Cortisol

From Anvita Health Wiki

Contents 1 Indications 2 Dosage 3 Pharmacokinetics 4 Adverse-effects 5 Mechanism-of-action 6 More General Terms 7 Additional Terms 8 Internet Database 9 References

Indications

• topical anti-inflammatory agent
• treatment of acute & chronic adrenal insufficiency
• adjunctive treatment of ulcerative colitis
• anti-inflammatory agent for adjunctive treatment of:

• hypersensitivity reactions
• shock
• status asthmaticus

Dosage

• acute adrenal insufficiency

• adults: ( succinate, phosphate)

• 15-240 mg IV/ IM/ SC every 12 hours

• older children

• 1-2 mg/kg bolus IM/ IV
• 150-250 mg/day in divided doses

• infants & young children:

• 1-2 mg/kg bolus IM/ IV
• 25-150 mg/day in divided doses

• physiologic replacement: (children)

• oral: 0.5-0.75 mg/kg/day or 20-25 mg/m2/day divided every 8 hours
• IM: 0.25-0.35 mg/kg or 12-15 mg/m2 QD

• anti-inflammatory or immunosuppressive:

• adults:

• 15-20 mg IM/ SC/ IV every 12 hours as phosphate
• 5-60 mg PO QID

• infants & children

• oral 2.5-10 mg/kg/day or 75-300 mg/m2/day divided every 6-12 hours
• IM/ IV ( succinate): 1-5 mg/kg/day or 30-150 mg/m2/day divided every 6-12 hours

• status asthmaticus: (children)

• load 1-2 mg/kg every 6 hours for 24 hours
• maintenance of 0.5-1 mg/kg every 6 hours

• shock

• adults: 500-2000 mg every 2-6 hours IM/ IV as succinate
• children:

• 50 mg/kg IM/ IV initial as succinate
• repeat in 4 hours
• then 50 mg/kg IM/ IV QD PRN

• Tabs: 5, 10, 20 mg.
• Suspension: 10 mg/5 mL (120 mL).
• Injection:

• phosphate 50 mg/mL (10 mL)
• succinate 100 mg, 250 mg. 500 mg
• succinate may be given IV or IM
• acetate may only be given IM, not IV

• Topical agent: cream: 1%, 2%, 5%. ointment: 0.5%, 1%, 2.5%. lotion: 0.25%, 0.5%,1%, 2%, 2.5%. gel: 0.5%. solution: 1% aerosol 0.5%. Low potency: 1%. Apply TID/ QID.

Pharmacokinetics

• 90% of circulating cortisol is bound to plasma proteins, primarily to corticosteroid-binding globulin. There is also weak binding to albumin.
  

• elimination via liver

Adverse-effects

• common (> 10%)

• increased appetite, insomnia, indigestion, nervousness

• less common (1-10%)

• cataracts, hypeglycemia, hirsutism, joint pain epistaxis

• uncommon (< 1%)

• seizures, mood swings, headache, skin atrophy, bruising, hyperpigmentation, acne, amenorrhea, Na+ & H2O retention, Cushing's syndrome, suppression of bone growth, abdominal distention, ulcerative esophagitis, pancreatitis, muscle wasting, hypersensitivity, delirium, hallucinations, euphoria, hypotension, peptic ulcer, immunosuppression

• short-term

• fluid & electrolyte disturbances
• hyperglycemia
• poor wound healing
• GI disturbances
• spread of infection

• long term

• osteoporosis
• bone fractures
• pituitary adrenal insufficiency
• Cushing's syndrome
• rapid withdrawal may cause acute adrenal insufficiency

• topical

• irritation
• rash
• skin atrophy
• acne

• Drug interactions:

• aminoglutethimide
• anticholinesterases
• barbiturates
• carbamazepine
• phenytoin
• rifampin
• live virus vaccines
  
• drug adverse effects of glucocorticoids
• drug adverse effects of immunosuppressive agents

Mechanism-of-action

• short-acting glucocorticoid
• some mineralocorticoid activity

More General Terms

• pregnenedione
• 11 hydroxycorticosteroid
• 17 hydroxycorticosteroid
• adrenal cortex hormone
• glucocorticoid

Additional Terms

• 24 hour urine cortisol (free)
• cortisol in serum

Internet Database

PubChem: 5754
PubChem: 3640
PubChem: 657311

References

1. The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
2. Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
3. Department of Veterans Affairs, VA National Formulary

cortisol; hydrocortisone (Cortef, Solu-Cortef, Alphaderm, Cetacort, Cortenema, Hytone, Nutracort, Westcort)