Cortisol

Fluid and Electrolyte Disturbances: Sodium retention, fluid retention, congestive heart failure in susceptible patients, potassium loss, hypokalemic alkalosis, hypertension.

Musculoskeletal: Muscle weakness, steroid myopathy, loss of muscle mass, osteoporosis, vertebral compression fractures, aseptic necrosis of femoral and humeral heads, pathologic fracture of long bones.

Gastrointestinal: Peptic ulcer with possible perforation and hemorrhage, pancreatitis, abdominal distention, ulcerative esophagitis.

Dermatologic: lmpaired wound healing, thin fragile skin, petechiae and ecchymoses, facial erythema, increased
sweating, may suppress reactions to skin tests.

Neurological: Convulsions, increased intracranial pressure with papilledema (cerebral pseudo-tumor) usually after treatment, vertigo, headache.

Endocrine: Menstrual irregularities, development of Cushingoid state, suppression of growth in children, secondary adrenocortical and pituitary unresponsiveness, particularly in times of stress as in trauma surgery or illness, decreased carbohydrate tolerance, manifestations of latent diabetes mellitus, increased requirements for insulin or oral hypoglycemic agents in diabetics.

Ophthalmic: Posterior subcapsular cataracts, increased intraocular pressure, glaucoma, exophthalmos.

Metabolic: Negative nitrogen balance due to protein catabolism.

This medicine is not recommended for use during pregnancy unless considered essential by your doctor. It should only be used if the expected benefit to the mother is greater than any possible risk to the foetus. Corticosteroids appear in breast milk and could suppress growth, interfere with endogenous corticosteroid production or cause other unwanted effects.

Patients who are on immunosuppressant doses of corticosteroids should be warned to avoid exposure to chickenpox or measles. Patients should also be advised that if they are exposed, medical advice should be sought without delay.

ln patients on corticosteroid therapy subjected to unusual stress, increased dosage of rapidly acting corticosteroids before, during and after the stressful situation is indicated. Corticosteroids may mask some signs of infection, and new infections may appear during their use. There may be decreased resistance and inability to localize infection when corticosteroids are used. Prolonged use of corticosteroids may produce posterior subcapsular cataracts, glaucoma with possible damage to the optic nerves, and may enhance the establishment of secondary ocular infections due to fungi or viruses.

Average and large doses of hydrocortisone or cortisone can cause elevation of blood pressure, salt and water retention, and increased excretion of potassium.

While on corticosteroid therapy, patient should not be vaccinated against smallpox. Other immunization procedures should not be undertaken in patients who are on corticosteroids, specially on high dose, because of possible hazards of neurological complications and a lack antibody response.

Children who are on drugs, which suppress the immune system, are more susceptible to infections than healthy children.

Chickenpox and measles, for example, can have more serious or even fatal course in non-immune children or adults on corticosteroids.

Pediatric use: ln the treatment of endocrine disorders such as primary and secondary adrenocortical insufficiency in infancy, mineralocorticoid supplementation is of particular importance. lnfants born to mothers who have received substantial doses of corticosteroids during pregnancy should be carefully observed for signs of hypoadrenalism. lmmunization procedures should not be undertaken in patients who are on corticosteroids. Pediatric patients who are on drugs which suppress the immune system are more susceptible to infections than healthy pediatric patients. Chickenpox and measles, for example, can have more serious or even fatal course in non-immune patients on corticosteroids. Growth and development in pediatric population on prolonged corticosteroid therapy should be carefully observed. See contraindications and warnings for complete information.

Store in a cool and dry place, protected from light. Keep out of the reach of the children.