Cortan

Description

Indications:

Cortan (Prednisolone) is used for the treatment of various conditions, including:

• Rheumatic Disorders:

  • Psoriatic arthritis, rheumatoid arthritis, juvenile rheumatoid arthritis, ankylosing spondylitis
  • Acute and subacute bursitis, acute nonspecific tenosynovitis
  • Acute gouty arthritis, post-traumatic osteoarthritis

• Endocrine Disorders:

  • Primary or secondary adrenocortical insufficiency
  • Congenital adrenal hyperplasia, nonsuppurative thyroiditis
  • Hypercalcemia associated with cancer

• Dermatologic Diseases:

  • Pemphigus, bullous dermatitis herpetiformis
  • Severe erythema multiforme, exfoliative dermatitis
  • Mycosis fungoides, severe psoriasis

• Allergic States:

  • Seasonal or perennial allergic rhinitis, bronchial asthma
  • Contact dermatitis, atopic dermatitis, serum sickness
  • Drug hypersensitivity reactions

• Respiratory Diseases:

  • Symptomatic sarcoidosis, berylliosis, fulminating aspiration pneumonitis

• Hematologic Disorders:

  • Idiopathic thrombocytopenic purpura, secondary thrombocytopenia
  • Acquired autoimmune hemolytic anemia, erythroblastopenia (RBC anemia)

• Edematous States:

  • To induce a diuresis or remission of proteinuria in nephrotic syndrome

• Gastrointestinal Diseases:

  • Ulcerative colitis, regional enteritis

Pharmacology:

Prednisolone is a synthetic glucocorticoid that inhibits the action of Phospholipase A2, which is responsible for producing various inflammatory mediators like leukotrienes, prostaglandins, and others. It is rapidly absorbed from the gastrointestinal tract and is 70-90% protein-bound in plasma. It is metabolized in the liver and excreted through urine, with a half-life of 2-4 hours.

Dosage & Administration:

• Adults:
  • Nephrotic Syndrome:
    • Initial: 2 mg/kg/day (maximum 80 mg/day) in divided doses until urine is protein-free for 3 consecutive days (max 28 days)
    • Maintenance: 0.5 to 1 mg/kg/day every other day for 3-6 months
  • Anti-inflammatory: 5 to 60 mg/day in divided doses
  • Acute Asthma: 40-60 mg/day for 3-10 days
  • Allergic Conditions: Starting with a tapering dose over 6 days (10 mg, 5 mg, etc.)
• Pediatric Dosing (Asthma):
  • 1 year: Acute: 10 mg every 12 hours, Maintenance: 10 mg every other day
  • 1 to 4 years: Acute: 20 mg every 12 hours, Maintenance: 20 mg every other day
  • 5 to 12 years: Acute: 30 mg every 12 hours, Maintenance: 30 mg every other day
  • 12 years: Acute: 40 mg every 12 hours, Maintenance: 40 mg every other day

Interaction:

Cortan’s effectiveness can be reduced by:

• Aminoglutethimide, Antacids, Barbiturates, Carbamazepine, Griseofulvin, Mitotane, Phenylbutazone, Phenytoin, Primidone, Rifampin

• It also increases the risk of hypokalemia, especially when used with Digitalis, leading to potential cardiac arrhythmias.

Contraindications:

• Systemic infections (unless specific anti-infective therapy is given)
• Hypersensitivity to any ingredient
• Ocular herpes simplex due to the risk of perforation

Side Effects:

• Fluid & Electrolyte Disturbances:
  • Sodium retention, fluid retention, hypertension, hypokalemia, and alkalosis
• Musculoskeletal Issues:
  • Muscle weakness, osteoporosis, fractures, aseptic necrosis
• Gastrointestinal:
  • Peptic ulcers, pancreatitis, abdominal issues
• Dermatologic:
  • Impaired wound healing, fragile skin, bruising, facial erythema
• Neurological:
  • Convulsions, increased intracranial pressure, vertigo, and headache
• Endocrine:
  • Menstrual irregularities, Cushingoid state, growth suppression, increased diabetes risk
• Ophthalmic:
  • Cataracts, increased intraocular pressure, glaucoma
• Metabolic:
  • Negative nitrogen balance due to protein catabolism

Pregnancy & Lactation:

• Pregnancy: Not recommended unless essential for the mother, as potential risks to the fetus may exist.
• Lactation: Corticosteroids appear in breast milk and could suppress growth or cause unwanted effects in the neonate. Discontinue breastfeeding if necessary.

Precautions & Warnings:

• Immunosuppression: Use cautiously as it can mask signs of infection; avoid exposure to chickenpox or measles.
• Stress: Increase dose during periods of stress such as trauma or surgery.
• Prolonged Use: Can lead to posterior cataracts, glaucoma, or secondary ocular infections.
• Vaccination: Avoid live vaccines, including smallpox, while on corticosteroid therapy.

Use in Special Populations:

• Pediatric Use: Special care should be taken with immune suppression in children and in those with adrenal insufficiency.
• Postnatal Care: Infants born to mothers on high doses should be monitored for hypoadrenalism.

Overdose Effects:

• Adverse effects usually develop after prolonged use in excess of physiological requirements. Treatment involves reducing the dose gradually.

Therapeutic Class:

• Glucocorticoids

Storage Conditions:

• Store in a cool, dry place, away from light. Keep out of reach of children.