This document discusses types, routes of administration, pharmacological actions, and guidelines for weaning oral corticosteroids. It describes corticosteroid types including replacement therapy drugs like hydrocortisone and mineralocorticoid like fludrocortisone. It also discusses anti-inflammatory corticosteroids that can be short, intermediate, or long acting when administered systemically or locally. The document provides details on specific drugs and their uses, as well as a multi-step process for slowly weaning off oral corticosteroids to avoid withdrawal symptoms.

1. Dr.Azad A Haleem AL.Brefkani
University Of Duhok
College of pharmacy
Pediatrics Department
azad82d@gmail.com
2016

2. Types of Steroids
• Replacement Therapy
• glucocorticoid (hydrocortisone)
• mineralocorticoid (fludrocortisone)
• Anti-inflammatory Therapy
• Short acting: hydrocortisone
• Intermediate acting: prednisolone;
methylprednisolone; triamcinolone
• Long acting: dexamethasone

3. Routes of Administration
• Systemic : oral, transrectal, IV, IM
• Local: topical, intranasal, intraocular,
intraarticular

4. Pharmacological Actions
• Hydrocortisone used for:
• orally for replacement therapy,
• I.V: for shock and asthma,
• topically for eczema (ointment) and
• Enemas (ulcerative colitis).
• Prednisolone the most widely used drug given orally in inflammation and
allergic diseases.
• Betamethasone and dexamethasone: very potent, with out salt-retaining
properties; thus, very useful for high-dose therapies (e.g., cerebral
edemas).
• Beclometasone, diproprionate, budesonide: pass membranes poorly;
more active when applied topically (severe eczema for local anti-
inflammatory effects) than orally; used in asthma, (aerosol).
• Triamcinolone: used for severe asthma and for local joint inflammation
(intra-articular inj.).

5. Side Effects ?

6. Steps for weaning oral corticosteroids
• Divide each daily dose into a morning and an
afternoon portion.
• If the daily dose exceeds 20mg, reduce it by half every
two weeks until the daily dose is 20mg.
• At 20mg per day, the adrenal cortex must begin to
produce its own cortisol again, and the weaning
process needs to progress more slowly to minimize
withdrawal symptoms and to avoid dangerous
repercussions related to a lack of natural cortisol
• Begin reducing the afternoon dose while maintaining
the morning dose at the same level.

7. • When taking 10mg in the morning and 10mg in the
afternoon, begin to decrease the afternoon dose by 2.5mg
every seven days.
• When the afternoon dose is zero, divide the 10mg
morning dose in half again. Take 5mg in the morning and
5mg in the afternoon.
• Continue decreasing the afternoon dose by 2.5mg every
seven or more days until the afternoon dose is again
reduced to zero.
• Upon reaching 5mg per day, proceed more slowly. At this
point, the adrenal glands need to be producing natural
cortisol, as the Prednisone is no longer providing enough
corticosteroid to keep the body functioning properly.

8. • At 5mg per day, it is usually advisable to reduce
by only ½ mg at a time. Remain at each new dose
level for periods of not less than one week.
• Take 2.5mg in the morning and 2.5mg in the
afternoon. Decrease the afternoon dose by ½ mg
every one week.
• When the afternoon dose is again reduced to
zero, split the morning dose in half again and
continue decreasing the afternoon dose by ½ mg
as symptoms allow. Repeat the process until the
dose is reduced to zero.

9. Thanks