Traditional medicine

Glucocorticosteroid action. Characteristics and list of glucocorticosteroid drugs: rules for the use of hormonal drugs for renal diseases

For the correct, coordinated functioning of each organ and system of the body, it is necessary to maintain normal levels of hormones. The adrenal glands are paired endocrine glands. This is a component of the endocrine regulatory system that controls all processes occurring in the human body. The main function of the adrenal glands is the production of hormones called corticosteroids. They support immune strength, protect the body from harmful external factors, suppress inflammation, regulate metabolism and other important physiological processes. Depending on the functions performed, glucocorticosteroid hormones (glucocorticoids) and mineralocorticoids are distinguished. The role of glucocorticosteroids was first discovered by rheumatologist F. Hench in 1948. He noticed that in a woman suffering from rheumatoid arthritis, the severity of articular syndrome decreased significantly during pregnancy. This gave rise to the creation of analogues of glucocorticosteroids produced by the adrenal cortex and their widespread use in clinical medicine.

What are glucocorticosteroids?

What are glucocorticosteroids? - All drugs included in the group - steroids, have a certain biological activity. They are divided into substances of natural (cortisone, hydrocortisone) and synthetic origin (synthesized analogues of natural hormones, derivatives, including fluorinated ones, of the most active natural hormone hydrocortisone). Artificially created substances are stronger, are used in smaller dosages, and do not affect mineral metabolism. Their use does not pose a high risk of side effects. Most clinically significant classification of glucocorticosteroids– according to the duration of the therapeutic effect. According to these parameters, drugs are distinguished:

Short-acting - with a biological half-life of 8-12 hours. These are basic remedies for the treatment of skin pathologies, inflammatory and allergic manifestations, usually used externally, in this case they have the least impact on the water-salt balance. Tablets and injections are used primarily as hormone replacement therapy when their natural production is reduced or stopped.
With an average duration of effect - with a half-life of 18-36 hours. The most used group of drugs in clinical practice. The strength of the effect is 5 times greater than short-acting glucocorticosteroids, inferior to them in mineralocorticoid activity, and less likely to cause adverse effects for the body.
Long-acting - drugs with an active component, the concentration of which in the plasma will be halved after 36-54 hours. The anti-inflammatory effect of such drugs is 6-7 times stronger than Prednisolone; they do not affect the processes of mineral metabolism. When using them, various adverse reactions often occur. Not recommended for long-term use.

How do glucocorticosteroids work?

The extensive and multifaceted effects exerted by glucocorticosteroids are due to the ability of the active substance molecule to penetrate the membrane into the cell and act on the genetic apparatus at the level of transcription and processing of ribonucleic acid. By binding to cytoplasmic receptors located inside target cells, they form an active complex that penetrates the cell nucleus and affects the synthesis of activator proteins, which are natural regulators of genes. By interacting with nuclear factors, glucocorticosteroids change the immune response, directly and indirectly reducing the formation of substances that contribute to the development of inflammation - prostaglandins, highly active lipid inflammatory mediators leukotrienes, membrane phospholipid mediators PAF (platelet aggregation factor). The full mechanism of influence has not yet been fully studied.

It takes from half an hour to several hours for genomic effects to develop. At higher doses, non-genomic or receptor-mediated effects are realized. Action of glucocorticosteroids in this case, it appears within 1-2 minutes after application. The ability to quickly, within a few seconds, influence the membranes of target cells, changing their physicochemical properties and reducing the process of release of allergic and inflammatory mediators, allows you to instantly alleviate the patient’s condition and save his life. The main effects of taking glucocorticosteroids are as follows:

anti-inflammatory effect – inhibit inflammatory phenomena of any nature and stage of development, reduce the permeability of the cell membrane to inflammatory mediators, and the migration of immune cells to the site of inflammation;
anti-shock, anti-stress - increase blood pressure, stimulate the production of a large number of blood cells, which allows you to fight a state of shock and quickly replenish blood loss;
immunoregulatory effect - in low doses they slightly increase immunity, in high concentrations they suppress the functions of the immune system many times, which determines the use of glucocorticosteroids in transplantology for tissue and organ transplantation - bone marrow, kidneys, radiation therapy, chemotherapy of malignant neoplasms, during the treatment of autoimmune diseases ;
affect metabolism - slow down the excretion of sodium, water, chlorine from the body, increase the leaching of potassium and calcium from the bones, suppress its absorption. They increase glucose levels, impair sugar processing, disrupt protein and lipid metabolism, redistributing subcutaneous fat tissue - increasing its volume on the face, neck, chest and decreasing it in the extremities. Promote muscle atrophy, the appearance of stretch marks on the skin, delayed scarring of wounds, hemorrhages, and the development of osteoporosis;
anti-allergic effect – suppresses the clinical manifestations of allergies;
pain relief – reduce the severity of pain, improve the functionality of joints;
antipyretic, anti-edematous effect - eliminate fever, reduce or completely remove swelling, incl. mucous membranes;
adaptogenic – increase the body’s resistance to the harmful effects of physical, chemical, biological factors;
facilitate the work of the heart and blood vessels - reduce capillary permeability, tone, strengthen the walls of blood vessels, normalize the contractile function of the heart muscle;
affect the endocrine system - reduce the production of sex hormones, suppress the connection between various parts of the brain and the adrenal glands, interact with other hormones, reduce the sensitivity of tissues to them;
hemodynamic, hematological effect - greatly changes the blood picture, causes a deficiency of lymphocytes, leukocyte cells, stimulates the production of platelets, erythrocytes.

Indications for use

A wide spectrum of pharmacological action makes glucocorticosteroids almost universal drugs. In addition to their independent medicinal properties, they have the ability to enhance the effect of other drugs. This allows them to be used in the treatment of severe diseases of the spine and joints that cannot be treated with non-steroidal anti-inflammatory drugs and require complex therapy. Thus, treatment with glucocorticosteroids is indicated for the following pathologies:

inflammation of individual joints, small and large, accompanied by severe swelling, severe pain, rapid accumulation of inflammatory fluid released from the blood vessels in the tissues and cavity of the joint, which is fraught with rapid destruction of articular cartilage;
damage to the connective tissue of joints, tendons and other organs caused by autoimmune or rheumatic diseases - systemic lupus erythematosus, scleroderma, Sjogren's syndrome, Still's syndrome, polymyalgia rheumatica, dermatomyositis, vasculitis;
non-infectious joint changes - arthrosis deformans, rheumatoid arthritis;
inflammatory processes in the synovial, joint capsule, spinal cord and membranes;
spinal injuries, postoperative period;
damage to the axial skeleton, peripheral joints in ankylosing spondylitis.

Beyond rheumatology glucocorticosteroid therapy prescribed in many other areas of clinical medicine. Indications for use are:

respiratory failure - interstitial pneumonia, bronchial asthma, status asthmaticus, COPD;
exudative enteropathy, celiac disease, inflammatory diseases of the gastrointestinal tract - Crohn's disease, ulcerative colitis;
kidney dysfunction, viral, chronic hepatitis, liver cirrhosis, glomerular nephritis, adrenal insufficiency;
skin diseases - dermatitis, scaly lichen, eczema, diseases of the neurogenic-allergic type;
pathologies of the nervous system, optic neuritis, non-infectious inflammation of the cornea, conjunctiva, iris, ciliary body of the eyeball, scleritis of the eye, uveitis;
acute and chronic inflammation of the ear, nasal mucosa, eczema of the external ear;
hematological pathologies, thyroid thyrotoxicosis, transplant rejection, myocardial damage;
allergic reactions, oncological processes, traumatic shock.

Admission rules

The dosage and regimen depend on the route of administration. It is not recommended to divide the daily dose into 3 doses; it is preferable to take GC in the morning or in the morning and evening hours. For each disease, a specific form of the drug is prescribed. There are several of them:

Glucocorticosteroid tablets are used for systemic diseases and chronic pathologies. This is the main method of application. Depending on the degree of activity of the disease, a one-time dose or a course of treatment is prescribed, lasting no more than a month. The daily dosage is determined based on the patient’s weight and is usually 1 mg/kg. The tablets are quickly and almost completely absorbed. Should be taken separately from food, because it slows down absorption.
Injectable forms of drugs are the most effective method of administration and have a maximum duration of action. Available in the form of ethers, solutions for intra-articular, intramuscular injections and for intravenous infusion. They do not begin to act immediately - the effect develops after a few hours, and for suspensions that are poorly soluble in water after 1-2 days, maximum 4-8. The effect lasts up to 1 month. Water-soluble glucocorticosteroids act quickly, but for a short time. Practiced in emergency situations, in cases of shock, severe forms of allergies - they are administered intravenously or intramuscularly. Intra-articular injections are used most often, because... act locally without significantly affecting other systems. The injection is given once, then the body’s response to the hormone is determined within a week, and if the prognosis is favorable, the injection is repeated.
Inhalation drugs are prescribed for respiratory diseases. Hormones are delivered to the affected organ using a nebulizer, are not absorbed into the blood, and do not act systemically. The effect is slow - it occurs after 7 days, reaching a maximum after 6 weeks.
Topical – used to treat skin allergies, dermatitis, subcutaneous inflammation. Applied to the skin directly in the affected area - local preparations, available in the form of ointments, lotions, gels, creams. Systemic absorption of the active substance with this method of administration is 5%. Lotions are convenient for applying to the scalp, ointments are greasy - they are chosen for dry skin, creams are quickly absorbed and are recommended for diaper rash. It should be taken into account that the more powerful glucocorticosteroids used in dermatology have fewer adverse reactions than weaker drugs.

To achieve a greater therapeutic effect in the case of severe, progressive inflammatory processes, acute relapses, injections into the joint are combined with a shortened course of tablets.

To quickly relieve painful symptoms during an exacerbation, pulse therapy is also used - a rapid infusion of large doses of the drug over 0.5-1 hour. Systemic diseases often require long-term, multi-year therapy.

Contraindications for use

With a one-time dose, the only limitation is established - individual intolerance to drugs of this series. Long-term use is not allowed for everyone. If it is necessary to use these potent drugs, the following conditions should be excluded:

diabetes, severe obesity, neuroendocrine disorder;
infectious blood poisoning, clotting disorders, frequent nosebleeds;
tuberculosis, immunodeficiency, syphilis, purulent infections, mycoses;
progressive osteoporosis of bones, infectious arthritis, fractures, joint surgeries;
mental disorders, hypertension, thromboembolism;
gastrointestinal diseases, severe renal failure, erosive and ulcerative lesions;
increased intraocular pressure, corneal diseases;
the period of bearing a child, breastfeeding, for 8 weeks before and 2 weeks after vaccination.

Side effects

Changes in hormonal balance lead to numerous undesirable consequences. They manifest themselves in varying degrees and forms, so the drug is prescribed only by a qualified doctor and in exceptional cases. Glucocorticosteroids can cause the following side effects:

neuromuscular diseases, osteoporosis, fractures, bone necrosis;
thinning skin, baldness, delayed scarring, acne;
mental disorders, depression, insomnia;
hoarseness, vision problems, cataracts, displacement of the eyeball;
atherosclerosis, high blood pressure, heart failure;
adrenal insufficiency, disruption of the endocrine system, metabolism, high glucose levels;
dysfunction of the digestive system, reproductive system, bleeding, thrush;
increased swelling, stomach pain, cough, dyspepsia.

Commonly Prescribed Drugs

From the group of short-acting drugs, the following are often prescribed:

ointment with glucocorticosteroids Hydrocortisone 1%, 10g – 28 rubles, eye ointment 0.5%, 5g – 56, Russia; Laticort 0.1%, 15g – 147 rubles, Poland; Lokoid 0.1%, 30g – 290 rub., Italy;
suspension for injections Hydrocortisone-Richter, 5 ml bottle – 230 rubles, Hungary;
emulsion Lokoid Crelo 0.1%, 30g – 315 rub., Italy;
tablets Kortef 0.01, 100 pcs. – 415 rubles, Canada; Cortisone 0.025, 80 pcs. – 900, Russia;
lyophilized powder for IV, IM Solu-Cortef 0.1, 100 mg – 94 rubles, Belgium.

The most popular are representatives of the group of glucocorticosteroids with an effect of medium duration:

tablets Medrol 0.032, 20 pcs. – 660 rub., Italy; Metypred 0.004, 30 pcs. – 204, Finland; Prednisolone 0.05 100 pcs. – 70, Russia; Kenalog 0.004, 50 pcs. – 374, Slovenia; Polcortolon 0.004, 50 pcs. – 393, Poland;
lyophilisate for IV, IM Solu-Medrol 1.0, 15.6 ml – 473 rubles, Belgium;
solution for intravenous, intramuscular injections Prednisolone Bufus 0.03, 10 ampoules – 162 rubles, Russia; Medopred 0.03, 10 ampoules – 153, Cyprus; Prednisol 3%, 3 amp. – 33, India;
Maxidex eye drops 0.1%, 5 ml – 310, Belgium; Oftan-Dexamethasone 0.001, 5 ml – 220, Finland; Dexamethasone 0.1%, 10 ml – 120, Romania;
injection solution Dexamethasone 0.004, 10 amp. – 76, Russia; 25 amp. – 160, India; Dexamethasone-Vial 0.004, 25 amp. – 116, China.

Safety precautions, drug interactions

Glucocorticosteroids are a powerful therapy; inpatient treatment is recommended for patients who require them. This includes constant medical monitoring, the ability to promptly take all necessary tests (laboratory, ultrasound, ECG), observation by a specialist of the body’s reaction, and, if necessary, adjustment of the treatment regimen. It is important to consider the presence of withdrawal syndrome, which requires a gradual reduction in dosage in order to prevent Addisonian crisis. simultaneous use with other drugs. During treatment with glucocorticosteroids, certain safety precautions should be observed:

Take the minimum dose, do not exceed the daily dosage and frequency of administration prescribed by your doctor.
To avoid addiction, avoid unnecessarily prolonged treatment with GCs.
Before intra-articular administration, it is necessary to remove the exudate accumulated in the joint cavity and prevent the drug from entering the joint cavity and muscle tissue.
Intra-articular and intravenous injections are performed by a specialist under particularly sterile conditions; the limit must be observed - no more than 3-4 injections into one joint during the year.
Do not take it together with any other medicine without first consulting your doctor.

Following these simple rules will allow you to cope with severe inflammation, chronic pathology, allergies, and progressive joint disease without the risk of serious side effects. Self-medication and incorrectly selected dosage can result in various complications - hormonal imbalance, diabetes or osteoporosis.

Chemical and biochemical processes constantly occur in the human body, as a result of which certain substances are produced. They affect the functionality of organs and systems, all processes occurring at the cellular level. The study of such components—hormones—allows us not only to understand their functionality and mechanisms of action, but also to use them for therapeutic purposes. Hormone replacement treatment for many patients is the only solution for diseases that cannot be treated with other medications. Glucocorticosteroid drugs are used in dental, gynecological, urological, dermatological and other practices. So, glucocorticosteroids, what are they?

Pharmacological action of GCS

Glucocorticosteroids (another name is glucocorticoids) are steroid hormonal substances, which are included in the subclass of corticosteroids, produced in the body by the adrenal cortex. These are cortisol (has the greatest biological activity), corticosterone, etc.

Worth knowing: glucocorticoids have a powerful anti-stress effect and anti-shock effect. Their concentration in the blood increases sharply against the background of a stressful situation, injury, accompanied by blood loss. An increase in hormone levels in such situations is associated with the body’s adaptation to intense blood loss, shock, the consequences of injury, and other negative influences.

The effect of glucosteroid hormones on the human body is as follows:

Helps increase systolic and diastolic pressure;
Increase the susceptibility of the cell walls of the heart muscle to the effects of catecholamines;
Prevent loss of receptor sensitivity with high levels of catecholamines;
Stimulates the production of leukocytes in the body;
Increase glucose synthesis in the liver;
Increases sugar concentration;
Inhibits the penetration of glucose into peripheral tissues;
Accelerate the production of glycogen;
Inhibits the process of production of protein substances and their breakdown;
Glucocorticosteroids remove calcium and potassium, ensure the accumulation of water, chlorine and sodium in the body;
Slows down the development of allergic reactions.

Glucocorticoid hormones “control” the consumption of lipids in subcutaneous tissue cells and affect the susceptibility of soft tissues to the effects of certain hormones. In addition, these substances affect the activity of the immune system - they inhibit the activity of some antibodies, but accelerate the formation of other cells, etc. The list of properties of hormones can be continued indefinitely. It is possible that they take an active part in other processes about which nothing is yet known.

So, glucocorticosteroids, what are they? These are hormones that are produced in the body of every person. They have many properties. But one of the most valuable actions that determines the use of GCS is its anti-inflammatory effect. GCS inhibit the activity of certain enzyme components in the body, which leads to rapid relief of inflammatory processes.

Hormones prevent the formation of edema at the site of inflammation, since they reduce the permeability of the vascular walls. They also trigger the production of other substances that have anti-inflammatory properties.

Important: glucocorticosteroids are drugs with a wide spectrum of effects, the use of which is allowed only for strict medical indications. Independent use is fraught with numerous complications.

Indications for use

Glucocorticosteroid drugs are prescribed for the treatment of adrenal pathologies. It is advisable to take them against the background of acute or chronic forms of renal failure, with congenital hyperplasia of the cortical layer. In these diseases, the natural production of hormones is disrupted, so the use of medications is required to restore hormonal balance.

Treatment of autoimmune diseases(for example, with rheumatism, sarcoidosis). Their purpose is based on their ability to accelerate or suppress certain immune processes. GCS is prescribed for the treatment of rheumatoid arthritis.
Therapy of pathologies of the urinary system, including those of an inflammatory nature (the purpose is due to its anti-inflammatory properties).
GCS for an allergic reaction are used as medications that affect the production of active components that enhance the reaction of physiological intolerance to irritants - allergens.
Hormone replacement therapy recommended for diseases of the respiratory system (against the background of bronchial asthma, allergic rhinitis, pneumonia). Note that hormonal medications differ in the mechanism and speed of action. Some medications work relatively quickly, others slowly. Slow-acting drugs cannot be used to relieve acute symptoms.
In dental practice GCS are prescribed for pulpitis, periodontitis and other diseases.
Therapy of dermatological diseases. As a rule, a cream or ointment based on hormonal substances is prescribed. They help relieve inflammatory processes in the dermis, relieve negative symptoms - rashes, hyperemia of the skin, ulcerative lesions, etc.
Treatment of gastrointestinal pathologies(Crohn's disease).
GCS are prescribed for injuries, which is based on anti-inflammatory and anti-shock effects.
In complex treatment against the background of cerebral edema.

Many medications have been created based on compounds that belong to the group of glucocorticosteroid hormones. They come in different dosage forms - lotions, balms, creams, ointments, gels, sprays, tablets for internal use.

Names of glucocorticosteroid drugs: Cortisone, Triamcinolone, Hydrocortisone, Prednisolone, Beclomethasone, Dexamethasone, etc. Hormone replacement therapy has its own characteristics; only a medical specialist prescribes medications that contain hormonal substances.

Possible side effects of glucocorticosteroids

Glucocorticosteroid drugs are used due to their effectiveness in the treatment of many diseases. They help restore hormonal balance in the body, which eliminates a number of pathologies. But hormonal treatment is not always safe, as it often leads to negative effects. That is why the drugs have strict indications.

The most common negative phenomena include:

Deterioration of the skin condition, hair, the appearance of stretch marks, acne, boils;
Intensive hair growth in women on atypical areas of the body (for example, on the chest, face, etc.);
Deterioration of blood vessels(strength, elasticity and resilience decrease);
Harmful effects on the central nervous system. It is manifested by sleep disturbance, emotional lability, causeless irritability, neurosis, apathy, depression and other pathological conditions;
Visual perception disorders.

Please note: glucocorticosteroids can provoke the development of diabetes mellitus (impaired absorption of sugar in the blood), peptic ulcers, arterial hypertension (chronically high blood pressure), immunodeficiency, obesity, etc.

In medical practice, cases are identified when GCS led to a rapid infectious process in the body. This is due to the fact that, against the background of the presence of pathogenic microorganisms, the drugs lead to a decrease in immunity, as a result, bacteria begin to actively multiply, since the immune system cannot cope with them.

Harmful phenomena develop not only with prolonged use or due to overdose, but also in cases where the patient takes medications according to instructions. Also, their development occurs against the background of drug withdrawal (withdrawal syndrome), because when receiving hormonal substances from the outside, the adrenal glands do not produce them on their own.

Upon completion of hormonal therapy, the following symptoms are often observed:

Muscle pain.
Decreased appetite.
Lethargy, apathy.
Increase in body temperature.
Exacerbation of chronic diseases with a history.

The most dangerous consequence of the use of glucocorticosteroids is the occurrence of acute adrenal insufficiency. It is characterized by a sharp decrease in blood pressure, disruption of the digestive process, abdominal pain, a state of lethargy, and convulsions.

Glucocorticosteroids have a withdrawal syndrome, so stopping their use on your own is no less dangerous than self-medicating. Therapy must be completed under the supervision of a doctor. The dose is reduced gradually, which reduces the severity of side effects.

Contraindications to treatment with GCS

Glucocorticosteroid drugs are not always prescribed because they have an extensive list of contraindications. You should not use medications during pregnancy or breastfeeding - this can lead to disruption of intrauterine development and other complications. Contraindications include the following diseases:

Malignant hypertension (high blood pressure that is difficult to respond to blood pressure-lowering medications);
Blood circulation disorders of any origin;
Syphilis, tuberculosis;
Diabetes mellitus;
Endocarditis;
Jade, etc.

Hormonal medications cannot be used to treat infections if there is no additional protection of the body from the occurrence of other infectious pathologies. For example, a patient uses a topical ointment with hormones, which leads to a decrease in local immunity, as a result, a fungal infection develops.

Glucocorticosteroids allow you to achieve the desired effect where other drugs are powerless. The dosage, frequency of use and duration of the treatment course are always determined individually. The medical specialist is obliged to tell the patient about all the nuances of use and withdrawal syndrome.

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

General information

Glucocorticoids are called steroid hormones secreted by the adrenal cortex, as well as their artificial analogues used in medicine.
The first samples of these drugs date back to the 40s of the twentieth century and the first hormones used were hydrocortisone and cortisone.

In total, five hormones of this group have been studied to date ( presented by the degree of impact on processes in the body in descending order):

Hydrocortisone
Cortisone
Corticosterone
11-deoxycortisol
11-dehydrocorticosterone.

The function of hormone production is regulated by the brain, more precisely by the pituitary gland. The maximum level of these hormones is produced in a person at the age of 30, and subsequently it gradually decreases.

Classification of drugs

All drugs in this group are divided into:

natural ( hydrocortisone and cortisone),
synthetic.

Synthetic ones, in turn, are divided into:

halogenated ( beclomethasone, dexamethasone, fluticasone),
non-halogenated ( prednisolone, budesonide, clobetasol).

Most synthetic drugs are more powerful, so smaller dosages are used. The most promising are fluorinated glucocorticoids, which act effectively, while they practically do not disturb the water-salt balance and provoke fewer side effects.

According to the duration of exposure, all drugs can be divided into:

short acting ( cortisone, hydrocortisone),
medium duration action ( prednisolone, methylprednisolone),
long-acting ( dexamethasone, betamethasone, triamcinolone).

Action

Scientists have not yet fully figured out the mechanism of action of these hormones on the body. Entering the cell through the cell membrane, the hormone acts on receptors sensitive to steroid substances, is sent along with the receptor to the cell nucleus and participates in the production of special protein components involved in the inflammatory process.

Hormones influence the following processes occurring in the body:

Carbohydrate metabolism. The processing of sugar in the body worsens, sometimes taking medications causes diabetes mellitus.
Protein metabolism. Protein production in bones, muscles and skin is suppressed. Therefore, a patient taking these drugs loses weight, has stretch marks on the skin, hemorrhages, cuts and scratches scar poorly, and muscles atrophy. Osteoporosis often develops.
Lipid metabolism. There is an increase in the amount of subcutaneous fat in the face, neck, chest and a decrease in volume in the arms and legs.
Calcium metabolism. Hormones of this class suppress the absorption of calcium by the intestines and accelerate its leaching from the bones. Therefore, there is a possibility of developing calcium deficiency.
Work of the heart and blood vessels. Under the influence of these hormones, the permeability of small blood vessels worsens. Hormones tone blood vessels and contractility of the heart muscle.
Inflammatory process. Any inflammatory manifestations are suppressed, since glucocorticoids reduce the permeability of cell membranes to certain substances involved in the inflammatory process. In addition, the walls of blood vessels are strengthened, which inhibits the movement of immune cells in the lesion.
Regulation of immunity. These hormones suppress the local immune response, which is why they are used in tissue transplantation. They suppress the activity of certain immune cells ( lymphocytes and “anti-inflammatory” cytokines), involved in the development of diseases such as meningitis and rheumatism.
Blood formation. Under the influence of these hormones, the production of lymphocytes, eosinophils, and monocytes simultaneously decreases and the production of erythrocytes and platelets increases. Even a single dose of the drug for a day changes the blood picture. If the treatment was long-term, it takes from 7 to 30 days to restore the normal picture.
The work of the endocrine glands. The connection between the hypothalamus, pituitary gland and adrenal glands is suppressed. This disorder becomes noticeable with long courses of taking medications. The production of sex hormones also decreases, which leads to the development of osteoporosis.

Indications

Adrenal insufficiency of any origin,
Shock therapy,
Rheumatism,
Acute lymphoblastic and myeloblastic leukemia,
Infectious mononucleosis,
Asthmatic status,
Allergies complicated by collagenosis, dermatoses, asthma,
Inflammations of different localizations,
Hemolytic anemia,
Acute pancreatitis,
Viral hepatitis,
Organ and tissue transplantation,
Autoimmune diseases.

The dosage regimen is prescribed by the attending physician. It should be borne in mind that in most cases, drugs significantly alleviate the patient’s condition, but do not in any way affect the cause of the disease.

Contraindications

Absolute:

Fungal diseases
Viral infections,
Individual intolerance.

Relative:

Severe osteoporosis,
Diabetes mellitus
High degree of heart failure
High blood pressure
Stomach or intestinal ulcer
Mental disorders.

Relative contraindications are taken into account in cases where long-term treatment is involved.
If we are talking about urgently saving the patient’s life, the drugs are used in any case.

More information about essential drugs

Cortisone
Used for replacement therapy in patients with adrenal insufficiency. Produced in tablets. Used only when the liver is functioning normally. Affects the exchange of water and salts.

Hydrocortisone
Prescribed for adrenal insufficiency. Not recommended for edema, cardiac dysfunction, hypertension, as it contributes to sodium retention in the body and potassium excretion. Produced in the form of liquid for injection, suspension.

Prednisolone
Quite a frequently prescribed drug. It is produced in the form of tablets, liquid and suspension for injection, powder in ampoules.

Methylprednisolone
Stronger than prednisolone, it causes fewer side effects and is more expensive. Indicated for patients suffering from obesity, stomach ulcers, and mental illness. Available in the form of tablets, suspensions, dry substances in bottles.

Dexamethasone
This is one of the most powerful drugs in this group. Since the drug has many side effects, it is not used in long courses. Prescribed, among other things, to alleviate the patient’s condition during chemotherapy, as well as to prevent breathing problems in premature infants. Available in the form of tablets and liquid for injection in ampoules.

Betamethasone
It is similar in power to dexamethasone and has fewer side effects. Most often used in the form of liquid for injection, including intra-articular and periarticular. The duration of action of such injections can reach a month due to the special chemical composition of the drug.
Produced in the form of tablets, liquid in ampoules, suspensions.

Inhalation medications

Beclomethasone– the drug is used in the treatment of bronchial asthma, relieves inflammation and relieves allergies. When used as inhalation, it is practically not absorbed into the blood and does not act systemically.

Contraindications:

acute bronchospasm,
intolerance,
status asthmaticus,
bacterial bronchitis.

The drug may cause some side effects, including bronchospasm and sore throat.

Budesonide– main therapy for bronchial asthma, chronic obstructive pulmonary disease.
Contraindications: individual intolerance. Liquid for inhalation is prohibited for use in the treatment of children under 16 years of age, suspension is prohibited for use in the treatment of children under 3 months of age, and powder for children under 6 years of age.

pregnancy, breastfeeding, fungal, viral and bacterial diseases of the respiratory system, tuberculosis.

The drug can provoke a coughing attack, drying of the oral mucosa, migraine-like pain, stomatitis, nausea, and hyperactivity.
The drug should not come into contact with the eyes.

Fluticasone– the drug is prescribed for bronchial asthma and chronic obstructive pulmonary disease as the main treatment.
Contraindications:

non-asthmatic bronchitis,
intolerance,
acute bronchospasm,
asthmatic status.

Relative contraindications:

osteoporosis,
common infections,
breastfeeding,
pregnancy.

The drug is used only in the form of inhalation. It can provoke candidiasis of the oral mucosa, changes in voice timbre, and bronchospasm. If used for a long time in large quantities, it causes systemic side effects. To prevent oral candidiasis, rinse your mouth after inhalation.
This drug is not used to relieve asthma attacks.

Preparations for systemic use

Drugs have been created for systemic use prednisone, cortisone.
There are quite a lot of drugs that are used both locally and systemically. These include: betamethasone, dexamethasone, triamcinolone, fludrocortisone, mazipredone, methylprednisolone, prednisolone.
Such drugs are used both in the form of tablets for oral use and in injections.

Ointments, creams, lotions

Glucocorticoids for external use are available in the form of ointments, gels, creams, and lotions. Prescribed for certain dermatological diseases of a non-infectious nature.

Indications:

contact dermatitis,
seborrheic dermatitis,
lichen planus,
erythroderma,
discoid lupus erythematosus.

These remedies relieve inflammation, itching, allergic reactions, redness and swelling of tissues.

How to choose the right dosage form of the drug?
Ointments They begin to act more slowly and their consistency is greasy. They are prescribed for dry skin prone to flaking and weeping processes.

Creams may cause irritation or dryness if there are wounds on the skin. They are prescribed for intertriginous phenomena. This form does not leave greasy stains and is quickly absorbed.

Lotions indicated for wet conditions, very convenient for treating the scalp.

All glucocorticosteroids used in dermatology are divided into four groups according to the power of their effect:

Very powerful: chalcinonide, clobetasol propionate.
Powerful: budesonide, dexamethasone, flumethasone, triaminolone.
Medium strength: prednisolone.
Weak: hydrocortisone.

It should be borne in mind that drugs of medium strength and weak ones have a less pronounced effect, and the number of side effects is higher than that of more powerful drugs.

Side effects

Glucocorticosteroid drugs really very quickly relieve many unwanted symptoms of diseases. However, they cause quite a lot of side effects. Therefore, they are prescribed only in cases where no others are able to help.
Particularly many side effects are observed with the systemic use of these drugs. Several new methods have been developed for using these drugs, which slightly reduce the likelihood of unwanted effects. But treatment with these drugs in any case requires constant monitoring of the patient’s general health.

When using steroid hormonal drugs, the following side effects are likely to develop:

From the motion apparatus side: osteoporosis, compression inhibition of puberty and growth, amenorrhea, diabetes, suppression of adrenal function,
From the heart and blood vessels: increase in blood pressure,
From the immune system: manifestations of infectious diseases intensify, the picture of diseases becomes unclear,
Violation of the ratio of water and salts in tissues, swelling, and lack of potassium in the body are observed.

The first side effects that appear during treatment are sleep disturbances, gluttony, mood swings, and weight gain.

Use during pregnancy

Despite the fact that these drugs easily penetrate the placental barrier, they do not cause severe disturbances in fetal formation. During pregnancy, it is safer to use natural or non-fluoridated products. Fluoridated ones, if used for a long enough time, can provoke fetal development disorders.

In some cases, drugs of the glucocorticoid group are even specifically prescribed in case of likelihood of miscarriage to maintain pregnancy. Although, the use of such drugs is usually carried out only for health reasons, which include:

Hyperandrogenism ( overproduction of male sex hormones),
Threat of premature birth in the third trimester,
Congenital intrauterine hyperplasia of the adrenal cortex in the fetus.

A woman who has been using glucocorticoids for the past one and a half years is prescribed hydrocortisone hemisuccinate in the form of injections every six hours. This will prevent the development of acute adrenal insufficiency.

During lactation, use of small dosages of steroid drugs ( in terms of not exceeding 5 mg of prednisolone) cannot harm the baby, because glucocorticoids pass into breast milk in small doses. If the course of treatment is long and the dosages are high, the child may experience inhibition of growth and development, as well as suppression of the adrenal glands, hypothalamus and pituitary gland.

Since doctors learned in the middle of the last century that the adrenal cortex synthesizes glucocorticoids, drugs based on this group of hormones have rapidly entered medicine. Unexpectedly, it turned out that hitherto an unknown hormone lives in almost all cells of the body and helps fight inflammation, suppress aggressive immunity, eliminate the consequences of shock - and this is not a complete list of actions. Nowadays, drugs based on GCS can be found in many forms: tablets, IV and intramuscular injections, ointments, inhaled glucocorticosteroids. Why are these drugs so popular among doctors?

What is it?

Glucocorticoids – this is a certain type of hormone produced by the adrenal cortex. They are part of the larger group “corticosteroids”, a relative of which is mineralocorticoids. Glucocorticoids are often referred to as “glucocorticosteroids” because the words are synonymous.

Glucocorticoids can be found in almost all tissues of the human body in varying quantities. The main representative of GCS is cortisol, a derivative of Hydrocortisone. Corticosterone and cortisone may also be seen in smaller doses. These chemical compounds influence many negative processes occurring in the body.

Expert opinion

Filimoshin Oleg Alexandrovich

Doctor - neurologist, city clinic of Orenburg. Education: Orenburg State Medical Academy, Orenburg.

Initially, natural hormones were used in medicine, but their use was associated with a high risk of side effects, so now chemists use more advanced corticosteroids. For example, synthesized Dexamethasone is 30 times more effective than cortisol, and at the same time it is much less likely to cause side effects when used.

How do they work?

A Nobel Prize may be awarded for the answer to this question, because at the moment the exact mechanism of action of GCS is unknown. In general, they work in the same way as all hormones - they transmit information to other cells of the body about the processes occurring in the body. The pituitary gland is responsible for the release of glucocorticoids, which can release a special substance into the blood - corticotropin. When necessary, this chemical element orders the adrenal glands to secrete corticosteroids. More corticotropin means more cortisol, and vice versa.

Ask your question to a neurologist for free

Irina Martynova. Graduated from Voronezh State Medical University named after. N.N. Burdenko. Clinical resident and neurologist of the BUZ VO \"Moscow Polyclinic\".

Expert opinion

Mitrukhanov Eduard Petrovich

Doctor - neurologist, city clinic, Moscow. Education: Russian State Medical University, State Budgetary Educational Institution of Further Professional Education, Russian Medical Academy of Postgraduate Education of the Ministry of Health of the Russian Federation, Volgograd State Medical University, Volgograd.

How glucocorticoids work inside cells is a medical mystery. It is believed that in the nuclei of all cells there are special receptors, which, when different amounts of steroids enter them, begin to behave in a certain way. But this is just a guess.

How do they affect the body?

GCS have a wide spectrum of action. Main directions:

Anti-inflammatory. Drugs (glucocorticoids) strongly inhibit inflammation by reducing the activity of enzymes that destroy tissue. Under their influence, cell membranes become coarser, as a result of which the exchange of fluids and chemical elements between the affected and healthy areas decreases. They also suppress the synthesis of lipocortin proteins from arachidonic acid, which are responsible for the spread of inflammation.
Effects on other hormones. GCS affect other mediators, most of all insulin. The release of steroids into the blood during hypoglycemia is the body’s main weapon to quickly correct the situation.
Anti-stress, anti-shock. This group of hormones, when stressed or in shock, tells the bone marrow to produce more blood cells (in case of blood loss) and the cardiovascular system to raise blood pressure.
Immunoregulatory effect. At low doses in the blood, GCS slightly increases immunity; at high doses it can suppress it many times, up to 1% effectiveness compared to the norm. This property is used to prevent tissue rejection after transplants.
Antiallergic. The mechanism of this action is also not completely clear, but glucocorticoids effectively cope with the manifestations of allergies.
Effect on metabolism. Glucocorticosteroids can interfere with the metabolism of glucose, glycolytic enzymes, glycogen, various proteins, fats, sodium, chlorine, potassium, calcium, and water.

It is worth noting that not in all these cases GCS acts to benefit the body. For example, with prolonged exposure to large amounts of the hormone, calcium is washed out of the bones, causing the patient to develop osteoporosis (increased skeletal fragility).

When are they prescribed?

The list of diseases that are treated with these steroids comes from their areas of action mentioned above. The main indications for use are as follows:

Allergic reactions, most often asthma. Despite the fact that the mechanism of action on allergic reactions has not yet been clarified, almost every asthmatic has inhaled glucocorticosteroids (ICS) in cans.
Non-infectious skin inflammations. The ability of GCS to reduce inflammation has found wide application in dermatology. In the case of infectious inflammation, the glucocorticoid used in treatment must be combined with a drug that kills the infection.
Anemia, diseases of the hematopoietic system. Medicines based on this stimulate the bone marrow to produce blood cells.
Injuries, rheumatic diseases. Typically, such a diagnosis includes inflammation, stress on the body, and a violation of the body's defense mechanisms.
The period after tissue and organ transplantation, radiation and chemotherapy. GCS changes the immune system's response to these factors, which has a positive effect on the dynamics.
Adrenal insufficiency. In this case, the drugs have the most direct effect - they replenish the lack of hormones in the blood that the adrenal glands should supply.

In addition to these indications, there are more specific ones. In such cases the decision to use glucocorticosteroids should be made by an experienced physician.

Side effects from the use of GCS

To interfere with the hormonal balance of the body means to interfere with the normal communication of body parts with each other. Adverse reactions from this action can be quite serious:

Osteoporosis. Due to changes in metabolism, calcium is eliminated from the body faster, which leads to bone fragility.
Emotional instability, psychosis. Caused by changes in the functioning of the pituitary gland.
Steroid diabetes. Steroids increase blood glucose levels.
Adrenal insufficiency. This may seem strange, given that a similar disease is an indication for use. But long-term exposure to drugs with corticosteroids on the body causes the adrenal glands to work less efficiently, since there are already a lot of hormones in the blood, and if the drug is abruptly discontinued, the adrenal glands are no longer able to provide the body with the required amount of glucocorticosteroids.
Bleeding, ulcers. An increase in the production of blood cells leads to a load on the circulatory system, and it can “break down.”
With a long-term (more than 1.5 year) course of treatment in children, sexual development is sometimes suppressed due to suppression of the adrenal glands.
Obesity, acne, puffy face, menstrual irregularities. These side effects are caused by hormonal imbalances.
Various eye diseases.

Local adverse reactions occur when using ointments and inhalers.

Ointments are usually cause dry skin due to low cell permeability, and inhalers almost always lead to cough, dry mouth, and hoarseness.

It is worth noting that almost all the consequences of using these drugs are reversible. Only diabetes, growth retardation in children and subcapsular cataracts are irreversible.

Use with caution!

Glucocorticosteroids are a powerful drug, but dangerous due to adverse reactions. They should be used for as short a course as possible and only under the constant supervision of a doctor. The surest way is treatment in a hospital, under the supervision of doctors who can take the necessary tests, do an ultrasound or ECG if necessary.

The drug has a withdrawal syndrome, so treatment should be ended smoothly, gradually reducing the dose of the drug. A mild version of the withdrawal syndrome is manifested by fever and malaise. Severe can lead to Addisonian crisis.

Contraindications

If one-time use is necessary, the only absolute contraindication is the patient’s individual intolerance to GCS. Long-term therapy should not be prescribed to people with:

diabetes;
pregnancy;
syphilis, tuberculosis, recently cured of infection;
Itsenko-Cushing's disease;
psychosis;
diseases of the liver, kidneys, gastrointestinal tract and circulatory system (each disease is individual, you need to check with your doctor);

Glucocorticoid drugs should only be prescribed to children in extreme cases.

Ointments and drops should not be used if there are infections at the sites of use.

Complications after taking

Common complications are diseases from the list of side effects. If they occur, you need to reconsider the dose or discontinue the drug altogether.

Self-medication with the wrong dose will most likely result in hormonal imbalance or diabetes.

Duration of action of GCS

Drugs (glucocorticosteroids) are divided into three types: short-acting, medium-acting and long-acting. Short-acting corticosteroids remain in the blood for 2-12 hours, medium-acting ones for 0.75-1.5 days, and long-acting ones for 36 to 52 hours.

The duration of action largely depends on the route of administration.

Methods of application

Methods of application include: pills(systemic glucocorticosteroids); injections(for joint diseases or as an alternative to tablets); ointment, gel, cream, plasters(topical glucocorticosteroids); inhalers(inhaled glucocorticoids).

Glucocorticoids in tablets are used for acute pulmonary diseases, such as bronchial asthma, chronic obstructive pulmonary disease, pneumonia and others. The medicine is almost completely absorbed from the stomach, peak concentration in the blood is reached after an hour and a half.

When it is not possible to give the patient systemic corticosteroids in the form of tablets or the drug needs to act faster, intravenous or soft tissue administration is used. The same tactics are used for joint diseases - corticosteroids are injected directly into the damaged ligament.

Topical application to the skin is successful in treating subcutaneous inflammation and allergic reactions on the skin. In addition, when used correctly, this option is quite safe in terms of side effects.

Inhalers deliver a dose of medication directly into the bronchi and lungs. This type has become very widespread among asthmatics, since inhaled glucocorticoids are the most convenient and effective way to control asthma.

List of medications

Active ingredients are divided according to duration into:

Short-acting corticosteroids: Alclomethasone, Budesonide, Hydrocortisone, Clobetasol, Cortisone, Mazipredone, Mometasone, Flunisolide, Fluocortolone, Fluocinolone acetonide, Fluticasone, Cyclesonide;
Medium-duration corticosteroids: Methylprednisolone, Methylprednisolone aceponate, Prednisolone, Triamcinolone, Fludrocortisone;
Long-acting corticosteroids: Beclomethasone, Betamethasone, Dexamethasone.

Glucocorticoids for oral use

Budenofalk, Budesonide;
Decdan, ;
Dexasone, Dexamethasone;
Dexamethasone, Dexamethasone;
Megadexane, Dexamethasone;
Fortecortin, Dexamethasone;
Cortisone, Cortisone;
, Methylprednisolone;
Apo-prednisone, Prednisone;
Prednisol;
Prednisolone, Prednisolone;
Berlicourt, ;
Polcortolone, Triamcinolone;
Triamcinolone, Triamcinolone;
Tricort, Triamcinolone;
Cortineff, Fludrocortisone.

Glucocorticoids for injection

Betamethasone sodium phosphate, Betamethasone;
Betamethasone dipropionate, Betamethasone;
Celeston, Betamethasone;
Decdan, Dexamethasone;
Dexasone, Dexamethasone;
Dexabene, Dexamethasone;
Dexafar, Dexamethasone;
Fortecortin Mono, Dexamethasone;
, Hydrocortisone;
Solu-Cortef, Hydrocortisone;
Urbazon, Methylprednisolone;
Medopred, Prednisolone;
Prednisolone, Prednisolone;
Prednisolone sodium phosphate, Prednisolone;
Solyu-Decortin N, Prednisolone;
, Triamcinolone;
Tricort, Triamcinolone.

Inhaled glucocorticoids

Beclazon, Beclomethasone;
Beclodet 250, Beclomethasone;
Beclomethasone, Beclomethasone;
Beclospir, Beclomethasone;
Becodisk, Beclomethasone;
Becotide, Beclomethasone;
Klenil, Beclomethasone;
Plibecort, Beclomethasone;
Rinoclenil, Beclomethasone;
Benacort, Budesonide;
Budesonide, Budesonide;
Asmanex Twistheiler, Mometasone;
Azmacort, Triacinolone;
Ingacort, Flunisolide;
Alvesco, Cyclesonide.

GCS for intranasal use

Aldecin, Beclomethasone;
Nasobek, Beclomethasone;
Budoster, Budesonide;
Tafen nasal, Budesonide;
Desrinit, Mometasone;
Nosephrine, Mometasone;
Sintaris, Flunisolide;
Nazarel, Fluticasone.

GCS for local use in ophthalmology, gynecology, etc.

Dexamethasone, Dexamethasone;
Dexoftan, Dexamethasone;
, Hydrocortisone;
, Prednisolone;
Prednisolone sodium phosphate, Prednisolone;
Rektodelt, Prednisone;
Cortineff, Fludrocortisone.

Ointment, gel or cream for external use

Afloderm, Alclomethasone;
Akriderm, Betamethasone;
Betliben, Betamethasone;
Betnovate, Betamethasone;
Celestoderm-B, Betamethasone;
Apulein, Budesonide;
Novopulmon E Novolizer, Budesonide;
Dermovate, Clobetasol;
Powercourt, Clobetasol;
Akortin, Hydrocortisone;
Laticort, Hydrocortisone;
Lokoid, Hydrocortisone;
Deperzolon, Mazipredone;
Advantan, Methylprednisolone aceponate;
Mometasone-Akrikhin, Mometasone;
Monovo, Mometasone;
Uniderm, Mometasone;
Ultralan, Fluocortolone;
Sinaflan, Fluocinolone acetonide;
Flucort, Fluocinolone acetonide;
Fluocinolone acetonide, Fluocinolone acetonide;
Flucinar, Fluocinolone acetonide.

Glucocorticosteroids are hormones produced by the adrenal glands. They can be found in almost all tissues of the body. They perform many functions, mainly developmental (in childhood) and therapeutic effects. For some illnesses, it is possible to increase the amount of glucocorticosteroids in the body through medication to combat complex inflammation, immune response, or other medical problem.

Glucocorticosteroids are a group of drugs of synthetic or natural origin (analogues of endogenous hormones) belonging to the subclass of adrenal hormones. It has antitoxic, antishock, immunosuppressive, desensitizing and anti-inflammatory effects.

List of drugs

The group of glucocorticosteroids includes many different substances, here are some of them:

Alclomethasone (for example, the drug Afloderm);
Beclomethasone dipropionate (Beclazon Eco, Aldecin, Beclodget, Klenil, etc.);
Betamethasone (Beloderm, Belogent, Diprospan, Nasobek, Celeston, etc.);
Budesonide (Pulmicort, Flumethasone, Seretide, etc.);
Dexamethasone (Maxidex, Ambene, Polydex, Maxitrol, etc.);
Hydrocortisone (Cortef, Oxycort, etc.);
Methylprednisolone (Metypred, Advantan, etc.);
Mometasone furoate (Nasonex, Momat, Elokom, etc.);
Prednisolone (Dermosolone, Aurobin, etc.);
Triamcinolone acetonide (Polcortolone, Kenalog, Fluorocort, etc.);
Fluticasone propionate (Flixotide, Flixonase, etc.);
Fluocortolone (Ultraproct, etc.).

Glucocorticosteroids are divided into three groups: short-, medium- and long-acting.

Mechanism of action and properties

Glucocorticosteroids are steroids by their chemical nature. In the animal and human body, the place of their formation is the adrenal cortex. The biological significance of these substances lies in their ability to increase the body’s resistance to the influence of various stress factors.

Glucocorticosteroids affect the processes of water, protein, mineral and carbohydrate metabolism in the body.

Created under artificial conditions, glucocorticosteroid drugs act as powerful antishock, antitoxic, immunosuppressive, desensitizing and anti-inflammatory agents.

The mechanism of action of glucocorticosteroids is due to their ability to diffusely penetrate into the cytoplasm through cell membranes. There, by binding to certain intracellular receptors, they influence protein synthesis. Hormones inhibit hyaluronidase and phospholipase A2, which are one of the main inflammatory enzymes.

Glucocorticosteroids stabilize cell membranes, thereby blunting the release of biologically active substances such as thromboxane, leukotrienes and histamine from mast cells. The drugs also significantly slow down the formation of anti-inflammatory cytokines from arachidonic acid.

The antitoxic and antishock effect of glucocorticosteroids is:

increased blood pressure (the concentration of catecholamines circulating in the blood increases, the sensitivity of antidepressants to them is restored, and blood vessels constrict);
reducing vascular permeability;
stimulation of liver enzymes that take part in the biotransformation of endo- and xenobiotics.

Glucocorticosteroids activate protein catabolism and gluconeogenesis in the liver, thereby producing the release of amino acids (substrates for gluconeogenesis) from peripheral tissues. As a result of these processes, hyperglycemia develops.

Glucocorticosteroids have an anabolic effect on protein metabolism in the liver and a catabolic effect on muscle, bone, skin, lymphoid and adipose tissue.

Glucocorticosteroid drugs enhance the lipolytic effect of growth hormone and catecholamines, reduce the consumption and release of glucose by adipose tissue. An excess of these hormones stimulates lipolysis in the extremities and lipogenesis on the body and face, and also helps to increase the level of free fatty acids in the plasma.

The biological effect of the use of glucocorticosteroids lasts for a long time.

Indications for use

When treating with glucocorticosteroids, oral, intranasal, parenteral (inhalation and injection) forms of drugs are used.

Medicines are prescribed in the form of injections and tablets in the following cases:

Crohn's disease;
Nonspecific ulcerative colitis;
Interstitial lung diseases;
Acute respiratory distress syndrome;
Severe pneumonia;
Chronic obstructive pulmonary diseases;
Bronchial asthma;
Subacute thyroiditis;
Congenital dysfunction of the adrenal cortex;
Acute adrenal insufficiency;
Replacement therapy for secondary chronic and primary adrenal insufficiency.

Intranasal glucocorticosteroid preparations are prescribed for vasomotor (idiopathic) rhinitis, non-allergic rhinitis accompanied by eosinophilia, nasal polyposis, persistent (year-round) and intermittent (seasonal) allergic rhinitis.

High effectiveness of inhaled glucocorticosteroids in the treatment of chronic obstructive pulmonary disease and bronchial asthma has been noted.

Contraindications

Contraindications to glucocorticosteroids are:

Glaucoma;
Diseases of the cornea combined with epithelial disorders;
Fungal or viral eye diseases;
Purulent infections;
Vaccination period;
Syphilis;
Active form of tuberculosis;
Herpes;
Systemic mycosis;
Mental illnesses with productive symptoms;
Severe renal failure;
Arterial hypertension;
Thromboembolism;
Breastfeeding period;
Stomach and duodenal ulcers;
Diabetes mellitus;
Itsenko-Cushing's disease.

Contraindications to glucocorticosteroids in intranasal form:

Increased sensitivity;
Hemorrhagic diathesis;
Frequent nosebleeds.

Side effects

When using glucocorticosteroids, adverse reactions from the body may be observed:

Central nervous system: psychosis, depression, euphoria, insomnia, increased excitability;
Cardiovascular system: thromboembolism, deep vein thrombosis, high blood pressure, myocardial dystrophy;
Digestive system: fatty liver, pancreatitis, bleeding from the gastrointestinal tract, steroid ulcers of the intestines and stomach;
Sense organs: glaucoma;
Endocrine system: Cushing's syndrome, obesity, diabetes mellitus;
Skin: alopecia, stretch marks, thinning of the skin;
Musculoskeletal system: muscle wasting, myopathy, growth retardation (in children), osteoporosis;
Reproductive system: hirsutism, sexual function and menstrual cycle disorders.

Local side effects are also possible when using inhaled and intranasal glucocorticosteroids.

Additional information

During treatment with glucocorticosteroids, chickenpox and measles are more severe.

People who are taking immunosuppressive doses of the substance should not receive live vaccines.

In most cases, with long-term use of oral and intranasal glucocorticosteroids, patients develop osteoporosis.