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Pronunciation |
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(KOR
ti sone AS e
tate) |
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U.S. Brand
Names |
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Cortone®
Acetate |
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Generic
Available |
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Yes |
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Synonyms |
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Compound E |
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Pharmacological Index |
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Corticosteroid, Oral; Corticosteroid, Parenteral |
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Use |
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Management of adrenocortical insufficiency |
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Pregnancy Risk
Factor |
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D |
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Contraindications |
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Serious infections, except septic shock or tuberculous meningitis;
administration of live virus vaccines |
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Warnings/Precautions |
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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 |
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Adverse
Reactions |
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>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
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Overdosage/Toxicology |
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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. |
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Drug
Interactions |
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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
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Mechanism of
Action |
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Decreases inflammation by suppression of migration of polymorphonuclear
leukocytes and reversal of increased capillary permeability |
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Pharmacodynamics/Kinetics |
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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 |
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Usual Dosage |
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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 |
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Dietary
Considerations |
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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 |
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Administration |
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Administer I.M. daily dose before 9 AM to minimize adrenocortical
suppression |
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Mental Health: Effects
on Mental Status |
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Insomnia and nervousness are common; may cause euphoria or
hallucinations |
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Mental Health:
Effects on Psychiatric
Treatment |
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Barbiturates may decrease the levels of cortisone |
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Dental Health: Local
Anesthetic/Vasoconstrictor
Precautions |
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No information available to require special precautions |
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Dental Health:
Effects on Dental Treatment |
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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 |
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Patient
Information |
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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. |
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Nursing
Implications |
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Withdraw gradually following long-term therapy |
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Dosage Forms |
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Tablet: 5 mg, 10 mg, 25 mg |
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