Glucocorticosteroids (GCS) are called synthetic drugs, which are analogues of endogenous hormones produced by the adrenal cortex. GCS have a whole range of effects on the human body: anti-inflammatory and desensitizing, immunosuppressive, antitoxic and anti-shock.
Today, the pharmaceutical market of the Russian Federation presents a large list of such medicines. One of them is Kortef. Instructions for use recommend taking it for a number of diseases.
Composition and form of release
The medication is intended for oral administration. The main active component of the drug "Cortef" (the instruction contains this information) is hydrocortisone - a hormone produced by the adrenal glands. For systemic and local use in a medical environment, natural hydrocortisone or its esters are used.
In the drug "Cortef" this hormone is contained in a volume of 10 mg. Substances such as calcium stearate, corn starch and sucrose, lactose, mineral oil and sorbic acid are additional substances .
The main form in which Cortef is offered to consumers is tablets. Instructions for use, reviews of health workers and patients indicate the high effectiveness of this tool. The tablets are round in shape with a notch on the surface and the inscription “CORTEF10” squeezed out onto it, packaged in tinted glass bottles (each pack contains 100 pieces). You can buy a medication only by prescription.
Pharmacodynamics
As already mentioned, the medication has a whole list of effects on the human body: anti-inflammatory and anti-shock, desensitizing and anti-allergic, antitoxic, antimetabolic and immunosuppressive. The description of the drug (instructions for use) contains information on the mass of processes that are affected by the drug. It inhibits the release of inflammatory mediators and significantly slows the release of cytokines (interferon, interleukins) from microphages and lymphocytes.
Cortef also stimulates the accumulation of glycogen in the liver, increases the amount of glucose contained in the blood, slows the excretion of fluid and Na + from the body, and increases K +. With the direct participation of this medication, the production of histamine is reduced (mediator, i.e., mediator, necessary for allergic reactions of an immediate type).
In addition, about the drug Kortef, the instructions for use speak as a means of reducing the number of cellular infiltrates (elements of cells with an admixture of blood and lymph) and suppressing the motor activity of leukocytes and lymphocytes in the inflammatory focus, which helps to reduce capillary permeability. The drug inhibits the synthesis and increases the rate of breakdown of proteins.
"Cortef" has an effect on the pituitary gland and inhibits the production of corticotropin (ACTH), without which the functioning of the adrenal cortex may completely cease.
Cortef medicine: instruction, application
Reviews of experts say that the medication we are considering is used in various fields of medicine. It is used to remove the patient from toxic, traumatic, burn, cardiogenic, surgical shock in cases where standard anti-shock therapy has failed. Let us dwell on these points in more detail.
So, what categories of patients are prescribed Cortef?
Instructions for use, a description of the medication bring to consumers information about the possibility of using it in endocrinology. Here, the drug will be effective in diseases such as insufficiency of the adrenal cortex, thyroiditis (subacute form), adrenal hyperplasia (congenital nature), hypercalcemia, which appeared on the background of malignant neoplasms.
Further, in rheumatology, “Cortef” manifests itself positively in the treatment of bursitis, arthritis (gouty, psoriatic, rheumatoid), ankylosing spondylitis, nonspecific tendosynovitis. Good results are achieved by patients taking Cortef with systemic lupus erythematosus, acute rheumatic heart disease, polymyositis, and epicondylitis.
There are indications for the use of "Cortef" in the field of dermatology. Here, the medication is effective in the treatment of pemphigus, fungoid mycosis, herpetiform and exfoliative dermatitis. It is also prescribed for severe psoriasis, seborrheic dermatitis, severe erythema multiforme.
Allergists prescribe Kortef for serum sickness, allergic rhinitis, for atypical and contact dermatitis, for bronchial asthma and individual hypersensitivity to medications.
Ophthalmologists also practice the appointment of Cortef for a variety of diseases. The medication is effective for corneal ulcers and conjunctivitis of an allergic origin, for iritis and keratitis, for iridocyclitis, neuritis, uevit, etc. In the field of oncology, GCS “Cortef” is prescribed for leukemia, and in neurology for multiple sclerosis.
Where else does Kortef apply? Instructions for use contain information that pulmonologists (symptomatic sarcoidosis, fulminant pulmonary tuberculosis, aspiration pneumonia) and hematologists (secondary thrombocytopenia, hemolytic or hypoplastic anemia, erythroblastopenia) can prescribe it to their patients.
Dosage and Administration
The drug "Kortef" is intended for oral use. However, the lyophilisate for the manufacture of the Solu-Cortef solution prescribes the instructions for use intramuscularly, intravenously (drip or stream) and in the periarticular bag.
As for oral administration, the initial dosage can vary from 20 to 240 mg during the day, depending on the diagnosed pathology and the severity of the patient's condition. The optimal dose in each case is selected by reducing the initially taken to the lowest, which will provide the desired effect.
In acute conditions and the need for emergency treatment, intravenous administration of the Solu-Cortef medication is recommended. Instructions for use describe the following standard scheme. The first 100 mg of the solution (initial dose) is administered within half a minute. The next volume of the drug in 500 mg should be administered over 10 minutes. Then, every 2-6 hours of the procedure should be repeated, not forgetting to constantly monitor the patient's condition.
It must be remembered that in large doses, Solu-Cortef is prescribed only for the period of stabilization of the patient's condition, but not longer than 3 days.
V / m "Cortef" is administered in a volume of 125-250 mg / day. A positive drug effect is manifested 6-25 hours after the procedure and can last from several days to several weeks.
If necessary, Cortef injections are done in an intraarticular or periarticular bag. The effective dosage for large joints (shoulder, knee, femur) is 25-50 mg, but in acute conditions it can reach 100 mg. For small joints (elbows, wrists, phalanx of the fingers), an injection of 10-20 mg given once will be sufficient. Repeating the procedure is recommended every 1-3 weeks (sometimes it is required and more often - every 3-5 days).
In general, as regards therapy with the Cortef drug, only the attending doctor can choose the method of application and dose. Suddenly discontinuing treatment is undesirable, the likelihood of an exacerbation is high. The completion of treatment occurs by gradually reducing the dosage.
Contraindications to the use of "Cortef"
There is a certain list of diseases and conditions of the body when it is unacceptable to take the medicine we are considering. These are parasitic and infectious diseases of a viral, fungal or bacterial origin (transferred in the recent past, ongoing at the moment).
Do not prescribe it if the patient is diagnosed with acute psychosis, decompensated diabetes mellitus, or a person suffers from hypothyroidism, thyrotoxicosis, arterial hypertension, gastrointestinal ulcers and dermatological lesions of an infectious or ulcerative nature.
There is a whole list of contraindications for intraarticular administration of the drug “Solu-Cortef”. Do not prescribe medication for a number of problems with the cardiovascular system, including those with recent myocardial infarction.
For a single dose, even for "vital" need, a contraindication to use is individual hypersensitivity to the components of the drug.
Undesirable manifestations
The frequency and brightness of the manifestation of side effects depends on several reasons, the list of which contains instructions for use for the Cortef drug. Indications, doses, course duration prescribed by the attending physician must be observed without fail. A certain importance is also attached to observing the circadian rhythm of the appointment (fluctuations in the intensity of various biological processes associated with the change of day and night).
The endocrine system in response to taking "Cortef" is able to respond by reducing glucose susceptibility, the development of steroid diabetes mellitus , and suppressing the functioning of the adrenal glands. There is a likelihood of developing Itsenko-Cushing's syndrome, the main symptoms of which are the moon-shaped face, obesity by the pituitary type, an increase in blood pressure, myasthenia gravis, and various menstrual disorders in women.
The reaction from the gastrointestinal tract can be symptoms such as nausea and vomiting, pancreatitis and steroid ulceration of various parts of the digestive tract, bleeding and perforation (GIT) of the walls, erosive esophagitis.
On the part of the cardiovascular system, adverse reactions to Cortef (the instruction confirms this information) are arrhythmia, bradycardia, thrombosis, and an increase in blood pressure. Against the background of acute and subacute form of myocardial infarction, “Cortef” can cause the spread of foci of necrosis, inhibition of the formation of scar tissue, which can cause rupture of the heart muscle.
In general, a variety of organs and systems of the human body can negatively react to the use of Cortef in one way or another. Possible manifestations of the central nervous system and sensory organs, impaired metabolism and musculoskeletal system. A variety of allergic reactions can occur. The most complete information is contained in the instructions for use of the drug "Cortef".
Pregnancy and lactation
During the period of carrying the baby and breastfeeding, it is strictly forbidden to take the drug "Kortef" instructions for use. The description (the presence of benzyl alcohol in some forms of the medication speaks for itself) of the drug contains information about the possible effects of the use of Cortef in such periods in the form of adrenal insufficiency, dyspnea, and death.
Children whose mothers were forced to take hydrocortisone during pregnancy should be closely monitored by medical staff in order to detect early signs of adrenal insufficiency.
What you should pay attention to?
During the treatment with the use of the drug "Kortef", the instructions for use recommend a diet that limits salt intake. In addition, the body must receive a sufficient amount of protein. Also, during this period, it is unacceptable to carry out any type of vaccination. It is necessary to conduct constant monitoring of blood pressure, glucose concentration in the blood and its coagulability. It is also important to control the diuresis and weight of the patient.
In any stressful situations, people undergoing a therapeutic course with the use of "Cortef" need to increase the dosage of corticosteroids. As for patients suffering from tuberculosis, those in the active stage should take "Cortef" only in parallel with the appropriate therapy aimed at treating the underlying disease. In case of tuberculosis proceeding in a latent form, or during the turn of tuberculin samples, the medical staff should carefully monitor the patient's condition and, if necessary, prescribe appropriate chemoprophylaxis.
If the appointment of a medication provoked the development of secondary insufficiency of the adrenal cortex, then the situation can be normalized by gradually reducing the dose. After the course of therapy is completed, for another several months this type of insufficiency can be observed. Stressful situations that occurred during this period are an indication for the resumption of the appointment of GCS.
As for a simple herpetic infection of the eyes, the “Cortef” (instructions, application, reviews of specialists are considered in the article) and any other corticosteroids should be prescribed with great care, since the development of perforation of the cornea is possible.
Health care providers should be aware of the fact that, with Cortef treatment, certain infectious diseases can be asymptomatic, latent, and of varying severity. With an increase in the applied doses of corticosteroids, the likelihood of developing latent infections increases. That is, under the influence of "Kortef" resistance to infections decreases, the ability to localize the infectious focus decreases.
Those who are prescribed immunosuppressive doses of Cortef or any other corticosteroids are advised not to contact people with chickenpox or measles. If such contacts nevertheless took place, you should immediately contact your doctor.
GCS can cause the occurrence of mental disorders or enhance existing psychotic manifestations, increase emotional instability.
There is information that in some patients, against the background of "Cortef" (or other GCS), Kaposi's sarcoma developed. However, after drug withdrawal, clinical remission was observed.
For the reason that the complications after taking the drug directly depend on the duration of the course and dosage, the doctor makes a decision on the start of the treatment course, its duration and acceptable dosages after assessing the expected benefits for his patient and the potential risks of the drug.
Interaction with other drugs
So, we discussed what Kortef is. Instructions for use, indications and contraindications for use and side effects of this drug are also considered. It remains to note that specialists in prescribing the drug to patients should take into account that hydrocortisone can interact with a number of substances, and these compounds can cause serious damage to the body.
Firstly, hydrocortisone is pharmaceutically incompatible with other drugs and, when attempted to form, may form insoluble substances. Secondly, it increases the toxicity of cardiac glycosides, as a result of which hypokalemia may develop, and then there is a risk of an increase in arrhythmia.
With the direct participation of Cortef (in particular, its main component), the rate of acetylsalicylic acid (ASA) excretion increases, and its level in the blood composition decreases.
The use of live antiviral vaccines against the background of hydrocortisone can give an impetus to the activation of viruses and the development of infection.
Paracetamol in tandem with Cortef may become hepatotoxic. With long courses of use, the concentration in the body of folic acid increases. In high dosages, hydrocortisone reduces the effectiveness of somatropin (growth hormone).
In addition, the main active ingredient reduces the effectiveness of hypoglycemic drugs, but increases the anticoagulant effect of coumarin derivatives. “Cortef” suppresses the effect of vitamin D on the absorption of Ca 2 + in the intestinal lumen. Under the influence of hydrocortisone, the toxicity of cyclosporin and ketoconazole increases.
In the presence of substances such as ephedrine, theophylline, rifampicin, any barbiturates, the therapeutic effect of the influence of GCS decreases. The appearance of acne and the development of hirsutism (excessive growth of terminal - hard and dark - hair in women of a male type) is preceded by taking other steroid hormonal drugs (anabolics, estrogens, oral contraceptives) in parallel with hydrocortisone.
Consumer opinion on the drug "Cortef"
Cortef is too complex a preparation to have negative reviews. Although positive at times more. The description of the drug “Kortef” (reviews of health workers confirm this fact) allows us to understand: how wide its scope is, the list of side effects is just as long. Judging by the reviews of the patients themselves, he quickly relieved someone of suffering, resulting in an improved quality of life, and someone caused a lot of negative impressions, and according to the feelings of patients, had no effect.
Is this drug good or bad - the question is too narrow for a remedy such as Cortef. The main thing here is to rely on the experience and knowledge of the attending physician and follow all his recommendations.