andmust be determined by your doctor.

• For hydrocortisone
• For oral dosage forms (oral suspension, tablets):
  • Adults and teenagers: 20 to 800 milligrams (mg) everyone or two days, as a single dose or divided into severaldoses.
  • Children: Dose is based on body weight or size andmust be determined by your doctor.
• For injection dosage form:
  • Adults and teenagers: 5 to 500 mg injected into ajoint, lesion, muscle, or vein, or under the skin asoften as necessary, as determined by your doctor.
  • Children: Dose is based on body weight or size andmust be determined by your doctor.

• For methylprednisolone
• For oral dosage form (tablets):
  • Adults and teenagers: 4 to 160 milligrams (mg) everyone or two days, as a single dose or divided into severaldoses.
  • Children: Dose is based on body weight or size andmust be determined by your doctor.
• For injection dosage form:
  • Adults and teenagers: 4 to 160 mg injected into ajoint, lesion, muscle, or vein as often as necessary, asdetermined by your doctor.
  • Children: Dose is based on body weight or size andmust be determined by your doctor.

• For prednisolone
• For oral dosage forms (oral solution, syrup, tablets):
  • Adults and teenagers: 5 to 200 milligrams (mg) takenas often as necessary, as determined by your doctor.
  • Children: Dose is based on body weight or size andmust be determined by your doctor.
• For injection dosage form:
  • Adults and teenagers: 2 to 100 mg injected into ajoint, lesion, muscle, or vein as often as necessary, asdetermined by your doctor.
  • Children: Dose is based on body weight or size andmust be determined by your doctor.

• For prednisone
• For oral dosage forms (oral solution, syrup, tablets):
  • Adults and teenagers: 5 to 200 milligrams (mg) everyone or two days, as a single dose or divided into severaldoses.
  • Children: Dose is based on body weight or size andmust be determined by your doctor.

• For triamcinolone
• For oral dosage forms (syrup, tablets):
  • Adults and teenagers: 2 to 60 milligrams (mg) a day,as a single dose or divided into several doses.
  • Children: Dose is based on body weight or size andmust be determined by your doctor.
• For injection dosage form:
  • Adults and teenagers: 0.5 to 100 mg injected into ajoint, lesion, or muscle, or under the skin as often asnecessary, as determined by your doctor.
  • Children: Dose is based on body weight or size andmust be determined by your doctor.

Missed dose—

If you miss a dose of this medicine and your dosingschedule is:

• One dose every other day—Take the missed dose assoon as possible if you remember it the same morning, thengo back to your regular dosing schedule. If you do notremember the missed dose until later, wait and take it thefollowing morning. Then skip a day and start your regulardosing schedule again.
• One dose a day—Take the missed dose as soon aspossible, then go back to your regular dosing schedule. Ifyou do not remember until the next day, skip the misseddose and do not double the next one.
• Several doses a day—Take the missed dose as soonas possible, then go back to your regular dosing schedule.If you do not remember until your next dose is due, doublethe next dose.

If you have any questions about this, check with yourhealth care professional.

Storage—

To store this medicine:

• Keep out of the reach of children.
• Store away from heat and direct light.
• Do not store capsules or tablets in the bathroom, nearthe kitchen sink, or in other damp places. Heat or moisturemay cause the medicine to break down.
• Keep the liquid dosage forms of this medicine fromfreezing.
• Do not keep outdated medicine or medicine no longerneeded. Be sure that any discarded medicine is out of thereach of children.

Your doctor should check your progress at regularvisits. Also, your progress may have to be checked afteryou have stopped using this medicine, since some of theeffects may continue.

Do not stop using this medicine without first checkingwith your doctor. Your doctor may want you to reducegradually the amount you are using before stopping themedicine completely.

Check with your doctor if your condition reappears orworsens after the dose has been reduced or treatment withthis medicine is stopped.

If you will be using corticosteroids for a long time:

• Your doctor may want you to follow a low-salt dietand/or a potassium-rich diet.
• Your doctor may want you to watch your calories toprevent weight gain.
• Your doctor may want you to add extra protein to yourdiet.
• Your doctor may want you to have your eyes examined byan ophthalmologist (eye doctor) before, and also sometimelater during treatment.
• Your doctor may want you to carry a medicalidentification card stating that you are using thismedicine.

Tell the doctor in charge that you are using thismedicine:

• Before having skin tests.
• Before having any kind of surgery (including dentalsurgery) or emergency treatment.
• If you get a serious infection or injury.

Avoid close contact with anyone who has chickenpox ormeasles. This is especially important for children. Tell your doctor right away if you think you have beenexposed to chickenpox or measles.

While you are being treated with this medicine, and afteryou stop taking it, do not have any immunizations without your doctor'sapproval. Also, other people living in your home shouldnot receive the oral polio vaccine, since there is a chancethey could pass the polio virus on to you. In addition, youshould avoid close contact with other people at school orwork who have recently taken the oral polio vaccine.

For patients with diabetes:

• This medicine may affect blood glucose (sugar) levels.If you notice a change in the results of your blood orurine sugar tests or if you have any questions, check withyour doctor.

For patients having this medicine injected into their joints:

• If this medicine is injected into one of your joints,you should be careful not to put too much stress or strainon that joint for a while, even if it begins to feelbetter. Make sure your doctor has told you how much you areallowed to move this joint while it is healing.
• If redness or swelling occurs at the place ofinjection, and continues or gets worse, check with yourdoctor.

Corticosteroids may lower your resistance to infections.Also, any infection you get may be harder to treat. Alwayscheck with your doctor as soon as possible if you notice anysigns of a possible infection, such as sore throat, fever,sneezing, or coughing.

Along with its needed effects, a medicine may cause someunwanted effects. Although not all of these side effects mayoccur, if they do occur they may need medical attention. Whenthis medicine is used for short periods of time, side effectsusually are rare. However, check with your doctor as soon aspossible if any of the following side effects occur:

• Less common
  • Decreased or blurred vision; frequent urination;increased thirst
  
  

• Rare
  • Blindness (sudden, when injected in the head orneck area); burning, numbness, pain, or tingling at ornear place of injection ; confusion; excitement ; falsesense of well-being; hallucinations (seeing, hearing,or feeling things that are not there); mentaldepression; mistaken feelings of self-importance orbeing mistreated; mood swings (sudden and wide);redness, swelling, or other sign of allergy orinfection at place of injection; restlessness ; skinrash or hives
  
  

Additional side effects may occur if you take thismedicine for a long time. Check with your doctor if any ofthe following side effects occur:

• Abdominal or stomach pain or burning (continuing);acne; bloody or black, tarry stools ; changes in vision;eye pain; filling or rounding out of the face; headache;irregular heartbeat; menstrual problems; muscle cramps orpain; muscle weakness; nausea; pain in arms, back, hips,legs, ribs, or shoulders; pitting, scarring, or depressionof skin at place of injection; reddish purple lines onarms, face, groin, legs, or trunk; redness of eyes;sensitivity of eyes to light; stunting of growth (inchildren); swelling of feet or lower legs; tearing of eyes;thin, shiny skin; trouble in sleeping; unusual bruising;unusual increase in hair growth; unusual tiredness orweakness; vomiting; weight gain (rapid); wounds that willnot heal

Other side effects may occur that usually do not needmedical attention. These side effects may go away duringtreatment as your body adjusts to the medicine. However,check with your doctor if any of the following side effectscontinue or are bothersome:

• More common
  • Increased appetite; indigestion; loss of appetite(for triamcinolone only); nervousness orrestlessness
  
  

• Less common or rare
  • Darkening or lightening of skin color; dizziness orlightheadedness; flushing of face or cheeks; hiccups;increased joint pain (after injection into a joint);increased sweating; nosebleeds (after injection intothe nose) ; sensation of spinning
  
  

After you stop using this medicine, your body may needtime to adjust. The length of time this takes depends onthe amount of medicine you were using and how long you usedit. If you have taken large doses of this medicine for a longtime, your body may need one year to adjust. During thistime, check with your doctor immediately if any of the followingside effects occur:

• Abdominal, stomach, or back pain; dizziness ; fainting;fever; loss of appetite (continuing); muscle or joint pain;nausea; reappearance of disease symptoms; shortness ofbreath ; unexplained headaches (frequent or continuing) ;unusual tiredness or weakness; vomiting; weight loss(rapid)

Other side effects not listed above may also occur in somepatients. If you notice any other effects, check with yourdoctor.

Once a medicine has been approved for marketing for acertain use, experience may show that it is also useful forother medical problems. Although this use is not included inproduct labeling, some corticosteroids are used in certainpatients with the following medical condition:

• Croup in children (dexamethasone)