Cortisone Acetate Tablets 25mg N80
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Active ingredients
Cortisone
Release form
Pills
Composition
Cortisone Acetate 25 mg
Pharmacological effect
GKS. It has a significant impact on carbohydrate metabolism and to a lesser extent on water and electrolyte metabolism. It has mineralocorticoid activity: sodium retention, loss of potassium, fluid retention in the body. It promotes the accumulation of glycogen in the liver, increases blood glucose, increases the excretion of nitrogen in the urine. It has anti-inflammatory, desensitizing and antiallergic effects, has immunosuppressive activity. Anti-inflammatory effect due to inhibition of phospholipase A2, which leads to inhibition of prostaglandin synthesis, reduction of macrophage chemotactic factor, decrease in the migration of macrophages and lymphocytes in the center of inflammation, stabilization of lysosomal membranes and prevent the release of lysosomal enzymes. The immunosuppressive effect is associated with a decrease in the number of immunocompetent cells, a decrease in immunoglobulin binding to cellular receptors, inhibition of B-lymphocyte blast transformation, a decrease in the number of interleukins, lymphokines, circulating immunocomplexes, and complement fractions. Increases the excretion of calcium in the urine, activates the lysis of bone tissue by indirectly increasing the amount of calcitonin, increases the activity of osteoclasts, reduces the function of osteoblasts. It has a catabolic effect, increases the breakdown of proteins. Providing a lipolytic effect, increases the content of fatty acids in the blood. It reduces the production of ACTH by the anterior lobe of the pituitary gland, which leads to suppression of activity and subsequent atrophy of the adrenal cortex.
Indications
Addison's disease, secondary chronic insufficiency of the adrenal cortex (with hypopituitarism). Allergic, inflammatory, infectious-allergic, autoimmune diseases.
Contraindications
Peptic ulcer and duodenal ulcer in the acute phase, Cushing's disease, tendency to thromboembolism, renal failure, severe arterial hypertension, systemic mycoses, viral infections, vaccination period, active form of tuberculosis, glaucoma, osteoporosis, productive symptomatology in psychiatric cases. cortisone.
Use during pregnancy and lactation
During pregnancy (especially in the first trimester), as well as during lactation (breastfeeding), cortisone is used taking into account the expected therapeutic effect and the negative effect on the fetus. With prolonged therapy is not excluded the possibility of fetal growth disorders. In the case of receiving cortisone at the end of pregnancy there is a risk of atrophy of the adrenal cortex in the fetus, which may require replacement therapy in the newborn.
Dosage and administration
Individual. The daily daily dose is 10-300 mg in several doses. Maximum doses for adults: one-time - 150 mg, daily - 300 mg. In children, use in smaller doses. It should be borne in mind that the individual dose of cortisone is determined rather by the severity of the disease than by the patient's age.
Side effects
Since the cardiovascular system: edema, arterial hypertension. From the side of water and electrolyte balance: an increase in potassium excretion up to the development of hypokalemic alkalosis, a negative nitrogen balance. On the part of the endocrine system: hyperglycemia, increased appetite, weight gain, Itsenko-Cushing syndrome, amenorrhea. From the musculoskeletal system: osteoporosis, aseptic necrosis of bones. On the part of the central nervous system and peripheral nervous system: mental and neurological disorders, increased intracranial pressure. From the blood coagulation system: increased blood clotting and increased risk of thromboembolic complications. On the part of the digestive system: hemorrhagic pancreatitis, erosive and ulcerative lesions of the gastrointestinal tract, perforation of an unrecognized ulcer. Others: hyperhidrosis, reduced resistance to infectious diseases.
Overdose
Symptoms: increased side effects. Treatment: symptomatic.
Interaction with other drugs
The simultaneous appointment of Cortisone with: Inductors of "liver" microsomal enzymes (phenobarbital, rifampicin, phenytoin, theophylline, ephedrine) leads to a decrease in its concentration. Diuretics (especially "thiazide" and carbonic anhydrase inhibitors) and amphotericin B can lead to increased excretion of K + from the body, and with sodium-containing drugs, edema and increased blood pressure.Amphotericin B increases the risk of developing heart failure. Cardiac glycosides worsen their tolerability and increase the likelihood of ventricular extrasystoles (due to induced hypokalemia). Indirect anticoagulants weakens (rarely enhances) their action (dose adjustment is required). Anticoagulants and thrombolytics increase the risk of bleeding from ulcers in the gastrointestinal tract. Ethanol and nonsteroidal anti-inflammatory drugs (NSAIDs) increase the risk of gastrointestinal ulcers and ulceration in the gastrointestinal tract and the development of bleeding (in combination with NSAIDs in the treatment of arthritis may reduce the dose of glucocorticosteroids due to the summation of the therapeutic effect). Paracetamol increases the risk of hepatotoxicity (induction of hepatic enzymes and the formation of a toxic metabolite of paracetamol). Acetylsalicylic acid accelerates its excretion and reduces the concentration in the blood (with the cancellation of Cortisone, the level of salicylates in the blood increases and the risk of side effects increases). Insulin and oral hypoglycemic drugs, antihypertensive drugs decreases their effectiveness. Vitamin D reduces its effect on the absorption of Ca 2+ in the intestine. Growth hormone reduces the effectiveness of the latter, and with praziquantel - its concentration. M-holinoblokatorami (including antihistamines and tricyclic antidepressants) and nitrates helps to increase intraocular pressure. Isoniazid and Mexelitin increase their metabolism (especially in "slow" acetylators), which leads to a decrease in their plasma concentrations. Carboanhydrase inhibitors and "loopback" diuretics may increase the risk of osteoporosis. Indomethacin, displacing Cortisone from its association with albumin, increases the risk of its side effects. ACTH enhances the action of Cortisone. Ergocalciferol and parathyroid hormone prevent the development of osteopathy caused by Cortisone. Cyclosporine and ketoconazole, slowing the metabolism of Cortisone, can in some cases increase its toxicity. The simultaneous appointment of androgens and steroid anabolic drugs with Cortisone contributes to the development of peripheral oects and hirsutism, the appearance of acne.Estrogens and oral estrogen-containing contraceptives reduce the clearance of Cortisone, which may be accompanied by increased severity of its action. Mitotan and other inhibitors of the function of the adrenal cortex may necessitate an increase in the dose of Cortisone. When applied simultaneously with live antiviral vaccines and against the background of other types of immunization increases the risk of activation of viruses and the development of infections. Antipsychotics (neuroleptics) and azathioprine increase the risk of developing cataracts when prescribing Cortisone. The simultaneous appointment of antacids reduces the absorption of Cortisone. With simultaneous use with antithyroid drugs decreases, and with thyroid hormones - increases the clearance of Cortisone.
special instructions
It is used with caution in patients with NUC, with diverticulitis, a newly created intestinal anastomosis, gastric ulcer and duodenal ulcer, renal failure, myasthenia, hypotension, diabetes, mental illness, hypoalbuminemia. In hypothyroidism, as well as in liver cirrhosis, the effect of cortisone may be enhanced. With initial emotional instability or psychotic tendencies, these phenomena may intensify. When applying cortisone in patients with herpes of the cornea should be borne in mind the possibility of perforation. During treatment, it is necessary to control the intraocular pressure and the state of the cornea. With the sudden cancellation of treatment, especially in the case of previous use in high doses, there is a so-called GCS withdrawal syndrome (not caused by hypocorticism): anorexia, nausea, lethargy, generalized musculoskeletal pain, and general weakness. After cortisone withdrawal for several months, relative insufficiency of the adrenal cortex may persist. If during this period there are stressful situations, appoint (if indicated) at the time of the SCS, if necessary, in combination with mineralocorticoids. In children during long-term treatment, careful monitoring of the dynamics of growth and development is necessary. Children who were in contact with measles or chicken pox during treatment are given specific immunoglobulins prophylactically.