Corticosteroids dosage

Corticosteroids Dosage Forms Strength (%) USP Potency Ratings3 Vasoconstrictive Potency Rating ... 

Corticosteroids Dosage Forms/Strength (°/o) Ratings0 Potency Rating6... 

When corticosteroids are administered for more than 2 weeks, adrenal suppression may occur. If treatment extends over weeks to months, the patient should be given appropriate supplementary therapy at times of minor stress (two-fold dosage increases for 24-48 hours) or severe stress (up to ten-fold dosage increases for 48-72 hours) such as accidental trauma or major surgery. If corticosteroid dosage is to be reduced, it should be tapered slowly. If therapy is to be stopped, the reduction process should be quite slow when the dose reaches replacement levels. It may take 2-12 months for the hypothalamic-pituitary-adrenal axis to function acceptably, and cortisol levels may not return to normal for another 6-9 months. The glucocorticoid-induced suppression is not a pituitary problem, and treatment with ACTH does not reduce the time required for the return of normal function. 

The interaction between the corticosteroids and phenobarbital is well documented, well established and of clinical importance. Concurrent use need not be avoided but the outcome should be monitored. Increase the corticosteroid dosage as necessary. The extent of the increase is variable. Dex-amethasone, hydrocortisone, " methylprednisolone, prednisone and prednisolone are all known to be affected. Prednisone and prednisolone appear to be less affected than methylprednisolone and may be preferred. Be alert for the same interaction with other corticosteroids and other barbiturates, which also are enzyme-inducers, although direct evidence seems to be lacking. The dexamethasone adrenal suppression test may be expected to be unreliable in those taking phenobarbital, just as it is with pheny-toin, another potent enzyme-inducer. See Corticosteroids + Phenytoin , p.1059. 

Increase the corticosteroid dosage proportionately to the increase in clearance (see Table 29.2 , (see above)). With prednisolone an average increase of 100% (range 58 to 260% in 5 subjects) proved effective." A fourfold increase may be necessary with dexamethasone, and much greater increases have been required with fludrocortisone. ... 

A patient with Addison s disease in whom the plasma half-life of cortisone was considerably reduced, requiring increased corticosteroid dosage, was described by Edwards et al. (34 ). Cortisone production rates in 4 patients with active pulmonary tuberculosis under treatment with rifampicin were also found to be greatly increased, the mean rate rising from 14.4 to 23.0 mg per 24 hours. It was postulated that these effects were the result of hepatic enzyme induction by rifampicin. 

When corticosteroid use is discontinued, the dosage must be tapered gradually over several days If high dosages have been given, it may take a week or more to taper the dosage. 

The corticosteroids are administered with caution in older adults because they are more likely to have preexisting conditions such as congestive heart failure, hypertension, osteo-poros s and arthritis which may be worsened by the use of such agents The nurse monitors older adults for exacerbation of existing conditionsduring corticosteroid therapy. In addition, lower dosages may be needed because of the effects of aging, such as decreased muscle mass renal function, and plasma volume. 

Corticosteroids are the most potent anti-inflammatory agents available for the treatment of asthma. The efficacy of corticosteroids is due to their ability to affect multiple inflammatory pathways, resulting in the suppression of inflammatory cell activation and function, prevention of microvascular leakage, decreased mucus production, and upregulation of P2-adrenergic receptors.10,18 Clinically, corticosteroids decrease airway inflammation, decrease AHR, decrease mucus production and secretion, and improve the response to P2-agonists.18 Corticosteroids for the treatment of asthma are available in inhaled, oral, and injectable dosage forms. 

TABLE 11-3. Estimated Comparative Dosages for Inhaled Corticosteroids... 

Because all inhaled corticosteroids are equally effective if given in equipotent doses, product selection should be individualized based on the available dosage form, delivery device, and patient preference. In infants, administration may require the use of a nebulizer or spacer/holding chamber with a facemask. Caregivers should use a soft, damp cloth to wipe the face of infants receiving an inhaled corticosteroid via a facemask to prevent topical candidiasis.18... 

Azathioprine was originally approved by the FDA in 1968 as an adjunct immunosuppressant for use in renal transplant recipients. It is available in oral and IV dosage forms.11 Prior to the advent of cyclosporine, the combination of azathioprine and corticosteroids was the mainstay of immunosuppressive therapy. Over the past 10 years, the use of azathioprine has declined markedly due in large part to the success of the MPA derivatives, which are more specific inhibitors of T cell proliferation. 

Corticosteroids play a key role in the management of SVCS, particularly in cases of lymphoma, because these tumors inherently respond to corticosteroid therapy. They are also helpful in the setting of respiratory compromise. Corticosteroids benefit patients who are receiving radiation therapy by reducing local radiation-induced inflammation and increased intracranial pressure. Dexamethasone 4 mg intravenously or by mouth every 6 hours is a frequently used regimen. The dosage should be tapered on completion of radiation therapy or resolution of symptoms. 

Hydrocortisone given parenterally is the corticosteroid of choice because of its combined glucocorticoid and mineralocorticoid activity. The starting dose is 100 mg IV by rapid infusion, followed by a continuous infusion or intermittent bolus of 100 to 200 mg every 24 hours. IV administration is continued for 24 to 48 hours. If the patient is stable at that time, oral hydrocortisone can be started at a dose of 50 mg every 8 hours for another 48 hours. A hydrocortisone taper is then initiated until the dosage is 30 to 50 mg/day in divided doses. 

Infliximab is used for moderate to severe active Crohn s disease in patients failing immunosuppressive therapy, in those who are corticosteroid dependent, and for treatment of fistulizing disease. A single, 5 mg/kg infusion is effective when given every day for 8 weeks. Additional doses at 2 and 6 weeks following the initial dose results in higher response rates. Adalimumab is effective in 54% of patients with moderate to severe Crohn s disease who have lost response to infliximab. The typical dosage is 160 mg subcutaneously initially, followed by 80 mg subcutaneously at week 2, with subsequent doses of 40 mg subcutaneously every other week thereafter. 

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