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Corticosteroids, Systemic

Overview :

Because they both have mineralocorticoid and glucocorticoid effects, cortisone and hydrocortisone are preferred for use in treating adrenal insufficiency. When glucocorticoids are used for their anti-inflammatory and immunosuppressant properties and their effects on blood and lymphatic systems, synthetic compounds, which have increased glucocorticoid effects and minimal mineralocorticoid effects, are generally preferred.

A number of systemic corticosteroid compounds are commercially available. Although they are generally similar, they vary in their potency, sodium-retaining effects, and duration of action.

Short acting

Cortisone has both glucocorticoid and mineralocorticoid effects. It has the lowest potency of the commercially available corticosteroids and a short duration of action. It is appropriate for replacement therapy in patients with adrenal insufficiency.

Hydrocortisone has both glucocorticoid and mineralocorticoid effects. It is more potent than cortisone and has a somewhat longer duration of action. Although hydrocortisone may be used for its systemic effects, it is most commonly used in skin preparations.

Intermediate acting

Prednisone is probably the most widely used of the systemic steroids. It has about half the sodium-retaining effects of hydrocortisone but several times the anti-inflammatory effects. Because of the low level of mineralocorticoid effects, however, prednisone is not suitable for treatment of adrenal insufficiency unless it is used in combination with a mineralocorticoid drug. Prednisolone is very similar to prednisone. In addition to oral dosage form, it is available for subcutaneous, intramuscular, and intravenous injection.

Triamcinolone is slightly more potent than prednisone or prednisolone but has no sodium-retaining effects. It is administered various ways, including inhalation for respiratory problems and as ointments and creams for skin conditions. Methylprednisolone, which is similar to triamcinolone, is most commonly given by injection.

Long acting

Dexamethasone is a very potent glucocorticoid, with no mineralocorticoid activity. It is used in various forms, including tablets, injection, ointments, and eye and eardrops. In cancer treatment, dexamethasone is used both for its corticosteroid properties and as an antinauseant, to help control the side effects of other drugs. Betamethasone is similar to dexamethasone. Although the drug is available for systemic use, it is more commonly used in the form of inhalations and ointments. Other corticosteroids are available but are most often used in inhalation form, for asthma, allergic rhinitis, or other respiratory conditions.

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