Fluid and Electrolyte Disturbances
Sodium retention, Fluid retention, Congestive heart failure in susceptible patients, Potassium loss, Hypokalemic alkalosis, Hypertension
Muscle weakness, Steroid myopathy, Loss of muscle mass, Osteoporosis, Vertebral compression fractures, Aseptic necrosis of femoral and humeral heads, Pathologic fracture of long bones
Peptic ulcer with possible perforation and hemorrhage, Pancreatitis, Abdominal distention, Ulcerative esophagitis
Impaired wound healing, Thin fragile skin, Petechiae and ecchymoses, Facial erythema, Increased sweating, May suppress reactions to skin tests
Convulsions, Increased intracranial pressure with papilledema (pseudotumor cerebri) usually after treatment, Vertigo, Headache
Menstrual irregularities, Development of Cushingoid state, Suppression of growth in children, Secondary adrenocortical and pituitary unresponsiveness, particularly in times of stress, as in trauma, surgery, or illness, Decreased carbohydrate tolerance, Manifestations of latent diabetes mellitus, Increased requirements of insulin or oral hypoglycemic agents in diabetics
Posterior subcapsular cataracts, Increased intraocular pressure, Glaucoma, Exophthalmos
Negative nitrogen balance due to protein catabolism
The following additional reactions are related to parenteral corticosteroid therapy:
Allergic, anaphylactic or other hypersensitivity reactions, Hyperpigmentation or hypopigmentation, Subcutaneous and cutaneous atrophy, Sterile abscess
Hydrocortisone Pregnancy Warnings
This drug readily crosses the placenta. Teratogenicity including increased incidence of cleft palate have occurred in animal studies, however, the relevance to humans has been questioned. This drug has been used without reports of adverse outcomes in women with adrenal insufficiency. Untreated adrenal insufficiency during pregnancy has been associated with poor outcomes in both mothers and infants. There is the possibility of adrenal cortex suppression in newborns with maternal long term use at higher doses; however, the short term use of corticosteroids antepartum for the prevention of respiratory distress syndrome does not seem to pose a risk. Maternal pulmonary edema has been reported with inhibition of uterine contractions and fluid overload. There are no adequate and well controlled studies in pregnant women. Corticosteroids have been shown to impair fertility in male rats. AU TGA pregnancy category A: Drugs which have been taken by a large number of pregnant women and women of childbearing age without any proven increase in the frequency of malformations or other direct or indirect harmful effects on the fetus having been observed. AU TGA pregnancy category C: Drugs which, owing to their pharmacological effects, have caused or may be suspected of causing, harmful effects on the human fetus or neonate without causing malformations. These effects may be reversible. Accompanying texts should be consulted for further details. US FDA pregnancy category C: Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.
Benefit should outweigh risk AU TGA pregnancy category: A (oral, rectal foam); C (parenteral) US FDA pregnancy category: C Comments: -Women receiving this drug for adrenal insufficiency should be carefully monitored; dosing during pregnancy should be individualized to clinical response. -Infants exposed to higher doses in utero should be observed for signs and symptoms of hypoadrenalism. -The short-term use of corticosteroids antepartum for the prevention of respiratory distress syndrome does not seem to pose a risk to the fetus or newborn infant.
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