Products
Cortisone tablets are medicinal products which are intended for ingestion and contain active substances from the group of glucocorticoids. The tablets, water-soluble tablets and sustained-release tablets are usually monopreparations, which are often divisible. Glucocorticoids were first used medicinally in the late 1940s.
Structure and properties
The glucocorticoids contained in the drugs are derived from the body’s natural hormones such as hydrocortisone (= cortisol), which are produced by the adrenal cortex under central control by ACTH. The synthetic active ingredients were structurally modified, for example fluorinated, esterified or anellated. This modified their pharmacokinetic and pharmacodynamic properties, for example, in terms of their half-life, potency, and glucocorticoid and mineralocorticoid effects. Arranged by ascending potency: cortisone < hydrocortisone < prednisone < prednisolone < triamcinolone < methylprednisolone < dexamethasone.
Effects
Glucocorticoids (ATC H02AB) have anti-inflammatory, immunosuppressive, antiallergic, vasoconstrictive, and antiproliferative properties. The effects are based on binding to intracellular glucocorticoid receptors in the cytoplasm of cells. The resulting complex interacts with DNA. It must be noted that the effects occur with a time delay of several hours. Glucocorticoids are therefore not suitable for acute emergency therapy! In addition, the active substances also exert extragenomic effects.
Indications
Cortisone tablets can be administered for numerous indications. Indications include:
- Rheumatic diseases, such as rheumatoid arthritis.
- Autoimmune diseases, e.g., a multiple sclerosis.
- Skin diseases, e.g. psoriasis, atopic dermatitis, lupus erythematosus.
- Allergic diseases, e.g. as part of the allergy emergency kit, severe allergic rhinitis.
- Endocrine disorders, e.g. adrenocortical insufficiency, substitution therapy.
- Eye diseases, e.g., severe inflammatory diseases.
- Inflammatory bowel diseases, e.g. ulcerative colitis, Crohn’s disease.
- Respiratory diseases, e.g. asthma, COPD
- Cancer, e.g. as antiemetics, in leukemias.
- Hematological diseases, e.g., certain anemias.
Dosage
According to the professional information. The dose is adjusted individually. The initial dose may be comparatively high. Generally, the lowest effective dose should be administered for subsequent maintenance therapy. Cortisone tablets are usually taken early in the morning, for example between 6 and 8 a.m., due to the natural circadian rhythm of glucocorticoid release. To reduce irritation of the intestinal mucosa, the tablets may be administered with food.
Abuse
Taking cortisone tablets may result in a positive doping test.
Active ingredients
The following glucocorticoids are administered orally and in tablet form (selection):
- Betamethasone (Betnesol)
- Deflazacort (Calcort)
- Dexamethasone (Fortecortin, generics)
- Hydrocortisone (Hydrocortone, generics)
- Methylprednisolone (Medrol)
- Prednisolone (Spiricort, generics)
- Prednisone (generic, Lodotra)
- Triamcinolone (Kenacort)
Fludrocortisone has some glucocorticoid action, but is characterized by its predominantly mineralocorticoid effects.
Contraindications
Contraindications include (selection):
- Hypersensitivity
- Stomach and intestinal ulcers
- Severe osteoporosis
- Diabetes mellitus
- Severe hypertension
- Viral infections, systemic infections
- Immunization with live vaccines
- Psychiatric diseases in the patient history
- Systemic fungal infections
For complete precautions, see the drug label.
Interactions
Oral glucocorticoids have a high potential for drug-drug interactions. Interactions must be reviewed before initiating therapy. Caution should also be exercised when self-medicating (e.g., pain relievers such as the NSAIDs).
Adverse effects
Short-term therapy of up to 10 days is considered relatively well tolerated.The following possible adverse effects may occur, especially with long-term treatment: Immune system:
- Immunosuppression, masking of infections, opportunistic infectious diseases, activation of latent infections.
Endocrine system:
- Inhibition of ACTH release, NNR insufficiency, Cushing’s syndrome, gynecomastia, high blood sugar, diabetes, cycle disorders.
- Children: growth retardation
Water and electrolyte balance:
- Water retention, edema, sodium retention, hypertension, potassium loss, calcium and phosphate loss.
Central nervous system:
- Dizziness, headache, increased intracranial pressure, mental disorders such as sleep disturbances, euphoria, depression, mood and personality changes, emotional instability, psychosis.
Eyes:
Gastrointestinal tract:
- Gastric and intestinal ulcers (especially in combination with NSAIDs), perforations and bleeding, increased appetite, weight gain, ulcerative esophagitis.
Skin:
- Skin lesions, atrophy, striae, steroid acne, poor wound healing.
Muscles, joints and skeleton:
- Osteoporosis, muscle weakness, muscle atrophy, myopathy, vision, bone and joint damage.
Blood:
- Blood count disorders, increase in the risk of thrombosis.
