Replacement therapy in adrenocortical insufficiency usually in combination w/ a more potent mineralocorticoid; other conditions for which corticosteroid therapy is indicated.
IV/slow inj/infusionEmergency conditions Usual dose: 100-500 mg repeated tid or qid. Childn 6-12 yr 100 mg; 1-5 yr 50 mg; ≤1 yr 25 mg. Supplementary therapy:Minor surgery under general anesth 25-50 mg IV at induction. Moderate or major surgery Usual oral corticosteroid dose in the morning plus 25-50 mg IV at induction, followed by similar doses tid for 24 hr (moderate surgery) & 48-72 hr (major surgery). Local administration into soft tissues 100-200 mg.
May mask some signs of infection. Decreased resistance & inability to localize infection. Possible damage to the optic nerve in prolonged use. May enhance the establishment of secondary ocular infection. Dietary salt restriction & K supplementation is recommended. Immunization procedures should not be undertaken while on therapy.
Adverse Reactions
Elevation of BP, salt & water retention, increased K excretion in large doses. Posterior subcapsular cataracts & glaucoma in prolonged use.
Drug Interactions
Barbiturates, carbamazepine, phenytoin, primidone, rifampicin; OCs or ritonavir; K-depleting diuretics eg thiazides or frusemide (furosemide); amphotericin B or bronchodilator therapy w/ xanthine or β2-agonists, NSAIDs, anticoagulants, antidiabetics & antihypertensives; salicylates, antimuscarinics.
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