The drug "Kortef": instructions for use, indications, contraindications, doses, reviews
Glucocorticosteroids (GCS) are calledSynthetic drugs, which are analogues of endogenous hormones produced by the adrenal cortex. SCS exerts on the human body a whole range of effects: anti-inflammatory and desensitizing, immunosuppressive, antitoxic and anti-shock.
Today a large list of such medicines is presented on the Russian pharmaceutical market. One of them is "Cortef". Instruction for use recommends taking it for a variety of diseases.
Composition and form of release
The medication is intended for oral administration. The main active ingredient of the drug "Cortef" (the instruction contains this information) is hydrocortisone - a hormone produced by the adrenal glands. For systemic and local use in a medical environment, natural hydrocortisone or its esters are used.
In medication "Kortef" this hormone is contained involume of 10 mg. Additional substances include calcium stearate, corn starch and sucrose, lactose, mineral oil and sorbic acid.
The main form in which the proposedconsumers "Kortef", - tablets. Instructions for use, reviews of health workers and patients indicate the high effectiveness of this tool. Round tablets with a risk on the surface and the "CORTEF10" inscription stamped on it are packaged in vials of darkened glass (each packed in 100 pieces). You can buy the medicine only by prescription.
As mentioned earlier, the drug hasa whole list of effects on the human body: anti-inflammatory and anti-shock, desensitizing and anti-allergic, antitoxic, antimetabolic and immunosuppressive. Description of the preparation (instructions for use) contains information on the mass of the processes affected by the drug. It inhibits the release of inflammatory mediators and significantly slows the release of cytokines (interferon, interleukins) from microphages and lymphocytes.
Also, "Cortef" stimulates the accumulation of glycogen inliver, increases the amount of glucose contained in the blood, slows the excretion of fluid and Na + from the body and increases K +. With the direct participation of this medication, the production of histamine (mediator, i.e. mediator, necessary for carrying out allergic reactions of immediate type) is reduced.
In addition, the preparation of Cortef "instruction onapplication speaks of as a means of reducing the number of cellular infiltrates (cell elements with an admixture of blood and lymph) and an overwhelming inflammatory focus of the motor activity of leukocytes and lymphocytes, contributing to a decrease in the permeability of capillaries. The drug slows the synthesis and increases the rate of protein breakdown.
"Cortef" has an effect on the pituitary gland and inhibits the production of corticotropin (ACTH), without which the functioning of the adrenal cortex can completely stop.
Medication "Cortef": instruction, application
The feedback from experts says that theWe use the medicine in different fields of medicine. It is used to exclude a patient from toxic, traumatic, burn, cardiogenic, operational shock in cases when standard anti-shock therapy has not produced a result. Let us dwell on these points in more detail.
So, what are the categories of patients assigned to "Cortef"?
Instructions for use, description of the medicamentbring to consumers information about the possibility of using it in endocrinology. Here the drug will be effective in such diseases as insufficiency of the functioning of the adrenal cortex, thyroiditis (subacute form), adrenal hyperplasia (congenital nature), hypercalcemia, appeared against the background of malignant neoplasms.
Further, in rheumatology, "Cortef" is positivemanifests itself in the treatment of bursitis, arthritis (gouty, psoriatic, rheumatoid), ankylosing spondylitis, nonspecific tendosinovitis. Good results are achieved by patients taking "Kortef" with systemic lupus erythematosus, acute rheumatic carditis, polymyositis, epicondylitis.
There are indications for the use of "Kortef" and inthe field of dermatology. Here the medication is effective in the treatment of pemphigus, mushroom mycosis, herpetiform and exfoliative dermatitis. He is also prescribed for severe psoriasis, seborrheic dermatitis, erythema multiforme severe leakage.
Allergists prescribe "Cortef" with serumdiseases, rhinitis allergic origin, with atypical and contact dermatitis, with bronchial asthma and individual hypersensitivity to medicines.
Ophthalmologists also practicethe appointment of "Cortef" in a number of diseases. The medication is effective in corneal ulcer and conjunctivitis of allergic origin, with iritis and keratitis, with iridocyclitis, neuritis, uveitis, etc. In the field of oncology, SCS "Kortef" is prescribed for leukemia, in neurology for multiple sclerosis.
Where else is applied "Cortef"? The instructions for use contain information that pulmonologists (symptomatic sarcoidosis, pulmonary tuberculosis of lungs, aspiration pneumonia) and hematologists (secondary thrombocytopenia, hemolytic or hypoplastic anemia, erythroblastopenia) may prescribe it to their patients.
Variants of application and dosing
Medication "Cortef" is intended for oralapplication. However, the lyophilizate for the Solu-Cortef solution is prescribed for administration by intramuscular, intravenous (drip or jet) and into the periarticular bag.
With regard to oral administration, the initialthe dosage can vary from 20 to 240 mg during the day, depending on the diagnosed pathology and severity of the patient's condition. The optimal dose in each specific case is selected by reducing the initially accepted to the lowest, which will provide the desired effect.
In acute conditions and the need forIt is recommended to use intravenous medication "Solu-Kortef". The instruction manual describes the following standard scheme. The first 100 mg of the solution (initial dose) are administered within half a minute. The next volume of the drug in 500 mg should be administered for 10 minutes. Further, every 2-6 hours the procedure should be repeated, not forgetting to conduct constant monitoring of the patient's condition.
It should be remembered that in large dosages, "Solu-Cortef" is prescribed only for the period of stabilization of the patient's condition, but not longer than 3 days.
In / m "Cortef" is administered in the amount of 125-250 mg / day. Positive drug treatment is manifested after 6-25 hours after the procedure and can last from several days to several weeks.
If necessary, injections of "Kortef" makeintraarticular or periarticular bag. Effective dosage for large joints (shoulder, knee, femur) is 25-50 mg, but in acute conditions can reach 100 mg. For small joints (elbows, wrists, phalanx of fingers), an injection of 10-20 mg will be sufficient, done once. Repeat procedures are recommended every 1-3 weeks (sometimes required and more often - every 3-5 days).
In general, with regard to drug therapy"Cortef", the method of application and dose can be chosen only by the attending doctor. Suddenly stop treatment is undesirable, there is a high probability of exacerbation. The completion of treatment is by gradually reducing the dosage.
Contraindications to the use of "Cortef"
There is a certain list of diseases andstates of the body when it is unacceptable to take the medicine we are considering. These are parasitic and infectious diseases of viral, fungal or bacterial origin (carried over in the recent past, taking place at the moment).
Do not assign it if the patient is diagnosedpsychosis in the acute stage, decompensated diabetes, or a person suffers from hypothyroidism, thyrotoxicosis, hypertension, gastrointestinal ulcers and dermatological lesions having an infectious or ulcerative nature.
There is a whole list of contraindications forintra-articular administration of the drug "Solu-Cortef". Do not prescribe medication and with a number of problems with the cardiovascular system, including with the recently transferred myocardial infarction.
For a single admission, even for "vital" need, a contraindication to use is individual hypersensitivity to the components of the medication.
The frequency and brightness depend on several reasonsmanifestations of side effects, the list of which contains for the preparation "Kortef" instructions for use. The indications, doses, duration of the course prescribed by the attending physician must be observed without fail. A certain importance is also attached to the observance of the circadian rhythm of the appointment (fluctuations in the intensity of various biological processes associated with the change of day and night).
Endocrine system in response to the reception of "Cortef"is capable of responding to a decrease in susceptibility to glucose, the development of diabetes mellitus of a steroid nature, suppression of the functioning of the adrenal glands. There is a possibility of developing the Itenko-Cushing syndrome, the main symptoms of which are the lunar shape of the face, obesity in the pituitary type, an increase in the indices of blood pressure, myasthenia gravis, and various disorders of the menstrual cycle in women.
The reaction from the gastrointestinal tract can be suchsymptoms like nausea and vomiting, pancreatitis and steroid ulceration of various parts of the digestive tract, bleeding and perforation of its (GIT) walls, erosive esophagitis.
Cardiovascular side effectsreactions to "Cortef" (the instruction confirms this information) are arrhythmia, bradycardia, thrombosis, an increase in the indices of blood pressure. Against the backdrop of acute and subacute form of myocardial infarction "Cortef" can cause the spread of foci of necrosis, inhibition of the formation of scar tissue, which can cause a rupture of the heart muscle.
In general, a negative response to the application"Cortef" in one way or another can have a variety of organs and systems of the human body. There are manifestations from the side of the central nervous system and sensory organs, disturbances in the work of metabolism and the musculoskeletal system. A variety of allergic reactions may occur. The most complete information is contained in the instructions for the use of the drug "Cortef".
Pregnancy and lactemia
In the period of gestation of the baby and breastfeeding strictly prohibits taking the drug "Cortef" instructions for use. Description (the presence in some forms of the drug of benzyl alcohol speaks for itself) of the drug contains information on the possible effects of the use of "Cortef" in such periods in the form of development of insufficiency of adrenal activity, dyspnea, death.
Children whose mothers during pregnancy wereare forced to take hydrocortisone, should be under close supervision of medical personnel with the purpose of early detection of signs of development of adrenal insufficiency.
What you should pay attention to?
During treatment with the use of medicinalmeans "Kortef" instructions for use recommend a diet that limits the intake of salt. In addition, the body should receive a sufficient amount of protein. Also during this period it is unacceptable to conduct any kind of vaccination. It is necessary to maintain constant monitoring of blood pressure, glucose concentration in the blood and its coagulability. It is also important to monitor diuresis and weight of the patient.
Under any stressful situations, people,passing the therapeutic course with the use of "Cortef", need to increase the dosage of GCS. As for patients suffering from tuberculosis, those who are in an active stage should take "Cortef" only in parallel with the appropriate therapy aimed at treating the underlying disease. If tuberculosis occurs in a latent form, or in the process of bending tuberculin samples, the medical staff should closely monitor the patient's condition and, if necessary, prescribe appropriate chemoprophylaxis.
If the prescription of the medicine provokedthe development of secondary insufficiency of the adrenal cortex, then the situation can be normalized by gradually reducing the dose. After the course of therapy is over, this type of deficiency can still be observed for several months. Stressful situations that occurred during this period are an indication for the resumption of the appointment of the SCS.
As for simple herpetic infection of the eye,then "Cortef" (instruction, application, expert reviews are discussed in the article) and any other SCS should be administered with great care, as it is possible to develop corneal perforation.
Health workers should be aware of the fact thatbackground treatment "Cortef" individual infectious diseases can occur asymptomatically, in a latent form and have varying degrees of severity. With the increase in the applied doses of GCS, the likelihood of developing latent infections increases. That is, under the influence of "Cortef" the resistance to infections decreases, the ability to localize the infectious focus decreases.
Those who are prescribed immunosuppressive doses"Cortef" or any other SCS, it is recommended not to contact people suffering from chicken pox or measles. If such contacts are still taken, you should immediately contact your doctor.
SCS can cause mental disorders or exacerbate existing psychotic manifestations, increase emotional instability.
There is information that in some patients against the background of "Cortéf" (or other SCS), Kaposi's sarcoma developed. However, after the withdrawal of the drug, clinical remission was observed.
For the reason that complications after takingof the drug directly depend on the duration of the course and dosage, the doctor decides whether to start the treatment course, its duration and the acceptable dosages after assessing the perceived benefit to his patient and the potential risks from the drug.
Interaction with other drugs
So, we discussed what is"Cortef." Instructions for use, indications and contraindications to the use and side effects of this drug are also considered. It remains to note that specialists in prescribing patients should take into account that hydrocortisone can interact with a variety of substances, and these compounds can cause serious damage to the body.
First, hydrocortisone is pharmaceuticallyIt is incompatible with other drugs and, when trying to connect, it can form insoluble substances. Secondly, it increases the toxicity of cardiac glycosides, which can lead to hypokalemia, and then there is a risk of arrhythmia.
With the direct participation of "Cortef" (in particular, its main component), the rate of excretion of acetylsalicylic acid (ASA) increases, and the level of its content in the blood falls.
The use of live antiviral vaccines against the background of hydrocortisone can give an impetus to the activation of viruses and the development of infection.
Paracetamol in tandem with "Cortef" can becomehepatotoxic. With long courses of use, the concentration of folic acid in the body increases. In high dosages, hydrocortisone reduces the effectiveness of somatropin (growth hormone).
In addition, the main active substance reducesthe effectiveness of hypoglycemic medications, but increases the anticoagulant effect of coumarin derivatives. "Cortef" suppresses the effect of vitamin D on the absorption of Ca2+ in the lumen of the intestine. Under the influence of hydrocortisone, the toxicity of cyclosporine and ketoconazole increases.
In the presence of substances such as ephedrine,theophylline, rifampicin, any barbiturates, the therapeutic effect of the effect of GCS decreases. The appearance of acne and the development of hirsutism (excessive growth of terminal - hard and dark - hair in women in the male type) is preceded by the reception in parallel with hydrocortisone of other steroid hormones (anabolic, estrogen, oral contraceptives).
Opinion of consumers about the drug "Kortef"
Cortef is too complicated to not havenegative feedback. Although positive at times more. Description of the drug "Kortef" (reviews of health workers confirm this fact) allows us to understand: how wide its scope, the list of side effects is also long. Judging by the opinions of the patients themselves, someone quickly relieved them of suffering, resulting in improved quality of life, and someone caused a lot of negative impressions, and according to the feelings of the patients, had no effect.
Whether this drug is bad or good is too narrow a question for such a tool as "Cortef". The main thing here is to rely on the experience and knowledge of the attending physician and to follow all his recommendations.