Cortisone is a very important steroid hormone secreted by the adrenal glands. Glucocorticoid activates the synthesis of carbohydrates from protein, suppresses lymphoid organs, modifies metabolic processes, increases the body's resistance to stress. The pharmaceutical industry has developed an analogue to the human hormone - cortisone acetate. The drug is an effective synthetic corticosteroid.
Characteristics, composition and form of release
Cortisone is a glucocorticosteroid in the form of white tablets from a crystalline powder, odorless and poorly soluble in water and ethanol. The chemical structure is similar to cortisol and is considered its inactive metabolic product. The agent is used orally, parenterally, externally. The active substance of the drug is cortisone acetate. Manufacturers produce the drug in the following forms:
- Tablets containing 25 and 50 mg of active substance, 80 pieces in a cardboard box.
- Suspension 2.5% in bottles of 5 or 10 ml, 10 pieces in a pack. The content of the active pharmaceutical substance is 0.025 g per 1.0 ml.
An ointment containing cortisone also refers to glucocorticoids, but has a narrower pharmacological effect. The product has anti-allergic and local anti-inflammatory effects. The active substance of the ointment is hydrocortisone acetate, which, like cortisone, is a steroid hormone produced by the adrenal cortex. Of the excipients, the composition of the drug includes propylene glycol - a solvent, glucite - a thickener, povidone - enterosorbent, sodium chloride - detoxifier.
Pharmacological properties
Glucocorticoid has anti-inflammatory, immunosuppressive, anti-allergic properties, reduces the sensitivity of the body.
The anti-inflammatory effect is due to the suppression of the formation of 2-lysophospholipid and fatty acid. This leads to inhibition of prostaglandin synthesis, a decrease in the release of proteins that stimulate the aggregation of platelets, malignant cells, and white blood cells.
The antiallergic effect is determined by the stabilization of the membrane of the cell organoid, which maintains an acidic environment and prevents the isolation of cells with a damaging effect and involved in changing the structure of the tissue in the place where the allergy occurred during lysis.
Immunosuppressive properties are associated with a decrease in the number of cells capable of recognizing an antigen and giving a protective response to it. As well as inhibition of cell proliferation with the transition of lymphocytes into blasts, a decrease in the number of active substances with immunoregulatory and mediator features.
Cortisone acetate increases potassium excretion and sodium retention, which leads to a decrease in the outflow of water from the body. It stimulates the enzymes that are responsible for metabolism, increases blood glucose levels, and increases protein synthesis.
Indications
According to the instructions for use of cortisone acetate is prescribed for the following diseases:
- Endocrine disease characterized by the inability of the adrenal glands to produce enough hormones (Addison's disease).
- Hypocorticism after complete surgical removal of the adrenal gland.
- Violation of the anterior pituitary gland.
- Congenital disorder of the adrenal cortex.
- Rheumatic diseases.
- Hemolytic anemia.
- Atopic dermatitis.
- Allergic reactions.
- Bronchial airway obstruction.
- Infectious mononucleosis.
- Hepatitis of viral genesis.
- Severe form of vascular insufficiency (collapse).
- Disruption of the body's adaptive response to damage (shock).
Dosage forms of cortisone for external use are used in ophthalmology to treat inflammation of the organs of vision. Ointments are prescribed to stop the pathological protective and adaptive process, reduce swelling and itching.
Contraindications cortisone acetate
The drug is a prescription and has a rather impressive list of health conditions in which its use is not recommended.
- Hypersensitivity to the components of the drug.
- Invasive disease.
- Infectious diseases of various origins.
- The pre- and post-vaccination period (8 weeks before vaccination and 2 after).
- AIDS and HIV.
- Stomach ulcer.
- Inflammation of the mucous membrane of the esophagus.
- Gastritis.
- Intestinal anastomosis.
- Chronic pathological disease of the mucous membrane of the lower part of the digestive tract (ulcerative colitis).
- Diverticulitis.
- Myocardial infarction.
- Arterial hypertension.
- Dyslipidemia.
- Diabetes.
- Cushing's disease.
- Renal and liver failure.
- III – IV stages of obesity.
The use of the drug is carried out under the supervision of the doctor who prescribed it. Patients with cirrhosis of the liver, with a prolonged lack of thyroid hormones, are under special attention. With these pathologies, the effect of the drug substance may increase and there will be a need for dose adjustment.
If a patient who is prescribed therapy with drugs containing cortisone has recently been in contact with patients with herpes, chickenpox, amoebiasis, tuberculosis, then it is imperative to notify the doctor.
The use of tablets and suspensions: dosage
The use of the drug on its own is a great threat to health, the drug should be taken only as directed by a medical specialist and under his supervision.
The dosage is calculated individually depending on the patient's condition, pathology and its course. The daily intake of Cortisone tablets according to the instructions should not exceed 300 mg. The initial dose of the drug is 10-20 mg at a time up to 4 times a day. Depending on the severity of the pathology, the amount of substance increases, but a single dose for adults should not exceed 150 mg. With an improvement in health status, the dosage is gradually reduced to a minimum.
In children, the drug is prescribed in a smaller amount, the dosage depends on the age of the small patient - from 12 to 25 mg at a time.
The suspension is used intramuscularly or into the joint cavity. The ampoule is shaken and the contents are injected deep into the buttock from 50 to 300 mg at a time. The daily dose is 1000-1500 mg. The calculation of the drug for children depends on the weight of the child: the most acceptable dose is 6–9 mg per 1 kg of body weight.
Intra-articular administration is carried out at 5–25 mg once every 7 days. The duration of the course is 3-5 weeks.
Ointment cortisone: instructions for use
The drug for external use has a local anti-inflammatory, decongestant effect. An ointment with cortisone is applied in a thin layer on the affected area of ​​the skin 2-3 times a day. To enhance the therapeutic effect, occlusive dressings are used that provide sealing of the affected area. The duration of therapy depends on the characteristics, severity of the pathology and the effectiveness of the treatment. The duration of the course is usually from one to two weeks, with a persistent process of the disease, therapy can be increased to 20 days.
The use of ointments in children is possible from the age of two. Excluded are measures that enhance the absorption of glucocorticoid.
Cortisone during pregnancy and lactation
Adequate studies on the use of corticosteroids during pregnancy and lactation have not been conducted. Cortisone tablets are steroid hormones, but they have neither estrogenic (produced by the follicular apparatus of the ovaries) nor gestagenic (produced by the placenta of the fetus) activity. Glucocorticosteroids support homeostasis. However, during pregnancy, women are more susceptible to stress signals, which leads to increased adrenal secretion. High cortisone levels increase blood pressure, which can lead to involuntary miscarriage.
The drug can be used during pregnancy only if the benefit of it exceeds the risk of negative consequences. If there is at least a slight chance of harming the fetus, then such therapy is considered inappropriate and even dangerous. If a woman in the position took cortisone, then the babies born need careful monitoring due to possible hypofunction of the adrenal glands.
During lactation, it is also better to abandon the use of the drug due to the fact that it is secreted into milk. If there is an urgent need for the use of a corticosteroid, then it is better to abandon breastfeeding.
Side effects
The frequency of formation and manifestation of undesirable effects depends on the duration of use, dosage and compliance with cyclic fluctuations in the destination.
- On the part of the endocrine system, after taking cortisone acetate, steroid diabetes mellitus, suppression of adrenal function, Itsenko-Cushing's syndrome can be observed, in children delayed sexual development.
- Metabolic processes: hypocalcemia, hypernatremia, increased sweating, weight gain, reflex convulsive muscle contraction, fatigue, fatigue.
- Cardiovascular system: arrhythmia, sinus rhythm disturbance (bradycardia), increased blood pressure, thrombophilia, development of heart failure.
- CNS and sensory organs: impaired consciousness from stupefaction to coma (delirium), impaired ability to navigate in space, hallucinations, euphoria, causeless change in mood in any direction, paranoia, nervousness, frequent insomnia, sudden headaches, increased intraocular pressure, displacement of the eye apples - bulging eyes (exophthalmos).
- Musculoskeletal system: osteoporosis, muscle atrophy, steroid myopathy.
- Digestive system: pancreatitis, inflammation of the esophagus with the appearance of erosion and ulcers, flatulence, nausea, vomiting.
- Allergic reactions.
- Acne.
- Thinning of the skin.
Precautionary measures
During therapy, an intraocular pressure check should be performed.
According to the instructions, cortisone acetate for children should be prescribed only according to absolute indications and carefully monitored by a doctor. With prolonged therapy, the dynamics of growth and development should be monitored. If the child has been in contact with patients affected by chickenpox or measles, specific immunoglobulins are prescribed for prevention.
The drug is canceled gradually by successively reducing the dose, in order to avoid the formation of withdrawal syndrome.
Interaction with other drugs
The therapeutic properties of various drugs with the interaction of cortisone acetate may vary depending on the type of drug.
- Glucocorticosteroid enhances the healing properties of anticoagulants (agents that reduce blood coagulation), antiplatelet agents (medicines that prevent blood clots.
- It enhances the side effects of NSAIDs, female steroid sex hormones (estrogens), cardiac glycosides, steroid anabolics, the antifungal drug Amphotericin B, and the cystatic drug L-asparaginase.
- Reduces the effectiveness of hypoglycemic (glucose-lowering), antihypertensive drugs and diuretics (diuretics).
- Derivatives of barbituric acid reduce the effectiveness of cortisone.
Shelf life and storage rules
According to the instructions "Cortisone" in tablets stored 5 years from the date of manufacture in a dark place at t + 25 ° C. The shelf life of the ointment and suspension is 3 years, they must be stored at a temperature of + 15 ° C. Do not freeze the product for external use.
Reviews
Reviews about doctors' cortisone are only good. Doctors have long and successfully used a synthetic corticosteroid. In their opinion, the negative consequences are due solely to non-compliance with medical recommendations.
Patient reviews are not so supportive due to side effects. Some patients complain of headaches, nausea, lack of taste in food during course therapy. Patients experience great relief after treatment. But doctors say that this is more a consequence of the fact that a person has recovered.
Analogs
The main analogues of cortisone acetate and hydrocortisone are Akortin, Dexamethasone, Metipred, Kanizon Plus. Also used are “Avamys”, “Betaderm”, “Altezon”, “Rinocorten”, “Zirtodrin”.