Glucocorticosteroids (GCS) are synthetic drugs that are analogues of endogenous hormones produced by the adrenal cortex. GCS have a whole range of effects on the human body: anti-inflammatory and desensitizing, immunosuppressive, antitoxic and anti-shock.
Today, a large list of such medicines is presented on the pharmaceutical market of the Russian Federation. One of them is Cortef. Instructions for use recommend taking it for a number of diseases.
Composition and release form
The medicine is for oral use. The main active ingredient of the drug "Cortef" (the instruction contains this information) is hydrocortisone, a hormone produced by the adrenal glands. For systemic and local use in the medical environment, natural hydrocortisone or its esters are used.
In the medical preparation "Cortef" this hormone is contained in a volume of 10 mg. As additional ones aresubstances like calcium stearate, corn starch and sucrose, lactose, mineral oil and sorbic acid.
The main form in which Cortef is offered to consumers is tablets. Instructions for use, reviews of he alth workers and patients indicate the high effectiveness of this tool. Round-shaped tablets with a score on the surface and the inscription “CORTEF10” squeezed out on it are packaged in tinted glass bottles (100 pieces are packed in each). You can buy a medicine only with a doctor's prescription.
Pharmacodynamics
As mentioned earlier, the drug has a whole list of effects on the human body: anti-inflammatory and anti-shock, desensitizing and anti-allergic, anti-toxic, anti-metabolic and immunosuppressive. Description of the drug (instruction for use) contains information about the mass of processes that are affected by the drug. It inhibits the release of inflammatory mediators and significantly slows down the release of cytokines (interferon, interleukins) from microphages and lymphocytes.
Also, "Cortef" stimulates the accumulation of glycogen in the liver, increases the amount of glucose contained in the blood, slows down the excretion of fluid and Na + from the body and increases K +. With the direct participation of this medication, the production of histamine (a mediator, that is, a mediator necessary for immediate allergic reactions) is reduced.
In addition, about Cortef, the instructions for use speak as a remedy that reduces the number of cellular infiltrates(elements of cells with an admixture of blood and lymph) and suppressing the locomotor activity of leukocytes and lymphocytes in the inflammatory focus, contributing to a decrease in capillary permeability. The drug inhibits the synthesis and increases the rate of protein breakdown.
"Cortef" affects the pituitary gland and suppresses the production of corticotropin (ACTH), without which the functioning of the adrenal cortex can completely stop.
Medicine "Cortef": instruction, application
Reviews of experts say that the medication we are considering is used in various fields of medicine. It is used to remove a patient from toxic, traumatic, burn, cardiogenic, operational shock in cases where standard anti-shock therapy has failed. Let's dwell on these points in more detail.
So, what categories of patients are prescribed Cortef?
Instructions for use, description of the medication bring to consumers information about the possibility of using it in endocrinology. Here, the drug will be effective in such diseases as adrenal insufficiency, thyroiditis (subacute form), adrenal hyperplasia (congenital nature), hypercalcemia, which appeared on the background of malignant neoplasms.
Further, in rheumatology "Cortef" positively manifests itself in the treatment of bursitis, arthritis (gouty, psoriatic, rheumatoid), ankylosing spondylitis, nonspecific tendosynovitis. Patients get good resultstaking Cortef for systemic lupus erythematosus, acute rheumatic heart disease, polymyositis, epicondylitis.
There are indications for the use of "Cortef" in the field of dermatology. Here, the drug is effective in the treatment of pemphigus, mycosis fungoides, herpetiformis and exfoliative dermatitis. It is also prescribed for severe psoriasis, seborrheic dermatitis, severe erythema multiforme.
Allergists prescribe Cortef for serum sickness, allergic rhinitis, atypical and contact dermatitis, bronchial asthma and individual hypersensitivity to medications.
Specialists-ophthalmologists also practice the appointment of "Cortef" in a number of diseases. The drug is effective for corneal ulcers and conjunctivitis of allergic origin, for iritis and keratitis, for iridocyclitis, neuritis, uevitis, etc. In the field of oncology, GCS "Cortef" is prescribed for leukemia, in neurology - for multiple sclerosis.
Where else is Cortef used? The instructions for use contain information that pulmonologists (symptomatic sarcoidosis, fulminant pulmonary tuberculosis, aspiration pneumonia) and hematologists (secondary thrombocytopenia, hemolytic or hypoplastic anemia, erythroblastopenia) can prescribe it to their patients.
Uses and dosing
Medication "Cortef" is intended for oral use. However, the lyophilizate for the manufacture of the Solu-Cortef solution, the instructions for use, prescribes to be administered intramuscularly, intravenously (drip or jet) and into the periarticularbag.
With regard to oral administration, the initial dosage may vary from 20 to 240 mg during the day, depending on the diagnosed pathology and the severity of the patient's condition. The optimal dose in each case is selected by reducing the initially taken to the smallest, which will provide the desired effect.
In acute conditions and the need for emergency therapy, intravenous administration of the Solu-Cortef medication is recommended. The instructions for use describe the following standard scheme. The first 100 mg of the solution (initial dose) are administered within half a minute. The next volume of the drug in 500 mg should be administered over 10 minutes. Then, every 2-6 hours, the procedure should be repeated, while not forgetting to constantly monitor the patient's condition.
It must be remembered that in large doses, "Solu-Cortef" is prescribed only for the period of stabilization of the patient's condition, but not longer than 3 days.
V/m "Cortef" is administered in the amount of 125-250 mg/day. The positive drug effect appears 6-25 hours after the procedure and can last from several days to several weeks.
If necessary, Cortef injections are made into the intraarticular or periarticular sac. The effective dosage for large joints (shoulder, knee, hip) is 25-50 mg, but in acute conditions it can reach 100 mg. For small joints (elbows, wrists, phalanges of fingers), an injection of 10-20 mg, made 1 time, will suffice. Repeatprocedures are recommended every 1-3 weeks (sometimes required and more often - every 3-5 days).
In general, with regard to therapy with Cortef, only the attending doctor can choose the method of application and dose. It is undesirable to suddenly stop treatment, the likelihood of an exacerbation is high. Completion of treatment occurs by gradually reducing the dosage.
Contraindications to the use of "Cortef"
There is a certain list of diseases and conditions of the body when it is unacceptable to take the medicine we are considering. These are parasitic and infectious diseases of viral, fungal or bacterial origin (transferred in the recent past, occurring at the moment).
Do not prescribe it if the patient is diagnosed with acute psychosis, decompensated diabetes mellitus, or a person suffers from hypothyroidism, thyrotoxicosis, arterial hypertension, gastrointestinal ulcers and dermatological lesions of an infectious or ulcerative nature.
There is a whole list of contraindications for the intra-articular injection of the drug "Solu-Cortef". Do not prescribe a medication for a number of problems with the cardiovascular system, including with a recent myocardial infarction.
For a single dose, even for "vital" necessity, a contraindication to use is individual hypersensitivity to the components of the medication.
Unwanted manifestations
The frequency and brightness of side effects depends on several reasons, the list of which containsfor the drug "Cortef" instructions for use. Indications, doses, duration of the course prescribed by the attending physician must be observed without fail. A certain importance is also attached to the observance of the circadian rhythm of the appointment (fluctuations in the intensity of various biological processes associated with the change of day and night).
The endocrine system in response to taking "Cortef" is able to respond with a decrease in susceptibility to glucose, the development of diabetes mellitus of a steroid nature, and suppression of the functioning of the adrenal glands. There is a possibility of developing Itsenko-Cushing's syndrome, the main symptoms of which are a moon-shaped face, pituitary-type obesity, an increase in blood pressure, myasthenia gravis, and various menstrual disorders in women.
Reaction from the gastrointestinal tract can be symptoms such as nausea and vomiting, pancreatitis and steroid ulceration of various parts of the digestive tract, bleeding and perforation of its (GIT) walls, erosive esophagitis.
On the part of the cardiovascular system, adverse reactions to Cortef (the instruction confirms this information) are arrhythmia, bradycardia, thrombosis, and an increase in blood pressure. Against the background of acute and subacute forms of myocardial infarction, Cortef can cause the spread of foci of necrosis, inhibition of the formation of scar tissue, which can cause rupture of the heart muscle.
In general, a variety of organs and systems can react negatively to the use of Cortef in one way or anotherhuman body. There may be manifestations from the central nervous system and sensory organs, metabolic disorders and the musculoskeletal system. A variety of allergic reactions may occur. The most complete information is contained in the instructions for use of the drug "Cortef".
Pregnancy and lactation
During the period of bearing a baby and breastfeeding, it is strictly forbidden to take the drug "Cortef" instructions for use. The description (the presence of benzyl alcohol in some forms of the drug speaks for itself) of the drug contains information about the possible effects of the use of Cortef during such periods in the form of the development of adrenal insufficiency, shortness of breath, and death.
Children whose mothers were forced to take hydrocortisone during pregnancy should be closely monitored by medical staff in order to detect early signs of adrenal insufficiency.
What should I pay attention to?
During the period of treatment with the use of the drug "Cortef", the instructions for use recommend that you follow a diet that limits s alt intake. In addition, the body must receive enough protein. Also during this period it is unacceptable to carry out any type of vaccination. It is necessary to conduct constant monitoring of blood pressure, glucose concentration in the blood and its coagulability. It is also important to control urine output and patient weight.
In any stressful situations, people undergoing therapycourse with the use of "Cortef", need to increase the dosage of GCS. As for patients suffering from tuberculosis, those in the active stage should take Cortef only in parallel with appropriate therapy aimed at treating the underlying disease. In case of latent tuberculosis, or in the process of tuberculin tests turning, the medical staff should carefully monitor the patient's condition and, if necessary, prescribe appropriate chemoprophylaxis.
If the prescription of the drug provoked the development of secondary adrenal insufficiency, then the situation can be normalized by gradually reducing the dose. After the course of therapy is completed, this type of insufficiency may be observed for several more months. Stressful situations that occurred during this period are an indication for the resumption of the appointment of GCS.
As for a simple herpetic eye infection, Cortef (instruction, application, expert reviews are discussed in the article) and any other GCS should be prescribed with great care, since corneal perforation may develop.
He alth workers should be aware of the fact that against the background of treatment with Cortef, individual infectious diseases can be asymptomatic, latent and have varying degrees of severity. With an increase in the doses of corticosteroids used, the likelihood of developing latent infections increases. That is, under the influence of Cortef, resistance to infections decreases, the ability to localize an infectioushearth.
Those who are prescribed immunosuppressive doses of Cortef or any other GCS are advised not to come into contact with people suffering from chickenpox or measles. If such contacts nevertheless took place, you should immediately contact your doctor.
GCS can cause mental disorders or increase existing psychotic manifestations, increase emotional instability.
There is information that some patients on the background of "Cortef" (or other GCS) developed Kaposi's sarcoma. However, after the drug was discontinued, clinical remission was observed.
Due to the fact that complications after taking the drug directly depend on the duration of the course and dosage, the decision to start the treatment course, its duration and acceptable dosages is made by the doctor after assessing the expected benefits for his patient and the potential risks from the drug.
Interaction with other drugs
So, we discussed what Cortef is. Instructions for use, indications and contraindications for use and side effects of this drug are also considered. It remains to note that when prescribing the drug to patients, specialists should take into account that hydrocortisone can interact with a number of substances, and these compounds can cause serious damage to the body.
Firstly, hydrocortisone is pharmaceutically incompatible with other drugs and may form insoluble substances when trying to connect. In-secondly, it increases the toxicity of cardiac glycosides, as a result of which hypokalemia may develop, and then there is a risk of an increase in arrhythmia.
With the direct participation of "Cortef" (in particular, its main component), the rate of excretion of acetylsalicylic acid (ASA) increases, and the level of its content in the blood falls.
The use of live antiviral vaccines against the background of hydrocortisone can give an impetus to the activation of viruses and the development of infection.
Paracetamol in tandem with Cortef can become hepatotoxic. With long courses of use, the concentration of folic acid in the body increases. In high doses, hydrocortisone reduces the effectiveness of somatropin (growth hormone).
In addition, the main active ingredient reduces the effectiveness of hypoglycemic drugs, but increases the anticoagulant effect of coumarin derivatives. "Cortef" inhibits the effect of vitamin D on the absorption of Ca2+ in the intestinal lumen. Under the influence of hydrocortisone, the toxicity of cyclosporine and ketoconazole increases.
In the presence of substances such as ephedrine, theophylline, rifampicin, any barbiturates, the therapeutic effect of the influence of corticosteroids decreases. The appearance of acne and the development of hirsutism (excessive growth of terminal - hard and dark - hair in women according to the male type) is preceded by taking other steroid hormonal drugs (anabolics, estrogens, oral contraceptives) in parallel with hydrocortisone.
Consumer opinion about Cortef
"Cortef" is too complex a drug not to have negative reviews. Although there are many more positive ones. Description of the drug "Cortef" (reviews of he alth workers confirm this fact) allows you to understand: how wide is its scope, how long is the list of side effects. Judging by the reviews of the patients themselves, he quickly relieved someone of suffering, as a result of which the quality of life improved, while for someone he caused a lot of negative impressions, and, according to the patients, had no effect.
Whether this drug is good or bad is too narrow a question for a remedy like Cortef. The main thing here is to rely on the experience and knowledge of the attending physician and follow all his recommendations.
