CLINICAL USE

Corticosteroid

DOSE IN NORMAL RENAL FUNCTION

IM: 40 mg of acetonide; maximum single dose 100 mg Intra-articular: 2.5–40 mg of acetonide

PHARMACOKINETICS

  • Molecular weight &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp : 394.4 (434.5 as acetonide)
  • %Protein binding &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp : Low
  • %Excreted unchanged in urine &nbsp &nbsp : <1

  • Volume of distribution (L/kg) &nbsp &nbsp &nbsp : 1.4–2.1

  • half-life – normal/ESRD (hrs)&nbsp &nbsp &nbsp : 2–5/Unchanged

    DOSE IN RENAL IMPAIRMENT

    GFR (mL/MIN)

  • 20 to 50 &nbsp &nbsp : Dose as in normal renal function
  • 10 to 20 &nbsp &nbsp : Dose as in normal renal function
  • <10 &nbsp &nbsp &nbsp &nbsp &nbsp : Dose as in normal renal function

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

  • CAPD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp: Unknown dialysability. Dose as in normal renal function

  • HD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp : Unknown dialysability. Dose as in normal renal function
  • HDF/high flux &nbsp : Unknown dialysability. Dose as in normal renal function
  • CAV/VVHD &nbsp &nbsp &nbsp: Unknown dialysability. Dose as in normal renal function

    IMPORTANT DRUG INTERACTIONS

    Potentially hazardous interactions with other drugs
  • Antibacterials: metabolism accelerated by rifampicin; metabolism possibly inhibited by erythromycin
  • Anticoagulants: efficacy of coumarins may be altered
  • Anti-epileptics: metabolism accelerated by carbamazepine, barbiturates, phenytoin and primidone
  • Antifungals: increased risk of hypokalaemia with amphotericin – avoid concomitant use; metabolism possibly inhibited by itraconazole and ketoconazole
  • Antivirals: concentration possibly increased by ritonavir
  • Ciclosporin: rare reports of convulsions in patients on ciclosporin and high-dose corticosteroids Cytotoxics: increased risk of haematological toxicity with methotrexate
  • Diuretics: enhanced hypokalaemic effects of acetazolamide, loop diuretics and thiazide diuretics Vaccines: high dose corticosteroids can impair immune response to vaccines; avoid concomitant use with live vaccines

    ADMINISTRATION

    Reconstition

    –

    Route

    IM, intra-articular, topical, nasal spray, intradermal

    Rate of Administration

    –

    Comments

    –

    OTHER INFORMATION

    Use with caution in severe renal impairment as sodium and water retention may occur 4 mg is equivalent to 5 mg of prednisolone .
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