Prednisone DosageIncidence rates of adverse events in corticosteroid users and non-users. Incidence rate ratios for adverse events within 30 day and day risk oral corticosteroids dosage after drug initiation. The most common indications for use were oral corticosteroids dosage respiratory tract infections, spinal conditions, and allergies. Prescriptions were provided by a diverse range of specialties. Within 30 days of drug initiation, there was an increase in rates of sepsis incidence rate ratio 5.
Corticosteroids: Drug Facts, Side Effects and Dosing
What are systemic corticosteroids and how do they work? Systemic corticosteroids refer to corticosteroids that are given orally or by injection and distribute throughout the body. It does not include corticosteroids used in the eyes, ears, or nose, on the skin or that are inhaled, although small amounts of these corticosteroids can be absorbed into the body. Naturally occurring corticosteroids, hydrocortisone Cortef and cortisone , are produced by the outer portion of the adrenal gland known as the cortex hence the name, corticosteroid.
Corticosteroids are classified as either:. Synthetic corticosteroids mimic the actions of naturally occurring corticosteroids and may be used to replace corticosteroids in people with adrenal glands that are unable to produce adequate amounts of corticosteroids, however, they more often are used in higher-than-replacement doses to treat diseases of immunity, inflammation or salt and water balance.
Some glucocorticoids also in addition to their anti-inflammatory actions have salt retaining properties but they are used mostly for their anti-inflammatory effects.
Fludrocortisone Florinef , a synthetic mineralocorticoid has strong salt retaining effects with significant anti-inflammatory actions, and is used mostly for it's salt retaining capabilities. What are some examples of systemic oral and injectable corticosteroids? The following is a list of the systemic oral and injectable corticosteroids that are available in the United States:.
For what conditions are systemic corticosteroids used? Corticosteroids belonging to the glucocorticoid class influence the body system in several ways, but they are used mostly for their strong anti-inflammatory effects and in conditions that are related to the immune system function such as:. Glucocorticoid corticosteroids are used to treat systemic lupus , severe psoriasis , leukemia , lymphomas , idiopathic thrombocytopenic purpura, and autoimmune hemolytic anemia.
These corticosteroids also are used to suppress the immune system and prevent rejection in people who have undergone organ transplant as well as many other conditions. Fludrocortisone Florinef , a potent systemic oral mineralocorticoid corticosteroid is used to treat Addison's disease and diseases that cause salt loss as in congenital adrenal hyperplasia.
It also is used commonly to treat conditions of low blood pressure hypotension although this is not a Food and Drug Administration FDA approved indication. Are there any differences among the different types of systemic corticosteroids?
Corticosteroids differ in their relative amount of anti-inflammatory and mineralocorticoid potency and they are used according to these effects. Among the systemic oral and injectable corticosteroids, fludrocortisone Florinef has the most significant mineralocorticoid salt retaining actions and is best used for this effect despite it's strong anti-inflammatory action. Other systemically available corticosteroids have mostly glucocorticoid effects, and are used for their anti-inflammatory activities.
Examples of these include the naturally occurring hydrocortisone Cortef and cortisone, and the synthetic corticosteroids including:. Among all glucocorticoids, prednisone is not effective in the body unless it is converted to prednisolone by enzymes in the liver. For this reason prednisone may not be very effective in people with liver disease because of a reduction in their ability to convert prednisone to prednisolone. What are the side effects of systemic corticosteroids?
Corticosteroids have many side effects that can be mild or serious. These side effects are more apparent when corticosteroids are used at higher doses or for extended periods of time. This section lists only some of these side effects of corticosteroids.
The prolonged use of corticosteroids can cause obesity , growth retardation in children, and even lead to convulsions and psychiatric disturbances. Reported psychiatric disturbances include depression , euphoria , insomnia , mood swings , and personality changes. Psychotic behaviors also have been reported. Corticosteroids, since they suppress the immune system, can lead to an increase in the rate of infections and reduce the effectiveness of vaccines and antibiotics.
The long term use of corticosteroids may cause osteoporosis which can result in bone fractures. Shrinking atrophy of the adrenal glands can be caused by the long term use of corticosteroids resulting in the body's inability to produce cortisol, the body's natural corticosteroid, when the systemic corticosteroids are discontinued. Another condition which can result from the long term use of corticosteroids is adrenal necrosis of the hip joints, a very painful and serious condition that may require surgery.
Any symptoms of hip or knee pain in people taking corticosteroids require prompt medical attention. Corticosteroids should not be stopped suddenly after prolonged use as this can result in adrenal crisis because of the body's inability to secrete enough cortisol to make up for the withdrawal. Nausea , vomiting , and shock are the reported side effects of adrenal crisis. With which drugs do systemic oral and injectable corticosteroids interact?
Certain drugs such as troleandomycin TAO , erythromycin Ery-Tab , EryPed , and clarithromycin Biaxin and ketoconazole Nizoral can reduce the ability of the liver to metabolize breakdown corticosteroids and this may lead to an increase in the levels and side effects of corticosteroids in the body.
On the other hand, phenobarbital, ephedrine , phenytoin Dilantin , and rifampin Rifadin , Rimactane may reduce the blood levels of corticosteroids by increasing the breakdown of corticosteroids by the liver.
This may necessitate an increase of corticosteroid dose when they are used in combination with these drugs. Estrogens have been shown to increase the effects of corticosteroids possibly by decreasing their breakdown by the liver. Corticosteroid effects on warfarin Coumadin can vary; therefore when taking warfarin Coumadin along with corticosteroids, there may be increased need for monitoring coagulation levels more closely.
Low blood potassium hypokalemia and a higher chance of heart failure can result from combining corticosteroids with drugs that reduce potassium in the blood for example, diuretics, amphotericin B. Anticholinesterase drugs for example, physostigmine may cause severe weakness in some patients with myasthenia gravis when prescribed with corticosteroids.
Corticosteroids can increase blood glucose , so close monitoring of blood sugar and higher doses of diabetes medications may be needed. Cholestyramine Questran , Questran Light can decrease the absorption of oral corticosteroids from the stomach and this could reduce the blood levels of corticosteroids.
Oral and injectable systemic corticosterois are steroid hormones prescribed to decrease inflammation in diseases and conditions such as arthritis rheumatoid arthritis, for example , ulcerative colitis, Crohn's disease, asthma, bronchitis, some skin rashes, and allergic or inflammatory conditions that involve the nose and eyes.
Examples of systemic corticosteroids include hydrocortisone Cortef , cortisone, prednisone Prednisone Intensol , prednisolone Orapred, Prelone , and methylprednisolone Medrol, Depo-Medrol, Solu-Medrol. Some of the side effects of systemic corticosteroids are swelling of the legs, hypertension, headache, easy bruising, facial hair growth, diabetes, cataracts, and puffiness of the face.
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Colitis refers to inflammation of the inner lining of the colon. Symptoms of the inflammation of the colon lining include Low blood pressure, also referred to as hypotension, is blood pressure that is so low that it causes symptoms or signs due to the Psoriasis is a long-term skin condition that may cause large plaques of red, raised skin, flakes of dry skin, and skin scales Anemia is the condition of having less than the normal number of red blood cells or less than the normal quantity of hemoglobin Eczema refers to skin inflammation.
There are many different types of eczema that produce symptoms and signs that range from Diabetes is a chronic condition characterized by high levels of sugar glucose in the blood. The two types of diabetes are Leukemia is a type of cancer of the blood cells in which the growth and development of the blood cells are abnormal.
Rheumatoid arthritis RA is an autoimmune disease that causes chronic inflammation of the joints, the tissue around the joints, Crohn's disease is a chronic inflammatory disease, primarily involving the small and large intestine, but which can affect Arthritis is inflammation of one or more joints. When joints are inflamed they can develop stiffness, warmth, swelling, redness Cancer is a disease caused by an abnormal growth of cells, also called malignancy.
It is a group of different diseases, and Bronchitis is inflammation of the airways in the lung. Acute bronchitis is is short in duration 10 to 20 days in comparison Ulcerative colitis is a chronic inflammation of the colon. Symptoms include abdominal pain, diarrhea, and rectal bleeding Systemic lupus erythematosus is a condition characterized by chronic inflammation of body tissues caused by autoimmune disease Scalp psoriasis causes red, raised, scaly patches that may extend from the scalp to the forehead and the back of the neck and Chronic bronchitis is a cough that occurs daily with production of sputum that lasts for at least three months, two years in a The major goal in treating diabetes is controlling elevated blood sugar without causing abnormally low levels of blood sugar ALS amyotrophic lateral sclerosis, Lou Gehrig's disease and MS multiple sclerosis are both diseases of the nervous system Scleritis is inflammation of the white part of the eye.
It may be caused by a serious underlying condition, such as an autoimmune Interstitial lung disease refers to a variety of diseased that thicken the tissue between the lungs' air sacks. Asthma is a condition in which hyperreactive airways constrict and result in symptoms like wheezing, coughing, and shortness of Microscopic colitis lymphocytic colitis and collagenous colitis is a disease of inflammation of the colon.
IBS irritable bowel syndrome and IBD inflammatory bowel disease are both problems with the digestive tract Preeclampsia is a condition in pregnant women marked by high blood pressure and a high level of protein in the urine. Anaphylaxis is a serious allergic reaction that affects a number of different areas of the body at one time, and can be fatal COPD chronic obstructive pulmonary disease is the term doctors and other health care professionals use to describe a group of In the United States diabetes is the most common cause of kidney failure.
High blood pressure and high levels of blood glucose The lungs are primarily responsible for the exchange of oxygen and carbon dioxide between the air we breathe and the blood Crohn's disease and ulcerative colitis are diseases that cause inflammation of part of or the entire digestive tract GI Graft versus host disease GVHD is a condition that happens when immune cells from transplanted donor tissue attack the