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Page 6 of 9 Medication continued... Drug Category: Corticosteroids -- Have anti-inflammatory properties and cause profound and varied metabolic effects. In addition, these agents modify the body's immune response to diverse stimuli. Drug Name
| Clobetasol (Temovate) -- Class I superpotent topical steroid; suppresses mitosis and increases synthesis of proteins that decrease inflammation and cause vasoconstriction.
Use 0.05% cream or ointment. | | Adult Dose | Apply bid for up to 2 wk; not to exceed 50 g/wk | | Pediatric Dose | Not established | | Contraindications | Documented hypersensitivity; viral or fungal skin infections | | Interactions | None reported | | Pregnancy | C - Safety for use during pregnancy has not been established. | | Precautions | May suppress adrenal function in widespread or prolonged therapy; superpotent topical steroid and, in general, should not be applied to face or intertriginous areas except under care and close supervision of experienced dermatologist; skin atrophy, striae, or other problems may result from inappropriate use | Drug Name
| Hydrocortisone (Valerate, Westcort) -- Adrenocorticosteroid derivative suitable for application to skin or external mucous membranes. Has mineralocorticoid and glucocorticoid effects resulting in anti-inflammatory activity.
Use 0.2% cream or ointment. | | Adult Dose | Apply sparingly to affected areas bid | | Pediatric Dose | Apply as in adults | | Contraindications | Documented hypersensitivity; viral, fungal, and bacterial skin infections | | Interactions | None reported | | Pregnancy | C - Safety for use during pregnancy has not been established. | | Precautions | Prolonged use, applying over large surface areas, application of potent steroids, and occlusive dressings may increase systemic absorption of corticosteroids and may cause Cushing syndrome, reversible HPA-axis suppression, hyperglycemia, and glycosuria; ointment is more potent than cream and, in general, more caution should be exercised; should not be applied to face or intertriginous areas except under care and close supervision of experienced dermatologist; skin atrophy, striae, or other problems may result from inappropriate use | Drug Name
| Prednisone (Deltasone, Meticorten, Orasone) -- Immunosuppressant for treatment of autoimmune disorders; may decrease inflammation by reversing increased capillary permeability and suppressing PMN activity. Stabilizes lysosomal membranes and also suppresses lymphocytes and antibody production. | | Adult Dose | 40-60 mg/d PO qd or divided bid/qid; taper over 2-3 wk, as symptoms resolve; 0.5-2 mg/kg/d; taper as condition improves; single morning dose is safer for long-term use, but divided doses have more anti-inflammatory effect | | Pediatric Dose | 4-5 mg/m2/d PO; alternatively, 0.05-2 mg/kg PO divided bid/qid; taper over 2-3 wk, as symptoms resolve | | Contraindications | Documented hypersensitivity; viral infection, peptic ulcer disease; hepatic dysfunction; connective tissue infections; fungal or tubercular skin infections | | Interactions | Coadministration with estrogens may decrease prednisone clearance; when used with digoxin, digitalis toxicity secondary to hypokalemia may increase; phenobarbital, phenytoin, and rifampin may increase metabolism of glucocorticoids (consider increasing maintenance dose); monitor for hypokalemia with coadministration of diuretics | | Pregnancy | B - Usually safe but benefits must outweigh the risks. | | Precautions | Hyperglycemia, edema, osteonecrosis, myopathy, peptic ulcer disease, hypokalemia, osteoporosis, euphoria, psychosis, myasthenia gravis, growth suppression, and infections may occur with glucocorticoid use; abrupt discontinuation may cause adrenal crisis | Drug Name
| Triamcinolone (Aristocort, Amcort, Aristospan Intra-articular) -- For inflammatory dermatosis responsive to steroids; decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing capillary permeability. Intramuscular injection may be used for widespread skin disorder or intralesional injections may be used for localized skin disorder. | | Adult Dose | 40-60 mg IM, may repeat in 4-6 wk
3-10 mg/mL intralesional | | Pediatric Dose | <6 years: Not established
6-12 years: 0.03-0.2 mg/kg IM
>12 years: Administer as in adults | | Contraindications | Documented hypersensitivity; fungal, viral, and bacterial skin infections | | Interactions | Coadministration with barbiturates, phenytoin, and rifampin decreases effects of triamcinolone | | Pregnancy | C - Safety for use during pregnancy has not been established. | | Precautions | Multiple complications (eg, severe infections, hyperglycemia, edema, osteonecrosis, myopathy, peptic ulcer disease, hypokalemia, osteoporosis, euphoria, psychosis, myasthenia gravis, growth suppression) may occur; abrupt discontinuation of glucocorticoids may cause adrenal crisis; SC injection may cause skin atrophy that may be slow to recover |
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