Cortisone

DEA Class; Rx

Common Brand Names; Cortone

Oral corticosteroid with significant mineralocorticoid activity as well as glucocorticoid properties; cortisone has about 80% of the anti-inflammatory and sodium-retaining potency of hydrocortisone
Used primarily in adult and pediatric patients with primary or secondary adrenocortical insufficiency
Corticosteroids with minimal mineralocorticoid activity, such as prednisone, are preferred over cortisone for most other responsive conditions

Indicated for the treatment of a critical period of regional enteritis (Crohn’s disease) or ulcerative colitis.

For the treatment of trichinosis with neurologic or myocardial involvement.

For the treatment of tuberculous meningitis with subarachnoid block or impending block when used concurrently with appropriate antituberculous therapy.

Systemic fungal infection

Hypersensitivity to cortisone

Short-acting agent

Hydroxylated to the active compound hydrocortisone

Not indicated for IV use

Some suggestion of slightly increase cleft palate risk if corticosteroids used in pregnancy, but not fully substantiated

Following prolonged therapy, withdrawal of corticosteroids may result in symptoms of corticosteroid withdrawal syndrome including fever, myalgia, arthralgia, and malaise; this may occur in patients even without evidence of adrenal insufficiency

Patients on corticosteroid therapy subjected to unusual stress, increased dosage of rapidly acting corticosteroids before, during, and after the stressful situation is indicated

Drug-induced secondary adrenocortical insufficiency may result from too rapid withdrawal of corticosteroids and may be minimized by gradual reduction of dosage; this type of relative insufficiency may persist for months after discontinuation of therapy; therefore, in any situation of stress occurring during that period, hormone therapy should be reinstituted

If the patient is receiving steroids already, dosage may have to be increased; since mineralocorticoid secretion may be impaired, salt and/or a mineralocorticoid should be administered concurrently

Corticosteroids may mask some signs of infection, and new infections may appear during their use; there may be decreased resistance and inability to localize infection when corticosteroids are used; moreover, corticosteroids may affect the nitroblue-tetrazolium test for bacterial infection and produce false-negative results

In cerebral malaria, a double-blind trial has shown that use of corticosteroids is associated with prolongation of coma and a higher incidence of pneumonia and gastrointestinal bleeding

Corticosteroids may activate latent amebiasis; therefore, it is recommended that latent or active amebiasis be ruled out before initiating corticosteroid therapy in any patient who has time in the tropics or any patient with unexplained diarrhea

Prolonged use of corticosteroids may produce posterior subcapsular cataracts, glaucoma with possible damage to optic nerves, and may enhance establishment of secondary ocular infections due to fungi or viruses

Average and large doses of hydrocortisone or cortisone can cause elevation of blood pressure, salt and water retention, and increased excretion of potassium; these effects are less likely to occur with synthetic derivatives except when used in large doses; dietary salt restriction and potassium supplementation may be necessary; all corticosteroids increase calcium excretion

Since adequate human reproduction studies have not been done with corticosteroids, use of these drugs in pregnancy or in women of childbearing potential requires that the anticipated benefits be weighed against possible hazards to mother and embryo or fetus

Corticosteroids appear in breast milk and could suppress growth, interfere with endogenous corticosteroid production, or cause other unwanted effects; mothers taking pharmacologic doses of corticosteroids should be advised not to nurse