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CORTICOSTEROIDS—GLUCOCORTICOID EFFECTS (Veterinary—Systemic)

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CORTICOSTEROIDS—GLUCOCORTICOID EFFECTS (Veterinary—Systemic) This monograph contains information on the following: cell type.{R-30} A variety of glucocorticoids have been developed in Dexamethasone; Flumethasone; Hydrocortisone; Isoflupredone; an effort to vary the intensity and duration of effects and to Methylprednisolone; Prednisolone; Prednisone; Triamcinolone. decrease mineralocorticoid effects. However, systemic administration of these drugs is not a specifically targeted therapy Some commonly used brand names are: and should be structured to minimize unwanted effects and to For veterinary-labeled products— maximize therapeutic benefits. Cortalone Predef 2X Guidelines for use of glucocorticoids provided by product labeling [Triamcinolone] [Isoflupredone] range from broad to specific, depending on the product. A label Depo-Medrol PrednisTab may only state that a product is for use when an anti-inflammatory [Methylprednisolone] [Prednisolone] drug or adrenal glucocorticoid is needed or, alternatively, the label Dexamethasone 2 Predsone-5 [Prednisone] may list relatively specific indications for use.{R-18; 23} Many [Dexamethasone] product labels state that treatment of conditions known to be Dexamethasone 5 Rafter Dex responsive to anti-inflammatory glucocorticoids is indicated but [Dexamethasone] [Dexamethasone] then also list specific disorders for which the medication is known Dexasone Solu-Delta-Cortef to be effective.{R-4; 8; 11; 12; 14; 16; 17; 20; 22} For clarity, specific [Dexamethasone] [Prednisolone] indications noted on product labeling are listed in this section as Dexium [Dexamethasone] TriAcet [Triamcinolone] Accepted labeled indications and those not specifically named in Dexium SP Triamtabs U.S. or Canadian labeling are marked with an ELUS or ELCAN [Dexamethasone] [Triamcinolone] designation, respectively. However, it should be noted that Dexone [Dexamethasone] Uni-Dex products that are labeled for use in the treatment of general [Dexamethasone] inflammation might also be considered efficacious in the Dextab [Dexamethasone] Unimed treatment of more specific indications, such as musculoskeletal [Methylprednisolone] inflammation, for which it may not be listed because that specific Flucort [Flumethasone] Uni-Pred 50 type of inflammation is not mentioned on product labeling. [Prednisolone] Medrol Vetacortyl Accepted [Methylprednisolone] [Methylprednisolone] Adrenocortical insufficiency, acute (treatment)—Glucocorticoids are Methysone 40 Vetalog [Triamcinolone] indicated in the treatment of acute adrenocortical insufficiency [Methylprednisolone] (Addison’s disease); however, the mineralocorticoid effect will vary from product to product. For that small percentage of dogs For human-labeled products— with only glucocorticoid deficiency, long-term replacement can A-methaPred Dexone [Dexamethasone] be performed without a need for mineralocorticoid; however, for [Methylprednisolone] the majority of dogs, mineralocorticoid replacement is necessary. Cortef [Hydrocortisone] Emo Cort Hydrocortisone, methylprednisolone, prednisolone, and [Hydrocortisone] prednisone{R-34; 145} produce minor mineralocorticoid effects in Decadron Hydrocortone addition to their glucocorticoid effects and may adequately [Dexamethasone] [Hydrocortisone] reverse electrolyte imbalances when administered in conjunction Dexasone Solu-Medrol with intravenous sodium chloride solution; however, [Dexamethasone] [Methylprednisolone] methylprednisolone, prednisolone, and prednisone are considered insufficient for long-term control of the potassium-retention or Note: For a listing of dosage forms and brand names by country sodium and chloride losing effects of most cases of primary availability, see the Dosage Forms section(s). adrenocortical insufficiency{R-8} and a mineralocorticoid-specific medication is generally indicated. Category: In acute adrenocortical insufficiency, a rapidly acting parenteral Abortifacient—Dexamethasone. corticosteroid with the most mineralocorticoid effect available Anti-inflammatory agent (steroidal)—Dexamethasone; should be administered in conjunction with vascular volume Flumethasone; Hydrocortisone; Isoflupredone; expansion using isotonic saline.{R-213} Relative mineralocorticoid Methylprednisolone; Prednisolone; Prednisone; effect from the most to the least potency is hydrocortisone > Triamcinolone. prednisolone/prednisone > methylprednisolone > Diagnostic aid (hyperadrenocorticism)—Dexamethasone. dexamethasone.{R-38; 188} Gluconeogenic agent—Dexamethasone; Flumethasone; Cats: ELCANMethylprednisolone tabletsEL, ELUS,CANhydrocortisone Isoflupredone; Prednisolone. tabletsEL, prednisolone sodium succinate injection, Immunosuppressant—Prednisolone; Prednisone. ELUS,CANprednisolone tabletsEL, and ELUS,CANprednisone tabletsEL Parturifacient—Dexamethasone; Flumethasone. are indicated in the treatment of acute adrenocortical insufficiency.{R-9; 14; 193} Indications Dogs: Prednisolone sodium succinate is indicated in the treatment Note: The text between ELUS and EL describes uses that are not included of acute adrenocortical insufficiency when a rapid effect is in U.S. product labeling. Text between ELCAN and EL describes uses necessary.{R-7; 9} ELCANMethylprednisolone tabletsEL, that are not included in Canadian product labeling. ELCANprednisolone tabletsEL, ELUS,CANhydrocortisone tabletsEL, ELUS,CAN EL The ELUS or ELCAN designation can signify a lack of product and prednisone tablets are also indicated in the {R-8; 14; 100; 193; availability in the country indicated. See the Dosage Forms treatment of acute adrenocortical insufficiency. 195} section of this monograph to confirm availability. Horses: Dexamethasone sodium phosphate is indicated for use in situations in which a rapid adrenocortical effect is needed;{R- General considerations 11} Glucocorticoids potentially affect every cell in the body and produce a however, it provides no significant mineralocorticoid ELUS,CAN EL wide spectrum of effects depending on tissue concentration and effect. Prednisolone and prednisone have been used in the treatment of adrenocortical insufficiency. © 2008 The United States Pharmacopeial Convention All rights reserved 1 Allergic disorders (treatment)—Many glucocorticoids are likely to be flumethasone injection, methylprednisolone acetate injectable effective in the treatment of allergic reactions; however, the suspension, ELCANmethylprednisolone tabletsEL, prednisolone formulation should be chosen carefully to provide the onset of sodium succinate, ELUS,CANprednisolone tabletsEL, action, duration of action, and side effect profile to fit the type of ELUSprednisone tabletsEL, ELCANtriamcinolone acetonide reaction being treated. For example, for anaphylactic reactions, injectable suspensionEL, and ELCANtriamcinolone tabletsEL are corticosteroids play a secondary role to epinephrine and fluid indicated in the treatment of acute and chronic dermatoses of therapy. If corticosteroids are employed in the treatment of varying etiologies and the associated inflammation, irritation, anaphylaxis, short-acting water soluble formulations are and pruritus.{R-4; 9; 12; 14-18; 20; 22; 28} ELCANMethylprednisolone recommended. tablets are labeled for the treatment of otitis externa.EL{R-14} US Cats: Dexamethasone injection, methylprednisolone acetate Dogs: Dexamethasone injection, EL dexamethasone tabletsEL, injectable suspension, ELCANmethylprednisolone tabletsEL, flumethasone injection, methylprednisolone acetate injectable CAN prednisolone sodium succinate, ELCANtriamcinolone acetonide suspension, EL methylprednisolone tabletsEL, US injectable suspensionEL, and ELCANtriamcinolone tabletsEL are EL prednisolone acetate injectable suspensionEL, prednisolone CAN US indicated in the treatment of allergic conditions.{R-7; 9; 14-16; 20; sodium succinate, EL prednisolone tabletsEL, EL prednisone CAN 22} ELUS,CAN EL ELUS EL EL EL Flumethasone, prednisolone , and prednisone tablets , triamcinolone acetonide injectable CAN should also be effective in the treatment of allergic suspensionEL, and EL triamcinolone tabletsEL are indicated in disorders.{R-100; 194} the treatment of acute and chronic dermatoses of varying Cattle: Isoflupredone acetate injectable suspension and etiologies and the associated inflammation, irritation, and {R-4; 8-10; 12; 14-18; 20; 22; 28} dexamethasone injection are indicated in the treatment of pruritus. Flumethasone injection, allergic conditions.{R-6; 23; 24} ELUS,CANAlthough they are not methylprednisolone acetate injectable suspension, CAN CAN labeled for use in cattle in the U.S., flumethasone, EL methylprednisolone tabletsEL, and EL prednisolone {R-8; 14-18} prednisolone, and prednisone should also be effective in the tabletsEL are labeled for the treatment of otitis externa. treatment of allergic disorders.EL Disk disease, intervertebral (treatment)—Dogs: Dexamethasone Dogs: Dexamethasone injection, flumethasone injection,{R-18} injection and flumethasone injection are indicated as supportive methylprednisolone acetate injectable suspension, therapy in the treatment of intervertebral disk disease (disk ELCANmethylprednisolone tabletsEL, prednisolone sodium syndrome).{R-4; 18} But it should be noted that high dosages of succinate, ELCANprednisolone tabletsEL, ELCANtriamcinolone dexamethasone carry a risk of severe adverse effects.{R-166} acetonide injectable suspensionEL, and ELCANtriamcinolone Therapy should be tailored to the type of disk dysfunction and tabletsEL are indicated in the treatment of allergic clinical signs.
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