Corticosteroids, Corticosteroids Inhalers, Corticosteroids Nasal
Type of Drug
Corticosteroids, Eye Products
(kor-tih-koe-STER-oids)
Brand Names
Dexamethasone Maxidex
Dexamethasone + Ciprofloxacin Ciprodex
Dexamethasone + Tobramycin Tobradex
Dexamethasone + Neomycin Sulfate + Polymixin 8 Sulfate
Maxitrol
Fluorometholone
Flarex FML Forte
FML
Fluorometholone + Tobramycin Tobrasone
Loteprednol Etabonate Alrex Lotemax
Generic Ingredients: Loteprednol Etabonate + Tobramycin Zylet
Prednisolone Acetate OG
Econopred Plus Pred Forte
Omnipred Pred Mild
Prednisolone Acetate + Gentamicin Sulfate Pred G
Prednisolone Acetate + Sulfacetamide Sodium
Blepharnide Blephamide S.O.P.
Generic Ingredients: Prednisolone Acetate + Neomycin Sulfate + Polymyxin B Sulfate
Poly-Pred
Prednisolone Sodium Phosphate LQ
Prednisolone Sodium Phosphate + Sulfacetamide Sodium
Vasocidin
Rimexolone Vexol
Prescribed For
Allergic and inflammatory eye conditions, and to speed healing after eye surgery or injury.
General Information
Corticosteroid eye products are prescribed for general relief of inflammation due to allergy and other causes. They are also used after eye surgery or serious eye injury to aid the healing process by reducing the natural inflammatory process. Very severe eye conditions that do not respond to these products may require treatment with corticosteroid drugs taken by mouth. Fluorometholone, medrysone, and prednisolone (up to 0.125%) are preferred for long-term treatment because they are least likely to raise the fluid pressure inside the eye. corticosteroid eye products have not been widely studied in children, though fluorometholone has been proven safe for use in children age 2 and over.
Cautions and Warnings
Do not use a corticosteroid eye product if you are allergic or sensitive to corticosteroids. These products should be used with caution if you have a fungal, herpes, tuberculosis, or viral infection of the eye, or have cataracts, glaucoma, or diabetes. Do not use any of these products without your doctor’s knowledge.
Long-term use of these products can lead to eye damage, including glaucoma, infection, and nerve damage.
Do not use any of these products in children without consultng a doctor.
Possible Side Effects
V Rare: watery eyes; glaucoma; optic nerve damage; gradual blurring, reduction, or loss of vision; eye pain or infections; drooping eyelid; eye burning, stinging, or redness; nausea; and vomiting. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• Corticosteroids applied to the eye may interfere with the effect of antiglaucoma drugs.
• The risk of raising fluid pressure inside the eye is increased when corticosteroid eye products are taken with anticholinergic drugs, especially atropine, over a long period of time.
Food Interactions None known.
Usual Dose
Eyedrops: 1-2 drops several times a day.
Eye Ointment: Place a thin strip of ointment into the affected eye several times a day.
Overdosage
Swallowing a container of corticosteroid eyedrops or ointment usually does not produce serious effects. Call your local poison center or a hospital emergency room for more information. ALWAYS bring the prescription container.
Special Information
If you forget to administer a dose, do so as soon as you remember. If it is almost time for your next dose, skip the one you forgot and continue with your regular schedule.
To prevent infection, keep the eyedropper from touching your fingers, eyelids, or any surface. Wait at least 5 minutes before using any other eyedrops.
If the brand you are taking contains benzalkonium chloride, wait at least 15 minutes before inserting contact lenses. In some cases, you may be instructed not to wear contact lenses for the duration of treatment.
Special Populations
Pregnancy/Breast-feeding: Using large amounts of corticosteroid eyedrops during pregnancy may affect the adrenal gland of the fetus. When your doctor considers one of these products crucial, its potential benefits must be carefully weighed against its risks.
Oral corticosteroids pass into breast milk, but it is not known if this is also true of corticosteroid eyedrops. Nursing mothers who must use one of these medications should use infant formula.
Seniors: Seniors may use these products without special precaution.
Type of Drug
corticosteroids, Inhalers
(kor-tih-koe-STER-oids)
Brand Names
Generic Ingredient., Beclomethasone Dipropionate OVAR 40 OVAR 80
Budesonide
Pulmicort Flexhaler Pulmicort Respules
Generic Ingredients: Budesonide + Formoterol Symbicort
Ciclesonide Alvesco
Flunisolide
AeroBid Aerospan HFA
Fluticasone Propionate Flovent Diskus Flovent HFA
Fluticasone Propionate + Salmeterol Xinafoate
Advair Diskus Advair HFA
Mometasone Furoate Asmanex Twisthaler
Triamcinolone Acetonide Azmacort
Prescribed For
Chronic asthma and bronchial disease.
General Information
Corticosteroid inhalers relieve the symptoms associated with asthma and bronchial disease by reducing inflammation of bronchial mucous membranes, making it easier to breathe. Corticosteroid inhalers produce the same treatment effect as oral corticosteroids, with some important differences. Because inhalers deliver the drug directly to the lungs, smaller dosages can be used. They also have fewer side effects because little of the drug reaches the bloodstream. Corticosteroid inhalers can prevent asthma attacks if used regularly but do not relieve them once they start.
Cautions and Warnings
Do not use a corticosteroid inhaler if you are allergic or sensitive to any of its ingredients.
Corticosteroid inhalers should not be used as the primary treat- MV)~ of severe asthma. They are recommended only for people who take prednisone or another oral corticosteroid, or for people who do not respond to other asthma drugs. These drugs cannot relieve asthma attacks once they start.
In people with asthma, death from adrenal gland failure has occurred during and after switching from an oral corticosteroid to an inhaler. Adrenal function is impaired for several months after the
switch.
Those who use any corticosteroid product, including inhalation, are more likely to have reduced immune system function. This reduces the body’s ability to fight infection from any source, including chicken pox, shingles, and measles. Adults who have not had these viral infections should take care to avoid becoming infected while using any corticosteroid product. Do not receive a live virus vaccine while taking corticosteroids of any kind, as they interfere with the body’s reaction to the vaccine.
Combining an oral corticosteroid with a corticosteroid inhaler may cause pituitary gland suppression.
During a period of severe stress, you may have to switch to an oral corticosteroid if the inhaler does not control your asthma. During periods of stress or a severe asthmatic attack, people who have stopped using an inhaler should ask their doctors about taking an oral corticosteroid.
corticosteroid inhalers may be associated with immediate or delayed drug reactions, including breathing difficulties, rash, and bronchospasm.
Use corticosteroids with caution if you have respiratory tuberculosis, herpes of the eye, a bacterial, fungal, or parasitic infection, or any other untreated systemic infection.
The combination products Advair and Symbicort both contain beta-2 agonists. In some asthma patients, beta-2 agonists may increase the risk of asthma-related death. See Formoterol, page 509, and Salmeterol, page 1013, for more information on these drugs.
Possible Side Effects
V Most common: dry mouth, hoarseness, rash, bronchospasm, respiratory infections, fungal infection of the mouth, runny nose, headache, upset stomach, and palpitations.
V Rare: depression, cough, wheezing, infection, and facial swelling. Cough and wheezing are probably caused by an ingredient in the inhaler other than the corticosteroid itself. GW20 your doctor if you experience any side effect not listed above.
Drug Interactions
• Ketoconazole may increase blood levels of budesonide and fluticasone.
• Using an inhaled corticosteroid and an oral corticosteroid together may increase the effect of both drugs. Use with
caution.
• See Formoterol, page 509, for further drug interactions for the
combination product Symbicort.
• See Salmeterol, page 1013, for further drug interactions for
the combination product Advair. Food Interactions
None known.
Usual Dose
geclomethasone
Adult and Child (age 13 and over): 2 inhalations (84 mcg) 3-4 times a day, or 4 inhalations twice a day. People with severe asthma may take up to 16 inhalations a day.
Child (age 6-12): 1-2 inhalations 3-4 times a day.
Child (under age 6): not recommended.
Budesonide
Adult: starting dose-200-400 mcg (1-2 inhalations) twice a day. Do not exceed 800 mcg a day.
Child (age 6 and over): 200 mcg (1 inhalation) twice a day. Do not exceed 400 mcg a day.
Child (under age 6): not recommended.
Budesonide Respules
Child (age 1-8): 1-2 ml once or twice a day via jet nebulizer connected to an air compressor.
Child (under age 1): consult your doctor.
Budesonide and Formoterol Inhalation
Adult and Child (age 12 and over): 2 inhalations morning and evening.
Child (under age 12): not recommended.
Ciclesonide
Adult and Child (qla 12 and over): 1-2 inhalations once a day. Mlld (under age 12): not recommended.
Flunisolide
Aerobid
Adult and Child (age 16 and over): 2 inhalations (500 mcg) morning and evening. Do not exceed 8 inhalations a day.
Child (age 6-15): 2 inhalations (500 mcg) morning and evening. Do not exceed 4 inhalations a day.
Child (under age 6): not recommended.
Aerospan HFA
Adult and Child (age 12 and over): 160-320 mcg morning and
evening.
Child (age 6-11): 80-160 mcg morning and evening. Child (under age 6): not recommended.
Fluticasone Inhalation
Adult and Child (age 12 and over): 88-660 mcg twice a day. Child (6-12): 88-440 mcg twice a day.
Child (under age 6): not recommended.
Fluticasone Diskus
Adult and Child (age 12 and over): 100-1000 mcg twice a day. Child (age 4-11): 50-100 mcg twice a day.
Child (under age 4): not recommended.
Fluticasone and Salmeterol
Advair Diskus
Adult and Child (age 12 and over): 1 inhalation morning and evening.
Child (under age 12): not recommended.
Advair HFA
Adult and Child (age 12 and over): 2 inhalations morning and evening.
Child (under age 12): not recommended.
Mometasone Furoate
Adult and Child (age 12 and older): 1-4 inhalations a day. If you take this drug only once a day, it should be taken in the afternoon or evening. Otherwise, doses should be divided between the morning and evening.
Child (under age 12): not recommended.
Triamcinolone
AdWAVi6 Child (age 13 and over): 2 inhalations (200 mcg) 3-4 times a day. Do not exceed 16 inhalations a day without your doctor’s knowledge.
Child (age 6-12): 1-2 inhalations (100-200 mcg) 3-4 times a day. Do not exceed 12 inhalations a day.
Child (under age 6): not recommended.
Overdosage
Serious adverse effects are unlikely. Excessive use of large amounts of an inhaled corticosteroid may cause overdose symptoms and require gradually stopping the drug. Call your local poison control center or a hospital emergency room for more information.
Special Information People using both a corticosteroid inhaler and a bronchodilator, such as albuterol, should use the bronchodilator first, wait a few minutes, and then use the corticosteroid inhaler. This allows more corticosteroid to be absorbed.
These drugs are for preventive therapy only and will not affect an asthma attack. Inhaled corticosteroids must be taken regularly, as directed. Wait at least 1 minute between inhalations.
To properly take this medication, thoroughly shake the inhaler if it is one that must be shaken. Take a drink of water to moisten your throat. Place the inhaler 2 finger-widths away from your mouth and tilt your head back slightly. While activating the inhaler, take a slow, deep breath for 3-5 seconds. then hold your breath for about 10 seconds, and finally breathe out slowly. Allow at least 1 minute between puffs. Rinse your mouth after each use to reduce dry mouth and hoarseness.
If you forget to administer a dose, do so as soon as you remember. If it is almost time for your next dose, skip the dose you forgot and continue with your regular schedule. Do not take a double dose. Tell your doctor or pharmacist if you forget to take more than 1 dose.
Special Populations
Pregnancy/Breast-feeding: corticosteroids may cause birth defects or interfere with fetal development. When any of these drugs is considered crucial by your doctor, its potential benefits Must be carefully weighed against its risks.
It is not known if inhaled corticosteroids pass into breast milk, though oral corticosteroids do. Nursing mothers who must take an inhaled corticosteroid should use infant formula.
StniOrs: Seniors may use corticosteroid inhalers without special restriction. Tell your doctor if you have bone or bowel disease, colitis, diabetes, glaucoma, fungal or herpes infections, high blood pressure, high blood cholesterol, an underactive thyroid, or heart, kidney, or liver disease.
Type of Drug
Corticosteroids, Nasal
(kor-tih-koe-STER-oids)
Brand Names
Wectomethasone Dipropionate Beconase AQ
Budesonide Rhinocort
Ciclesonide Omnaris
Flunisolide RE Nasarel
Fluticasone Furoate Veramyst
Fluticasone Propionate Flonase
Mometasone Furoate Monohydrate Nasonex
Triamcinolone Acetonide Nasacort AQ
Prescribed For
Rhinitis (nasal inflammation) associated with seasonal or chronic allergy and other causes; also used to prevent recurrence of nasal polyps.
General Information
Nasal corticosteroids are used to treat severe symptoms of seasonal allergy that have not mSpDrided to other drugs such as deQQQgtS%TAS. ‘They work by reducing inflammation of the mucous membranes that line the nasal passages, making it easier to breathe. These drugs may take several days to produce an effect. Some nasal corticosteroids are approved for both allergic and non-allergic rhinitis.
Cautions and Warnings __ allergic or sensitive Do not use a nasal corticosteroid if you ate alle
to corticosteroids. Rarely, serious and life-threatening drug-sensitivity reactions have occurred.
very rarely, deaths caused by failure of the adrenal gland have occurred in people taking adrenal corticosteroid tablets or syrup who were switched to a nasal corticosteroid. This is a rare complication and usually results from stopping the liquid or tablets suddenly instead of gradually.
Combining prednisone or another oral corticosteroid with a nasal corticosteroid may cause pituitary gland suppression, although nasal corticosteroids alone rarely cause this problem.
Use nasal corticosteroids with caution if you have tuberculosis, chicken pox, measles, shingles, or any serious fungal, bacterial, or viral infection.
Do not receive a live virus vaccine while taking corticosteroids of any kind, as they interfere with the body’s reaction to the vaccine.
Rarely, nasal Candida infections develop in people using a nasal corticosteroid. These infections may require treatment with an antifungal drug, as well as the discontinuance of the nasal corticosteroid.
During a period of severe stress, you may have to switch to an oral corticosteroid drug if the nasal form does not control your symptoms.
Children using nasal corticosteriods may experience reduction in growth velocity.
Possible Side Effects
✓ Most common: mild irritation of the nose, nasal passages,
and throat; burning; stinging; dryness; and headache.
♦ Less common: lightheadedness, nausea, nosebleed or bloody mucous, unusual nasal congestion, bronchial asthma, sneezing attacks, runny nose, sore throat, and loss of the sense of taste.
✓ Rare: ulcers 0 Vie nasal passages, watery eyes, vomiting. hypersensitivity reactions (symptoms include itching, rash, swelling, bronchospasms, and breathing difficulties), nasal infection, wheezing, perforation of the wall between the nostrils, and increased eye pressure. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• Do not use fluticasone propionate with ritonavir.
• Ephedrine, phenobarbital, and rifampin may decrease the effect of nasal corticosteroids.
• Use caution when combining ketoconazole with any nasal corticosteroid.
Usual Dose
Beclomethasone
Adult and Child (age 13 and over): 1 spray (42 mcg) in each nostril 2-4 times a day.
Child (age 6-12): 1 spray (42 mcg) in each nostril 3 times a day. Child (under age 6): not recommended.
Budesonide
Adult and Child (age 6 and over): 2 sprays (64 mcg) in each nostril morning and evening, or 4 sprays in the morning.
Child (under age 6): not recommended.
Ciclesonide
Adult and Child (age 12 and over): 2 sprays (50 mcg/spray) in each nostril once a day.
Child (under age 12): not recommended.
Flunisolide
Adult and Child (age 15 and over): 2 sprays (50 mcg) in each nostril twice a day to start; may be increased up to 8 sprays a day in each nostril.
Child (age 6-14): 1 spray (25 mcg) in each nostril 3 times a day, or 2 sprays in each nostril twice a day.
Child (under age 6): not recommended.
Fluticasone Furoate
Adult and Child (age 12 and over): 2 sprays in each nostril once a date to start. Dose may be reduced to 1 spray in each nostril afer symptoms are controlled.
Child (age 2-11): 1 Yi) each nostril once a day.
C’%Ab junder age 2): riot recommended.
Fluticasone Propionate
Adult: 2 sprays (100 mcg) in each nostril once a day or divided in 2 doses, to start. Dosage may be reduced in half in a few days, if tolerated.
Child (age 4 and over): 1 spray (50 mcg) in each nostril once a day; may be increased to 2 sprays a day in each nostril, if needed. Child (under age 4): not recommended.
Mometasone
Adult and Child (age 12 and over): 2 sprays (100 mcg) in each nostril once a day; may be increased to 4 sprays a day in each nostril.
Child (under age 12): not recommended.
Triamcinolone
Adult and Child (age 13 and over): 2 sprays (220 mcg) in each nostril once a day; may be increased to 4 sprays a day in each nostril.
Child (age 6-12): 1 spray in each nostril once a day; may be increased to 2 sprays a day in each nostril, if needed.
Child (under age 6): not recommended.
Overdosage
Serious adverse effects are unlikely after accidental ingestion. Rarely, excessive use of large amounts of nasal corticosteroids may cause overdose symptoms such as irregular menses, acne, facial puffiness, and weight gain. These symptoms require gradual, not immediate, discontinuation of the drug. Call your local poison control center or a hospital emergency room for more information. ALWAYS bring the presciption container.
Special Information
It may be necessary to clear your nasal passages with a nasal decongestant before using a nasal corticosteroid to allow it to reach the mucous membranes.
Some of these drugs take 10-14 days to start working. Beclomethasone, budesonide, and triamcinolone work faster. in 3-7 days: ciclesonide starts working within 1 or 2 days and shows additional benefits after several weeks of use; in some cases, triamcinolone and budesonide provide relief in 12 hours. FWT isolide may take up to 2 weeks. Do not use -any of these drugs continuously for more tha”‘3 weeks unless you have experienced a def- fttlbenefit.
If you are using more than one spray at a time, wait at least 1 minute between sprays.
Nasal corticosteroids may cause irritation and drying of mucous membranes in the nose. Call your doctor if this effect persists or if symptoms get worse.
Call your doctor if you are exposed to measles or chicken pox while using an of these medicines.
People using a nasal corticosteroid to prevent the return of nasal polyps after surgery may experience nosebleeds because the drug can slow healing of the wound.
If you forget to administer a dose, do so as soon as you remember. If it is almost time for your next dose, skip the dose you forgot and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: Taking large amounts of corticosteroids during pregnancy may slow fetal growth. While the small amount of drug absorbed into the blood after nasal application is unlikely to have any effect, consult your doctor before taking any corticosteroid if you are or might be pregnant.
Dexamethasone passes into breast milk. Nursing mothers who must use this drug should use infant formula. It is not known if other nasal corticosteroids pass into breast milk, though oral corticosteroids do. Nursing mothers should consider using infant formula.
Seniors: Seniors may use nasal corticosteroids without special restriction. Tell your doctor if you have bone or bowel disease, colitis, diabetes, glaucoma, fungal or herpes infections, high blood pressure, high blood cholesterol, an underactive thyroid, or heart, kidney, or liver disease.