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Han: Clinical pharmacology review for primary health care providers: II. Steroids
Original Article

Translational and Clinical Pharmacology 2015;23(1):15-20.

Published online: 30 June 2015

DOI: https://doi.org/10.12793/tcp.2015.23.1.15

Clinical pharmacology review for primary health care providers: II. Steroids

Seunghoon Han∗

Department of Clinical Pharmacology and Therapeutics, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul 137–701, Korea

∗Correspondence: S. Han; Tel: +82-2-2258-7326, Fax: +82-2-2258-7876, E-mail: waystolove@catholic.ac.kr

Received 10 June 2015       Revised 15 June 2015       Accepted 20 June 2015

Copyright © 2015 Korean Society for Clinical Pharmacology and Therapeutics

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Primary health care providers play a critical role in maintaining public health, and the appropriate prescription of pharmaceutical products is a major component of their practice. This series of articles entitled ‘Clinical Pharmacology Review for Primary Health Care Providers' is intended to help primary health care providers select more appropriate prescriptions for frequently used drugs based on up-to-date information. We expect that this effort will contribute to improvements in public health and diminish unnecessary drug use.

Keywords: glucocorticoid, topical agent, systemic steroid, drug interaction, adverse effect

References

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Table 1.
Side effects of short-term glucocorticoid therapy
Gastrointestinal intolerance
Increased predisposition to infections
Delayed wound healing
Increased appetite
Hyperglycemia
Fluid and sodium retention
Mood changes
Weakness
Insomnia
Amenorrhea
Reduced sexual functioning (Impotence)
Difficulty or pain while urinating
Breast reduction
Acne
Rapid weight gain
Increased blood pressure and cholesterol levels
Headaches
Swelling of feet and ankles
Table 2.
Pharmacokinetic-pharmacodynamic characteristics of corticosteroids for general use
Agent Pharmacokinetics (oral) Relative activities Dosage forms
tmax (h) t1/2 (h) Anti-Inflammatory Topical Salt-Retaining Equivalent Oral Dose in mg (Relative potency) Forms Available
Short- to medium-acting (<12 h)
Hydrocortisone (cortisol) 1.2 ± 0.4 1.8 ± 0.5 1 1 1 20 (1.25) Oral, injectable, topical
Cortisone     0.8 0 0.8 25 (1) Oral
Prednisolone 1.3 ± 0.7 3.2 ± 1.0 4 0 0.3 5 (5) Oral
Methylprednisolone 2.1 ± 0.7 2.5 ± 1.2 5 4 0.3 5 (5) Oral, injectable
Meprednisone     5 5 0.25 4 (6.25) Oral, injectable
Intermediate-acting (12–36 h)
Triamcinolone 1 2 5 5 0 4 (6.25) Oral, injectable, topical
Paramethasone     10   0 2 (12.5) Oral, injectable
Fluprednisolone     15 7 0 1.5 (16.7) Oral
Long-acting (>36 h)
Betamethasone 2 8.1 25–40 10 0 0.6 (41.7) Oral, injectable, topical
Dexamethasone 1.5 4.0 ± 0.9 30 10 0 0.75 (33.3) Oral, injectable, topical
Table 3.
Topical corticosteroids in various formulations summarized by Robertson DB & Maibach HI
Concentration Drug
Lowest efficacy
0.25–2.5% Hydrocortisone
0.25% Methylprednisolone acetate (Medrol)
0.1% Dexamethasone1 (Decaderm)
1.0% Methylprednisolone acetate (Medrol)
0.5% Prednisolone (MetiDerm)
0.2% Betamethasone1 (Celestone)
Low efficacy
0.01% Fluocinolone acetonide1 (Fluonid, Synalar)
0.01% Betamethasone valerate1 (Valisone)
0.025% Fluorometholone1 (Oxylone)
0.05% Alclometasone dipropionate (Aclovate)
0.025% Triamcinolone acetonide1 (Aristocort, Kenalog, Triacet)
0.1% Clocortolone pivalate1 (Cloderm)
0.03% Flumethasone pivalate1 (Locorten)
Intermediate efficacy
0.2% Hydrocortisone valerate (Westcort)
0.1% Mometasone furoate (Elocon)
0.1% Hydrocortisone butyrate (Locoid)
0.1% Hydrocortisone probutate (Pandel)
0.025% Betamethasone benzoate1 (Uticort)
0.025% Flurandrenolide1 (Cordran)
0.1% Betamethasone valerate1 (Valisone)
0.1% Prednicarbate (Dermatop)
0.05% Fluticasone propionate (Cutivate)
0.05% Desonide (Desowen)
0.025% Halcinonide1 (Halog)
0.05% Desoximetasone1 (Topicort L.P.)
0.05% Flurandrenolide1 (Cordran)
0.1% Triamcinolone acetonide1
0.025% Fluocinolone acetonide1
High efficacy
0.05% Fluocinonide1 (Lidex)
0.05% Betamethasone dipropionate1 (Diprosone, Maxivate)
0.1% Amcinonide1 (Cyclocort)
0.25% Desoximetasone1 (Topicort)
0.5% Triamcinolone acetonide1
0.2% Fluocinolone acetonide1 (Synalar-HP)
0.05% Diflorasone diacetate1 (Florone, Maxiflor)
0.1% Halcinonide1 (Halog)
Highest efficacy
0.05% Betamethasone dipropionate in optimized vehicle (Diprolene)1
0.05% Diflorasone diacetate1 in optimized vehicle (Psorcon)
0.05% Halobetasol propionate1 (Ultravate)
0.05% Clobetasol propionate1 (Temovate)

1 Fluorinated steroids

Table 4.
Indications for the use of glucocorticoids in nonadrenal disorders
Disorder Examples
Allergic reactions Asthma, bee stings, contact dermatitis, allergic rhinitis, serum sickness, urticaria
Collagen-vascular disorders Lupus erythematosus, mixed connective tissue syndromes, polymyositis, rheumatoid arthritis, temporal arteritis
Eye diseases Acute uveitis, allergic conjunctivitis, choroiditis, optic neuritis
Gastrointestinal diseases Inflammatory bowel disease, nontropical sprue, subacute hepatic necrosis
Hematologic disorders Acquired hemolytic anemia, acute allergic purpura, leukemia, autoimmune hemolytic anemia, idiopathic thrombocytopenic purpura, multiple myeloma
Systemic inflammation Acute respiratory distress syndrome
Infections Acute respiratory distress syndrome, sepsis
Joints inflammation Arthritis, bursitis, tenosynovitis
Neurologic disorders Cerebral edema, multiple sclerosis
Organ transplants Prevention and treatment of rejection (immunosuppression)
Pulmonary diseases Aspiration pneumonia, bronchial asthma, fetal lung maturation, sarcoidosis
Renal disorders Nephrotic syndrome
Skin diseases Atopic dermatitis, dermatoses, mycosis fungoides, pemphigus, seborrheic dermatitis, xerosis
Thyroid diseases Malignant exophthalmos, subacute thyroiditis
Miscellaneous Hypercalcemia, mountain sickness
Table 5.
Various systemic side effects of long-term glucocorticoid use
Major Minor
Increased blood sugar for diabetics Nervousness
Difficulty controlling emotion Acne
Weight gain Skin rash
Immunosuppression Appetite gain
Facial swelling Hyperactivity
Depression, mania, psychosis Increased thirst
Unusual fatigue or weakness Frequent urination
Mental confusion / indecisiveness Diarrhea
Blurred vision Reduced intestinal flora
Abdominal pain Leg pain/cramps
Peptic ulcer Sensitive teeth
Painful hips or shoulders  
Steroid-induced osteoporosis  
Insomnia  
Severe joint pain  
Cataracts or glaucoma  
Anxiety  
Black stool  
Stomach pain or bloating  
Severe swelling  
Mouth sores or dry mouth  
Avascular necrosis  
Hepatic steatosis  
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