Home Forums Other Specialities Therapeutics GLUCOCORTICOID THERAPY- AN INTRODUCTION

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    Glucocorticoid therapy

    ?In comparing the relative potencies of corticosteroids in terms of their anti-inflammatory (glucocorticoid) effects it should be borne in mind that high glucocorticoid activity in itself is of no advantage unless it is accompanied by relatively low mineralocorticoid activity .
    The mineralocorticoid activity of fludrocortisone is so high that its anti-inflammatory activity is of no clinical relevance.

    Equivalent anti-inflammatory doses of corticosteroids
    This table takes no account of mineralocorticoid effects, nor does it take account of variations in duration of action
    Prednisolone 5 mg
    ? Betamethasone 750 micrograms
    ? Deflazacort 6 mg
    ? Dexamethasone 750 micrograms
    ? Hydrocortisone 20 mg
    ? Methylprednisolone 4 mg
    ? Prednisone 5 mg
    ? Triamcinolone 4 mg

    The relatively high mineralocorticoid activity of hydrocortisone, and the resulting fluid retention, makes it unsuitable for disease suppression on a long-term basis. However, hydrocortisone can be used for adrenal replacement therapy (section 6.3.1). Hydrocortisone is used on a short-term basis by intravenous injection for the emergency management of some conditions.
    The relatively moderate anti-inflammatory potency of hydrocortisone also makes it a useful topical corticosteroid for the management of inflammatory skin conditions because side-effects (both topical and systemic) are less marked .

    Prednisolone and prednisone have predominantly glucocorticoid activity. Prednisolone is the corticosteroid most commonly used by mouth for long-term disease suppression.

    Betamethasone and dexamethasone have very high glucocorticoid activity in conjunction with insignificant mineralocorticoid activity. This makes them particularly suitable for high-dose therapy in conditions where fluid retention would be a disadvantage.

    Betamethasone and dexamethasone also have a long duration of action and this, coupled with their lack of mineralocorticoid action makes them particularly suitable for conditions which require suppression of corticotropin (corticotrophin) secretion (e.g. congenital adrenal hyperplasia).
    Some esters of betamethasone and of beclometasone (beclomethasone) exert a considerably more marked topical effect (e.g. on the skin or the lungs) than when given by mouth; use is made of this to obtain topical effects whilst minimising systemic side-effects (e.g. for skin applications and asthma inhalations).

    Deflazacort has a high glucocorticoid activity; it is derived from prednisolone.

    G Mohan.

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