Cortisone acetate.JPG

Cortisone acetate

CLINICAL USE

Glucocorticoid replacement in adrenocortical insufficiency

DOSE IN NORMAL RENAL FUNCTION

25–37.5 mg daily in divided doses

PHARMACOKINETICS

  • Molecular weight                           :402.5
  • %Protein binding                           :90
  • %Excreted unchanged in urine     : 0
  • Volume of distribution (L/kg)       :0.3
  • half-life – normal/ESRD (hrs)      :0.5/3.5

    DOSE IN RENAL IMPAIRMENT

    GFR (mL/MIN)

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

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

  • CAPD                :Not dialysed. Dose as in normal renal function
  • HD                     :Not dialysed. Dose as in normal renal function
  • HDF/high flux   :Unknown dialysability. Dose as in normal renal function
  • CAV/VVHD      :Unknown dialysability. Dose as in normal renal function

    IMPORTANT DRUG INTERACTIONS

    Potentially hazardous interactions with other drugsAntibacterials: metabolism accelerated by rifampicin; metabolism possibly inhibited by erythromycinAnticoagulants: efficacy of coumarins may be alteredAnti-epileptics: metabolism accelerated by carbamazepine, barbiturates, phenytoin and primidoneAntifungals: increased risk of hypokalaemia with amphotericin – avoid concomitant use; metabolism possibly inhibited by itraconazole and ketoconazole. Antivirals: concentration possibly increased by ritonavirCiclosporin: rare reports of convulsions in patients on ciclosporin and high-dose corticosteroidsCytotoxics: increased risk of haematological toxicity with methotrexateDiuretics: enhanced hypokalaemic effects of acetazolamide, loop diuretics and thiazide diureticsVaccines: high-dose corticosteroids can impair immune response to vaccines; avoid concomitant use with live vaccines

    ADMINISTRATION

    Reconstition

    Route

    Oral

    Rate of Administration

    Comments

    OTHER INFORMATION

    Treatment of adrenocortical insufficiency with hydrocortisone is now generally preferred since cortisone itself is inactive. It must be converted by the liver to hydrocortisone, its active metabolite, and hence, in some liver disorders, its bioavailability is less reliableMineralocorticoid activity is usually supplemented by oral fludrocortisone acetateCortisone acetate has been used in the treatment of many allergic and inflammatory disorders, but prednisolone or other synthetic glucocorticoids are generally preferred because of their reduced sodium retaining properties.