Interactions with supplements
Dehydroepiandrosterone (DHEA)
Look Up > Drugs > Cortisone Acetate
Cortisone Acetate
Pronunciation
U.S. Brand Names
Generic Available
Synonyms
Pharmacological Index
Use
Pregnancy Risk Factor
Contraindications
Warnings/Precautions
Adverse Reactions
Overdosage/Toxicology
Drug Interactions
Mechanism of Action
Pharmacodynamics/Kinetics
Usual Dosage
Dietary Considerations
Administration
Mental Health: Effects on Mental Status
Mental Health: Effects on Psychiatric Treatment
Dental Health: Local Anesthetic/Vasoconstrictor Precautions
Dental Health: Effects on Dental Treatment
Patient Information
Nursing Implications
Dosage Forms

Pronunciation
(KOR ti sone AS e tate)

U.S. Brand Names
Cortone® Acetate

Generic Available

Yes


Synonyms
Compound E

Pharmacological Index

Corticosteroid, Oral; Corticosteroid, Parenteral


Use

Management of adrenocortical insufficiency


Pregnancy Risk Factor

D


Contraindications

Serious infections, except septic shock or tuberculous meningitis; administration of live virus vaccines


Warnings/Precautions

Use with caution in patients with hypothyroidism, cirrhosis, hypertension, congestive heart failure, ulcerative colitis, thromboembolic disorders, osteoporosis, convulsive disorders, peptic ulcer, diabetes mellitus, myasthenia gravis; prolonged therapy (>5 days) of pharmacologic doses of corticosteroids may lead to hypothalamic-pituitary-adrenal suppression, the degree of adrenal suppression varies with the degree and duration of glucocorticoid therapy; this must be taken into consideration when taking patients off steroids


Adverse Reactions

>10%:

Central nervous system: Insomnia, nervousness

Gastrointestinal: Increased appetite, indigestion

1% to 10%:

Dermatologic: Hirsutism

Endocrine & metabolic: Diabetes mellitus

Neuromuscular & skeletal: Arthralgia

Ocular: Cataracts, glaucoma

Respiratory: Epistaxis

<1%: Edema, hypertension, vertigo, seizures, headache, psychoses, pseudotumor cerebri, mood swings, delirium, hallucinations, euphoria, acne, skin atrophy, bruising, hyperpigmentation, Cushing's syndrome, pituitary-adrenal axis suppression, growth suppression, glucose intolerance, hypokalemia, alkalosis, amenorrhea, sodium and water retention, hyperglycemia, peptic ulcer, nausea, vomiting, abdominal distention, ulcerative esophagitis, pancreatitis, myalgia, osteoporosis, fractures, muscle wasting, hypersensitivity reactions


Overdosage/Toxicology

When consumed in excessive quantities for prolonged periods, systemic hypercorticism and adrenal suppression may occur; in those cases, discontinuation and withdrawal of the corticosteroid should be done judiciously. Cushingoid changes from continued administration of large doses results in moon face, central obesity, striae, hirsutism, acne, ecchymoses, hypertension, osteoporosis, myopathy, sexual dysfunction, diabetes, hyperlipidemia, peptic ulcer, increased susceptibility to infection, and electrolyte and fluid imbalance.


Drug Interactions

CYP3A3/4 enzyme substrate

Barbiturates, phenytoin, rifampin may decrease cortisone effects

Live virus vaccines

Anticholinesterase agents may decrease effect

Cortisone may decrease warfarin effects

Cortisone may decrease effects of salicylates

Increased effect: Estrogens (increase cortisone effects)

Increased toxicity:

Cortisone + NSAIDs may increase ulcerogenic potential

Cortisone may increase potassium deletion due to diuretics


Mechanism of Action

Decreases inflammation by suppression of migration of polymorphonuclear leukocytes and reversal of increased capillary permeability


Pharmacodynamics/Kinetics

Peak effect: Oral: Within 2 hours; I.M.: Within 20-48 hours

Duration of action: 30-36 hours

Absorption: Slow rate of absorption

Distribution: Crosses the placenta; appears in breast milk; distributes to muscles, liver, skin, intestines, and kidneys

Metabolism: In the liver to inactive metabolites

Half-life: 30 minutes to 2 hours

End-stage renal disease: 3.5 hours

Elimination: In bile and urine

Note: Insoluble in water; supplemental doses may be warranted during times of stress in the course of withdrawing therapy


Usual Dosage

If possible, administer glucocorticoids before 9 AM to minimize adrenocortical suppression; dosing depends upon the condition being treated and the response of the patient; supplemental doses may be warranted during times of stress in the course of withdrawing therapy

Anti-inflammatory or immunosuppressive: Oral: 2.5-10 mg/kg/day or 20-300 mg/m2/day in divided doses every 6-8 hours

Physiologic replacement: Oral: 0.5-0.75 mg/kg/day or 20-25 mg/m2/day in divided doses every 8 hours

Adults: Oral: 25-300 mg/day in divided doses every 12-24 hours

Hemodialysis: Supplemental dose is not necessary

Peritoneal dialysis: Supplemental dose is not necessary


Dietary Considerations

Limit caffeine; may need diet with increased potassium, pyridoxine, vitamin C, vitamin D, folate, calcium, and phosphorus and decreased sodium; may be taken with food to decrease GI distress


Administration

Administer I.M. daily dose before 9 AM to minimize adrenocortical suppression


Mental Health: Effects on Mental Status

Insomnia and nervousness are common; may cause euphoria or hallucinations


Mental Health: Effects on Psychiatric Treatment

Barbiturates may decrease the levels of cortisone


Dental Health: Local Anesthetic/Vasoconstrictor Precautions

No information available to require special precautions


Dental Health: Effects on Dental Treatment

A compromised immune response may occur if patient has been taking systemic cortisone; the need for corticosteroid coverage in these patients should be considered before any dental treatment; consult with physician


Patient Information

Take oral formulation as directed, with food or milk in the morning. Do not take more than prescribed or discontinue without consulting prescriber. Maintain adequate nutritional intake; consult prescriber for possibility of special dietary instructions. If diabetic, monitor serum glucose closely and notify prescriber of any changes; this medication can alter hypoglycemic requirements. Inform prescriber if you are experiencing unusual stress; dosage may need to be adjusted. You will be susceptible to infection; avoid crowds or infected persons or persons with contagious diseases. You may experience insomnia or nervousness; use caution when driving or engaging in tasks requiring alertness until response to drug is known. Report excessive or sudden weight gain, swelling of extremities, difficulty breathing, muscle pain or weakness, change in menstrual pattern, vision changes, signs of hyperglycemia, signs of infection (eg, fever, chills, mouth sores, perianal itching, vaginal discharge), other persistent side effects, or worsening of condition. Pregnancy/breast-feeding precautions: Do not get pregnant while taking this medication; use appropriate barrier contraceptive measures. Consult prescriber if breast-feeding.


Nursing Implications

Withdraw gradually following long-term therapy


Dosage Forms

Tablet: 5 mg, 10 mg, 25 mg


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