Corticosteroid hormones. Corticosteroids: inhalation drugs, topical drugs, list of drops, ointments, tablets. How they work, side effects Corticosteroid drugs name

Drugs based on steroid hormones in the treatment of joint diseases are currently one of the leading groups of drugs in terms of their effective therapeutic properties.

Their use for treatment provides significant benefits for the rheumatological patient, which exceed the strength of any non-steroidal anti-inflammatory drugs (NSAIDs). These include: a rapid onset of action and a strong anti-inflammatory effect on the lesion.

However, corticosteroid drugs have not only a positive side, but also a number of quite serious negative consequences, which, in cases of improper prescription and use, can cause significant harm to the patient’s health.

As a result, there is always an ambiguous position of both the patients themselves and doctors towards this. Some are ready to accept them just to eliminate the pain, while others, on the contrary, firmly refuse treatment, since it can cause harm.

Both judgments are incorrect, since corticosteroids or glucocorticoids are simply irreplaceable in some clinical circumstances with a competent approach to treatment. However, there are a number of situations when it is possible to do without them.

What are corticosteroids and their main effects

Corticosteroids or glucocorticoids is a subclass of steroid hormones that are produced exclusively by the adrenal cortex. Unlike other hormones, they are not produced by the gonads. They tend to have glucocorticoid or mineralocorticoid activity to varying degrees.

When glucocorticoid or mineralocorticoid activity predominates, corticosteroids are divided into glucocorticoids and mineralocorticoids. In our case, the main glucocorticoids produced in the human body are cortisone and hydrocortisone.

Also known as corticosteroids are hydrocortisone derivatives that are of semi-synthetic origin, including the following:

• Dexamethasone;
• Prednisolone;
• Methylprednisolone.

From the effects of corticosteroids on the human body, several can be distinguished and presented in the table:

Main indications for the use of corticosteroids

Corticosteroids can be used in the following ways:

1. Systemic – use is prescribed orally, intravenously, intramuscularly;
2. Local - the most common method is intra-articular injections.

Speaking about the use of systemic corticosteroids in the field of rheumatology, the following diseases are direct indications for them:

• Acute rheumatic fever.
• Systemic scleroderma.
• Systemic lupus erythematosus.
• Systemic vasculitis.

The most common use of glucocorticoids is in the form of intra-articular injections for the following diseases of the musculoskeletal system:

• Osteoarthritis.
• Gout.
• Acute traumatic arthritis.
• Synovitis of the knee joint.
• Rheumatoid arthritis.
• Reactive arthritis.
• Periarthritis of the shoulder joint.
• Psoriatic arthritis.

From the list of diseases listed above, the use of corticosteroids is not always indicated. Their prescription is advisable when treatment with NSAIDs for two weeks has not shown positive results. Also, their use occurs in the development of synovitis (inflammation of the synovial membrane of the joint with the formation of effusion in it). This condition in clinical manifestations is expressed by swelling of the joint, limited passive and active movements in the joint.

Contraindications to the use of corticosteroids

As a rule, there are no absolute contraindications to the use of systemic drugs of this type. There are relative restrictions on use, which are:

• Diabetes.
• Ulcerative formations in the stomach and duodenum.
• Heart failure.
• Epilepsy.
• Arterial type hypertension.
• Mental disorders.

The use of corticosteroids by injection into the joint is contraindicated in the following cases of diseases and disorders:

• Local or systemic infectious process;
• Transarticular fracture;
• Severe periarticular osteoporosis;
• Diseases of the blood coagulation system;
• or bone destruction that cannot be corrected.

Side effects of corticosteroids

With systemic use of corticosteroids for a long time, there is a possibility of a large number of unpleasant reactions. Their development must be anticipated before prophylaxis with appropriate drugs is carried out.

The list of adverse reactions from corticosteroids is quite large, among which the main ones are the following:

• Increased body weight;
• Atrophy and
• Stretch marks, hemorrhage and thinning of the skin, acne;
• Osteoporosis and vertebral compression fractures and other pathological fractures manifested against the background of this disease;
• Increased blood pressure;
• Steroid ulcers in the digestive organs;
• Nausea, vomiting, pain in the stomach and esophagus;
• Sleep disorders and psychoses, sudden mood changes;
• Glaucoma, cataract;
• linear growth in children, as well as delayed puberty;
• Increased glucose levels and lipids in the blood.

The manifestation of certain negative consequences (sleep disturbance, emotional instability, etc.) appears immediately after the start of therapy and it is not possible to avoid them. The development of others has a later manifestation and their onset may be limited by using small doses of the hormone, as well as by prescribing medications to prevent the complications caused.

Corticosteroids pharmacists name a wide group of drugs used in the treatment of allergic rashes, dermatological diseases, etc. The adrenal cortex produces hormonal substances called corticosteroids or glucocorticoids.

Prostaglandins, which are the source of inflammatory processes, are blocked by these hormones. If you use corticosteroids correctly, you can prevent the symptoms of the inflammatory process: eliminate pain and itching, stop purulent processes, and remove swelling.

Naturally occurring corticosteroids

Corticosteroids are the general name for hormones produced by the adrenal cortex. These hormones include mineralocorticoids and glucocorticoids. The human adrenal cortex produces hydrocortisone and cortisone, which are fundamental, and the mineralocorticoid is aldosterone. These hormones perform many important functions in the body. Glucocorticoids have an anti-inflammatory effect and are classified as steroids. They regulate the metabolism of fats, carbohydrates and proteins. Puberty is also controlled by these hormones. They also control kidney function, the body’s response to stress, and contribute to the normal course of pregnancy.

Main indications for the use of glucocorticoids:

When transplanting organs and tissues, glucocorticoids are used, because they have an immunosuppressive effect necessary to suppress the rejection reaction, as well as for various autoimmune diseases.

Aldosterone is used in the treatment of:

Corticosteroids are deactivated in the liver and then excreted in the urine. Aldosterone is responsible for the exchange of potassium and sodium. Na + is retained in the body, K + ions are excreted in increased quantities precisely under the influence of this mineralocorticoid - aldosterone.

Synthetic corticosteroids

Synthetic corticosteroids have found wide use in practical medicine, since they have the properties of natural corticosteroids, i.e. the ability to suppress the inflammatory process. Their antiallergic, antitoxic, antishock and immunosuppressive properties are used. At the same time, it has no effect on the infection itself, i.e., on the causative agents of the disease. The infection recurs after discontinuation of the drug.

The use of corticosteroids leads to stress and tension. And this, in turn, affects the state of the immune system. Immunity decreases, because only in a state of relaxation is immunity at a sufficiently high level. It can be concluded that due to the use of synthetic corticosteroids, the disease becomes protracted and the regeneration process is blocked. In addition, under their influence the functions of the adrenal glands are disrupted, because the functions of natural corticosteroids are impaired. Under the influence of these drugs, the work of other endocrine glands is also disrupted and the hormonal balance of the body is affected.

With all this, these drugs eliminate (suppress) inflammation, and also have a remarkable analgesic property.

Glucocorticoids began to be used as medicines in the 40s. XX century. Scientists back in the late 30s. The twentieth century proved that the adrenal cortex produces steroid hormones. In 1937, a mineralocorticoid, deoxycorticosterone, was isolated from the adrenal cortex; in the 40s. - glucocorticoids cortisone and hydrocortisone. Hormones such as cortisone and hydrocortisone have shown good results in the treatment of many diseases and therefore they began to be used as medicines. After some time they were synthesized.

Cortisol (hydrocortisone) is the most active glucocorticoid produced in the human body. Less active are 11-deoxycortisol, cortisone, 11-dehydrocorticosterone, corticosterone.

The most widely used drugs are hydrocortisone and cortisone. However, it is worth noting that cortisone causes strong side reactions and therefore is currently used much less frequently, because More effective and safe drugs have appeared. Currently, natural hydrocortisone or its esters (hydrocotrisone acetate and hydrocortisone hemisuccinate) are used.

Corticosteroid and glucocorticosteroid drugs

Ointments are made from synthetic analogues of natural human hormones. In addition, some chemicals are added to corticosteroids, giving them certain properties, for example, with a short-term and weak effect or, conversely, with a longer and more powerful effect. Glucocorticoids, in addition to their therapeutic effect, also cause side effects. Skin tissue may atrophy and immune activity may be affected.

There are 4 conventional types of ointments:

1. Made on the basis of hydrocortisone or prednisolone - light;
2. Based on fluocortolone, prednicarbate, flumethasone - moderate;
3. Strong - made on the basis of mometasone, budenosite, methylprednisolone, betamethasone and other corticosteroid hormonal substances;
4. Very strong - drugs made on the basis of flumethasone (Dermovate).

There is also a group of products of mixed origin.

“Weak” and “strong” hormonal ointments

As mentioned earlier, people have learned to create synthetic hormones by regulating their properties (potency) by adding certain chemicals to the molecules of human hormones.

By the strength of ointments, doctors mean the degree of effect of the ointment on the affected area skin and therefore how quickly the skin condition improves. The more anti-inflammatory properties the ointment has, the faster the damaged area of ​​skin will return to normal.

As a rule, the stronger the hormonal drugs, the more side effects they cause. The positive side of strong drugs is the ability to cope with serious illnesses, but the negative side is the presence of side effects. Accordingly, with weak hormonal ointments the opposite is true.

There are special preparations intended for topical use that have a weak effect, because... poorly absorbed. In the treatment of skin diseases, many combination drugs containing corticosteroids are used. These drugs, like glucocorticoids, promote tissue regeneration; they contain antimicrobial and antifungal substances or components.

How to use corticosteroid ointments correctly

Any corticosteroid drug should be used only by doctor's prescription. Experts will determine the duration of use of such a drug, as well as the frequency of its application to the skin per day. As practice shows, apply a similar preparation to the affected area of ​​skin once a day. The duration of treatment with a corticosteroid drug depends on the degree of the disease. You must read the instructions for the drug before you start using it.

Ointments or creams based on hormones have antiallergic, antipruritic and anti-inflammatory effects. Different forms of skin diseases are treated with drugs that differ in strength and are based on hormones.

The use of hormonal ointments and creams for the treatment of psoriasis

Hormonal ointments for psoriasis are medications that are used during exacerbation of the disease. Such ointments contain glucocorticosteroid hormones. These medicinals are quite quickly stop itching, reduce inflammation, and stop cell proliferation in areas of inflammation.

Ointments and creams based on glucocorticosteroids differentiated by the strength of impact. Children or adults with minor skin lesions are prescribed weak hormonal drugs. Weak products are made on the basis of hydrocortisone with different concentrations. Part moderately strong drugs include the following glucocorticosteroids: fluocortolone, prednisolone, prednicarbate. It is used when the disease has become chronic and involves lichenification of the skin. Strong ointments include halomethasone, betamethasone, mometasone, budesonide, dexamethasone, triamcinolone, flumethasone. Their used for extensive skin lesions.

Glucocorticoid drugs are distinguished by generation and by strength of action. The older the generation, the less effective and at the same time the small number of side effects, and the later the generation - on the contrary, high efficiency is inherent, but side effects also increase. In the treatment of psoriasis The most preferred drugs are the fourth generation of glucocorticoids: furoate, mometasone, methylprednisolone aceponate, hydrocortisone butyrate. These drugs do not contain fluorine atoms, which reduces the number and severity of side effects.

When using hormonal drugs to treat psoriasis, side effects. They arise due to a number of factors, including: use in large quantities, unsystematic and long-term use, as well as the individual characteristics of the organism. The main danger is addiction to the drug, which leads to an increase in dose. In turn, this leads to an overdose, and subsequently to withdrawal syndrome. After stopping taking the drug, the body begins to reproduce its own hormones after some time.

Medicines of the glucorticoid group are taken only under the supervision of a doctor- due to a large number of side effects. Used during an exacerbation in small quantities.

From the skin possible side effects such as hypertrichosis, skin atrophy, pyoderma, folliculitis, hypopigmentation, stretch marks, rosacea, pustular rash, increased itching, burning, irritation, dryness, etc.

There may also be side effects from the liver. The use of hormones of synthetic origin leads to a decrease in the efficiency of the liver, which in turn has an adverse effect on digestion and the entire body as a whole. This is largely why during hormonal therapy it is recommended to follow a gentle diet and additionally take sorbents and hepatoprotectors.

The kidneys also suffer if glucorticoids are used incorrectly. Due to impaired calcium metabolism, kidney stones form, the blood is poorly filtered, and the permeability of cell membranes decreases. Cardiovascular activity also suffers, and the development of arterial hypertension is also possible.

Hormonal creams or ointments for psoriasis are usually used 1-3 times a day. The course of treatment is 5–7 days with a further reduction in dosage. Another treatment tactic is also possible: first, strong drugs are prescribed for the first 2-4 days of treatment, and then weaker ones.

What are corticosteroids? This is the collective name for a whole group of hormones produced by the adrenal cortex. Preparations based on them are actively used in modern medicine. They are divided into two groups, the first is glucocorticoids, which include, in particular, cortisone (an oral glucocorticosteroid used for chronic adrenal insufficiency) and hydrocortisone. The second group is mineralocorticosteroids - regulators of water and sodium metabolism in the body.

For the first time, doctors and scientists started talking about their benefits and importance for the human body in 1886. Corticosteroids are necessary for humans to normalize metabolism, control kidney function, and also puberty.

Classification of corticosteroid hormones

In modern medicine, natural hormones are not used; they have been replaced by synthetic substitutes that affect humans in a similar way. Doctors classify them by activity level:

1. Steroid hormones produced exclusively by the adrenal cortex with reduced activity (Hydrocortisone and Prednisolone).
2. Steroid hormones with average activity, these include Flumethasone and Fluocortolone.
3. Hormones with highly pronounced activity are the most common steroids at present (Betamethasone and Mometasone).
4. Hormones with very high activity, these include Clobetasol and Chalcinonide.

Action

So what are “corticosteroids” and what effect do they have on the human body? Those drugs that are sold in pharmacies are synthetic compounds; they can be produced under different trade names, but the active substance in each group is the same. The effects of corticosteroids are as follows:

• anti-inflammatory effect without affecting the infectious origin and pathogens;
• the ability to influence all forms of metabolism: water-electrolyte, lipid, protein and carbohydrate;
• anti-allergic effect;
• effects on the cardiovascular system, increased sensitivity of the walls of blood vessels and heart muscles to adrenergic agonists and epinephrine, effect on blood pressure;
• the ability to stimulate the formation of blood platelets, megakaryocyte fragments and red blood cells;
• the ability to suppress the production of sex hormones, as well as reduce the sensitivity of organs and tissues to steroids produced by the thyroid gland.

Indications for use

Corticosteroids are used where conventional drugs (anti-inflammatory, painkillers, anti-allergenic) are powerless. Glucocorticoids and mineralocorticoids differ in the nature of their effects on the body. The former are most relevant in the treatment of bronchial asthma, rheumatism, pancreatitis, viral hepatitis, rheumatoid arthritis, etc. They have a pronounced anti-inflammatory effect. Mineralocorticoids are used for diseases the occurrence of which is associated with impaired mineral metabolism.

Glucocorticoids - what are they?

Corticosteroids produced by the adrenal cortex. This type of hormones most effectively affects carbohydrate metabolism. Steroid hormones get their name for their ability to increase sugar levels in the blood and lymph by enhancing the process of combining glucose in the liver. They also affect the metabolism of fats and proteins. The most effective of them is cortisol (a biologically active glucocorticoid hormone of a steroid nature, that is, it has a sterane core in its structure).

• all forms of arthralgia (joint pain);
• salt deposition in chronic metabolic diseases, which are characterized by a failure of purine metabolism and the inability of the kidneys to excrete uric acid;
• chronic systemic diseases of the joints with a predominant localization of the inflammatory process in the spine.

Important!Doctors prescribe steroid drugs if the use of other anti-inflammatory drugs has not given a positive result within fourteen days.

In addition to painful deviations from the normal state of the joints, corticosteroids are often prescribed for disturbances in the functioning of other organs and tissues (autoimmune diseases, bronchial asthma, severe allergic reactions).

Mineralocorticosteroids

Having found out what corticosteroids are, it would not be a bad idea to learn about their classification. This group includes hormones of the adrenal cortex that affect mineral metabolism, mainly the metabolism of sodium and potassium. These steroids are responsible for regulating the water-salt balance. Unlike other corticosteroids, this type is not in great demand in medicine. Mineralcorticoids are prescribed for:

• chronic adrenal insufficiency, or hypocortisolism (a rare endocrine disease, as a result of which the adrenal glands lose the ability to produce sufficient amounts of hormones, primarily cortisol);
• syndrome of severe muscle weakness, accompanied by a significant decrease or complete cessation of motor activity;
• Addison's disease.

Contraindications

Despite the high activity of many drugs with corticosteroids, there are no specific contraindications. However, there are conditions for which health care providers prescribe them with caution. Such diseases and disorders include:

1. Diabetes mellitus (a disease of endocrine origin that develops due to the lack or absence of insulin in the body).
2. Ulcer of the gastrointestinal tract during exacerbation.
3. Heart failure.
4. High blood pressure.
5. Acute renal or liver failure.
6. Glaucoma (an eye disease characterized by a constant or periodic increase in ophthalmotonus).
7. Cataract (a physiological condition associated with clouding of the lens of the eye and causing varying degrees of visual impairment up to its complete loss).
8. Chicken pox (an acute viral infection transmitted by airborne droplets).
9. Tuberculosis (an infectious disease caused by Mycobacterium tuberculosis).
10. Thrombosis.
11. Epilepsy (a common chronic neurological disease in humans, manifested in the body’s predisposition to the sudden onset of seizures).
12. Mental illnesses.

Side effects

The explicitness of adverse reactions when taking corticosteroids is determined by the class to which they belong. Glucocorticosteroids of the first type (Cortisone) provoke side effects more often than new, more modern drugs (Mometasone and Betamethasone). In addition, the strength of the effect directly depends on the dose and duration of use. The higher the dosage and duration of the course, the higher the likelihood of adverse reactions. In most cases, these medications cause:

1. Edema that is caused by sodium retention.
2. Increased blood pressure and increased blood glucose concentrations.
3. An inflammatory disease of the gastric mucosa, leading to its degenerative changes.
4. Dermatitis, acne, and in especially severe cases - atrophy of the skin.
5. An inflammatory lesion of the skin that occurs as a result of exposure to damaging factors of a chemical, physical or biological nature.
6. Depression, stress, mental disorders.
7. Malfunction of the adrenal glands.

Important! To prevent the occurrence of adverse reactions, it is necessary to timely adjust the dose and duration of taking steroid hormones.

Features of application

Corticosteroids are recommended to be taken from six o'clock in the morning to twelve o'clock in the afternoon. These conditions are as close as possible to the physiological production of adrenaline and norepinephrine (adrenal hormones) in the body. As a rule, the medication should be taken during or after meals.

Treatment with corticosteroids, especially with long courses, must be supplemented with calcium intake to protect against calcium deficiency, as well as food rich in protein.

Release form

Synthetic steroid hormones are produced in several forms:

• tablets or capsules;
• injection solutions in ampoules;
• topical corticosteroids, which are used externally (ointments, creams);
• solutions for inhalation.

Corticosteroids: list of drugs

The most popular steroids in tablet form are:

1. "Prednisolone."
2. "Celeston."
3. "Kenacourt."
4. "Metypred."
5. "Lemod."

Prednisolone is a drug that has a strong antiallergic and anti-inflammatory effect. The medication should not be taken if you have a stomach or intestinal ulcer, vaccination or persistent high blood pressure. The cost of Prednisolone (100 tablets) is about one hundred and fifty rubles. The drug is also available in the form of an injection solution.

“Celeston” is an anti-inflammatory medicine that contains betamethasone; tablets are prescribed after a heart attack, for high blood pressure, diseases of the endocrine system, glaucoma, osteoporosis, and sexually transmitted diseases.

"Kenacort" - tablets for stabilizing cell membranes, eliminate symptoms of inflammation and allergies. Contraindicated in psychosis (a pronounced disorder of mental activity, in which mental reactions grossly contradict the real situation), as well as in neuritis (an inflammatory disease of the peripheral nerves, in which, along with pain, symptoms are identified, the so-called loss, that is, loss or decrease in sensitivity, and also paralysis and paresis) and fungal infections. The cost of a package of tablets (50 pieces) is approximately two hundred and fifty rubles.

Methylprednisolone is a hormonal drug classified as a glucocorticosteroid. The only contraindication is individual intolerance. In emergency situations, it is prescribed to pregnant women, for psychosis and diseases of the endocrine system, as well as for disorders of the gastrointestinal tract. The cost of "Metyprednisolone" varies from 160 to 300 rubles.

"Lemod" is a medicine that is effective in the fight against disorders of an endocrine, allergic, musculoskeletal, and oncological nature. It is not recommended to take it for corneal herpes (a viral disease with a characteristic rash of grouped blisters), tuberculosis (a contagious infectious disease, the main cause of which is infection of the body with Koch bacilli), as well as for diabetes and fungal diseases. The cost of the drug is about 500 rubles.

The list of corticosteroids is extensive; hormones are also available in injection form:

1. "Hydrocortisone."
2. "Diprospan".
3. "Kenalog."
4. "Flosteron".
5. "Depo-Medrol."

Hydrocortisone is a hormonal steroid medicine. The medication suppresses inflammatory, allergic and immune reactions. The price of “Hydrocortisone” (10 ampoules) is about 150 rubles.

"Diprospan" is a hormonal drug that, in its pharmacological action, belongs to the group of glucocorticoids. The active ingredient is betamethasone. Injections are effective in the following cases:

• a pathological process manifested by excessive accumulation of fluid in the cells of the brain or spinal cord;
• adrenal insufficiency.

Contraindications for use:

• excessive sensitivity to one of the components;
• infectious lesion;
• diseases of the digestive system;
• high blood pressure;
• kidney and liver diseases.

The cost of one Diprospan ampoule is approximately 210 rubles.

Kenalog is a drug used to relieve inflammation and severe allergy attacks. The active ingredient of the drug is triamcinolone. "Kenalog" is characterized by a mild effect on the human body. Does not affect the functioning of the pituitary gland and metabolism. Five ampoules of the drug cost about 450 rubles.

"Flosteron" is a drug with anti-inflammatory, antitoxic, desensitizing, and immunosuppressive effects. The active substance included in the composition is betamethazole (has a prolonged effect). The price of five ampoules of Flosteron is approximately 250 rubles.

"Depo-Medrol" - what kind of corticosteroid drug is it? The medication belongs to the group of glucocorticosteroids (hormones of the adrenal cortex) and is used in the treatment of diseases of almost all internal organs, including the spinal column. Available in the form of a suspension. The cost of the Belgian drug is about 500 rubles.

The most common ointments with corticosteroids are:

1. "Lokoid".
2. "Lorinden S."
3. "Fluorocort".
4. "Fucidin G".
5. "Sinflan" ("Flucinar").

"Lokoid" is a synthetic glucocorticoid ointment for external use, widely used for the treatment of psoriasis, dermatitis and eczema. The medication has anti-inflammatory and antipruritic effects. The cost of "Lokoid" is within 350 rubles.

"Lorinden S" is an external preparation with antimicrobial, anti-allergenic and anti-inflammatory effects. The price of the drug "Lorinden S" varies from 350 to 600 rubles.

Inhaled steroids reduce the permeability of cell membranes and also limit the release of protease beyond the cellular organelles. Inhaled corticosteroids are:

1. "Beclamitozone" (analogs: "Alcedin", "Bekotide", "Beklokort").
2. "Baconase."
3. "Flunisolide" (analogue: "Ingacort").

"Beclocort" - the active ingredient of the drug inhibits the process of releasing chemical compounds from the group of physiologically active lipids, which are formed in the body enzymatically. The drug also reduces the production of pathological fluid released into tissues or cavities from small blood vessels during inflammation. The medication is contraindicated in children under six years of age, as well as in case of individual intolerance. The cost of Beclamitozone varies from 300 to 450 rubles.

"Beconase" is an antiallergenic agent that reduces swelling of the epithelium and secretion of mucus by the bronchial glands. Used as a nasal corticosteroid. The price of the drug is approximately 350 rubles.

Flunisolide is an anti-inflammatory drug that is effective for chronic respiratory diseases, obstructive bronchitis and runny nose. The medicine is not recommended for use in the first trimester of pregnancy, for children under five years of age, or for tuberculosis.

Corticosteroids are drugs for the treatment of inflammatory diseases. They have a powerful anti-inflammatory and anti-edematous effect, quickly relieving the patient of pain and fever. In terms of their action, these drugs are more effective than their non-hormonal analogues - NSAIDs, but have a number of side effects.

Corticosteroids are a type of hormone that is produced in the human body. They got their name because of their chemical structure (cholesterol plays an important role in their production) and the place of production (adrenal cortex). Another name for this group of hormones is glucocorticoids.

Their functions in the body are diverse - regulating the activity of the immune system, maintaining blood glucose levels, increasing the adaptive capabilities of the body. They are used in medicine due to their anti-inflammatory and immunosuppressive effects.

They are prescribed to quickly suppress inflammatory reactions, including chronic kidney pathologies. Another area of ​​application is complex therapy of autoimmune conditions, allergic reactions and antitumor treatment. The effect of increasing blood sugar is not used, but it must be taken into account when prescribing treatment.

The principle of operation of the funds

The mechanism of action of the drugs is based on intervention in the biochemical basis of the inflammatory response. The drugs slow down the synthesis of phospholipase, an enzyme without which the inflammatory reaction is impossible. This makes them the most effective group of drugs against any inflammation, including allergic ones.

The same enzyme (phospholipase) is also involved in a number of immune reactions and the formation of immune cells. Therefore, a slowdown in its synthesis leads to a decrease in immunity and normalization of the condition during autoimmune aggression.

Corticosteroids are produced normally in the human body. Their number constantly fluctuates depending on the current needs of the body. The production of corticosteroids is regulated by pituitary hormones. When a doctor prescribes drugs with corticosteroids, he has to take into account the patient's natural level of these hormones.

Classification

Drugs that contain corticosteroids are classified depending on several characteristics. First of all, natural and synthetic hormones are isolated, i.e. isolated from animal tissues, close in structure to human ones, and synthetic, having specified properties.

Based on the strength of impact, they are divided into strong, very strong, medium and weak GCS.

The need to prescribe weak steroids to patients is constantly the subject of debate among experts - some believe that such drugs are better replaced by NSAIDs.

According to the method of application, systemic ones are distinguished, i.e. used for complex effects (oral and injectable drugs), as well as local (in the form of ointments and solutions) and inhalation, which are administered using a nebulizer or in the form of a spray.

Weak

Classification by potency is mainly used in dermatology. It is important for determining the intensity of the drug's effect on the affected area. Weak drugs include hydrocortisone and its compounds.

Hydrocortisone shows a very modest local effect and is used to treat uncomplicated inflammation of the skin, in the form of eye and ear drops to combat inflammation. It is rarely prescribed internally. Most hydrocortisone compounds are actively absorbed when applied topically, creating a risk of unwanted side effects.

To get rid of them, hydrocortisone butyrate is used - this compound is not absorbed into the blood from the skin and mucous membranes.

Moderate

Corticosteroids are medications used for a variety of purposes. Classification by strength is adopted mainly for topical preparations - ointments, creams and lotions.

The purpose of prescribing moderate corticosteroids is to combat exacerbations of inflammatory skin diseases (except fungal ones).

Medium strength drugs include Prednisolone and Fluocortolone under various trade names. These are the most commonly used means.

Strong

Strong drugs include Betamethasone, Halomethasone, Mometosone and Dexamethasone.

They have a powerful local anti-inflammatory effect and are used for severe allergic reactions, atopic dermatitis, and bacterial inflammatory processes. Such ointments can only be used as prescribed by a doctor.

Very strong These drugs fight such dangerous conditions as exfoliative dermatitis, Lyell's syndrome, etc.

They are used only as part of complex therapy as a pathogenetic agent (i.e., disrupting the pathological process, but not affecting the cause of the disease). This group includes Clobetasol and Chalcinonide. Most often they are used in hospitals.

Synthetic corticosteroids

Corticosteroid drugs are divided according to their origin into natural and synthetic. The advantage of synthetic GCS is that they are created in laboratory conditions. This makes their production simpler and cheaper, which means the drugs are more accessible to the population.

Another, more important advantage is that these drugs are created with predetermined properties. Synthetic drugs have fewer side effects than natural hormones.

• Synthetic GCS:
• prednisolone;
• dexamethasone;
• betamethasone;

triamcinolone.

As can be seen from the list, most of the glucocorticoid drugs used are synthetic.

This is due to the fact that they are cheaper and safer than natural remedies. In terms of effectiveness, they are only slightly inferior to natural hormones, and there are very few situations where this difference is critical.

Hormonal corticosteroids

Corticosteroids are hormone drugs, so they are all classified as hormonal drugs. This explains their wide spectrum of action and severity of side effects - the effect of hormones is always versatile. Natural GCS were the first in their group that man learned to use. Currently, cortisone and hydrocortisone are used as natural hormones. Along with it, the severity of side effects is higher.

Drugs of this group are used in cases where a quick and powerful effect is important, and adverse reactions can be neglected, i.e. in emergency cases, when the patient’s condition is extremely serious and there is a threat to life. This group is not suitable for permanent use.

Local and systemic corticosteroids

The division into local and systemic is based on which effect is more necessary in a given situation. Systemic corticosteroids are taken orally in tablets or administered intravenously. These drugs are prescribed for severe systemic pathologies - autoimmune reactions, systemic inflammatory processes, common skin lesions.

The prescription of systemic corticosteroids is always associated with the risk of side effects, so the doctor prescribes them only in cases where serious intervention in the functioning of the body is required.

The patient should be warned about side effects and know how to reduce them. Also, systemic drugs are used in emergency conditions that threaten the patient’s life - status asthmaticus, anaphylactic shock, sepsis, shock.

Local preparations exert their effect strictly in the area of ​​application. They are used in the form of ointments and creams to combat skin lesions, as well as in the form of inhalations to treat bronchial asthma and other lesions of the respiratory system. Local corticosteroids can be combined with systemic ones or used as an independent element of treatment.

Indications for use

Corticosteroids are drugs with a wide range of indications, ranging from minor to life-threatening.

Full list of indications for the use of GCS:

These drugs are used strictly as prescribed by the doctor, especially for systemic drugs. You should strictly follow the dosage schedule - the effectiveness of treatment depends on this.

Contraindications

Since hormonal drugs have a significant effect on the body, their use should be done very carefully. The most effective drugs from this group are sold strictly with a prescription.

When you should not use GCS:

• hyperfunction of the adrenal glands (excess of its own corticosteroids);
• diabetes mellitus (GCS increase blood sugar levels);
• mycoses, severe purulent lesions, tuberculosis (GCS reduce immunity, stimulate the development of infection);
• immunodeficiency states of any origin;
• high blood pressure (CGS increase it even more);
• blood clotting disorders (GCS increase the tendency to thrombosis);
• glaucoma, corneal lesions (increased intraocular pressure);
• diseases of the digestive system (impaired production of protective substances in the gastric mucosa);
• pregnancy, lactation (all side effects of GCS have a bad effect on the child).

Possible adverse reactions

Drugs in this group have many adverse reactions that arise from their biological functions. In cortisone and hydrocortisone they are more pronounced, in synthetic hormones they are weaker.

GCS cause the breakdown of glycogen and an increase in blood sugar levels. Normally, this is necessary to maintain glycemia at a constant level, but during treatment it is a side effect. Because of this, patients need to follow a diet and avoid fast carbohydrates.

Constriction of the renal vessels, which causes an increase in blood pressure. Normally, this is part of the blood pressure regulation mechanism, but during treatment it is a dangerous side effect.

Effect on thrombus formation. GCS regulate the functioning of the coagulation system, but in cases where the tendency to thrombus formation is increased, this is dangerous.

Itsenko-Cushing syndrome. This is a condition that occurs when there is an excess of CGS. At the same time, the distribution of adipose tissue changes, the face becomes round and red, a “bull neck” appears, and the limbs are disproportionately thin. Decreased immunity, which entails susceptibility to various diseases.

Forms of release of drugs

Corticosteroids are available in various dosage forms. These are drugs for local and systemic use.

They are available in the following dosage forms:

Types of Corticosteroid Therapy

Depending on what goals the doctor pursues when prescribing GCS, there are several types of therapy with these drugs:

• Substitute is prescribed for a lack of own glucocorticosteroids. In this case, natural hormones are used, their intake imitates the daily activity of the adrenal glands. Doses are selected individually, the criterion being the patient’s good health, normal levels of sugar, blood pressure, and renal filtration.
• Blocking used to suppress excess hormone secretion. The dosage and type of drug are also selected individually. The effectiveness indicator is the normalization of hormonal levels, the patient’s well-being.
• Pharmacodynamic– these are the majority of indications for taking GCS. In this case, their immunosuppressive or anti-inflammatory effect, as well as their combination, is used. The dosage is selected based on the patient's condition.

List of effective nasal corticosteroid drops

Nasal drops with glucocorticosteroids are used to treat allergic and vasomotor rhinitis, rhinitis of unknown etiology, nasal polyposis, inflammatory processes in the paranasal sinuses, unless they are purulent or fungal in nature.

Trade names of drugs containing corticosteroids:

• Avamis.
• I'm sick of it.
• Tafen.
• Flixonase.

Mometasone and beclomethasone are used in the drops, and less commonly, flunisalide and flitkasone are used as independent agents or in combination with other drugs - antibiotics, antivirals. Drops are injected into each nostril, 1-2 drops, the frequency of administration depends on the course of the disease. Drugs with GCS should not be taken for more than 2 weeks in a row to avoid the development of side effects.

Table of the best ointments

Ointments with GCS are the most common dosage form of corticosteroids. They are prescribed for chronic skin diseases and acute inflammatory lesions.

Inhalation products

Corticosteroids are medications for the treatment of bronchial asthma. They are used in complex therapy to prevent attacks. The purpose of the drug is to stabilize cell membranes. As a result, substances that provoke bronchospasm are no longer released, and the reaction to the allergen is reduced. The patient can go without seizures for a long time.

The peculiarity of the use of GCS is that they are prescribed strictly on time. They are not able to stop an attack and should not be used during an attack. They are used to prevent attacks.

The most effective drug is Beclomethasone. Flunisolide, Budesonide and Fluticosone are also used. The drugs are used as part of complex therapy. The main methods of use are in the form of a powder for a spacer or a solution for a nebulizer. After inhaling ICS, you must rinse your mouth thoroughly to avoid the development of fungal diseases.

Oral medications

Oral administration of GCS is prescribed for severe pathologies of the immune system - allergic diseases, autoimmune conditions, diseases of the joints and connective tissue. Their list is quite large, it includes dexamethasone, prednisolone, fluticasone under various trade names.

Oral corticosteroids are prescribed as part of complex therapy. The dosage of drugs is selected individually. The first dose is the smallest possible, then it is increased if necessary. If the patient experiences significant side effects, the doctor decides whether to reduce the dose or prescribe additional medications that will alleviate the patient's condition.

Medicines are prescribed in courses, the duration of the course is determined by the doctor depending on the patient’s condition. The effectiveness criterion is an improvement in the clinical picture and a decrease in the severity of complaints. Complete cure of diseases occurs quite rarely.

Duration of the therapeutic course

The effect of corticosteroids is cumulative, i.e. it appears after some time of regular use, and lasts for some time after the end of the course. Therefore, it is impossible to obtain an immediate therapeutic effect from GCS, and the dosage is always selected at the lowest possible level.

The minimum course duration is a week of continuous use of the drug, the maximum is up to a month. The doctor can indicate more precise dates based on examination data., assessing the patient’s well-being, as well as the results of therapy.

To obtain results, it is extremely important to adhere to the timing of taking the medications. The daily dose and interval between doses are calculated based on maintaining the required dose of the drug in the blood throughout the day, but at the same time it should be convenient for the patient to observe the interval between doses of the drug.

Precautions during treatment with corticosteroids

To avoid undesirable consequences of taking GCS, you must follow the rules for taking medications:

Corticosteroids are used to combat a wide variety of pathologies. These are drugs that are effective for both itchy dermatitis and life-threatening conditions.

Article format: Lozinsky Oleg

Video about corticosteroids

What are corticosteroid drugs and what are they:

Corticosteroids are substances that belong to the steroid subclass; in the normal state of the body, they are produced by the human adrenal glands. In this article we will take a detailed look at what corticosteroids are, what types of them exist, how they are taken in synthetic form and how long it takes to be absorbed, and whether side reactions are possible.

What it is?

These substances are divided into two types: mineralocorticoids and glucocorticoids. The first type includes the substance aldosterone, the second - hydrocortisone and cortisone.

Natural

Biologically healthy human adrenal glands are capable of regularly synthesizing glucocorticoids. They have the necessary therapeutic effect in various inflammatory processes in the human body. In addition, without a normal amount of glucocorticoids, regulation of protein, fat and carbohydrate metabolism will not occur.

Cortisone and hydrocortisone promote the most correct functional course of all processes during pregnancy, support normal kidney function, control hormonal maturation and stress situations. The components of glucocorticoids disintegrate in, and then are excreted through the kidneys along with urine.

Did you know? The mineralocorticoid was first artificially synthesized from the adrenal cortex in 1937.

Corticosteroids are vital hormones, one of the key functions of which is played by mineralocorticoids. Aldosterone, which is the basis of mineralocorticoids, regulates metabolic processes and. Aldosterone provokes a retention of Na+ ions in the body, but at the same time promotes the accelerated excretion of K+ ions.

Synthetic

Researchers in the field of biology have long synthesized corticosteroids and found their use in the field of therapeutic treatment of infectious diseases.

But the whole point is that corticosteroid drugs do not have a healing effect (they do not kill infectious agents and do not suppress the causes of infection). Hormonal corticosteroids are able to temporarily suppress processes at the site of inflammatory reactions, but nothing more.

These substances, like many other adrenal hormones, can increase the body's sensitivity to external irritations. Corticosteroids provoke the appearance, which directly affects the decline of the body, because many people know that the body’s defenses are most “viable” only with a moderately calm life.

Since these steroid substances are capable of blocking regeneration processes, then the use of such hormones leads to a protracted course of the disease.

With frequent use of synthetic hormones, the adrenal glands “relax” and stop producing sufficient amounts of aldosterone, cortisone and hydrocortisone for the body, and after stopping taking synthetic steroids, the adrenal glands may never return to their normal previous state.

When are corticosteroids taken?

Glucocorticoids and mineralocorticoids are produced as different drugs and, accordingly, are taken for various diseases. Hydrocortisone along with cortisone is indicated for the following diseases:

• rheumatoid arthritis and its other manifestations;
• rheumatism;
• some types of benign and malignant neoplasms;
• collagenoses;
• autoimmune diseases (dermatomyositis, scleroderma, periarteritis nodosa, systemic lupus erythematosus);
• and bronchial;
• diseases (lichen planus, psoriasis, erythroderma, seborrheic dermatitis, discoid lupus, eczema, neurodermatitis, atopic dermatitis);
• glomerulonephritis;
• fibrosing alveolitis, pneumonia and bronchitis;
• and ulcerative colitis;
• Crohn's disease;
• external otitis (chronic and acute);
• viral diseases (viral hepatitis, infectious mononucleosis);
• hemolytic anemia;
• infectious diseases in ophthalmology (scleritis, iritis, uveitis, iridocyclitis, keratitis);
• prevention and treatment of shock;
• to suppress rejection of transplanted organs;
• neuralgic diseases (optic neuritis, acute spinal cord injury, multiple sclerosis).

There are much fewer indications for the use of aldosterone-based substances, but they still exist:

• myasthenia gravis (muscle weakness due to autosomal diseases);
• Addison's disease (manifests in cases of chronically malfunctioning adrenal glands);
• adynamia;
• disturbances of mineral metabolism.

Release forms and application features

There are different forms of release of corticosteroids; they are prescribed depending on what disease caused the necessary intake of hormones.

Tablets and capsules

Corticosteroid-based drugs have a fairly extensive list. The most popular and most in demand on the market are the following corticosteroid drugs: Kenacort, Celeston, Medrol, Kenalog, Lemod, Florinef, Prednisolone, Urbazon, Cortineff and many others .

Preparations in the form of capsules and tablets accepted at intervals of 8 hours. This regimen of taking synthetic hormones is associated with their natural entry into the blood from the adrenal cortex.

Important! With long-term treatment with corticosteroid drugs, it is necessary to conduct regular examinations for the electrolyte composition of the blood, blood pressure, condition, and the quantitative ratio of glucose in the urine and blood.

There are cases that tablet drugs are taken 3-4 times over 16-18 hours (in cases of acute disease). This regimen can only be prescribed by a doctor, otherwise there may be dangerous health consequences. Corticosteroid hormones are taken immediately after reception or during meals. Tablets or capsules should be taken with a glass of water.

Injections

The most famous glucocorticoid and mineralocorticoid drugs for intravenous administration are: Methylprednisolone, Diprospan (Betamethasone), Medrol, Prednisolone, Flosterone, Kenalog, Dexamethasone. In most cases, such injections are prescribed only when there is a threat to human life. Drugs are prescribed and administered only by experienced specialists from medical institutions.

In intensive therapy for certain diseases, the patient is treated in a hospital; corticosteroid drugs are administered intravenously in dosages indicated after the examination. Intensive therapy with these hormones is prescribed in a very short time, and when an acceptable effect is achieved, treatment is stopped just as quickly.

Alternative therapy involves minimizing the inhibitory effect on the normal functioning of the endocrine glands. In cases of such therapy, Prednisolone is often used, administered between 6 and 8 am every two days.

The drug “Methylprednisolone” is used in pulse therapy. It is administered intravenously, quickly and in large dosages (at least 1 g). Pulse therapy is indicated only in emergency cases, for example, for intensive care patients.

Inhalations

Scientists continue to study the chemical and biological properties of these hormones, which puts them on a par with some of the most complex chemical structures. Based on all this, it is important to understand that the independent use of corticosteroids in any form of release can negatively affect your health, therefore, before a course of treatment, a mandatory consultation with a doctor is necessary.