CORTISONE ACETATE

Adrenal hormone

Dosage Forms

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Tablet

25 mg

Uses

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  • Addison’s disease
  • Primary or secondary adrenal insufficiency
  • Congenital adrenal hyperplasia

Dose and Duration

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All uses
Adult:12.5-37.5 mg daily in 2 divided doses
Child:5–25 mg daily in 2 divided doses

Morning dose should be larger than the evening dose

Contraindications

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  • Systemic fungal and viral infections
  • Untreated acute bacterial infection
  • Hypersensitivity to cortisone acetate

Side Effects

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  • Dyspepsia, peptic ulceration and haemorrhage, abdominal distension, oesophageal candidiasis, acute pancreatitis
  • Proximal myopathy, osteoporosis, bone fractures
  • Sodium and water retention, hypokalaemic alkalosis
  • Impaired healing, skin atrophy, bruising, striae, petechial haemorrhage
  • Suppression of hypothalamo-pituitary axis, growth suppression in children and adolescents
  • Menstrual disturbances, hirsutism, cushingoid faces

Interactions

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  • Carbamazepine, phenobarbital, phenytoin, rifamycins (reduced effect of cortisone)
  • Amphotericin B (increased risk of hypokalaemia)
  • Live vaccines (high doses of cortisone impair immune response to vaccines)

Pregnancy

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  • Do not use

Breastfeeding

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  • Can be used

⚠️ Caution

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  • Use with caution in the elderly due to increased risk of side effects
  • Avoid abrupt withdrawal after prolonged use. Reduce dose gradually by 5–12.5 mg every few days
  • Observe patient for side effects
  • May increase susceptibility to infection. Some signs of infection may be masked
  • Use with caution in history of TB, severe affective disorders, osteoporosis, diabetes mellitus, hypertension, glaucoma, peptic ulceration or in epilepsy
  • May cause growth retardation in infants, children and adolescents. Treat for the shortest possible period
  • Cortisone needs to be converted to its active metabolite. Bioavailability in some liver diseases may be less reliable
  • Cortisone may cause intra-uterine growth retardation. Only use when it is clearly necessary