Glucocorticosteroids of local action nasal spray. What are corticosteroids and why they are used in the treatment of diseases of the nasopharynx and respiratory system. When are corticosteroid injections given?

Glucocorticosteroids (GCS) are hormones of the adrenal cortex. Since the excellent effect of cortisol in patients with rheumatoid arthritis was first published in 1949, corticosteroids have become indispensable drugs in the treatment of a huge number of diseases.

Scope of ointments with GCS

They are used by doctors of absolutely all clinical specialties, since the ability of these drugs to effectively relieve inflammation, interrupt allergic reactions, and modulate the immune response has proven to be in demand in the treatment of many diseases. Various dosage forms of glucocorticoids have been developed, such as injection solutions, tablets, ointments, creams, gels, solutions for external use, drops in the eyes, nose, ears, sprays, solutions for intracavitary/intraarticular use.

One of the popular dosage forms of these hormones are glucocorticosteroid ointments. They are used mainly for the treatment of diseases of the skin, eyes, joints, diseases of the veins.

Very effective as a topical therapy for:

Atopic dermatitis.
Chronic contact dermatitis of various origins.
Acute allergic reactions to insect bites.
Conjunctivitis resistant to other treatments.
Osteoarthritis and arthritis.
In the acute period of varicose veins (with thrombophlebitis).

Mechanism of action of glucocorticoids

Receptors for corticosteroids are found in almost all cells of the body, and therefore these drugs are effective against the pathology of many organs. The action of these hormones is associated with the development of genomic and non-genomic pathways for the interaction of glucocorticoids with their receptors.

As a result of the genomic mechanism, corticosteroids regulate gene transcription (both stimulate and inhibit). These genes control the synthesis of proteins and DNA in the cells of various organs. And as a result, either stimulation or inhibition of the activity of various cells occurs. The genomic mechanism develops with the use of small doses of glucocorticoids.

Non-genomic effects are due to the direct interaction of the glucocorticoid with biological membranes and / or membrane receptors for corticosteroids. This mechanism of action of hormones is manifested when large doses of corticosteroids are used for several minutes, and sometimes even seconds.

Non-genomic effects of corticosteroids:

Strengthening of lysosome membranes and outer cell membranes.
Decreased capillary permeability and local blood flow in areas of inflammation.
Reducing the ability of antigen-antibody complexes to penetrate the membrane.
Slowing down the development of fibroblasts.
Inhibition of the production of collagen and mucopolysaccharides.
Vasoconstriction in the focus of inflammation and their permeability (partly due to suppression of prostaglandin synthesis).
The attraction and accumulation of leukocytes in the focus of inflammation is inhibited.
Violation of the ability to local protection against bacteria and others.

It is important to remember that corticosteroids for external use act not only on inflammatory cells in the skin, but also on structural cells (i.e., cells that form the structure of the skin), which causes their many side reactions.

Classification

Divide external corticosteroids depending on the degree of their activity into 4 classes. The vasoconstrictor effect and local side effects depend on which group the drug belongs to.

Allocate:

Weak: Hydrocortisone, Kortonitol-Darnitsa, Gyoksizon, Pimafukort.
GCS of medium strength: Betnovate, Dermatol, Ultraprokt.
Strong GCS: Beloderm, Celestoderm, Travocort, Apulein, Sinaflan, Fluorocort, Flucinar, Lokoid, Advantan, Elocom.
Very strong: Delors, Dermovate.

Application rules

It should be remembered that the appointment of any glucocorticoids, including those for external use, is made only by a doctor! This is due to their rather dangerous side effects. There are general rules for the use of GCS:

Never use these drugs for prevention.
Effective in all stages of the disease (both for the treatment of exacerbations and chronic manifestations).
They are used only if other (safer and less toxic) drugs are ineffective. Usually this is a severe exacerbation or a continuously relapsing course of the disease.
The choice of dosage form (ointment, lipocream, cream, lotion, crelo, solution) depends on the nature of the rash. For example, if the rash is chronic with signs of lichenification (rough skin with a pronounced skin pattern), then an ointment is used. In contrast, for weeping acute lesions, solutions with glucocorticoids are usually more effective. That is, the choice of medicine can only be made by a doctor! The patient has no such experience, and this group of drugs is dangerous enough for self-treatment.

It is recommended to use external corticosteroids with caution in the scrotum, physiological folds, in places of diaper rash, since the skin in these places is very thin and the likelihood of developing systemic adverse reactions increases as the absorption of GCS increases.
It is advisable to avoid use on the face, because with prolonged use, depigmentation of the skin may develop and the face will look “bald”.
There can be two approaches to the choice of the drug: on the principle of "step up" (step up) and "step down" (step down). With the “step up” approach, treatment is started with less strong drugs and, if they are ineffective, stronger ones are prescribed. In “step down” therapy, they start with potent ones, and then, when the effect occurs, they switch to maintenance treatment with less active corticosteroids.
The border duration of the use of these drugs, in which the likelihood of developing complications of steroid therapy is minimal, is 2 weeks.
The maximum that we can process with external glucocorticoids is 20% of the body surface.
It is necessary to use such technologies for applying funds for external therapy: tandem therapy - an ointment with steroids is applied once a day, and the second is an emollient. Stepwise approach - the application is made in turn to different areas (that is, in the morning - one area, in the evening - another). The dashed method is used if the affected area is large enough. A small amount of the product is applied with a thin layer of strokes to the entire affected surface, one might say, in a “chessboard pattern”.

In children, it is better not to use pure products. It is better to dilute them with an indifferent ointment (emollient) in various ratios (depending both on the age of the child and on the intensity of clinical manifestations).
In no case should you use it under occlusive dressings (which tightly cover the skin), because the temperature inside such a dressing is high and all products applied under it are quickly absorbed into the skin. Accordingly, the likelihood of side effects is much higher.

All the rules described above are designed to minimize the risk of adverse reactions and should be followed strictly.

Contraindications to external corticosteroids

There is a list of skin conditions in which the appointment of topical corticosteroids is absolutely contraindicated (that is, under no circumstances should they be used). These include:

Acute viral skin diseases (herpetic infection, chickenpox).
Tuberculosis and syphilis at the site of application of the drug.
Bacterial and fungal skin infections.
Hypersensitivity / allergy to the components of the drug.

Side effects

When prescribing external corticosteroids in children, it should be remembered that, due to the structural features of their skin, the likelihood of developing systemic side effects is several times higher than in adults. These are factors such as good blood supply to the skin, thin layers of the epidermis, significant permeability of the skin barrier.

To understand the seriousness of the situation, it is worth citing a fact: when 90 grams of steroid ointment is applied to the skin of a child under 5 years of age, the adrenal cortex is suppressed (one of the most serious systemic side effects).

When used for the treatment of external glucocorticoids, general (systemic) and local side effects may develop. What are general effects and why do they occur? These manifestations arise due to the absorption of the steroid into the bloodstream and interaction with glucocorticoid receptors of all body cells. Accordingly, local side effects develop at the site of application of GCS.

List of side effects when using external corticosteroids.
The severity of adverse reactions depends on the duration of use and the dose of the drug. To reduce the negative effects, it is necessary to strictly adhere to all the rules for the use of external glucocorticosteroids, as well as the algorithm for their cancellation. Only a doctor should prescribe this type of medication! Do not self-medicate!

The main intranasal corticosteroids (glucocorticosteroids) are beclomethasone, fluticasone, mometasone, budesonide, dexamethasone.

Beclomethasone dipropionate (Alcecin, Baconase, Nasobek, Rinoclenil)

Historically, the first commercially available intranasal corticosteroid preparation appeared in 1973. The effectiveness of this intranasal corticosteroid in seasonal, year-round and non-allergic rhinitis in adults and children has been confirmed by a number of controlled studies. With rhinitis, the recommended dose is 200 mcg, in children - 100 mcg per day. The drug Aldecin is available in cans equipped with two nozzles for intranasal and oral use. Unlike Aldecin, Nasobek is an aqueous suspension produced in 30 ml plastic bottles containing 200 doses. The maximum daily dose is 400 mcg (8 doses).

Budesonide (Tafen Nasal)

Appeared on the pharmaceutical market in 1980. It is available as an aerosol, aqueous nasal spray and powder for spraying into the nasal cavity. The effectiveness of the drug in terms of impact on all symptoms of allergic rhinitis has been proven in many studies.

Fluticasone propionate (Flixonase, Nazarel)

Produced as an aqueous suspension in vials containing 120 doses. One dose contains 50 micrograms of the drug. In allergic rhinitis, 2 doses are prescribed in each half of the nose (200 mcg) once a day, preferably in the morning. The maximum daily dose in the treatment of severe forms of rhinitis is 400 mcg. The bioavailability of the drug is low, no more than 1%, which makes it completely safe even with prolonged use. The effectiveness of fluticasone in seasonal, allergic rhinitis in adults and children over 5 years of age has been proven in a large number of controlled studies.

Mometasone furoate (Nasonex)

Aqueous nasal spray of intranasal GCS is available in vials containing 120 doses (50 mcg each). For the treatment of rhinitis, adults usually give 2 doses in each half of the nose (200 mcg) once a day. The daily dose for children from 3 to 12 years old is 100 mcg (one dose in each nostril). It is proved that these doses do not affect the production of endogenous cortisol and do not slow growth. At the moment, among the existing intranasal corticosteroids, mometasone has the lowest bioavailability, which is 0.1% and a rapid effect, which is recorded as early as 5-7 hours after the start of administration.

Fluticasone furoate (Avamys)

The latest in a generation of modern intranasal glucocorticosteroids, designed exclusively for the treatment of seasonal, allergic rhinitis. As with mometasone, high clinical efficacy is associated with the presence of a furoate ester group in the molecule, which provides higher affinity for glucocorticosteroid receptors and selectivity of action. The effectiveness of intranasal corticosteroids in the treatment of various forms of allergic rhinitis has been proven by a number of large-scale multicenter studies. Produced in a highly ergonomic container with a shortened tip, which provide higher patient adherence during the course of therapy. One dose of the drug contains 27.5 mcg, adults are prescribed a daily dose of 110 mcg (2 doses in each half of the nose once). In children aged 2-11 years, the recommended starting dose is 55 mcg (dose in each nostril once a day), which, however, can be increased to 110 mcg / day if necessary.

Combined intranasal corticosteroids

There are several other intranasal corticosteroid drugs used. Dexamethasone is part of the combined nasal drops, aerosols, in combination with

Corticoids are hormonal substances produced by the human adrenal cortex. There are several varieties of them - mineral and glucocorticoids. Preparations that contain only one type of the given hormonal substances are called corticosteroids. Intranasal corticosteroids are the most commonly used form of these drugs in otolaryngology.

Synthetic glucocorticoids have the same properties as natural ones. Nasal corticosteroids, like other forms of hormonal drugs, have a pronounced anti-inflammatory and anti-allergic effect. The basis of the anti-inflammatory effect is the inhibition of the production of active substances (leukotrienes, prostaglandins), which are involved in the protective function of the body. There is also a delay in the reproduction of new protective cells, which significantly affects local immunity. Anti-allergic action of hormonal drugs is performed by inhibiting the release of allergy mediators, in particular, histamine. As a result, a long-term (during the day) anti-edematous effect is achieved.

Due to all the above properties, nasal hormonal preparations are indispensable for many inflammatory and allergic diseases of the nose.

Use of nasal corticosteroids

Currently, in the practice of an ENT doctor, the use of hormonal groups of drugs is widespread, based on their high efficiency. Most often they are prescribed for diseases that occur against the background of contact with an allergen:

allergic rhinitis.
Sinusitis.
Sinusitis.

Nasal corticosteroids effectively eliminate local allergic manifestations, namely sneezing, nasal congestion, rhinorrhea.

The drugs are also prescribed for vasomotor rhinitis in pregnant women. In this situation, they significantly improve nasal breathing, but do not contribute to a complete cure.

When polyps are detected in the nasal cavity, the use of nasal hormonal preparations, at the moment, has no alternative among other methods of drug treatment.

Before the direct use of a nasal hormonal agent, it is important to establish the cause of the disease.

It must be remembered that these drugs do not affect the pathogen itself (viruses, bacteria), but only eliminate the main local manifestations of the disease.

Contraindications

In most cases, the use of glucocorticoid drugs is well tolerated by patients. Despite this, there are a number of limitations to their appointment:

Hypersensitivity to the components of the drug.
Tendency to nosebleeds.
Younger children's age.

Taking hormonal drugs for pregnant women is prescribed with caution, and during breastfeeding it is not recommended for use at all.

Side effects

Most often, undesirable clinical manifestations on the part of the body occur with their prolonged and uncontrolled use.

May be observed:

Pain in the nasopharynx.
Dryness of the nasal mucosa.
Bleeding from the nasal passages.
Headaches, dizziness, drowsiness.

If high doses of corticosteroids are used for a long time, the risk of developing candidiasis in the nasopharyngeal region increases.

The possibility of such clinical manifestations remains quite low, since intranasal hormonal preparations, unlike tablets, act only locally and are not absorbed into the bloodstream.

Release form

Intranasal hormonal drugs are released in the form of drops and sprays. It is necessary to bury the medicine in the nose in a supine position, with the head thrown back and set aside for better penetration of the drug into the nasal cavity.

If the technique of instillation of the drug is not followed, a person may experience pain in the forehead, a sensation of the taste of the drug in the mouth. Unlike drops, nasal sprays are much more convenient to use because they do not require any preparation before using them.

Their main advantage is that due to the presence of a dispenser, the drug is difficult to overdose.

Types of intranasal hormonal preparations

Currently, there are a large number of hormonal drugs on the pharmaceutical market that are similar in their action, but have varying degrees of pronounced effectiveness.

The table below shows the most commonly used nasal corticosteroids and their analogues.

It is worth dwelling in detail on the features of the main drugs in order to understand what the advantage of each of them is.

Flixonase

In addition to the main substance - fluticasone propionate, the drug contains a number of auxiliary components: dextrose, cellulose, phenylethyl alcohol and purified water.

Flixonase is produced in vials with a dispenser of 60 and 120 doses (in one dose - 50 μg of the active substance). The anti-inflammatory effect of the drug is moderately pronounced, but it has a fairly strong anti-allergic property.

The clinical effect of the drug develops 4 hours after administration, but a significant improvement occurs only on the 3rd day from the start of therapy. With a decrease in the symptoms of the disease, the dosage can be reduced.

The average duration of the course is 5-7 days. It is allowed to take the drug for prophylactic purposes during seasonal allergies. Unlike other hormonal drugs, Flixonase does not have a negative effect on the hypothalamic-pituitary system.

The medication is strictly forbidden to be taken with a herpes infection, and also, in addition to the side reactions common with other hormones, it can provoke the development of glaucoma and cataracts. For children, the drug is allowed for use only from 4 years of age.

Alcedin

The drug is available in bottles of 8.5 g with a dispenser and a mouthpiece in the form of a white, opaque suspension. Contains the active substance - beclomethasone (in a single dose - 50 mcg). In addition to anti-inflammatory, anti-allergic, it also has an immunosuppressive effect. When using standard doses, the drug does not have a systemic effect.

When injecting Alcedin into the nasal cavity, direct contact of the applicator with the mucosa should be avoided. Rinse your mouth after each dose. In addition to indications for use common with other hormonal agents, it can be used as part of the complex therapy of bronchial asthma (not used during an attack).

Alcedin can increase blood glucose, so it should be taken with caution in people with diabetes. Also, special attention during its administration is given to people with hypertension, with dysfunction of the liver and thyroid gland.

For women in the first trimester of pregnancy and during breastfeeding, as well as for children under 6 years of age, the drug is contraindicated.

Nasonex

The main component of the drug is mometasone furoate, a synthetic glucocorticosteroid with pronounced anti-inflammatory and antihistamine effects. Produced in the form of a white suspension in plastic bottles of 60 and 120 doses.

In its action and method of application, Nasonex is similar to Flixonase, but, unlike it, has an effect on the hypothalamic-pituitary system. The first clinical effect after the administration of the drug is observed after 12 hours, which is significantly later than when taking Flixonase.

Very rarely, prolonged and uncontrolled use of the drug can lead to an increase in intraocular pressure and disruption of the integrity of the nasal septum (its perforation).

Nasonex is not prescribed for people with pulmonary tuberculosis, for acute infectious diseases, as well as for people who have recently undergone trauma or surgery in the nasopharynx. There are no absolute contraindications to taking this drug in pregnant women.

However, after the birth of a child, it must be examined for the safety of adrenal function. He is appointed to children from the age of two.

Avamys

A hormonal drug in which, unlike others, a powerful anti-inflammatory effect prevails. It contains fluticasone furoate and excipients. It is produced, like previous drugs, in vials of 30, 60 and 120 doses.

The clinical effect after the first dose becomes noticeable after 8 hours. If accidentally swallowed during instillation, Avamys is not absorbed into the bloodstream and does not have a systemic effect.

The drug has a number of advantages in comparison with other nasal hormones and, first of all, this is due to the good tolerance of the drug substance and the absence of serious contraindications to its administration.

Caution requires only the appointment of Avamys to people with severe impairment of the functional ability of the liver. It is not recommended to use the drug for pregnant and lactating women due to the insufficient number of ongoing studies on its action.

Avaris children are prescribed from the age of two. Cases of overdose with this drug have also not been recorded.

Polydex

The drug is significantly different from all previous ones. This is a combination drug that includes drugs from three groups, namely antibiotics (neomycin and polymyxin sulfate), vasoconstrictors (phenylephrine hydrochloride) and hormones (dexamethasone 0.25 mg).

Due to the presence of an antibiotic, Polydex is active against bacterial infections (the only exception is representatives of the coccus group). Therefore, its appointment is justified for people with diseases of the nasopharynx of an allergic nature, in the presence of an infectious agent.

Polydex is made in the form of drops and spray. Drops, as a rule, are used only in the treatment of inflammatory ear diseases, however, their use for the treatment of inflammatory processes in the nose is also acceptable. Drops are released in yellow-brown bottles with a capacity of 10.5 ml. Spray, unlike ear drops, includes phenylephrine in its composition and is available in a blue bottle (15 ml), protected from daylight.

The duration of drug therapy averages 5-10 days, with prolonged use of the drug, the risk of developing candidiasis and nasopharyngeal dysbiosis is high.

The use of Polydex is absolutely contraindicated in viral diseases of the nasopharynx, angle-closure glaucoma, severe renal impairment, as well as during pregnancy and lactation.

Children under two years of age are not prescribed the drug. It is forbidden to use Polidex simultaneously with antibacterial aminoglycoside drugs.

Comparative characteristics of nasal corticosteroids

Given the variety of nasal hormonal preparations, it is often difficult for a person to distinguish them by their action and give preference to any of them. The following table is presented, the main purpose of which is to simplify the understanding of the main differences between nasal corticosteroids.

Despite the fact that hormonal preparations in the form of nasal sprays do not enter the general circulation, the risk of adverse reactions remains high. Given this, the choice of corticosteroids should be approached with all seriousness.

Only the attending physician can prescribe these medicines. The patient should take only the prescribed dosage and observe the duration of the drug.

Currently, in clinical practice for intranasal use, beclomethasone dipropionate, flunisolide, budesonide, fluticasone propionate, mometasone furoate, triamcinolone acetonide are used. Flunisolide and triamcinolone in the form of nasal aerosols are not currently used in Russia. Hydrocortisone, prednisolone and dexamethasone should not be used intranasally, as they have a very high bioavailability and may cause side effects characteristic of systemic glucocorticoid therapy. Based on safety data, mometasone furoate and fluticasone propionate are recommended for long-term use.

After intranasal administration, part of the dose that settles in the pharynx is swallowed and absorbed in the intestine (> 50% of the administered dose), part is absorbed into the blood from the nasal mucosa. With a functioning mucociliary transport, only a small part of the drug remains in the nasal cavity already 20-30 minutes after spraying the powder or aerosol. Up to 96% of the drug is transported by the cilia of the nasal mucosa into the pharynx, swallowed, enters the stomach, and is absorbed into the blood. Therefore, oral and intranasal bioavailability are important pharmacokinetic characteristics of topical steroids. These indicators largely determine the therapeutic index of glucocorticoids, i.e. the ratio of their local anti-inflammatory activity and possible systemic action.
The low bioavailability of modern topical corticosteroids is explained by their minimal (1-8%) absorption from the gastrointestinal tract and almost complete (about 100%) biotransformation to inactive metabolites during the first passage through the liver. A small part of the drug, which is absorbed from the mucous membrane of the respiratory tract, is hydrolyzed by esterases to inactive substances. The bioavailability of many intranasal corticosteroids is relatively high. For example, in beclamethasone, it is approximately 10%. Modern drugs in this group (fluticasone and mometasone) have a bioavailability of 1% and 0.1%, respectively. That is, among intranasal corticosteroids, mometasone has the lowest bioavailability.
Bioavailability of nasal glucocorticoids

Glucocorticoids	Bioavailability after intranasal administration (%)	Bioavailability after oral administration
Beclomethasone dipropionate	44	20-25
Triamcinolone acetonide	No data	10,6-23
Flunisolide	40-50	21
Budesonide	34	11
fluticasone propionate	0,5-2
mometasone furoate

Nasal glucocorticoid delivery systems
The efficacy and safety of topical steroids are largely determined by their delivery systems to the nasal cavity. The characteristics of the existing inhalation administration systems are given in the table.

Efficiency of drug delivery into the nasal cavity using various dosing devices

Dosing device	The amount of the drug delivered to the patient (% of a single dose)	Amount of drug remaining in the nasal cavity (% of delivered dose)
Dosing aerosol	64	20
nasal spray	100	50
Turbuhaler	70	90

Dosage forms in the form of a metered-dose aerosol and nasal spray are currently registered in our country. The latter has a greater drug delivery efficiency and fewer local side effects that occur in patients when using glucocorticoids (nosebleeds, dryness and burning in the nose, itching and sneezing). It is believed that they are due to the irritating effect of freon and the high rate of drug entry into the nasal cavity, observed when using metered-dose aerosols.

Synthetic and natural corticosteroids come to the rescue when other anti-inflammatory drugs have been powerless.

Corticosteroids

This is the collective name for a group of steroid hormones. They are produced only by the adrenal glands. These hormones do not have androgenic, estrogenic, or gestamine activity.

Types

The type of hormone is determined by its main activity.

Glucocortisoids

They are glucocorticoids. The main hormones of this type that are synthesized in the human body are cortisone and hydrocortisone (aka cortisol).

They affect carbohydrate metabolism in the human body, as well as the metabolism of proteins and fats.

It is synthetic drugs of this type that are used, among other things, for the treatment of ENT diseases.

Mineralocortisoids

They are mineralocorticoids. The main hormone of this type, which is produced by the adrenal glands, is aldosterone. Hormones of this type affect the water-salt balance of the body.

Indications

Diseases for which corticosteroids are used include:

Purulent processes in the maxillary sinuses
Bronchitis
Bronchial asthma
pneumonia
Prolonged spastic conditions of the bronchi
Fibrosing alveolitis
Some types of malignancies

About the drugs of the corticosteroid group, see our video:

Preparations

In the European classification, four groups of synthetic corticosteroids are distinguished: weak, moderate action, strong, very strong. The main properties of such drugs are anti-inflammatory and depressing immunity. Additional features include:

Antiallergic
Adjustment of water-salt balance
Regulation of calcium metabolism
Regulation of carbohydrate metabolism
Regulation of protein metabolism
regulation of fat metabolism
Effect on the cardiovascular system
Effect on the blood
Influence on the hormonal system

There are the following treatment options for these drugs:

intensive
alternating
Pulse therapy
limiting
Intermittent

Injections

List of drugs:

Popular use of intra-articular injections for the treatment of relevant inflammatory diseases of the musculoskeletal system. Local (intramuscular) injections are also carried out in exceptional cases to combat respiratory problems, oncology.

Medications to treat breathing problems

intranasal

Most often used for allergic rhinitis and purulent inflammation in the maxillary sinuses.

They quickly facilitate breathing through the nose, stop the development of pathogenic microflora on the mucous membranes.

They have one of the most modest negative effects on the body among all dosage forms.

List of drugs:

Nasonex
Nasobek
Flixonase
Aldecin
Nazarel
Rinoclenil
Tafen nasal
beclomethasone
Avamys
Fluticasone
flunisolide

Nasal corticosteroids

Drops

Drops are used to treat diseases of the nose and eyes, often with allergies or with viral, bacterial, fungal, infectious inflammatory processes. Short courses are used.

Creams, ointments

These drugs are used mainly for diseases of the dermatological profile. Most often, these are combined drugs - in addition to topical corticosteroids, they contain components with antiseptic, anti-inflammatory and antibiotic effects:

Topical corticosteroids

Inhalations

Inhalations are done with bronchial asthma and prolonged spastic conditions of the bronchi.

List of drugs:

Budesonide
fluticasone propionate
Triamsinalon
Flunisolide
Beclazone Eco
Beclamethasone dipropionate
Klenil
Benacort
Beclospir
Budenit Steri-Sky
Pulmicort Turbuhaler
Depot medrol
Diprospan
Tafen Novolizer
Bekodisk

Preparations with corticosteroids for inhalation

Medicines come in the form of ready-made solutions, emulsions and powders. In accordance with the instructions of the doctor, prepare the filler for the inhaler and use it according to the prescribed scheme.

This variant of corticosteroid use is also very safe relative to other

Instructions for use

The instruction depends on the chosen drug and its dosage form. Consult with your doctor and do not neglect the information from the attached instructions when buying.

They try to use drugs during the natural activity of the adrenal glands.

It is necessary to competently stop treatment with corticosteroids, to think over the withdrawal scheme.

Side effects

When using weak and moderate drugs, side effects occur less frequently and are less pronounced. Possible side effects include:

High blood sugar (up to corticosteroid diabetes)
Osteoporosis
Aseptic necrosis of bone tissues
(exacerbation or onset)
Enhanced thrombus formation
Weight gain
Secondary immunodeficiency (the appearance of infections, often fungal and bacterial)
Menstrual irregularities in women
Neurological disorders
Development or exacerbation of glaucoma
Development or exacerbation of cataracts
Increased sweating
Appearance or exacerbation
Slowing down tissue regeneration processes (for example, long wound healing)
Increased facial hair growth
Inhibition of adrenal function
Unstable emotional state
The onset or worsening of depression
Itsenko-Cushing's syndrome

Side effects from corticosteroid use:

Overdose

In case of overdose, life-threatening conditions rarely occur. Most often, these or other side effects are manifested.

In case of an overdose, the doctor adjusts the dosage or replaces the drug, symptomatic treatment is carried out, taking into account drug interactions.

special instructions

Diabetes
Liver failure
Hypothyroidism
Cirrhosis of the liver
Glaucoma
Cataract
recent vaccination
, Isoniazid slow down the metabolism of corticosteroids in the liver
Corticosteroids accelerate the excretion of salicylates, Butadione, barbiturates, Digitoxin, Difenin, Chloramphenicol and Isoniazid from the body
Co-administration with Isoniazid causes mental disorders
Co-administration with reserpine causes depressive states
Tricyclic antidepressants with corticosteroids increase intraocular pressure
With prolonged use, corticosteroids increase the effectiveness of adrenomimetics.
Theophylline enhances the anti-inflammatory effect and contributes to the cardiotoxic effect
Amotericin, diuretics may increase the diuretic effect, lead to sodium retention or a decrease in potassium in the blood
Simultaneous intake of mineralocorticoids and glucocorticoids exacerbates hypokalemia and hypernatremia, and hypokalemia enhances the side effects and effects of cardiac glycosides
Decrease in efficiency
Decreased antiviral effect of Idoxuridine
Estrogens enhance the effect of corticosteroids
Androgens and iron preparations increase the formation of red blood cells, reduce the excretion of hormones, increase side effects, especially increased blood clotting, menstrual disorders, sodium retention
It needs to be reduced to
The initial stage of anesthesia is longer, the total duration is shorter.