Drug

Cortisone tablets

introduction

Medicines with the active ingredient cortisone are used in a wide variety of areas and for a wide variety of diseases.
Cortisone is used especially in the course of organ transplants, joint and skin diseases.

application areas

Cortisone tablets can be used wherever inflammatory reactions are to be slowed down.
With many diseases Local therapy with ointments, nasal sprays, etc. is not sufficient and the cortisone must be given systemically, i.e. distributed throughout the body.
Symptoms that make it necessary to take cortisone tablets, for example:

Transplants
acute deterioration of the COPD (Chronic obstructive pulmonary disease)
severe asthma Level 4
Rheumatic diseases
inflammatory bowel disease, how Crohn's disease or Ulcerative colitis
multiple sclerosis
Autoimmune diseases
severe allergic reactionse.g. after wasp stings, taking medication, hay fever
meningitis
severe forms of eczema

Cortisone tablets can also be used for a Underactive adrenal or pituitary gland be taken.

Dosage and application

Cortisone tablets can either be used as short-term therapy for acute attacks of certain diseases such as Crohn's disease or as long-term therapy with regular intake to e.g. prevent organ rejection after transplantation.

In the case of short-term therapy in the context of acute inflammation, a high dosage is given at the beginning, this is gradually reduced over time until it is finally tapered off completely.
In the case of long-term therapy, the smallest possible effective dose is chosen, since a longer treatment with cortisone always has certain side effects.

The active ingredient prednisone or prednisolone is often used instead of the actual cortisone.
As a rule, cortisone tablets (e.g. prednisolone) are taken during or immediately after meals. The tablets must be swallowed whole and with sufficient liquid, preferably water.

Application areas of cortisone tablets

Cortisone tablets for neurodermatitis

Atopic dermatitis is a skin condition that leads to dry, itchy eczema of the skin. The eczema is mainly localized on the flexors of the arms and legs. However, they can also affect other parts of the body. For the treatment of atopic dermatitis, various drugs are available for external and internal treatment. Slight forms of progress are only treated externally, with ointments or creams. This also includes treatment with ointments containing cortisone. Such ointments or creams are only intended for short-term use in the episode, as long-term use leads to thinning of the skin (atrophy).

In severe forms, systemic drugs are prescribed for ingestion. Cortisone tablets can also be used. However, they are also only suitable for short-term therapy and can lead to a rapid improvement in the condition of very severe attacks. Prednisolone is the drug of choice.

Cortisone tablets for tinnitus

Around 4% of the German population suffer from chronic tinnitus. The annoying noise in the ear can not only have physical consequences, such as a lack of sleep, but also psychological stress and even depression. Therefore, tinnitus should be treated as early as possible to prevent chronification.

Ultimately, there are very few treatment options for tinnitus. If the cause cannot be remedied or is not known, the options are very limited. Cortisone tablets and cortisone infusions are possible treatment options. Treatment with cortisone is particularly useful for acute tinnitus. The exact effect of the tablets on tinnitus is not known. Anti-inflammatory and immunological factors are discussed. However, therapy via the vein with cortisone infusions is more recommendable than therapy with cortisone tablets. They are more effective than tablets in the case of tinnitus. Regardless of whether as an infusion or in tablet form, the therapy is started with a high dose and then reduced from day to day. The duration of therapy is approximately 10 days.

Cortisone tablets for pimples

Cortisone tablets are not used to treat pimples. Regular use of cortisone tablets or the application of cortisone ointments and creams can even lead to acne. Colloquially, this is also known as steroid acne. Typically, the pimples appear on the back and shoulders, less often on the face. Cortisone therapy for pimples is therefore not useful. However, cortisone tablets are used to treat many other skin changes, rashes, and eczema.

Cortisone tablets for asthma

Bronchial asthma is treated with inhaled glucocorticoids. Cortisone tablets are not part of the step therapy for asthma. Inhaled glucocorticoids, on the other hand, are very effective and are used in the long-term therapy of asthma. They are initially given in low doses. If the therapy is unsuccessful, the dose can be increased. Important active ingredients are budesonide and beclomethasone.

You can find more information on the topic here: Cortisone therapy for asthma

Cortisone tablets for bursitis

Bursitis is treated with drugs that relieve pain, such as diclofenac and ibuprofen. Treatment with cortisone tablets is usually not intended. However, it can occur if the bursitis has occurred due to another disease, for example rheumatism. The cortisone tablets then primarily treat the underlying disease and not the bursitis.

Cortisone tablets for a herniated disc

A herniated disc can be a very stressful event for those affected. Pain, sensory disturbances and even paralysis are the possible consequences. However, most herniated discs do not require surgery. An operation is only unavoidable if there are signs of paralysis.

Treatment also includes glucocorticoids, but not in the form of tablets. They are injected directly into the vicinity of the affected nerve root together with local anesthetics (local anesthetics) under X-ray control. This is a purely symptomatic therapy aimed at relieving the pain and inflammation in the area of the herniated disc.

Cortisone tablets for skin rashes

Cortisone tablets are used to treat a wide variety of skin rashes. Especially in high doses, they are very effective against some autoimmune skin diseases. These include, for example, blistering diseases such as pemphigus vulgaris or bullous pemphigoid. There are also many other skin diseases that can be treated with cortisone tablets, such as neurodermatitis.

Cortisone tablets are not suitable for the permanent treatment of skin diseases, but are only used for a short period of time. Eczema of all kinds can also be treated with cortisone tablets if topical treatment with ointments or creams does not bring the desired result.

Cortisone tablets for multiple sclerosis

For multiple sclerosis, relapse therapy is given with a glucocorticoid called methylprednisolone. This is a powerful glucocorticoid that is supposed to stop inflammatory activity in the flare-up of MS. At the beginning of the attack, it is not given in the form of tablets, but rather through the vein at a dose of 500 to 1000 mg per day. This therapy must be administered via the vein for 3 to 5 days. Thereafter, the methylprednisolone is tapered in the form of tablets in increasingly lower doses to prevent complications such as adrenal insufficiency or an Addison's crisis.

You can find more information on the topic here: Therapy of multiple sclerosis

When should cortisone tablets not be used?

Patients who have already had an allergic reaction to this active ingredient should not be taken again.
There are no contraindications for short-term applications that may be life-threatening.
For longer-term use, certain relative contraindications should be mentioned:

acute viral infections such as Herpes simplex, chickenpox, polio
active chronic hepatitis B
about 8 weeks before to 2 weeks after vaccinations
Complications after tuberculosis vaccination

During pregnancy and breastfeeding, cortisone tablets should only be taken in urgent cases, as a harmful effect on the child cannot be ruled out.

Read more on the subject at:

Cortisone in Pregnancy
Cortisone in the child

Prednisolone

Prednisolone is a glucocorticoid that is more effective than cortisone. A dose of 7.5 mg prednisolone has a comparable strength of 30 mg cortisone.

Prednisolone is available in tablet form, for example as Decortin in dosages of 25/50 and 75 mg. It is used to treat various diseases. A large area of application are skin diseases of various causes. Prednisolone tablets can also be used in the treatment of rheumatic diseases, sarcoid, respiratory diseases, chronic inflammatory bowel diseases or hair loss. Prednisolone tablets should not be stopped suddenly, but always tapered to avoid complications.

Cortisone tablets and alcohol - are they compatible?

During treatment with cortisone tablets, one should refrain from consuming alcohol. By consuming alcohol, the effects of cortisone and the associated side effects can be increased. In addition, alcohol promotes inflammatory processes in the body and impairs the healing process.Most diseases that have to be treated with higher-dose cortisone tablets are aggravated or even prevented from healing. In addition, side effects from alcohol consumption cannot be 100% predicted. Liver damage from alcohol is also possible and can lead to serious consequences.

Weight gain from cortisone tablets

Long-term therapy with high-dose cortisone tablets can lead to weight gain as a possible side effect. This is based on several mechanisms of action of the cortisone. The cortisone leads to water retention in the tissue (edema), which increases weight. Furthermore, the appetite can be increased so that more calories are consumed. Overweight people in particular should therefore pay more attention to their diet when taking cortisone therapy in order not to gain more weight.

In addition, cortsion has effects on lipid metabolism. There is a redistribution of adipose tissue, so that in long-term therapy above the Cushing threshold, trunk obesity develops. Fat is deposited on the face, neck and trunk. In this context one speaks of a moon face and a bull's neck.

Are there cortisone tablets without a prescription?

Cortisone tablets mean various glucocorticoids that are available in different strengths. It doesn't necessarily have to be the active ingredient cortisone. For example, there are also tablets with the much stronger active ingredient prednisolone. Glucocorticoid tablets are not available without a prescription.

The purchase from dubious internet pharmacies that promise over-the-counter shipping should therefore be avoided. Glucocorticoids are very effective and important drugs, but they should not be taken without a doctor's agreement and a precise application schedule. Therefore, these tablets are not available without a prescription.

Drug interactions

The effect of cortisone tablets can be changed by taking different drugs at the same time.
Important drugs are:

Anti-inflammatory drugs
Cardiac glycosides (e.g. digitalis)
ACE inhibitors
"the pill“
Certain Antibiotics like rifampicin
Oral anti-diabetic drugs and insulin

When is the best time to take cortisone tablets - before or after a meal?

Cortisone tablets should best be taken in the morning before 8:00 a.m. This is when the body produces its highest levels of cortisone. Taking the cortisone tablets in the morning disturbs the body's own hormonal control circuits as little as possible and minimizes the likelihood of side effects.

There are no relevant recommendations for taking before or after eating. Cortisone tablets can be taken both before and after meals.

Side effects

As a general rule, cortisone should never be suddenly discontinued, as this promotes the development of side effects. The discontinuation of medication containing cortisone must always be carried out strictly according to the instructions of the attending physician!

Side effects of long-term use of cortisone tablets usually only occur if the dose is above the body's own production for a long time.
With short-term use (approx. 2 weeks) the risk of side effects is very low.

Some patients have general immunodeficiency after taking cortisone tablets.
In addition, the intake of cortisone can cause muscle wasting in the arms and legs with simultaneous fat accumulation in the area of the body trunk (trunk obesity).
Some patients have developed high blood pressure, diabetes mellitus, water retention and inflammation of the pancreas after prolonged use of cortisone tablets.
The occurrence of osteoporosis and death (necrosis) of the bones, especially the bone heads, is possible in the course of a long-term cortisone overdose.
Another side effect is the inhibition of the natural processes during blood clotting. Patients often complain of delayed blood clotting, poor wound healing and the appearance of punctiform hematomas all over the body.
Furthermore, taking cortisone can lead to a sharp rise in intraocular pressure (glaucoma) and / or clouding of the lens (cataracts).
Since the production of gastric mucus is restricted in the course of cortisone therapy, stomach pain and inflammation of the gastric mucosa often develop.
Psychological symptoms such as depression, irritability, loss of appetite and lack of drive are also possible.

Read a lot more information on this topic at: Taper off side effects of cortisone and cortisone

What should I watch out for if I stop taking cortisone tablets?

Treatment with cortisone tablets is often a major concern for many people. There are many concerns in the population about the very effective cortisone. For many diseases, however, cortisone is a very good and effective therapy that has far fewer negative consequences than is often assumed. If cortisone is used properly, no serious consequences are expected. It is therefore very important not to simply stop cortisone at a dosage above the so-called Cushing threshold. The Cushing threshold is a threshold above the body's natural cortisone requirement.

Due to the external supply of additional cortisone, the adrenal cortex (the adrenal cortex is the actual cortisone producer in the human body) itself produces less cortisone. If you stop taking the cortisone tablets suddenly, it can lead to adrenal insufficiency. The adrenal cortex hardly produces its own cortisone and this results in a lack of cortisone in the body. The result can be a life-threatening Addison's crisis, which is characterized by impaired consciousness, vomiting, nausea, drop in blood pressure and shock. Therefore, cortisone tablets need to be reduced gradually to avoid such complications.

However, a gradual reduction does not apply to cortisone therapy below the Cushing threshold mentioned. The threshold values differ for different cortisone preparations and are taken into account by the attending physician. Lower dose tablets do not need to be tapered. They may be stopped abruptly.

Read more on the topic: Taper off cortisone

effect

The main action of cortisone is to suppress inflammatory processes and exaggerate immune responses. By administering cortisone, the symptoms of the inflammatory reaction disappear, but the cause itself is not combated!
Basically, cortisone is just that inactive form of the body's own hormone cortisol. Cortisone itself has no biological effect, as it is not able to bind to the corresponding cells due to its chemical structure.
It has to be inside the body first converted into the active form become.
Cortisol belongs to the group of Steroid hormones, more precisely, it is the most important Glucocorticoid.
Since it is one of the fat-soluble hormones, it is able to get into the cell and bind to important structures there.
It is formed in the adrenal cortex from the raw material cholesterol and from there released into the bloodstream.
Both the build-up rate and the amount are strictly controlled by the pituitary gland and repeatedly adapted to the body's energy requirements.
In the course of long-term stressful situations, cortisol is increasingly produced and released into the bloodstream. In this context, it has a similar effect to adrenaline and noradrenaline, but the effect only sets in later.

For very interested readers:

This delayed effect is due to the fact that cortisone cannot bind to a so-called G-protein-coupled receptor.
G-protein-coupled receptors are cell surface receptors that are activated after hormone binding on the side facing the cell interior. After activation, they set a cascade in motion inside the cell via various chemical processes, which ultimately has a regulatory (i.e. activating or inhibiting) effect on the behavior of the cell.
In the case of cortisol, binding to such a receptor is not possible. On the one hand, this is due to the fact that the hormone does not fit into the binding site of a G protein-coupled receptor and, on the other hand, it can penetrate the cell membrane and bind to receptors inside the cell (intracellular receptors).
Such an intracellular receptor can act directly on the regulation, i.e. switching on and off, of various genes. By switching on genes that favor the formation of specific enzymes, cortisol is able to specifically influence metabolic pathways.