Cortisone Acetate

1. Health Canada Product Monograph — Cortisone Acetate

• Used to treat adrenal gland disorders such as primary or secondary adrenal insufficiency, including Addison's disease, and congenital adrenal hyperplasia.
• Used short-term to control flare-ups of rheumatic conditions such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and acute gouty or bursitis-related joint inflammation.
• Used during exacerbations of collagen diseases such as systemic lupus erythematosus and acute rheumatic carditis.
• Used for severe allergic, dermatologic, ophthalmic, respiratory, hematologic, and gastrointestinal conditions that have not responded to conventional treatment, and as palliative therapy for certain blood cancers.

• Pregnancy is treated as a relative contraindication to cortisone therapy, particularly in the first trimester, because corticosteroids have caused fetal abnormalities in animal studies; it should only be used in pregnancy if the anticipated benefit outweighs the risk.
• If corticosteroid therapy is necessary during pregnancy, the newborn should be monitored closely after delivery for signs of reduced adrenal function (hypoadrenalism) and treated appropriately if this occurs.

• Breastfeeding is not specifically addressed in the product information; as with other corticosteroids, small amounts may pass into breast milk, so the benefits of treatment should be weighed against any potential effect on a nursing infant in consultation with the prescriber.

• No dedicated geriatric dosing guidance is provided; as with other corticosteroids, older adults may be more susceptible to bone loss, blood pressure elevation, and blood sugar changes, so clinical monitoring is advisable.

• No dedicated pediatric dosing information is provided; corticosteroids are known to suppress growth in children with prolonged use, so growth should be monitored if cortisone acetate is used in this population.

• For chronic, non-life-threatening conditions, treatment usually starts at 25 to 50 mg per day, gradually reduced to the lowest dose that controls symptoms.
• For acute, self-limited conditions such as severe seasonal asthma or dermatologic flares, doses of 75 to 150 mg per day are typical, without the need for prolonged maintenance therapy.
• For potentially life-threatening disease flares, higher initial doses of 75 to 300 mg per day or more, in divided doses for the most severe cases, may be used and then reduced once the condition is controlled.
• Chronic adrenal insufficiency is usually managed with 10 to 25 mg per day or more, often together with dietary salt or a mineralocorticoid, and additional cortisone is needed during illness, surgery, or major physical stress.

• Increased appetite and weight gain may occur.
• Fluid retention and mild swelling may occur.
• Increased sweating may occur.
• Mood changes or difficulty sleeping may occur.
• Indigestion may occur.
• Menstrual irregularities may occur.

Serious side effects require immediate discussion with the prescriber or emergency care.

• Cortisone acetate can cause salt and water retention, raised blood pressure, and low blood potassium, which may lead to congestive heart failure or worsening swelling if treatment continues despite these signs.
• Long-term use can cause muscle weakness, steroid-related muscle disease, bone thinning (osteoporosis), and fractures of the spine or hip and shoulder joints.
• Peptic ulcers with possible bleeding or perforation, pancreatitis, and abdominal distention may occur.
• Skin changes such as poor wound healing, thinning and fragile skin, and easy bruising may occur.
• Increased pressure within the skull, with headache and vertigo, has been reported, usually after stopping treatment.
• Cushingoid features, growth suppression in children, and adrenal or pituitary suppression may develop, particularly with prolonged use or during times of physical stress.
• Corticosteroids can worsen or unmask diabetes, requiring adjustment of insulin or oral diabetes medication.
• Cataracts, glaucoma, and increased eye pressure may develop with prolonged use.
• Corticosteroids can mask the signs of infection and allow infections to spread, so any new infection during treatment needs prompt evaluation and treatment.
• Blood clots and hypersensitivity reactions may occur.

• Use with caution in patients with active or healed tuberculosis, since steroids can reactivate infection, and antituberculosis therapy must be given alongside cortisone if used.
• Use with caution in patients with diverticulitis, a recent bowel surgery, active or latent peptic ulcer disease, or ulcerative bowel conditions.
• Use with caution in patients with high blood pressure, reduced kidney function, clotting problems, osteoporosis, or diabetes.
• Use with caution in patients with a history of psychiatric illness, given the risk of mood or behavioural changes.
• Use with caution in patients with active or chronic infections, including fungal or viral illnesses such as chickenpox, and in those with myasthenia gravis or reduced cardiac reserve.
• Use with caution in patients with glaucoma; eye pressure should be checked periodically during treatment.

• Tuberculosis, whether active or previously treated, is generally an absolute contraindication to steroid therapy unless the infection is being actively and adequately treated with antituberculosis medication.
• Ocular herpes simplex infection is generally an absolute contraindication.
• Acute psychosis is generally an absolute contraindication.

• Phenytoin can speed up the breakdown of corticosteroids, which may mean higher cortisone doses are needed to maintain the desired effect.
• Cortisone can worsen blood sugar control and may increase the insulin or oral diabetes medication dose a patient needs.
• Diuretics used to manage fluid retention can worsen potassium loss caused by cortisone, requiring closer monitoring of blood potassium.
• Live vaccines and other immune-modulating therapies should be used cautiously, since corticosteroids suppress the immune response.

• A high-potassium, low-sodium diet may help offset the salt and water retention and potassium loss associated with cortisone therapy; specific food-drug interaction data are otherwise not established.

• Usually taken with food to reduce stomach upset; the dosing schedule and frequency are individualized to the condition being treated.

• Store the tablets at room temperature, protected from moisture and light, and out of reach of children.

• Cortisone acetate is a corticosteroid used to replace low adrenal hormone levels or to control inflammation in a range of conditions.
• Take it exactly as directed, usually with food, and never stop or change the dose abruptly since your adrenal glands may need time to resume normal hormone production.
• Common effects include increased appetite, weight gain, fluid retention, and mood or sleep changes.
• Contact the prescriber's office immediately for signs of infection, black or bloody stools, severe stomach pain, significant swelling, vision changes, or unusual mood or behavioural changes.
• Let your care team know before any surgery, dental work, or during illness, since your steroid dose may need to be increased temporarily during physical stress.
• Store at room temperature away from moisture and out of reach of children, and keep up with recommended blood pressure, blood sugar, and bone health monitoring.