Diprolene

Definition

Medicines that are similar to the natural hormone cortisone and belong to the family of drugs called steroids.

Purpose

Corticosteroids are used in several forms, to treat many different conditions. Because they reduce itching, swelling, redness, and allergic reactions, they are often used in treating skin problems, severe allergies, asthma, and arthritis. These drugs also suppress the body's immune response, so they are used in patients who have received organ transplants, to reduce the chance of rejection. In people whose bodies do not produce enough natural corticosteroids, the drugs can raise the levels of those hormones. Corticosteroids also are used to treat certain cancers (along with other drugs), and to reduce inflammation in other medical conditions.

Description

Corticosteroids are medicines that are similar to the natural hormone cortisone. They affect many body processes, including the breakdown of protein, fat, and carbohydrate; the activity of the nervous system; the balance of salt and water; and the regulation of blood pressure. Because of their widespread effects, these drugs are useful in treating many medical conditions, but they can also have undesirable side effects.

These medicines come in a variety of forms, suitable for treating different conditions. For example, inhalant corticosteroids are used to prevent asthma attacks, while corticosteroid ointments, creams and gels are used to treat skin problems. Some examples of corticosteroids are beclomethasone (Beconase, Vancenase, Vanceril), betamethasone (Diprolene, Lotrisone), hydrocortisone, mometasone (Elocon), prednisone (Deltasone, Orasone), and triamcinolone (Azmacort, Nasacort).

Recommended dosage

Recommended dosage depends on the patient, the type and strength of the drug, and the form in which it is used. Also, the physician may change the dose during the course of treatment. Check with the physician who prescribed the drug or the pharmacist who filled the prescription for the correct dosage.

Always use corticosteroids exactly as the physician directs. Never take larger or more frequent doses, and do not take the drug for longer than directed. Do not use the medicine for any conditions other than those for which it was prescribed.

People who take some oral forms of corticosteroids may be told to take the medicine only every other day. This keeps the body from losing the ability to produce its own natural corticosteroids. More medicine may be needed before, during, and after stressful situations, but dosages should only be increased according to a physician's directions.

Precautions

Corticosteroids are powerful drugs that may cause serious side effects. Anyone taking them should be sure they fully understand the benefits and risks of these drugs.

Inhalant forms of these drugs will reduce the frequency and severity of asthma attacks when taken every day, but will not relieve an asthma attack once it has started. To relieve asthma symptoms, patients must use airway-opening medications (brochodilators). When using inhalant forms of both a bronchodilator and a corticosteroid, use the bronchodilator first and then wait several minutes before using the corticosteroid.

Gargling and rinsing the mouth with water after using inhalant corticosteroids helps prevent hoarseness and throat irritation.

In children and teenagers, these medicines can stop or slow growth and affect the function of the adrenal glands (small glands located above each kidney, which secrete natural corticosteroids). Another possible problem for children is that corticosteroids may make infections such as chickenpox and measles more serious. The benefits and risks of giving corticosteroids to children and teenagers should be thoroughly discussed with the child's physician. By adjusting the doses and forms in which corticosteroids are given, the physician may be able to lower the chance of unwanted side effects.

In older people, corticosteroids may increase the risk of high blood pressure and bone disease. Bone problems from corticosteroids are especially likely in older women.

Patients who take corticosteroids regularly should not stop taking them suddenly, even if their symptoms improve. Gradually tapering the dose before stopping the drug completely can allow the body time to adjust. If directed by a physician to reduce the dose, follow directions exactly and see the physician as often as directed.

Corticosteroid ointments, creams and gels can be absorbed through the skin and travel into the bloodstream. This is not a problem unless large amounts are absorbed. Then, unwanted side effects in other parts of the body are possible. To reduce the chance of that happening, do not spread the medicine over too large an area and do not cover it with plastic wrap, adhesive bandage, or any other type of airtight covering unless told to by your physician.

Patients taking corticosteroids over long periods may need to follow special diets, reducing the amount of sodium or increasing the amount of protein they eat, for example. Their health care providers can tell them if any diet changes are necessary.

Some patients may need to carry or wear medical identification indicating that they use this medicine and may need more of it in times of emergency, such as a severe asthma attack. The patient's physician can advise the patient whether such identification is necessary.

Before having skin tests, emergency treatment, or surgery (including dental surgery), anyone using corticosteroids should let the physician or dentist in charge know that they use this type of medicine.

Corticosteroids can lower a person's resistance to infection and can make infections harder to treat. Anyone who has a serious infection or injury while taking corticosteroids should get prompt medical attention and should make sure the physician in charge knows about the medicine. Avoid contact with people who have infections, especially chickenpox and measles. People who are taking or have been taking corticosteroids should not have immunizations, such as live vaccinations for polio without checking with their physicians. They should also avoid contact with anyone who has taken the oral polio vaccine, as there is a chance the virus could be passed on to them. Other people living in their home should not take the oral polio vaccine. The injectable form of the polio vaccine should be used instead because the virus used to form the vaccine is inactive.

Special conditions

People with certain medical conditions or who are taking certain other medicines can have problems if they take corticosteroids. Corticosteroids can also cover up the symptoms of some medical problems. If the condition gets worse, the patient has no way of knowing it. Before taking these drugs, be sure to let the physician know about any of these conditions:

Anyone who has had unusual reactions to corticosteroids in the past should let his or her physician know before taking the drugs again. The physician should also be told about any allergies to foods, dyes, preservatives, or other substances.

Too much use of corticosteroids during pregnancy may cause problems in the baby after it is born, such as slower growth. Nasal and inhalant forms of the drugs are considered safer to use in pregnancy than are corticosteroids taken by mouth or injection. When used properly, corticosteroid ointments, creams, and gels -- used to treat skin conditions -- are not known to cause any problems if used during pregnancy.

The safety of using corticosteroids while breastfeeding depends on the type of corticosteroid and the form in which it is being used. When taken by mouth or injection, for example, the drugs pass into breast milk and may cause growth problems in nursing babies. Creams, gels, and other forms that are applied to the skin are not known to cause problems in nursing babies whose mothers use them. However, these medicines should not be applied to the breasts just before breastfeeding. In general, women who are breastfeeding should ask their physicians before using any type of corticosteroid.

Corticosteroids may affect blood sugar levels. Any person with diabetes who notices changes in blood or urine test results while taking corticosteroids should check with a physician.

Before using corticosteroids, people with any of these medical problems should make sure their physicians are aware of their conditions:

• Osteoporosis or any other bone disease
• Current or past tuberculosis
• Glaucoma or cataracts
• Infections of any type (virus, bacteria, fungus, amoeba)
• Sores in the nose or recent nose surgery (if using nasal spray forms of corticosteroids)
• Underactive or overactive thyroid
• Liver disease
• Stomach or intestine problems
• Diabetes
• Heart disease
• High blood pressure
• High cholesterol
• Kidney disease or kidney stones
• Myasthenia gravis
• Systemic lupus erythematosus (SLE)
• Emotional problems
• Skin conditions that cause the skin to be thinner to bruise more easily.

Taking corticosteroids with certain other drugs may affect the way the drugs work or may increase the chance of side effects.

Side effects

Side effects generally are rare when corticosteroids are used for a short time. However, when they are used over time, they may lower the body's ability to fight off infections or may make infections harder to treat. Other common side effects include changes in appetite (increase or decrease), nervousness, restlessness, sleep problems, and indigestion. These problems usually go away as the body adjusts to the drug and do not require medical treatment. Less common side effects may occur with some forms of corticosteroids. Inhalants may cause dry throat, headache, nausea, skin bruising or thinning, and an unpleasant taste. Nasal spray forms may irritate the nose or throat, and ointments, gels, or creams may irritate the skin. Again, these side effects do not need medical attention unless they don't go away or they interfere with normal activities.

More serious side effects are not common, but may occur. If breathing problems, wheezing, or tightness in the chest occur, call a physician immediately. Additional side effects do not need emergency care, but should have prompt medical attention. Anyone who is taking corticosteroids and has any of the symptoms listed below should check with the physician who prescribed the medicine as soon as possible:

• White, curd-like patches in the mouth or throat
• Pain when swallowing or eating
• White patches or sores inside nose or in the anal area
• Eye pain or vision problems
• Loss of sense of taste or smell
• Stomach or abdominal pains, nausea, or vomiting
• Rash, acne, or other skin problems
• Swelling of face, eyelids, or lips
• Unusual tiredness or weakness
• Stuffy, dry, or runny nose (continuing over time)
• Watery eyes (continuing over time)
• Black, tarry stools
• Irregular heartbeat
• Menstrual problems
• Muscle cramps, weakness, or pain
• Rapid weight gain
• Unusual marks or bruises; wounds that won't heal
• Confusion, excitement, restlessness, mood swings, or unusual or disturbing thoughts or feelings
• Hallucinations.

Other rare side effects are possible. Anyone who has unusual or bothersome symptoms after taking corticosteroids should get in touch with his or her physician.

Interactions

Corticosteroids may interact with a variety of other medicines. When this happens, the effects of one or both of the drugs may change or the risk of side effects may be greater. Anyone who takes corticosteroids should let the physician know all other medicines he or she is taking. Among the drugs that may interact with corticosteroids are:

• Insulin and diabetes medicines
• Heart medicine such as digitalis
• Diuretics (water pills)
• Medicine containing potassium or sodium
• Immunizations (vaccinations)
• Cyclosporine (Sandimmune)
• Blood thinners, such as warfarin (Coumadin)
• Estrogen drugs, such as conjugated estrogens (Premarin) or oral contraceptives
• Antacids (if taken frequently).

Key Terms

Carbohydrates

Compounds such as starch and sugar that contain only carbon, hydrogen, and oxygen and are a source of energy for people and other animals. Examples of foods that contain carbohydrates are pasta, rice and bread.

Hallucination

A false or distorted perception of objects, sounds, or events that seems real. Hallucinations usually result from drugs or mental disorders.

Hormone

A substance that is produced in one part of the body, then travels through the bloodstream to another part of the body where it has its effect.

Immune response

The body's natural, protective reaction to disease and infection.

Immunization

A process or procedure that protects the body against an infectious disease. A smallpox vaccination is a type of immunization.

Inflammation

Pain, redness, swelling, and heat that usually develop in response to injury or illness.

Inhalant

Medicine that is breathed into the lungs.

Ointment

A thick, spreadable substance that contains medicine and is meant to be used on the outside of the body.

Rejection

The failure of a recipient's body to accept a transplanted organ or tissue.

Further Reading

For Your Information

Organizations

• American Academy of Allergy, Asthma and Immunology. Address: 611 East Wells Street, Milwaukee, WI 53202.(414) 272-6071. http://www.aaaai.org.
• Asthma and Allergy Foundation of America. Address: 1125 15th Street NW, Suite 502, Washington, DC 20005. (800) 727-8462. http://www.aafa.org.
• National Heart, Lung and Blood Institute. Address: National Institutes of Health, P.O. Box 30105, Bethesda, MD 20824-0105. (301 0 251-1222. http://www.nhlbi.nih.gov/nhlbi/nhlbi.htm.

Gale Encyclopedia of Medicine. Gale Research, 1999.