Endocrinology Book

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Systemic CorticosteroidAka: Corticosteroid, Betamethasone, Dexamethasone, Cortisone, Hydrocortisone, Methylprednisolone, Prednisolone

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  1. See Also
    1. Topical Corticosteroid
    2. Inhaled Corticosteroid
    3. Intranasal Steroid
    4. Intra-articular Corticosteroid
    5. Corticosteroid Associated Osteoporosis
  2. Dosing: Adult
    1. Betamethasone (Celestone) 0.5 to 0.9 mg IM/PO qd
    2. Cortisone (Cortone) 25-300 mg PO qd
    3. Dexamethasone (Decadron) 0.75-9 mg PO/IM/IV divided q6h
    4. Hydrocortisone (Cortef)
      1. Parenteral: 100 to 150 mg IV/IM q2-6 hours prn
      2. Oral: 20 to 240 mg/day PO in divided dosing
    5. Methylprednisolone
      1. Parenteral (Solu-Medrol) 10 to 125 mg IV/IM
      2. Oral (Medrol) 4 to 48 mg PO qd
      3. Medrol Dose pack: tapers from 24 to 0 PO over 7 days
    6. Prednisolone (Prelone) 5-60 mg PO/IV/IM qd
    7. Prednisone (Deltasone) 5-60 mg PO qd
    8. Triamcinolone (Aristocort, Kenalog) 4 to 48 mg PO/IM qd
  3. Dosing: Child
    1. Methylprednisolone (Solu-Medrol)
      1. Dose: 1-2 mg/kg/dose PO/IV/IM q6h up to 125 mg/dose
    2. Prednisolone (Prelone)
      1. Dose: 1-2 mg/kg/dose PO qd to bid up to 60 mg/day
      2. Maximum: 60 mg per day
      3. Preparations
        1. Syrup: 15 mg/5 ml
        2. Liquid: 5 mg/5 ml
  4. Agents: Overall potency (equivalent dosages)
    1. High potency
      1. Betamethasone 0.6 to 0.75 mg
      2. Dexamethasone 0.75 mg
    2. Medium potency
      1. Methylprednisolone 4 mg
      2. Triamcinolone 4 mg
      3. Prednisolone 5 mg
      4. Prednisone 5 mg
    3. Low potency
      1. Hydrocortisone 20 mg
      2. Cortisone 25 mg
  5. Agents: Relative anti-inflammatory potency
    1. High anti-inflammatory potency
      1. Betamethasone 20-30
      2. Dexamethasone 20-30
    2. Medium anti-inflammatory potency
      1. Methylprednisolone 5
      2. Triamcinolone 5
      3. Prednisolone 4
      4. Prednisone 4
    3. Low anti-inflammatory potency
      1. Hydrocortisone 1
      2. Cortisone 0.8
  6. Agents: Relative Mineralocorticoid Potency
    1. Mineralocorticoid Activity
      1. Cortisone 2
      2. Hydrocortisone 2
      3. Prednisolone 1
      4. Prednisone 1
    2. No Mineralocorticoid Activity
      1. Betamethasone
      2. Dexamethasone
      3. Methylprednisolone
      4. Triamcinolone
  7. Agents: Half Life
    1. Long half-life (36-54 hours)
      1. Betamethasone
      2. Dexamethasone
    2. Medium half-life (18-36 hours)
      1. Methylprednisolone
      2. Prednisolone
      3. Prednisone
      4. Triamcinolone
    3. Short half-life (8-12 hours)
      1. Cortisone
      2. Hydrocortisone
  8. Adverse Effects: Long-term Corticosteroids
    1. Corticosteroid Associated Osteoporosis
    2. Corticosteroid Myopathy
    3. Emotional lability (depression or hypomania)
    4. Motor restlessness
    5. Insomnia
    6. Hypertension
    7. Iatrogenic Diabetes Mellitus
    8. Hyperlipidemia
    9. Fluid retention
    10. Osteonecrosis of the hip
  9. Prevention of Corticosteroid complications
    1. See Corticosteroid Associated Osteoporosis
  10. References
    1. Lane (1998) Endocrinol Metab Clin North Am 27:465

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