cortisone (Rx)

Brand and Other Names:
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet

  • 5mg
  • 10mg
  • 25mg

Anti-inflammatory/Immunosuppressive

2.5-10 mg/kg/day PO divided q8hr or 25-300 mg/day PO qDay or divided q12hr

1-5 mg/kg IM qDay

Physiologic Replacement

0.5-0.75 mg/kg/day PO divided q8hr or 25-35 mg/day

0.25-0.35 mg/kg IM qDay

Other Indications & Uses

Adrenal insufficiency, conditions treated with immunosuppression, corticosteroid responsive dermatoses, inflammatory conditions

Dosage Forms & Strengths

tablet

  • 5mg
  • 10mg
  • 25mg

Anti-inflammatory/Immunosuppressive

2.5 mg-10 mg/kg/day PO or 20-300 mg/sq.meter/day PO divided q6-8hr

Physiologic Replacement

0.5-0.75 mg/kg/day PO or 20-25 mg/sq.meter/day PO divided q8hr

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Interactions

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            Adverse Effects

            >10%

            Insomnia

            Indigestion

            Incr appetite

            1-10%

            Hirsutism

            Arthragia

            Cataract

            Epistaxis

            DM

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            Warnings

            Contraindications

            Systemic fungal infection

            Hypersensitivity to cortisone

            Cautions

            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

            Administration of live virus vaccines, including smallpox, is contraindicated in individuals receiving immunosuppressive doses of corticosteroids; if inactivated viral or bacterial vaccines are administered to individuals receiving immunosuppressive doses of corticosteroids, the expected serum antibody response may not be obtained; however, immunization procedures may be undertaken in patients who are receiving corticosteroids as replacement therapy, eg, for Addison’s disease

            Persons who are on drugs that suppress immune system are more susceptible to infections than healthy individuals; chickenpox and measles, for example, can have more serious or even fatal course in non-immune children or adults on corticosteroids; in such children or adults who have not had these diseases, particular care should be taken to avoid exposure

            How the dose, route, and duration of corticosteroid administration affects risk of developing a disseminated infection is not known; the contribution of underlying disease and/or prior corticosteroid treatment to the risk is also not known

            If exposed to chickenpox, prophylaxis with varicella-zoster immune globulin (VZIG) may be indicated; if exposed to measles, prophylaxis with pooled intramuscular immunoglobulin (IG) may be indicated; if chickenpox develops, treatment with antiviral agents may be considered

            Literature reports suggest an apparent association between use of corticosteroids and left ventricular free wall rupture after a recent myocardial infarction; therapy with corticosteroids should be used with great caution in these patients

            There is enhanced effect of corticosteroids in patients with hypothyroidism and in those with cirrhosis

            Corticosteroids should be used cautiously in patients with ocular herpes simplex because of possible corneal perforation

            The lowest possible dose of corticosteroid should be used to control the condition under treatment, and when reduction in dosage possible, reduction should be gradual

            Psychotic derangements may appear when corticosteroids are used, ranging from euphoria, insomnia, mood swings, personality changes, and severe depression, to frank psychotic manifestations; also, existing emotional instability or psychotic tendencies may be aggravated by corticosteroids

            Aspirin should be used cautiously in conjunction with corticosteroids in hypoprothrombinemia

            Tuberculosis

            • The use of this drug in active tuberculosis should be restricted to those cases of fulminating or disseminated tuberculosis in which corticosteroid is used for the management of the disease in conjunction with an appropriate antituberculous regimen
            • If corticosteroids are indicated in patients with latent tuberculosis or tuberculin reactivity, close observation is necessary as reactivation of disease may occur; during prolonged corticosteroid therapy, these patients should receive chemoprophylaxis
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            Pregnancy & Lactation

            Pregnancy

            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; infants born of mothers who have received substantial doses of corticosteroids during pregnancy should be carefully observed for signs of hypoadrenalism

            Lactation

            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

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Mechanism of Action

            Glucocorticoid; elicits mild mineralocorticoid activity and moderate anti-inflammatory effects; controls or prevents inflammation by controling the rate of protein synthesis, suppressing migration of PMNs and fibroblasts, and reversing capillary permeability

            Absorption

            Duration: 10 days (IM); 30-36 hr (PO)

            Onset: PO: 24 hr (IM); within 2 hr (PO)

            Distribution

            Protein Bound: 90%

            Metabolism

            Extensively and rapidly in the liver to hydrocortisone (active metabolite) which is then metabolized in tissues and the liver to inactive glucuronide & sulfate metabolites

            Metabolites: Hydrocortisone (active), glucuronide and sulfate metabolites (inactive)

            Elimination

            Half-life: 0.4-2 hr

            Excretion: Mainly in urine, minimally in bile

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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            cortisone oral
            -
            25 mg tablet

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

            Patient Education
            cortisone oral

            CORTISONE - ORAL

            (KOR-ti-sone)

            COMMON BRAND NAME(S): Cortone

            USES: Cortisone is a corticosteroid hormone (glucocorticoid). It decreases your body's natural defensive response and reduces symptoms such as swelling and allergic-type reactions.This medication is used to treat conditions such as arthritis, blood/hormone/immune system disorders, allergic reactions, certain skin and eye conditions, breathing problems, and certain cancers.

            HOW TO USE: Take this medication by mouth with food or milk to prevent stomach upset. Take this medication by mouth with a full glass of water (8 ounces/240 milliliters) unless your doctor directs you otherwise. If you take this medication once daily, take it in the morning before 9 AM. If you are taking this medication every other day or on another schedule besides a daily one, it may help to mark your calendar with a reminder.The dosage and length of treatment are based on your medical condition and response to therapy. Use this medication regularly in order to get the most benefit from it. To help you remember, take it at the same time(s) each day. Keep taking this medication even if you feel well. Follow the dosing schedule carefully, and take this medication exactly as prescribed.Do not stop taking this medication without consulting your doctor. Some conditions may become worse when this drug is suddenly stopped. Your dose may need to be gradually decreased.Inform your doctor if your condition lasts or gets worse.

            SIDE EFFECTS: Stomach upset, headache, dizziness, menstrual changes (such as delayed/irregular/absent periods), trouble sleeping, increased appetite, or weight gain may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: bone/joint pain, easy bruising/bleeding, fast/pounding/irregular heartbeat, increased thirst/urination, mental/mood changes (such as depression, mood swings, agitation), muscle pain, ongoing weight gain, puffy face, slow wound healing, seizures, signs of infection (such as sore throat that doesn't go away, fever), swelling of the ankles/feet, thinning skin, unusual hair growth, unusual skin growths, vision changes, symptoms of stomach/intestinal bleeding (such as stomach/abdominal pain, black/tarry stools, vomit that looks like coffee grounds), weakness.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

            PRECAUTIONS: Before taking cortisone, tell your doctor or pharmacist if you are allergic to it; or to other corticosteroids (such as prednisone); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: bleeding problems, history of blood clots, brittle bones (osteoporosis), diabetes, eye diseases (such as cataracts, glaucoma, herpes infection of the eye), heart problems (such as congestive heart failure), high blood pressure, infections (such as fungal infections, tuberculosis, herpes), kidney disease, liver problems (such as cirrhosis), mental/mood conditions (such as psychosis, anxiety, depression), low blood minerals (such as low potassium or calcium), stomach/intestinal problems (such as ulcer, ulcerative colitis, diverticulitis), thyroid problems.This medication may mask signs of infection or put you at greater risk of developing very serious infections. Report any injuries or signs of infection (such as sore throat that doesn't go away, fever, cough, pain during urination, muscle aches) that occur during treatment.Using corticosteroid medications for a long time can make it more difficult for your body to respond to physical stress. Before having surgery or emergency treatment, or if you get a serious illness/injury, tell your doctor or dentist that you are using this medication or have used this medication within the past 12 months. Tell your doctor right away if you develop unusual/extreme tiredness or weight loss. If you will be using this medication for a long time, carry a warning card or medical ID bracelet that identifies your use of this medication.Tell your health care professional that you are using cortisone before having any immunizations, vaccinations, or skin tests. Avoid contact with people who have recently received live vaccines (such as flu vaccine inhaled through the nose).Avoid contact with people who have chickenpox or measles unless you have previously had these diseases (such as in childhood). If you are exposed to one of these infections and you have not previously had it, seek immediate medical attention.If you have a history of ulcers or take large doses of aspirin or other arthritis medication, limit alcoholic beverages while taking this medication to decrease the risk of stomach/intestinal bleeding.If you have diabetes, this drug may make it harder to control your blood sugar levels. Monitor your blood sugar levels regularly and inform your doctor of the results. Your medicine, exercise plan, or diet may need to be adjusted.This drug may make you dizzy. Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Older adults may be more sensitive to the side effects of this drug, especially bone loss/pain, stomach/intestinal bleeding, and mental/mood changes (such as confusion).This medication may slow down a child's growth if used for a long time. Consult the doctor or pharmacist for more details. See the doctor regularly so your child's height and growth can be checked.During pregnancy, this medication should be used only when clearly needed. There have been rare reports of harm to the unborn baby. Infants born to mothers who have been using this medication for an extended time may have low levels of corticosteroid hormone. Discuss the risks and benefits with your doctor. Tell your doctor right away if you notice symptoms such as nausea/vomiting that doesn't stop, severe diarrhea, or weakness in your newborn.It is not known whether this drug passes into breast milk. Consult your doctor before breast-feeding.

            DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug are: aldesleukin, birth control pills, diabetes medications, estrogen hormone replacement, mifepristone, drugs that can cause bleeding/bruising (including antiplatelet drugs such as clopidogrel, "blood thinners" such as dabigatran/warfarin, NSAIDs such as aspirin/celecoxib/ibuprofen).If your doctor has directed you to take low-dose aspirin for heart attack or stroke prevention (usually 81-162 milligrams a day), you should continue taking it unless your doctor instructs you otherwise. Ask your doctor or pharmacist for more details.Other medications can affect the removal of cortisone from your body, which may affect how cortisone works. Examples include azole antifungals (such as ketoconazole), rifamycins (such as rifabutin), drugs used to treat seizures (such as phenytoin), among others.This medication may interfere with certain laboratory tests, possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.

            OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

            NOTES: Do not share this medication with others.If this medication is used for a long time, lab and/or medical tests (such as blood sugar/mineral levels, blood pressure, eye exams) should be done while you are taking this medication. Keep all medical and lab appointments. Consult your doctor for more details.Lifestyle changes that may help reduce the risk of brittle bones (osteoporosis) while taking this drug for an extended time include doing weight-bearing exercise, stopping smoking, getting enough calcium and vitamin D, and limiting alcohol. Discuss with your doctor lifestyle changes that might benefit you.If you take this medication for long-term treatment, wear or carry identification stating that you are using it. (See also Medical Alert section.)

            MISSED DOSE: If you are taking this medication once daily and miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.Ask your doctor ahead of time what you should do if you miss a dose while taking this medication every other day or on another schedule besides a daily one.

            STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

            MEDICAL ALERT: Your condition can cause complications in a medical emergency. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada).

            Information last revised December 2022. Copyright(c) 2023 First Databank, Inc.

            IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
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            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
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            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
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            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.