DOCSLIB.ORG

Steroid Use in Clinical Practice

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Steroid Use in Clinical Practice Steroid Use In Clinical Practice DR. TIN WIN AUNG Consultant Endocrinologist Department of Diabetes & Endocrinology North Okkalapa General & Teaching Hospital Outlines ◼ Overview of Steroids → What are steroids? →Steroidogenesis, Regulation, Physiological & Adverse Effects ◼ Steroids use in Clinical practice → Classification → Topical Steroids → Inhaled Corticosteroids → Systemic Corticosteroids → Prevention & Treatment of Complications of using CS What are steroids? ◼ Steroids (short for corticosteroids) are synthetic drugs that closely resemble cortisol, a hormone that your adrenal glands produce naturally. ◼ Corticosteroids are different from the male hormone-related steroid compounds that some athletes use. Corticosteroids ◼ Corticosteroids divided into: –Glucocorticoids –Mineralocorticoids Endogenous Steroidogenesis Regulation of Cortisol Secretion ◼ Three major mechanisms control ACTH release and the Cortisol secretion (1) Negative feedback mechanism →ACTH from anterior pituitary (2) Diurnal variation →Levels are the highest in the morning on waking and the lowest in the middle of evening. (3) Stress- physical (trauma, surgery, exercise) - psychological (pain, anxiety, apprehension) - physiological (nausea, fever and hypoglycemia) The Role of Cortisol in Regulation of HPA Axis 20 mg/day Plasma Cortisol -140- 700 nmol/l (Ref: range) Glucocorticoids Physiological Effects Carbohydrate metabolism ↑gluconeogenesis and conserve glucose for use during stress or starvation. Protein metabolism catabolic effect → negative nitrogen balance with muscle wasting, osteoporosis, growth slowing, skin atrophy, increased capillary fragility, bruising and striae. → Delayed wound healing Fat deposition → ↑on shoulders, face and abdomen. Anti-inflammatory and immunosuppressive effects → ↓ recruitment and function of inflammatory cells and vascular permeability at the site of inflammation. → Inhibit prostaglandin and leucotriene synthesis by inhibiting the release of arachidonic acid from the phospholipids. Use as anti-inflammatory and immunosuppressive agents Maintainance of blood pressure → enhances the vascular reactivity to other vasoactive substances such as nor- epinephrine and angiotensin-II Anti-vitamin D action → ↓ calcium absorption from the gut and ↑ urinary calcium excretion, → useful in treatment of hypercalcemia in sarcoidosis and vitamin D intoxication. Fluid and electrolyte balance Renal excretion of urate is increased Systems Adverse Effects Cautions/Comments Fluid/Electrolyte Sodium Retension Caution in CHF/hypertension disturbances Edema ↓ Salt intake ↑ Potassium exerction Potassium supplements ↑ Calcium excretion ↑ risk of osteoporosis, Ca supplements Gastrointestinal Gastric Irritation Risk ↑ with ↑doses & prolonged use. N, V, Wt loss/ Wt gain Use PPI only in long term high dose Abd distension, Peptic ulcer steroid therapy Endocrine Hypercortisolism (Cushingoid state) Associated with long term use even at Secondary adrenal insufficiency lower dosages Menstrual difficulties: Amenorrhea, post-menopausal bleeding Precipitation of diabetes mellitus Glucose Intolerance: hyperglycemia Others Insomnia Psychiatric disturbances Immunosuppression Cataracts / Glaucoma Hirsutism/ Acne Classification of Corticosteroids Classification of Synthetic Corticosteroids by Chemical Structure Progesterone-type Hydrocortisone- Methasone-type Acetonides & type related Flugestone Alclometasone Fluorometholone Chloroprednisone Beclomethasone Amcinonide Medrysone Cloprednol Betamethasone Budesonide Prebediolone acetate Fludrocortisone Clobetasol Ciclesonide Progestrin→ Fluocinolone Clobetasone Deflazacort cyproterone acetate Fluprednisolone Dexamethasone Desonide Medroxyprogesterone Methylprednisolone Diflucortolone Formocortal acetate Prednisolone Fluclorolone Flunisolide Prednisone Flumetasone Halocinonide Tixocortol Fluticasone Triamcinolone Triamcinolone Meprednisone acetonide Paramethasone Ulobetasol Other Cortivazol Classification of Corticosteroids by Route of Administration ❑ Topical ❑ Oral →creams ❑ Parental →IV/ IM ❑ Inhalation- Aerosol →ointments ❑ Others →lotions, mousses, → Intrarticular →shampoos → ocular, nasal, rectal (enema), in ear or spinal →gels or tapes Steroid Use in Clinical Practice Common clinical uses of systemic corticosteroids Allergy and •Moderate to severe asthma exacerbations/ Acute exacerbations of COPD respirology • Allergic rhinitis • Atopic dermatitis • Urticaria/angioedema • Anaphylaxis/ Food and drug allergies • Hypersensitivity pneumonitis • Sarcoidosis • Acute and chronic eosinophilic pneumonia • Interstitial lung disease Dermatology •Pemphigus vulgaris • Acute, severe contact dermatitis Endocrinology • Adrenal insufficiency • Congenital adrenal hyperplasia Gastroenterology • Ulcerative colitis/ Crohn’s disease • Autoimmune hepatitis Hematology •Lymphoma/leukemia • Hemolytic anemia • Idiopathic thrombocytopenic purpura Rheumatology/ • Rheumatoid arthritis/ Systemic lupus erythematosus immunology • Polymyalgia rheumatica • Polymyositis/dermatomyositis • Polyarteritis/ Vasculitis Ophthalmology • Uveitis • Keratoconjunctivitis Other • Organ Transplant • Multiple sclerosis • Nephrotic syndrome • Chronic active hepatitis • Cerebral edema PRESCRIBING CORTICOSTEROIDS ◼ In non-endocrine disorders, GCs are commonly given in pharmacologic (therapeutic) doses to suppress inflammation ◼ In endocrine disorders, corticosteroid doses are often given at or close to physiologic doses (rather than in therapeutic ranges) Topical Corticosteroids Potency Ratings of Topical Corticosteroids Ultra high Augmented betamethasone dipropionate 0.05% (I) Clobetasol propionate 0.05%, Diflorasone diacetate 0.05% Fluocinonide 0.1%, Flurandrenolide 4 mcg per m2 Halobetasol propionate 0.05% High Amcinonide 0.1% (II) Betamethasone dipropionate 0.05% Desoximetasone, Diflorasone diacetate 0.05% Fluocinonide 0.05%, Halcinonide 0.1% Medium to Amcinonide 0.1% High Betamethasone dipropionate 0.05% (III) Fluticasone propionate 0.005% Triamcinolone acetonide 0.5% Medium Betamethasone valerate , Desoximetasone 0.05% (IV and V) Fluocinolone acetonide 0.025%, Fluticasone propionate 0.05% Hydrocortisone butyrate 0.1%/probutate 0.1%/valerate 0.2% Triamcinolone acetonide 0.025%/ acetonide 0.1% Low Alclometasone dipropionate 0.05%, Desonide 0.05% (VI) Fluocinolone 0.01%, Hydrocortisone butyrate 0.1% Least potent Hydrocortisone 1%, 2.5% (VII) http://www.factsandcomparisons.com Indications of topical corticosteroids Disorders very responsive to topical Disorders less responsive to topical corticosteroids corticosteroids (remission with low to medium topical CS) (high potency steroids at higher CS) •Atopic dermatitis •Dscoid lupus erythematosus •Seborrheic dermatitis •Psoriasis of palms and soles •Lichen simplex chronicus •Necrobiosis lipoidica diabeticorum •Pruritus ani •Sarcoidosis •Later phase of allergic contact dermatitis •Lichen striatus •Later phase of irritant contact dermatitis •Pemphigus •Nummular eczematous dermatitis •Familial benign pemphigus •Stasis dermatitis •Vitiligo •Psoriasis •Granuloma annularae Is Corticosteroid cream safe? ◼ In most cases, topical steroids are safe and well tolerated if used correctly. ◼ People who experience side effects usually are not using steroid creams properly. ◼ Applying the cream or ointment thinly and evenly to the affected areas on the skin is important. ◼ This minimizes the amount absorbed through the skin into the body Clobetasol propionate (0.05%) ◼ Use of 2g/day → ↓ morning cortisol level after a few days ◼ Use over 100 g/week or 100-300 g/week →features of Cushing’s $ and symptoms of adrenal insufficiency. ◼ Allenby et al (1987) Clobetasol propionate > 50 g/week→ Adrenal suppression Recommended dose- Not more than 50 g/week for Not more than 2 weeks ◼ Cushing’s $ was also reported with the use of relatively low potent topical steroid triamcinolone acetonide (0.1%) of 38 g daily under occlusion for ~ 4 years Tips for use of Topical steroids ◼ Once or twice-daily application is recommended for most preparations ◼ More frequent administration does not provide better results ◼ Chronic application of topical steroids →tolerance & tachyphylaxis. ◼ Ultra-high-potency steroids should not be used for > 3 weeks continuously. ◼ If a longer duration is needed, the steroid should be gradually tapered to avoid rebound symptoms, and treatment should be resumed after a steroid-free period of at least one week. Inhaled Corticosteroids Major ICS ◼ beclomethasone dipropionate (Half life- 15 hrs) ◼ fluticasone propionate (Half life- 14 hrs) ◼ Budesonide (Half life- 2 to 3 hrs) ◼ mometasone furoate (Half life- 5 to 8 hrs) Newer generations of ICS ◼ ciclesonide (Half life 0.71 hrs) ◼ Flunisolide (Half life 1-2 hrs) Relative ICS potencies ◼ mometasone > fluticasone propionate > ciclesonide > beclomethasone monoproprionate > budesonide EVIDENCE FOR SYSTEMIC ABSORPTION OF ICS ◼ ~ 10% to 20% of a dose of ICS → respiratory tract ◼ 80% to 90% →swallowed and absorbed through the GI tract. ◼ Most of the drug that is swallowed will undergo first-pass metabolism and does not enter the systemic circulation. ◼ The ICSs in current use have a high first pass metabolism, exceeding 99% in the case of fluticasone propionate. Extent of absorption is determined by ◼ inhaler device ◼ particle size ◼ deposition site, pharmacokinetic and physicochemical properties of the drug (lipophilicity) ◼ The rate of dissolution of different ICSs in human bronchial fluid → 6 min for budesonide → 5 hours for beclomethasone → 8 hours for fluticasone ICS & HPA
Load more

Recommended publications
  • Do Intra-Articular Steroid Injections Affect Glycemic Control in Patients
    Evidence-based answers from the Family Physicians Inquiries Network Erin Kallock, MD; Do intra-articular steroid Jon O. Neher, MD Valley Family Medicine Residency, Renton, Wash. injections aff ect glycemic control Leilani St. Anna, MLIS, AHIP University of Washington in patients with diabetes? Health Services Library, Seattle EVIDENCE-BASED ANSWER yes, but the clinical importance mendation [SOR]: B, small cohort studies). A is minimal. A single intra-articular Intra-articular steroid injections into the steroid injection into the knee produces shoulder may briefl y raise postprandial (but acute hyperglycemia for 2 or 3 days in pa- not mean) glucose levels with larger and re- tients with diabetes who otherwise have peated doses (SOR: C, extrapolated from het- good glucose control (strength of recom- erogenous and mixed cohort studies). A single steroid injection into the knee joint Evidence summary 1 week; investigators measured fructosamine causes acute Two prospective cohort studies evaluated the levels (a measure of intermediate-term hyperglycemia eff ect on glycemic control of a single gluco- glucose control) at baseline and again for 2 or 3 days corticoid injection into the knee of patients 2 weeks after injection. in patients with with controlled type 2 diabetes (glycosylated Th e injection produced hyperglycemia in diabetes who hemoglobin A1c Ͻ7.0%). Th e fi rst enrolled all participants, with peak blood glucose lev- otherwise have 9 patients with symptomatic osteoarthritis of els ranging from 251 to 430 mg/dL and time to good glucose the knee unresponsive to 3 months of nonste- peak glucose usually less than 6 hours. Fruc- control.
    [Show full text]
  • United States Patent (10) Patent No.: US 7,524,836 B2 Del Soldato (45) Date of Patent: Apr
    USOO7524836B2 (12) United States Patent (10) Patent No.: US 7,524,836 B2 Del Soldato (45) Date of Patent: Apr. 28, 2009 (54) NITROOXYDERIVATIVESTEROIDAL JP 58-045724 3, 1983 COMPOUNDS JP 5-39.261 2, 1992 JP 4-273892 9, 1992 (75) Inventor: Piero Del Soldato, Milan (IT) WO 98.15568 4f1998 OTHER PUBLICATIONS (73) Assignee: Nicox S.A., Paris (FR) English language abstract of JP 58-045724. (*) Notice: Subject to any disclaimer, the term of this English language abstract of JP4-273892. patent is extended or adjusted under 35 English language abstract of DE 19634793. U.S.C. 154(b) by 173 days. K. B. Schwarz, “Oxidative Sress During Viral Infection: A Review”. Free Radical Biology & Medicine, vol. 21, No. 5, 1996, pp. 641-649. Goodman & Gillman, “The Pharmacological Basis of Therapeutics'. (21) Appl. No.: 11/643,887 9" Edition, 1996, McGraw-Hill Health preffsions Division, pp. 1-1. 1459–1465 and 1474. (22) Filed: Dec. 22, 2006 Martindale, The Extraphamacopeia,30" Edition, 1993, pp. 712-723. O O Nenseter et al., “Paracetamol inhibits Copper Ion-Induced, AZO Com (65) Prior Publication Data pound-Initialed, and Mononuclear Cell-Mediated Oxidative Modifi US 2007/O142342 A1 June 21, 2007 cation of LDL', Arterioscierosis, Thombosis, and Vascular Biology, s vol. 15, No. 9, Sep. 1995, pp. 1338-1344. O O Baylis et al. “Chronic Blockade of Nitric Oxide Synthesis in the Rat Related U.S. Application Data Produces Syntemic Hypertension and Glomemerular Damage'. J. (62) Division of application No. 1 1/028, 198, filed on Jan. 4, Clin. Investigation, vol.90, 1992, pp.
    [Show full text]
  • )&F1y3x PHARMACEUTICAL APPENDIX to THE
    )&f1y3X PHARMACEUTICAL APPENDIX TO THE HARMONIZED TARIFF SCHEDULE )&f1y3X PHARMACEUTICAL APPENDIX TO THE TARIFF SCHEDULE 3 Table 1. This table enumerates products described by International Non-proprietary Names (INN) which shall be entered free of duty under general note 13 to the tariff schedule. The Chemical Abstracts Service (CAS) registry numbers also set forth in this table are included to assist in the identification of the products concerned. For purposes of the tariff schedule, any references to a product enumerated in this table includes such product by whatever name known. Product CAS No. Product CAS No. ABAMECTIN 65195-55-3 ACTODIGIN 36983-69-4 ABANOQUIL 90402-40-7 ADAFENOXATE 82168-26-1 ABCIXIMAB 143653-53-6 ADAMEXINE 54785-02-3 ABECARNIL 111841-85-1 ADAPALENE 106685-40-9 ABITESARTAN 137882-98-5 ADAPROLOL 101479-70-3 ABLUKAST 96566-25-5 ADATANSERIN 127266-56-2 ABUNIDAZOLE 91017-58-2 ADEFOVIR 106941-25-7 ACADESINE 2627-69-2 ADELMIDROL 1675-66-7 ACAMPROSATE 77337-76-9 ADEMETIONINE 17176-17-9 ACAPRAZINE 55485-20-6 ADENOSINE PHOSPHATE 61-19-8 ACARBOSE 56180-94-0 ADIBENDAN 100510-33-6 ACEBROCHOL 514-50-1 ADICILLIN 525-94-0 ACEBURIC ACID 26976-72-7 ADIMOLOL 78459-19-5 ACEBUTOLOL 37517-30-9 ADINAZOLAM 37115-32-5 ACECAINIDE 32795-44-1 ADIPHENINE 64-95-9 ACECARBROMAL 77-66-7 ADIPIODONE 606-17-7 ACECLIDINE 827-61-2 ADITEREN 56066-19-4 ACECLOFENAC 89796-99-6 ADITOPRIM 56066-63-8 ACEDAPSONE 77-46-3 ADOSOPINE 88124-26-9 ACEDIASULFONE SODIUM 127-60-6 ADOZELESIN 110314-48-2 ACEDOBEN 556-08-1 ADRAFINIL 63547-13-7 ACEFLURANOL 80595-73-9 ADRENALONE
    [Show full text]
  • A New Robust Technique for Testing of Glucocorticosteroids in Dogs and Horses Terry E
    Iowa State University Capstones, Theses and Retrospective Theses and Dissertations Dissertations 2007 A new robust technique for testing of glucocorticosteroids in dogs and horses Terry E. Webster Iowa State University Follow this and additional works at: https://lib.dr.iastate.edu/rtd Part of the Veterinary Toxicology and Pharmacology Commons Recommended Citation Webster, Terry E., "A new robust technique for testing of glucocorticosteroids in dogs and horses" (2007). Retrospective Theses and Dissertations. 15029. https://lib.dr.iastate.edu/rtd/15029 This Thesis is brought to you for free and open access by the Iowa State University Capstones, Theses and Dissertations at Iowa State University Digital Repository. It has been accepted for inclusion in Retrospective Theses and Dissertations by an authorized administrator of Iowa State University Digital Repository. For more information, please contact [email protected]. A new robust technique for testing of glucocorticosteroids in dogs and horses by Terry E. Webster A thesis submitted to the graduate faculty in partial fulfillment of the requirements for the degree of MASTER OF SCIENCE Major: Toxicology Program o f Study Committee: Walter G. Hyde, Major Professor Steve Ensley Thomas Isenhart Iowa State University Ames, Iowa 2007 Copyright © Terry Edward Webster, 2007. All rights reserved UMI Number: 1446027 Copyright 2007 by Webster, Terry E. All rights reserved. UMI Microform 1446027 Copyright 2007 by ProQuest Information and Learning Company. All rights reserved. This microform edition is protected against unauthorized copying under Title 17, United States Code. ProQuest Information and Learning Company 300 North Zeeb Road P.O. Box 1346 Ann Arbor, MI 48106-1346 ii DEDICATION I want to dedicate this project to my wife, Jackie, and my children, Shauna, Luke and Jake for their patience and understanding without which this project would not have been possible.
    [Show full text]
  • Steroid Use in Prednisone Allergy Abby Shuck, Pharmd Candidate
    Steroid Use in Prednisone Allergy Abby Shuck, PharmD candidate 2015 University of Findlay If a patient has an allergy to prednisone and methylprednisolone, what (if any) other corticosteroid can the patient use to avoid an allergic reaction? Corticosteroids very rarely cause allergic reactions in patients that receive them. Since corticosteroids are typically used to treat severe allergic reactions and anaphylaxis, it seems unlikely that these drugs could actually induce an allergic reaction of their own. However, between 0.5-5% of people have reported any sort of reaction to a corticosteroid that they have received.1 Corticosteroids can cause anything from minor skin irritations to full blown anaphylactic shock. Worsening of allergic symptoms during corticosteroid treatment may not always mean that the patient has failed treatment, although it may appear to be so.2,3 There are essentially four classes of corticosteroids: Class A, hydrocortisone-type, Class B, triamcinolone acetonide type, Class C, betamethasone type, and Class D, hydrocortisone-17-butyrate and clobetasone-17-butyrate type. Major* corticosteroids in Class A include cortisone, hydrocortisone, methylprednisolone, prednisolone, and prednisone. Major* corticosteroids in Class B include budesonide, fluocinolone, and triamcinolone. Major* corticosteroids in Class C include beclomethasone and dexamethasone. Finally, major* corticosteroids in Class D include betamethasone, fluticasone, and mometasone.4,5 Class D was later subdivided into Class D1 and D2 depending on the presence or 5,6 absence of a C16 methyl substitution and/or halogenation on C9 of the steroid B-ring. It is often hard to determine what exactly a patient is allergic to if they experience a reaction to a corticosteroid.
    [Show full text]
  • Summary of Product Characteristics 1. Name Of
    Revised: July 2020 AN: 00391/2020 SUMMARY OF PRODUCT CHARACTERISTICS 1. NAME OF THE VETERINARY MEDICINAL PRODUCT Chronogest CR, 20 mg controlled release vaginal sponge for sheep. 2. QUALITATIVE AND QUANTITATIVE COMPOSITION Each polyester polyurethane sponge contains Active substance(s) Flugestone acetate, 20 mg. List of excipients Excipients qsp 1 sponge. For a full list of excipients, see section 6.1 3. PHARMACEUTICAL FORM Vaginal sponge. White cylindrical polyester polyurethane foam equipped with string. 4. CLINICAL PARTICULARS 4.1 Target species Sheep (ewes and ewe-lambs). 4.2 Indications for use In ewes and ewe lambs, in combination with PMSG (Pregnant Mare Serum Gonadotrophin) - Induction and synchronization of oestrus and ovulation (non cycling ewes during seasonal anoestrus and ewe lambs). - Synchronization of oestrus and ovulation (cycling ewes and ewe-lambs). 4.3 Contraindications Please refer to section 4.7 and section 4.8. 4.4 Special warnings None. Page 1 of 5 Revised: July 2020 AN: 00391/2020 4.5 Special precautions for use (i) Special precautions for use in animals - The repeated treatment with the product combined with PMSG may trigger the appearance of PMSG antibodies in some ewes. This in turn may affect the time of ovulation and result in reduced fertility when combined with fixed time artificial insemination at 55h following sponge removal. - The repeated use of sponges within one year has not been studied. - The use of a vaginal applicator designed for ewes or ewe lambs is recommended to correctly insert sponges and to avoid vaginal injuries. (ii) Special precautions to be taken by the person administering the medicinal product to animals - Direct contact with the skin should be avoided.
    [Show full text]
  • Immediate Hypersensitivity Reactions Caused by Drug Excipients: a Literature Review Caballero ML, Quirce S
    REVIEWS Immediate Hypersensitivity Reactions Caused by Drug Excipients: A Literature Review Caballero ML, Quirce S Department of Allergy, La Paz University Hospital, IdiPAZ, Madrid, Spain J Investig Allergol Clin Immunol 2020; Vol. 30(2): 86-100 doi: 10.18176/jiaci.0476 Abstract The European Medicines Agency defines excipients as the constituents of a pharmaceutical form apart from the active substance. Immediate hypersensitivity reactions (IHRs) caused by excipients contained in the formulation of medications have been described. However, there are no data on the prevalence of IHRs due to drug excipients. Clinical manifestations of allergy to excipients can range from skin disorders to life-threatening systemic reactions. The aim of this study was to review the literature on allergy to pharmaceutical excipients and to record the IHRs described with various types of medications, specifically reactions due to the excipients contained in their formulations. The cases reported were sorted alphabetically by type of medication and excipient in order to obtain a list of the excipients most frequently involved for each type of medication. Key words: Allergy. Drug immediate hypersensitivity reaction. Excipient. Pharmaceutical excipients. Resumen La Agencia Europea de Medicamentos define los excipientes como los componentes de una forma farmacéutica diferenciados del principio activo. Se han descrito reacciones de hipersensibilidad inmediata causadas por los excipientes contenidos en la formulación de medicamentos. Sin embargo, no hay datos sobre la prevalencia de dichas reacciones. Las manifestaciones clínicas de la alergia a los excipientes pueden ir desde trastornos de la piel hasta reacciones sistémicas que ponen en peligro la vida. El objetivo de este estudio fue realizar una revisión de la literatura sobre la alergia a los excipientes farmacéuticos y recopilar las reacciones inmediatas descritas con diferentes tipos de medicamento, debido solo a excipientes contenidos en sus formulaciones.
    [Show full text]
  • Ep 0173478 A1
    Patentamt JEuropaischesJ European Patent Office @ Publication number: 0173 478 ^ ^ Office europeen des brevets EUROPEAN PATENT APPLICATION Application number: 85305552.3 © 'nt. CI ": A 61 K 35/78, A 61 K 31 /57 Dateof filing: 05.08.85 (A61K35/78, 31 :57),(A61K31/57, 31 :23, 31 :20) @ Priority: 15.08.84 GB 8420771 @ Applicant: EFAMOL LIMITED, Efamol House Woodbridge Meadows, Guildford Surrey GU1 1BA (GB) @ Date of publication of application: 05.03.86 @ Bulletin 86/10 efamol House woodbridge meadows, Guildford Surrey GU1 1BA (GB) @ Representative : Caro, William Egerton et al, J. MILLER & @ Designated Contracting States: AT BE CH DE FR GB IT CO. Lincoln House 296-302 High Holborn, London LILUNLSE WC1V7JH(GB) @ Treatment of skin disorders. A topical composition for skin treatment contains an anti- inflammatory glucocorticoid in combination with an essential fatty acid (EFA) of the n-6 or n-3 series or equivalent poly- unsaturated fatty acid, as such or in the form of a physio- logically acceptable derivative convertible in the body thereto. FIELD OF INVENTION The invention relates to compositions of y-linolenic acid and related materials with anti-inflammatory glucocorticoids and to the treatment of inflammatory skin disorders with them. BACKGROUND AND EXPLANATION OF INVENTION Much interest has been shown in recent years in essential fatty acid metabolism, especially in its relation to prosta- glandin (PG) metabolism and in particular to the balance of 1-series and 2-series PGs in the body. The main dietary essential fatty acid (EFA) utilised in the fully healthy human body is linoleic acid, but the Δ6- desaturase that converts it to the next acid in the n-6 series, namely y-linoleic acid (GLA) is at a low level of activity in many conditions.
    [Show full text]
  • (12) United States Patent (10) Patent No.: US 8,871.241 B2 Chou Et Al
    USOO8871241 B2 (12) United States Patent (10) Patent No.: US 8,871.241 B2 Chou et al. (45) Date of Patent: Oct. 28, 2014 (54) INJECTABLE SUSTAINED RELEASE 3,829,570 A 8, 1974 Heider et al. DELIVERY DEVICES 3,854,480 A 12/1974 Zaffaroni 3,896,819 A 7, 1975 Zaffaroni et al. 3,916,899 A 11/1975 Theeuwes et al. (75) Inventors: Kang-Jye Chou, Watertown, MA (US); 3,948,254 A 4, 1976 Zaffaroni Hong Guo, Belmont, MA (US); Paul 3,961,628 A 6, 1976 Arnold Ashton, Boston, MA (US); Robert W. 3,977.404 A 8, 1976 Theeuwes Shimizu, Acton, MA (US); David A. 3,980,463 A 9, 1976 Muramoto et al. Watson, Westwood, MA (US) 3,993,071 A 1 1/1976 Higuchi et al. 4,008,719 A 2f1977 Theeuwes et al. (73) Assignee: pSivida US, Inc., Watertown, MA (US) 4,014,334 A 3, 1977 Theeuwes et al. 4,014,335 A 3, 1977 Arnold 4,034,758 A 7, 1977 Theeuwes (*) Notice: Subject to any disclaimer, the term of this 4,036.227 A 7, 1977 Zaffaroni et al. patent is extended or adjusted under 35 4,077.407 A 3, 1978 Theeuwes et al. U.S.C. 154(b) by 1563 days. 4,111.201 A 9, 1978 Theeuwes 4,111,203 A 9, 1978 Theeuwes (21) Appl. No.: 10/714,549 (Continued) (22) Filed: Nov. 13, 2003 FOREIGN PATENT DOCUMENTS (65) Prior Publication Data CA 2544460 A1 5, 2001 US 2004/O176341 A1 Sep. 9, 2004 CN 1200033.
    [Show full text]
  • Pharmaceuticals Appendix
    )&f1y3X PHARMACEUTICAL APPENDIX TO THE HARMONIZED TARIFF SCHEDULE )&f1y3X PHARMACEUTICAL APPENDIX TO THE TARIFF SCHEDULE 3 Table 1. This table enumerates products described by International Non-proprietary Names (INN) which shall be entered free of duty under general note 13 to the tariff schedule. The Chemical Abstracts Service (CAS) registry numbers also set forth in this table are included to assist in the identification of the products concerned. For purposes of the tariff schedule, any references to a product enumerated in this table includes such product by whatever name known. Product CAS No. Product CAS No. ABAMECTIN 65195-55-3 ADAPALENE 106685-40-9 ABANOQUIL 90402-40-7 ADAPROLOL 101479-70-3 ABECARNIL 111841-85-1 ADEMETIONINE 17176-17-9 ABLUKAST 96566-25-5 ADENOSINE PHOSPHATE 61-19-8 ABUNIDAZOLE 91017-58-2 ADIBENDAN 100510-33-6 ACADESINE 2627-69-2 ADICILLIN 525-94-0 ACAMPROSATE 77337-76-9 ADIMOLOL 78459-19-5 ACAPRAZINE 55485-20-6 ADINAZOLAM 37115-32-5 ACARBOSE 56180-94-0 ADIPHENINE 64-95-9 ACEBROCHOL 514-50-1 ADIPIODONE 606-17-7 ACEBURIC ACID 26976-72-7 ADITEREN 56066-19-4 ACEBUTOLOL 37517-30-9 ADITOPRIME 56066-63-8 ACECAINIDE 32795-44-1 ADOSOPINE 88124-26-9 ACECARBROMAL 77-66-7 ADOZELESIN 110314-48-2 ACECLIDINE 827-61-2 ADRAFINIL 63547-13-7 ACECLOFENAC 89796-99-6 ADRENALONE 99-45-6 ACEDAPSONE 77-46-3 AFALANINE 2901-75-9 ACEDIASULFONE SODIUM 127-60-6 AFLOQUALONE 56287-74-2 ACEDOBEN 556-08-1 AFUROLOL 65776-67-2 ACEFLURANOL 80595-73-9 AGANODINE 86696-87-9 ACEFURTIAMINE 10072-48-7 AKLOMIDE 3011-89-0 ACEFYLLINE CLOFIBROL 70788-27-1
    [Show full text]
  • Pharmaceutical Appendix to the Tariff Schedule 2
    Harmonized Tariff Schedule of the United States (2007) (Rev. 2) Annotated for Statistical Reporting Purposes PHARMACEUTICAL APPENDIX TO THE HARMONIZED TARIFF SCHEDULE Harmonized Tariff Schedule of the United States (2007) (Rev. 2) Annotated for Statistical Reporting Purposes PHARMACEUTICAL APPENDIX TO THE TARIFF SCHEDULE 2 Table 1. This table enumerates products described by International Non-proprietary Names (INN) which shall be entered free of duty under general note 13 to the tariff schedule. The Chemical Abstracts Service (CAS) registry numbers also set forth in this table are included to assist in the identification of the products concerned. For purposes of the tariff schedule, any references to a product enumerated in this table includes such product by whatever name known. ABACAVIR 136470-78-5 ACIDUM LIDADRONICUM 63132-38-7 ABAFUNGIN 129639-79-8 ACIDUM SALCAPROZICUM 183990-46-7 ABAMECTIN 65195-55-3 ACIDUM SALCLOBUZICUM 387825-03-8 ABANOQUIL 90402-40-7 ACIFRAN 72420-38-3 ABAPERIDONUM 183849-43-6 ACIPIMOX 51037-30-0 ABARELIX 183552-38-7 ACITAZANOLAST 114607-46-4 ABATACEPTUM 332348-12-6 ACITEMATE 101197-99-3 ABCIXIMAB 143653-53-6 ACITRETIN 55079-83-9 ABECARNIL 111841-85-1 ACIVICIN 42228-92-2 ABETIMUSUM 167362-48-3 ACLANTATE 39633-62-0 ABIRATERONE 154229-19-3 ACLARUBICIN 57576-44-0 ABITESARTAN 137882-98-5 ACLATONIUM NAPADISILATE 55077-30-0 ABLUKAST 96566-25-5 ACODAZOLE 79152-85-5 ABRINEURINUM 178535-93-8 ACOLBIFENUM 182167-02-8 ABUNIDAZOLE 91017-58-2 ACONIAZIDE 13410-86-1 ACADESINE 2627-69-2 ACOTIAMIDUM 185106-16-5 ACAMPROSATE 77337-76-9
    [Show full text]
  • (12) United States Patent (10) Patent No.: US 7,544,192 B2 Eaton Et Al
    US007544192B2 (12) United States Patent (10) Patent No.: US 7,544,192 B2 Eaton et al. (45) Date of Patent: Jun. 9, 2009 (54) SINUS DELIVERY OF SUSTAINED RELEASE 5,443,498 A 8, 1995 Fontaine THERAPEUTICS 5,512,055 A 4/1996 Domb et al. 5,664,567 A 9, 1997 Linder (75) Inventors: Donald J. Eaton, Woodside, CA (US); 5,693,065. A 12/1997 Rains, III Mary L. Moran, Woodside, CA (US); 5,792,100 A 8/1998 Shantha Rodney Brenneman, San Juan Capistrano, CA (US) (73) Assignee: Sinexus, Inc., Palo Alto, CA (US) (Continued) (*) Notice: Subject to any disclaimer, the term of this FOREIGN PATENT DOCUMENTS patent is extended or adjusted under 35 U.S.C. 154(b) by 992 days. WO WOO1/02024 1, 2001 (21) Appl. No.: 10/800,162 (22) Filed: Mar 12, 2004 (Continued) (65) Prior Publication Data OTHER PUBLICATIONS US 2005/OO437O6A1 Feb. 24, 2005 Hosemann, W. et al. (Mar. 2003, e-pub. Oct. 10, 2002). “Innovative s Frontal Sinus Stent Acting as a Local Drug-Releasing System.' Eur: Related U.S. Application Data Arch. Otorhinolarynolo. 260:131-134. (60) Provisional application No. 60/454,918, filed on Mar. (Continued) 14, 2003. Primary Examiner Kevin C Sirmons (51) Int. Cl Assistant Examiner Catherine NWitczak A. iM sI/00 (2006.01) (74) Attorney, Agent, or Firm Morrison & Foerster LLP (52) U.S. Cl. ........................ 604/506; 604/510; 604/514 (57) ABSTRACT (58) Field of Classification Search .............. 604/93.01, 604/891.1. 890.1, 57, 59-64, 510, 514,506; S lication file f 606/196 The invention provides biodegradable implants for treating ee application file for complete search history.
    [Show full text]