542
P A R T 6
Drugs acting on the endocrine system
TABLE 36.3
DRUGS IN FOCUS Adrenocortical agents (continued)
Drug name
Dosage/route
Usual indications
Glucocorticoids (continued)
cortisone (Cortate)
Oral, IM
Adult: 25–300 mg/day PO; 20–330 mg IM
Paediatric: base dose on response, monitor
closely
Replacement therapy in adrenal
insufficiency; allergic and inflammatory
disorders treatment
dexamethasone
(Dexmethsone)
Oral, IV, IM, inhalation, intranasal, ophthalmic,
topical
Adult and paediatric: individualise dose based
on response and severity: 0.75–9 mg/day PO;
8–16 mg/day IM; 0.5–9 mg/day IV; two to
three inhalations per day for inhalation; one to
two sprays in each nostril b.d. for nasal spray;
1 drop (gtt) t.d.s. to q.i.d. for ophthalmic
solutions; apply topical preparation sparingly
Management of allergic and inflammatory
disorders, adrenal hypofunction
hydrocortisone
(Sigmacort, Solu-Cortef)
Oral, IV, IM, topical, ophthalmic, rectal,
intra-articular
Adult: 100–500 mg IM or IV q 2–6 hours;
100 mg half-strength by retention enema
for 21 days; one applicator-full daily to
b.d. intrarectal; apply topical sparingly;
5–20 mg/day PO based on response
Paediatric: 20–240 mg/day PO, IM or SC;
100 mg half-strength by retention enema
for 21 days; one applicator-full daily to
b.d. intrarectal; apply topical sparingly;
5–20 mg/day PO based on response
Replacement therapy, treatment of allergic
and inflammatory disorders
methylprednisolone
(Advantan, Depo-
Medrol, Depo-Nisolone)
Oral, IV, IM, intra-articular
Adult: 40–120 mg/day PO or IM; 10–40 mg IV
slowly
Paediatric: base dose on severity and response
Treatment of allergic and inflammatory
disorders
prednisolone
(Panafcortelone, Predsol,
Redipred)
Oral, IV, IM, ophthalmic, intra-articular
Adult: 5–60 mg/day PO; 4–60 mg IM or IV;
1–2 gtt in affected eye t.d.s. to q.i.d.
Paediatric: base dose on severity and response
Treatment of allergic and inflammatory
disorders
prednisone (Lodotra,
Panafcort, Sone)
Adult: 5–80 mg in divided dose (initial dose);
5–20 mg daily (maintenance dose). Dose
individualised according to severity of the
disease and individual’s response rather than
age or body weight
Paediatric: base dose on severity and response
Replacement therapy for adrenal
insufficiency; treatment of allergic and
inflammatory disorders; severe bronchial
asthma, status asthmaticus, acquired
haemolytic anaemia, nephrotic syndrome
triamcinolone (Aristocort,
Kenacomb, Tricortone)
Oral, IM, inhalant, intra-articular, topical
Adult: 4–60 mg/day PO; 2.5–60 mg/day IM;
two inhalations t.d.s. to q.i.d.
Paediatric: individualise dose based on severity
and response; 6–12 years, one to two
inhalations t.d.s. to q.i.d.
Treatment of allergic and inflammatory
disorders, management of asthma;
treatment of adrenal insufficiency when
combined with a mineralocorticoid
Mineralocorticoids
cortisone (Cortate)
Oral, IM
Adult: 25–300 mg/day PO or 20–330 mg/day
IM
Paediatric: base dose on severity and response
Used for replacement therapy in adrenal
insufficiency, treatment of allergic and
inflammatory disorders
fludrocortisone
(Florinef)
Adult: 0.1–0.2 mg/day PO
Used for replacement therapy and
treatment of salt-losing adrenogenital
syndrome with a glucocorticoid; not
recommended for children; being tried
for treatment of severe orthostatic
hypotension because sodium and water
retention effects can lead to increased
blood pressure
