Intranasal glucocorticoids

The use of intranasal glucocorticoids in the treatment of allergic and vasomotor rhinitis in Sweden has doubled... 

Intranasal glucocorticoids Used to treat seasonal and perennial rhinitis... 

Three types of decongestants are nasal decongestants, systemic decongestants, and intranasal glucocorticoids. 

Triamcinolone to be used topically is generally dispensed as its more potent and lipophilic acetonide, a 16a,17a-methylenedioxy cyclic ketal or isopropylidene derivative (Fig. 33.14) (see Inhaled and Intranasal Glucocorticoids). It is effective in the treatment of psoriasis and other corticoid-sensitive dermatologic conditions. Topically, triamcinolone acetonide is a more potent derivative of triamcinolone and is approximately eight times more active than prednisolone. The side effects of the drug, however, have occurred with sufficient frequency ... 

Newer synthetic glucocorticoids have incorporated chlorine atoms onto the steroid molecule as fluorine substitutes. Beclomethasone, a 9a-chloro analogue of betamethasone, is a potent glucocorticoid with approximately half the potency of its fluoro analogue. It is used topically as its dipropionate derivative in inhalation aerosol therapy for asthma and rhinitis (see Inhaled and Intranasal Glucocorticoids) but not for treatment of steroid-responsive dermatoses (77). The topical anti-inflammatory potency for beclomethasone... 

There are three types of decongestants. These are nasal decongestants that provide quick relief to the patient systemic decongestants that provide a longer lasting relief from congestion and intranasal glucocorticoids that are used to treat seasonal and perennial rhinitis. 

Hochhaus G, Sahasranaman S, Deiendorf H, MolLmaim H (2002) Intranasal glucocorticoid delivery competition between local and systemic effects. STP Pharma Sci 12 23-31... 

Tolerance to glucocorticoids in this, as in some other respects, varies from individual to individual some patients tolerate 30 mg of prednisone for a long time without developing Cushing s syndrome, while others develop symptoms at 7.5 mg the doses recommended today to avoid Cushing s syndrome in most patients are usually equivalent to hydrocortisone 20 mg. Cushing s syndrome and other systemic adverse effects can occur not only from oral and injected glucocorticoids, but also from topical and intranasal treatment (115) and intrapul-monary or epidural administration (SEDA-19, 376 SEDA-20, 370 116,117). 

The usefulness of intranasally administered salmon calcitonin for 2 years has been evaluated in 44 glucocorticoid-dependent asthmatics (SEDA-19, 378 7). All were taking calcium supplements (1000 mg/day), but one group also took calcitonin 100 IU every other day. Calcitonin increased spinal bone mass during the first year of... 

Intranasal or inhalation glucocorticoid therapy reduces the expression of Th2-related interleukins and increases IFN-y as well as the corresponding receptors [13],... 

In case of an obstruction of the nasal airways, the swelling should first be reduced and then the patient should apply the anti-inflammatory medication to ensure its necessary distribution over the complete mucosa. Antihistamines in addition to oral therapy may also be applied locally, intranasally or conjunctivally. The combination of all three substance groups (H, antihistamines, topic glucocorticoids and antileukotrienes) as a pretreatment as well as a symptomatic treatment during immunotherapy increases the chances of success of hyposensitization in our experience [unpubl. data]. 

Anaphylactic shock has been described after intranasal hydrocortisone acetate, intramuscular methylprednisolone (SEDA-21, 419) (251), intravenous methylprednisolone (SEDA-22, 448) (252), intramuscular dexamethasone (SEDA-22, 448) (253), and intra-articular methylprednisolone (SEDA-22, 449) (254). A life-threatening anaphylac-tic-like reaction to intravenous hydrocortisone has been described in patients with asthma (255). Acute laryngeal obstruction has been described for the first time after the intravenous administration of hydrocortisone (SEDA-22, 449) (256). There is some reason to believe that sodium succinate esters are more likely to cause hypersensitivity reactions (SEDA-17, 449), but unconjugated glucocorticoids can definitely produce allergy in some cases (SEDA-16, 452). 

Glucocorticoid therapy is used in trauma, surgery, infections, emotional upsets, and anxiety. Most glucocorticoid drugs are synthetically produced and are administered orally, IM, IV, topically (see Chapter 20), intranasally (see Chapter 14), and as aerosol inhalers (see Chapter 14). 

Endocrine In a systematic review of 25 cases (15 adults and 10 children) of significant adrenal suppression secondary to an interaction between ritonavir and inhaled fluticasone, and three cases involving ritonavir and intranasal fluticasone, cases with other steroids were not reported [190 ]. The authors concluded that the combination of long-term fluticasone with ritonavir should be avoided and if ritonavir is required, another inhaled glucocorticoid, such as low-dose budesonide or beclo-methasone, can be used cautiously. When inhaled glucocorticoids are withdrawn, the patient should be closely monitored for adrenal insufficiency. 

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