Complex ointments with an antifungal component and glucocorticosteroids. List of the most effective corticosteroid ointments. Tablets and capsules

Substances belonging to a subclass are called corticosteroids. Moreover, they are produced not by the gonads, but exclusively by the adrenal cortex; that is why they do not have estrogenic, androgenic or progestogenic activity. Corticosteroid hormones are completely natural substances for the body that perform biochemical processes, regulate the mechanisms of life, support the immune system, take part in carbohydrate, water-salt and protein metabolism. Details about preparations containing these hormones, about what they are and why they are needed, will be discussed in our article.

Indications for the use of drugs that contain this type of hormones

A corticosteroid drug, which is most often called simply a steroid, is administered artificially, but it plays the same role as the so-called natural hormone: it provides metabolic processes, restores connective tissue, converts starch into sugar, fights various kinds of inflammation. Such drugs are often used in the treatment of diseases such as asthma, rheumatoid arthritis, lupus erythematosus, kidney and thyroid dysfunction, tendonitis. Corticosteroid creams and ointments are often used in transplantation because they protect the body from rejection of transplanted organs.

Contraindications to the use of drugs that contain corticosteroid hormones

Side effects when using corticosteroid drugs can be pronounced headaches, pain in the legs or back, dizziness, degeneration of tissues that are constantly in contact with the drug. The corticosteroid drug may be either a glucocorticoid or a mineralocorticoid. It is produced in the form of tablets, powders, ointments, sprays, drops, gels, capsules. Such drugs are very effective for the treatment of various diseases, for example, they are often prescribed as an alternative to surgery, they are also used to treat children (boys). True, such therapy can last quite a long time, sometimes up to 2-3 months. In this case, the ointment is usually applied 2 times a day.

Types of corticosteroid drugs

So, what are the names of corticosteroid drugs? The list of them is quite extensive, below are just a few of them. For starters - tablets and capsules:

• "Celeston";
• "Kenalog";
• "Metipred";
• "Kenakort";
• "Polcortolon";
• "Medrol";
• "Urbazon";
• "Prednisolone";
• "Corineff";
• "Florinef" and others.

And here is a list that includes ointments, gels and corticosteroid creams:

• "Diprosalik";
• "Dermozolon";
• "Mesoderm";
• "Kremgen";
• "Elokom";
• "Kutiveit";
• "Betamethasone";
• "Triderm";
• "Flucinar";
• "Triacutan";
• "Gyoksizon";
• "Sinoflan";
• "Dermovate";
• "Delor" and others.

It should also be taken into account that often a corticosteroid drug contains anti-inflammatory or antiseptic components, as well as antibiotics.

Other corticosteroid drugs are nasal. Detailed list

Nasal preparations of corticosteroid hormones include such medicines with which chronic rhinitis and purulent processes occurring in the nasopharynx are treated. As a result of the use of such drugs, the ease of breathing through the nose is restored and the possibility of reproduction of microorganisms dangerous to human health living on the mucous membranes is reduced. These drugs include:

• "Flixonase";
• "Nazarel";
• "Nasobek";
• "Nasonex";
• "Rinoklenil";
• "Beclomethasone";
• "Tafen Nasal";
• "Aldecin";
• "Avamis" and others.

It is important to note that this form of drugs has much less negative effects and side effects on the body than injections or tablets.

Corticosteroid drugs in the treatment of bronchi: inhalation

In the treatment of various spastic conditions of the bronchi (mainly bronchial asthma), indispensable drugs are used in the form of inhalations, because this is the most convenient form of therapy for such diseases. It is carried out using the following drugs that contain corticosteroids:

• "Triamcinolone";
• "Flunisolide";
• "Budesonide";
• "Fluticasone propionate";
• "Benacort";
• "Klenil";
• "Beklazon";
• "Beclomethasone dipropionate";
• "Beclospir";
• "Budenitis";
• "Pulmicort";
• "Bekodisk";
• "Depo-medrol";
• "Diprospan" and some others.

This form of the drug involves the following options: emulsion, ready-made solution, powder, which must first be diluted and prepared as an inhaler filler. In this form, the corticosteroid drug does not penetrate into the blood and mucous membranes at all, resistance to a particular substance is avoided, which does not lead to serious consequences of its use. Simply put, addiction to the drug does not develop, or it happens much later compared to if the patient used capsules or injections containing these hormones.

Consequences of corticosteroid treatment

If the patient has been taking drugs with these hormones for less than three weeks, then there will be no significant disturbances in the body. If the use of drugs was carried out for a longer time or more often, then various complications are possible. Therefore, patients are required to have a special card and bracelets for the use of steroids. Side effects with prolonged use of steroids - nausea, anorexia, arthralgia, skin peeling, weight loss, dizziness, drowsiness. In general, these drugs are used in the treatment of many different diseases (asthma, psoriasis, polyarthritis, and many others), but due to the fact that they are dangerous with prolonged use and have the ability to start irreversible processes in the body, their use without the participation of a doctor is strongly not recommended. With long-term corticosteroid therapy, undesirable side effects may occur, especially in cases where the recommended dose is greatly exceeded. Therefore, taking into account all the risks, the doctor must carefully calculate how much and what kind of corticosteroid drug the patient needs, adequately assess all the risks from its use and conduct therapy without exceeding the average recommended duration of taking these hormones (several weeks).

In severe forms of allergic diseases, non-hormonal ointments and wound healing agents, eye and nasal drops without potent components do not always help. The low effectiveness of therapy leads to an increase in negative symptoms, a deterioration in the patient's condition, bright skin reactions, and the development of bronchospasm.

To stop dangerous signs, suppress allergic inflammation, doctors recommend corticosteroids. A list of drugs for allergies, characteristics of hormonal drugs, features of the effect on the body, rules for use, possible side effects are described in the article.

What are corticosteroids

Potent drugs are produced on the basis of synthetic components that resemble adrenal hormones in composition and action.

Synthetic CS exhibit the same properties as natural hormones:

• suppress allergic inflammation;
• reduce the volume and area of ​​rashes;
• reduce the manifestations of allergies in rhinitis, conjunctivitis, dermatitis, bronchial asthma, itchy dermatoses, eczema;
• stop the action of the components of drugs, to which the patient has an acute immune response.

On a note! In a severe reaction, injections of corticosteroids give a good effect, but the maximum result is noticeable after 2-6 hours. With severe bronchospasm, epinephrine is simultaneously administered to immediately eliminate the dangerous phenomenon. For skin symptoms, ointments and creams are prescribed, tablets are taken less frequently. Rhinitis and conjunctivitis require the appointment of the use of sprays and drops, suspensions with hormonal components.

Types of medicines

The list of corticosteroids includes dozens of items. Each potent agent belongs to a certain group, has its own strength of activity, degree of toxicity to the body. Pharmacists offer drugs to suppress allergic inflammation and complex effects on the body. Many formulations are prohibited for use in childhood.

Only an experienced doctor selects the appropriate type of CS: the use of drugs at the initiative of the patient often ends in severe skin lesions, up to atrophy, intoxication, metabolic disorders and hormonal levels.

Combined drugs:

• COP + antiseptics. Lorinden C, Sinalar K, Dermozolon, Flucourt C.
• COP + antifungal + antimicrobial components. Pimafukort, Akriderm GK, Triderm.
• CS + antifungal agents. Candide B, Travocort, Lotriderm, Mikozolon.
• CS + antibiotics. Fucicort, Flucinar N, Oxycort, Fucidin G, Sinalar N.

Go to the address and find out effective treatments for allergic blepharitis of the eyelids.

Therapy rules:

• the use of non-fluorinated types of CS;
• it is forbidden to treat more than 1/5 of the body with hormonal ointments;
• to reduce the risk of side effects, alternate non-hormonal drugs and corticosteroids;
• Prevention of allergic diseases with the help of CS is prohibited: potent agents are only suitable for short-term use in the treatment of exacerbations.

Hormonal tablets, solutions for inhalation, creams, drops, ointments, suspensions are indispensable for severe forms of allergic inflammation. Corticosteroids quickly relieve painful symptoms, alleviate the condition of adults and children with allergic dermatosis, asthma, various types of dermatitis, eczema, runny nose and conjunctivitis against the background of hypersensitivity of the body.

Video - expert advice on the features of the use of corticosteroids for the treatment of atopic dermatitis:

Steroid hormone preparations have been, are and will remain one of the leading groups of drugs used to treat joint diseases, because they have such important qualities for a rheumatological patient: a quick onset of action and a powerful anti-inflammatory effect that exceeds any of them.

However, these drugs have not only advantages, but also a number of rather serious side effects, which, if glucocorticoids are used incorrectly, can cause serious damage to the patient's health. That is why the attitude of many patients and even doctors to this group of drugs is ambiguous. Some are ready to take them all the time, "if only it doesn't hurt," while others categorically refuse to make at least one injection into the joint, "because it's harmful." Both approaches are fundamentally wrong: glucocorticoids, or corticosteroids, are simply necessary in certain clinical situations and with a skillful approach to their treatment; but in some cases, of course, it is possible and necessary to do without them.

What are glucocorticoids and what are their main effects

Glucocorticoids, or corticosteroids, are steroid hormones produced by the adrenal cortex: cortisone and hydrocortisone. This term is also called hydrocortisone derivatives of semi-synthetic origin: prednisolone, dexamethasone, methylprednisolone and others. It is about them that will be discussed in this article.

The main effects of corticosteroids on the human body are:

1. Anti-inflammatory: these substances inhibit the formation of the phospholipase-A2 enzyme, as a result of which the synthesis of inflammatory mediators is disrupted: leukotrienes and prostaglandins; Regardless of the cause that caused the inflammation, corticosteroids effectively inhibit all its phases.
2. Antiallergic and immunoregulatory effects. They affect the immune system, in low doses they have an immunostimulating effect, and in high doses they have an immunosuppressive effect; inhibit the production of antibodies by B-lymphocytes and plasma cells, reduce the production of cytokines and lymphokines. They inhibit the increased formation of eosinophils and destroy existing cells in the blood, as well as reduce the production of immunoglobulin E, increase the histamine-binding ability of the blood and stabilize mast cell membranes, which prevents the release of histamine and other allergy mediators from them: all this leads to a decrease in the manifestations of allergic reactions.
3. Affect water-electrolyte metabolism. They increase the reabsorption of water and sodium from the lumen of the renal tubules into the blood, promote the excretion of potassium.
4. affect the exchange. They slow down the absorption of the trace element in the intestine, accelerate its release from the bones, and increase excretion from the body with urine.
5. They affect carbohydrate metabolism. They stimulate gluconeogenesis in the liver (the formation of glucose from non-carbohydrate products), reduce the permeability of cell membranes for glucose, which causes an increase in glucose levels in the blood and urine - hyperglycemia and glucosuria up to the development of steroid.
6. affect protein metabolism. They slow down the processes of protein synthesis and accelerate its breakdown in tissues, especially in muscles, bones and skin. The patient loses weight, his skin and muscles atrophy, stretch marks (striae), hemorrhages appear, wounds heal slowly, develop.
7. Participate in the processes of fat metabolism. In the tissues of the upper and lower extremities, fats are predominantly split, and in the face, neck, shoulder girdle, torso, they are synthesized. Subcutaneous adipose tissue is redistributed according to the cushingoid type.
8. They affect the cardiovascular system. They increase systemic arterial pressure, increasing the sensitivity of the heart muscle and artery walls to adrenaline and norepinephrine, and also enhance the pressor effect of angiotensin II.
9. Affect the blood system. Stimulate the formation of platelets and erythrocytes, inhibit the production of lymphocytes, monocytes, eosinophils.
10. They affect other hormones. Inhibit the production of sex hormones and luteinizing hormone of the pituitary gland. Contribute to the development of glucocorticoid. They reduce the sensitivity of tissues to thyroid hormones, as well as to somatomedin and somatotropin.

Pharmacodynamics of glucocorticoids

Quickly and completely absorbed in the small intestine when taken orally, reaching a maximum concentration in the blood after 30-90 minutes. Eating at the same time as taking the drug slows down the absorption process, but does not affect the degree of its effect.

The time of manifestation of the effect of drugs administered parenterally (intramuscularly or intravenously) depends on the characteristics of the drug and varies from 1-2 to 24-48 hours.

Once in the blood, corticosteroids bind to proteins by 40-60%, undergo structural changes in the liver. Excreted by the kidneys. When correcting the dosage of the administered drug is not required.

Routes of administration and indications for use

For the treatment of joint diseases, corticosteroids can be used both systemically (orally, intramuscularly or intravenously) and locally (more often, by intra-articular injections).

Direct indications for the use of systemic corticosteroids in rheumatology are:

• acute rheumatic fever, systemic and other diseases with severe articular syndrome;
• I-II degree in the absence of the effect of other types of treatment or III degree, especially with systemic manifestations;
• system .

Indications for the introduction of glucocorticoids into the joint are:

• juvenile rheumatoid arthritis or rheumatoid arthritis in adults;
• acute traumatic arthritis;
• periarthritis of the shoulder joint;
• synovitis of the knee joint that arose after plastic surgery of the hip joint on the opposite side.

Even with the conditions listed above, corticosteroids are not always indicated. They are prescribed if NSAID therapy has not given a positive result for 2 weeks, or when synovitis has already developed - inflammation of the synovial membrane of the joint with the formation of effusion in it (clinically, this condition is manifested by swelling of the joint, soreness and pain, as well as limitation active and passive movements in it).

Contraindications to the use of corticosteroids

There are no absolute contraindications to the use of systemic drugs in this group. Relative contraindications are:

• peptic ulcer of the stomach and duodenum;
• epilepsy, mental disorders;
• severe heart failure;
• expressed.

In urgent situations, glucocorticoids, if indicated, are administered to everyone without exception, without regard to contraindications. The latter should be taken into account only in the case of planned long-term hormone therapy.

The introduction of corticosteroids into the joint is contraindicated in:

• systemic or local infectious process;
• severe periarticular osteoporosis;
• transarticular fracture;
• severe bone destruction or joint deformity that cannot be corrected;
• difficult access to the affected joint;

Side effects of glucocorticoids

Systemic administration of glucocorticoids, especially for a long time, is often accompanied by many adverse reactions, the development of which should be anticipated and prevented with appropriate drugs.

So, the side effects of corticosteroids are:

• osteoporosis and compression fractures of the vertebrae and other pathological fractures that occur against the background of this disease, as well as aseptic necrosis of the femoral head;
• , improved appetite;
• muscle damage, atrophy;
• thinning of the skin, stretch marks and hemorrhages on it, acne;
• prolonged healing of wounds;
• frequent infectious diseases, lubrication of their clinical picture;
• , vomiting, discomfort, and esophagus, bleeding, steroid ulcers of the digestive system, ;
• psychosis, sleep disturbance, mood swings, brain pseudotumor syndrome;
• linear growth slowdown and delayed puberty in children, secondary amenorrhea, depression of the functions of the hypothalamic-pituitary-adrenal system, steroid diabetes;
• cataract, glaucoma, exophthalmos;
• water and sodium retention, which manifests itself as a decrease in blood levels, hyperosmolar coma;
• increased levels of glucose and lipids in the blood, cushingoid syndrome.

Some of the side effects (emotional instability, sleep disturbances, and others) occur immediately after the start of treatment, they cannot be avoided. Others develop later, and their occurrence can be prevented by the use of small doses of the hormone or prescribing drugs to prevent complications.

Side effects of local (into the joint) administration of glucocorticoids are:

• osteonecrosis;
• steroid arthropathy (joint destruction);
• tendon ruptures;
• fatty necrosis, lipodystrophy, atrophy of joint tissues, its calcification;
• "post-injection exacerbation";
• feeling of heat;
• damage to nerve trunks.

With a skillful approach to treatment, technically correct injection, not multiple, but single injections, the development of side effects from the introduction of the hormone into the joint is unlikely. As a rule, these reactions develop in case of abuse of glucocorticoid preparations and their introduction is technically incorrect.

Features of corticosteroid therapy

Treatment with glucocorticoids should be prescribed exclusively by a doctor if there are direct indications for it. During the period of therapy with systemic drugs, the patient should be under the supervision of a specialist and periodically undergo examinations to monitor the occurrence of adverse reactions. The surveys are as follows:

• regular weighing;
• daily measurement of blood pressure, in case of detection of hypertension - an appointment with a doctor, followed by taking antihypertensive drugs;
• blood and sugar test;
• biochemical blood test to determine its electrolyte composition;
• control over the state of the skeletal and muscular system;
• in case of complaints of bone pain - blood tests for calcium metabolism, as well as to confirm the diagnosis of osteoporosis; recommended prophylactic intake of calcium-containing drugs and vitamin D in order to prevent the development of this condition;
• in case of complaints from the digestive tract - esophagogastroduodenoscopy to examine the mucous membrane of the relevant organs for the presence of erosions and ulcers; possible prophylactic administration of antacids;
• consultation with an ophthalmologist with appropriate examinations;
• control of infectious diseases.

The effectiveness of local - in the joint cavity - therapy with corticosteroids in different patients is different, but, as a rule, after 1-2 injections, some degree of clinical improvement occurs. If it is minimally expressed or absent at all, local treatment with hormones is stopped and they are used systemically.

To increase the effectiveness of intra-articular anti-inflammatory therapy, it is necessary to ensure complete rest for the affected joints for 2-3 days after the hormone injection.

In order to prevent infection from entering the joint, the doctor must follow all the rules of asepsis during the manipulation.

A different volume of the drug is injected into different joints: it depends on the volume of the joint. So, in large (knee, shoulder, ankle) joints, 1-2 ml is injected at a time, in medium (wrist, elbow) - 0.5-1 ml, and in small (metatarsophalangeal, interphalangeal, metacarpophalangeal) - only 0.1-0.5 ml of hormone solution. In small joints, a corticosteroid is injected mixed with an anesthetic.

With frequent - more than 3-4 times a year - the introduction of a glucocorticoid into the same joint, a metabolic disorder in the articular cartilage is possible, followed by a violation of its structure, chondrodestruction. With a more rare administration of the drug, its negative effect on cartilage is absent.

Drug Overview

Let us consider in more detail glucocorticoids used to treat joint diseases.

Dexamethasone (Dexona, Dexamethasone)

For the treatment of joint diseases, it is used in the form of tablets of 0.5 mg and an injection solution containing 4 mg of the active substance per 1 ml.

With exacerbation of rheumatoid arthritis, the dose of the drug is 4-16 mg per day. If corticosteroid therapy is required for a long time, it is recommended to use prednisone instead of dexamethasone.

When taken orally, the daily dose of the drug should be taken once, in the morning (this is due to circadian rhythms), after meals, with a small amount of liquid.

It is also used intra-articularly (inside the joint). As a rule, it is injected into small joints - 2 mg (0.5 ml) of the drug at a time.

Contraindications to the use of dexamethasone are the same as those listed above under general contraindications for glucocorticoids. The side effects are the same. Functional insufficiency of the adrenal cortex develops, as a rule, after 14 or more days of daily administration of the drug.

Prednisolone (Prednisolone)

In diseases of the joints, it is used in the form of a solution for injection in ampoules containing 30 mg of the active substance per 1 ml, as well as in the form of tablets of 5 mg.

Inside, regardless of the meal, 20-75 mg is used at the beginning of treatment, later - 5-25 mg (this is the so-called maintenance dose). Cancel the drug gradually, for some time reducing the dose. At the end of treatment, corticotropin is administered to prevent adrenal atrophy.

The maximum single dose for an adult patient is 15 mg, the daily dose is 100 mg.

The duration of treatment is individual and depends on the specific disease and the severity of its course. However, it should be remembered that prednisolone should be taken at the minimum effective dose for the minimum time necessary to achieve the desired effect of treatment.

Intramuscularly or intravenously, the drug is administered in emergency situations. The daily dose for an adult in this case is 25-50 mg.

Prednisolone is taken exclusively as prescribed by a doctor and under his strict control. During treatment, they are contraindicated. During pregnancy, it is used according to strict indications; during breastfeeding, a dose of up to 5 mg per day is acceptable, higher doses can harm the health of the child.

Methylprednisolone (Medrol, Depo-medrol, Metipred, Solu-medrol, Methylprednisolone)

For the treatment of joint diseases, it is used in the dosage form of tablets of 4, 8, 16 and 32 mg, powder and suspension for injection in ampoules.

There are 4 schemes for taking methylprednisolone:

• Continuous: take the drug daily, taking into account the circadian rhythm of cortisol release in the body; while 2/3 of the recommended daily dose is taken in the morning, and the remaining 1/3 in the afternoon.
• Alternating: a double dose of the drug is recommended to be taken in the morning 1 time in 48 hours. With this treatment regimen, the effect of it will be the same, and the likelihood of side effects is significantly reduced. On days when the hormone is not taken, NSAIDs can be used. In severe cases of the disease, a continuous regimen is first prescribed, and after the acute manifestations subside, they switch to an alternating one, with a gradual decrease in the dose of the drug. With a moderate course of the disease, treatment can be started directly with an alternating regimen.
• Intermittent: take methylprednisolone for 3-4 days daily, then take a short break - for another 4 days. After this period, the drug is started again, and so on in a circle.
• Pulse therapy: rapid infusion (within 30 minutes) of ultra-high doses of the drug: 500-1000 mg per injection. The course of treatment according to this scheme is 3 days. Such treatment is prescribed for severe rheumatic diseases, characterized by a high activity of the inflammatory process, not amenable to treatment according to other schemes. The advantages of pulse therapy are the rapid onset of action of the drug, which is manifested by an effective decrease in the severity of the symptoms of the disease, a long therapeutic effect - up to 12 months, a low risk of side effects, and an easier subsequent course of the disease (especially if this treatment regimen is used at its early stage). Despite the many advantages of pulse therapy, patients for its implementation are selected according to strict criteria, since the reaction of a particular person to the introduction of such a large dose of the hormone cannot be foreseen.

Recommended oral doses range from 16 to 96 mg per day; in case of need for treatment for a long time, in order to minimize possible side effects, it is necessary to select the minimum effective dose of the drug. Can be taken every other day. The maintenance dose of methylprednisolone is 4-14 mg per day.

In emergencies, as well as in case of exacerbation of rheumatic diseases, methylprednisolone is administered intravenously by stream or drip, as well as intramuscularly. Dose - 100-500 mg per injection.

If indicated, the drug is administered intra-articularly. Its dose in this case depends on the size of the joint and the severity of the pathological process. The solution is injected into the synovial space, into a large joint - 20-80 mg, into the middle joint - 10-40 mg, into a small joint - 4-10 mg of the solution. If necessary, the injection can be repeated after 1-5 weeks or more.

Such a dosage form of the drug as a depot suspension is administered intramuscularly at a dose of 40-120 mg once every 1-4 weeks according to indications. Inside the joint - 4-80 mg, repeating after 1-5 weeks, also according to indications.

Methylprednisolone is contraindicated for systemic (mycoses), as well as in the case of individual human hypersensitivity to methylprednisolone.

Side effects and special instructions are similar to those described in the general section - see above.

Triamcinolone (Polcortolon, Kenalog)

Release forms for the treatment of diseases of the joints: suspension for injection, tablets of 4 mg.

The recommended doses for oral administration are 4-16 mg per day, the frequency of administration is 2-4 times. When the therapeutic effect is achieved and the acute manifestations of the disease have decreased, the dose should be reduced to a maintenance dose of 1 mg per day. The dose should be reduced gradually - by 2 mg in 1-2 days.

Systemically injected deep into the muscle at 40 mg per 1 injection. In severe cases of the disease, this dose can be doubled. So that the suspension containing the active substance does not leak out of the injection channel after the needle is pulled out, press a sterile cotton swab or napkin as tightly as possible to the injection site for 1-2 minutes. If after a single injection of the drug there is a need for a second injection, the interval between them should be at least 1 month.

With the introduction of the drug into the cavity of small joints, its dose is 10 mg, into medium joints - 30 mg, into large joints - 40 mg. If it is necessary to administer triamcinolone in parallel to several joints, the total dose of the drug should not exceed 80 mg.

Contraindications to the use of this drug are peptic ulcer of the stomach and duodenum, acute psychosis in history, with metastases, in the active form, as well as individual hypersensitivity to the components of the drug.

Side effects are noted quite rarely, regardless of the frequency and method of administration of the drug. These are allergic reactions, redness of the skin and a feeling of hot flashes, increased blood pressure. With repeated administration of triamcinolone in the same place around the latter, atrophy of the subcutaneous adipose tissue is possible, which is reversible. After injection into the joint, sometimes there is pain in it, which after a while passes on its own.

It is not recommended to use during pregnancy and lactation.

Hydrocortisone (Solu-Cortef, Hydrocortisone Acetate, Hydrocortisone)

Release form - tablets of 10 mg, suspension for injection and powder for solution for injection.

The initial dose of the drug, administered orally, varies widely depending on the disease and the severity of its course and for adults is 20-240 mg per day in 2-3 doses. When the therapeutic effect is achieved, the initial dose is gradually, slowly reduced to a maintenance dose.

Intramuscularly injected 125-200 mg of the active substance. Inside the joint is administered at a dose of 5 to 25 mg, depending on its size and the severity of the lesion. The effect of intra-articular administration of hydrocortisone develops after a period of 6 to 24 hours and lasts from 2-3 days to several weeks.

Contraindications, side effects and special instructions are similar to those described in the general section of this article - see above.

Betamethasone (Diprospan, Celeston, Betaspan, Flosteron, Lorakort)

For the treatment of joint diseases, it is used in the form of a suspension and injection solution in ampoules containing 4 mg of the active substance, as well as in the form of tablets.

The daily dose at the first stage of treatment when taking the drug orally is 0.25-8 mg and directly depends on the severity of the disease. If necessary, the indicated dose can be increased to the level at which the effect occurs. When positive results of treatment are achieved, the dosage of betamethasone is gradually reduced to maintenance. If, for some reason, therapy with this drug must be stopped, it should be canceled, again, not immediately, but gradually. The daily dose can be divided into 2-3-4 doses or, if it is convenient for the patient, can be taken in one dose, in the morning.

Intramuscularly, betamethasone is administered at an initial dose calculated individually, depending on the patient's body weight - it is 0.02-0.125 mg per kg of his body weight and is administered 1-2 times a day. Sometimes the drug is administered intravenously, in a 0.9% sodium chloride solution.

1-2 ml is injected intra-articularly into large joints, 0.5-1 ml into medium joints, 0.25-0.5 ml into small joints for injection. In some cases, the simultaneous administration of a local anesthetic (usually lidocaine or procaine) is indicated. The duration of the therapeutic effect after the introduction of betamethasone into the joint is up to 4 or more weeks.

It is contraindicated to use this drug in persons with hypersensitivity to it or other corticosteroids, as well as those suffering from systemic mycoses. Do not administer the drug intramuscularly to patients with idiopathic thrombocytopenic purpura.

The drug in the dosage form of a suspension is not indicated for subcutaneous or intravenous administration. The introduction of betamethasone into the joint can be accompanied not only by a pronounced local effect, but also have a systemic effect. You can not inject the drug into the joint if there is an infection in it: it is indicated only in the case of aseptic inflammation. To prevent atrophy of the subcutaneous adipose tissue at the injection site, the solution should be injected deep into a large muscle mass.

During pregnancy, the drug is used according to strict indications. Breastfeeding during treatment with medium and high doses of betamethasone should be discontinued.

Conclusion

In conclusion, we want to once again draw your attention to the fact that the data on the drugs given above are for informational purposes only. Only a specialist should recommend treatment with glucocorticoids. Uncontrolled intake of these drugs will lead to serious complications. Please be responsible for your health and the health of your loved ones.

Which doctor to contact

Glucocorticoids for joint damage are prescribed by a rheumatologist. In some cases, they are used by orthopedists. With the development of side effects of corticosteroids, the patient is consulted by a cardiologist (with increased pressure), a gastroenterologist (with damage to the gastrointestinal tract), an immunologist (with frequent infectious diseases), an endocrinologist (with suspected development of adrenal insufficiency or, conversely, signs of an overdose of adrenal hormones).

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The adrenal cortex performs a secretory function, producing corticosteroids. These are biologically active hormones, including a mineral (aldosterone) and glucocorticoids (cortisone).

Natural corticosteroids control the following processes in the body:

1. mineral metabolism (retain sodium ions and excrete potassium);
2. the process of puberty;
3. metabolism of lipids, proteins and carbohydrates;
4. stress reactions;
5. the course of pregnancy;
6. block the production of inflammatory mediators.

Synthetic corticosteroids have properties similar to natural hormones.

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Irina Martynova. Graduated from the Voronezh State Medical University. N.N. Burdenko. Clinical intern and neurologist of BUZ VO \"Moscow Polyclinic\".

They able to eliminate the symptoms of the inflammatory process(anesthetize, relieve swelling and redness, lower the temperature locally). Synthetic molecules of corticosteroids are built into the cycle of metabolic reactions natural for the body, removing natural hormones from them, which disrupts the functioning of the adrenal cortex and hormonal balance in general. In this regard, drugs based on synthetic corticosteroids are prescribed by a doctor when non-hormonal drugs are not effective.

Formulations of synthetic corticosteroids

Synthetic corticosteroids have the following forms of release:

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

Let us dwell in detail on the most popular and prescribed preparations.

prednisolone tablets

They have a powerful anti-allergic and anti-inflammatory effect. The drug is contraindicated in ulcerative pathology of the stomach and intestines, during the vaccination period, with hypertension and a tendency to form blood clots in the vessels.

The price for a package of 100 pieces is about 120 rubles. Prednisolone may be in liquid form for injection of corticosteroids.

Celeston

It has betamethasone as an active ingredient. Tablets are not prescribed for the following pathologies: after myocardial infarction, with hypertension, endocrine disorders, with glaucoma, with severe infections (syphilis, tuberculosis), osteoporosis, poliomyelitis. Inhibits natural immune responses.

The anti-inflammatory effect is 30 times more effective than hydrocortisone.

Kenacort tablets

The drug has a stabilizing effect on cell membranes, eliminates the symptoms of inflammation and allergies. Do not use for psychosis, chronic nephritis, complex infections and fungal infections.

50 tablets of 10 mg cost about 200 rubles.

Betamethasone dipropionate is present as an active ingredient in the composition. Injections with the drug are effective in the following pathologies: a state of shock of various nature, with cerebral edema, with acute adrenal insufficiency. "Diprosan" is contraindicated in case of hypersensitivity to the components of the composition, with infectious lesions, with diseases of the digestive organs, hypothyroidism, hypertension, with complex pathology of the kidneys and liver.

1 ampoule of medication costs about 200 rubles.

Kenalog

The active ingredient of the drug -. The drug compares favorably with a gentle effect on the body, no effect on the pituitary gland and mineral metabolism in the body.

A box with 5 ampoules of the drug costs about 400 rubles.

The active ingredient of the drug is methylprednisolone. Contraindicated in fungal infections and individual intolerance.

Topical corticosteroids for external use

Topical corticosteroids are classified as follows:

• weak activity ("", "Lokoid", "Korteid");
• moderately active ("Afloderm", "Esperson", "Laticort");
• highly active ("Kuterid", "Kutiveit", "Elokom");
• very highly active ("Dermovate", "Clobetasol").

The most used corticosteroid ointments

Locoid

The active ingredient hydrocortisone has an antipruritic, anti-inflammatory effect, eliminates swelling.

30 grams of the drug have a cost of about 300 rubles.

Lorinden S

The composition has an antimycotic effect. It is used for allergic and inflammatory processes complicated by a fungal component.

The price for a tube starts from 330 rubles.

Fluorocort - ointment based on triamcinolone

It perfectly relieves itching, swelling and redness.

The cost of the tuba is about 250 rudders.

Fucidin G

In addition to hydrocortisone, the product contains fusidic acid, which has an antibiotic effect. Compound applicable to children over 2 years of age.

The cream will cost 450 rubles, the ointment - 400.

The nuances of the use of topical agents

• The choice of means depends on the severity, localization and depth of the process. It must be administered by a doctor;
• depending on the dynamics of the process on the skin, a correction is carried out with a change in the drug of choice;
• after the removal of symptoms, the transition to a remedy without hormones is carried out.

Inhaled forms of corticosteroids

Corticosteroids in the form of solutions for inhalation are effective reduce membrane permeability, limit the release of proteolytic enzymes outside the lysosomes. A high concentration of the substance is created locally in the walls of the bronchial action, which minimizes the systemic effect.

Nasal corticosteroids effectively eliminate inflammatory and allergic manifestations, are used in the form of inhalations through the nose.

Beclamitosone (Aldecim, Bekotid, Beclocort)

The active substance reduces the secretion of prostaglandins and the production of pathological exudate. Contraindication is children under 6 years of age, individual intolerance.

A bottle of 200 mcg of Beclamitasone costs 300 - 400 rubles.

Beclamitasone-nasal, Baconase

They are used as nasal corticosteroids, eliminating swelling and hyperemia in the nasal mucosa.

A bottle of Baconase costs about 300 rubles.

Flunizalid (Ingacort)

Effective in bronchial asthma, obstructive bronchitis and chronic rhinitis.

Contraindicated in the 1st trimester of pregnancy, for children under 5 years of age, with fungal infections, active tuberculosis.

Main side effects of corticosteroids

Long-term use of corticosteroids side effects develop In most cases.

Preparations:

• violate the ionic composition of the biological fluids of the body, contributing to the alkalization of the blood;
• provoke the development of steroid diabetes;
• retain fluid, disrupting the work of the heart muscle;
• the loss of potassium ions leads to muscle weakness, and calcium to osteoporosis, a tendency to fractures;
• reduce immune responses, increasing susceptibility to infections;
• provoke insufficiency of the adrenal cortex;
• increase the risk of developing ulcerative lesions of the stomach, intestines.

Special cases of the use of corticosteroids

Childhood

Topical corticosteroids administered to children with caution. The smaller the child, the greater the ratio of surface area to body weight and the risk of developing systemic pathologies (developmental delay, hormonal imbalance, adrenal suppression). Children under one year old are prescribed ointments that contain no more than 1% active hydrocortisone, Dermatol can be used.

After 2 years, Mometasone is allowed.

During pregnancy

During pregnancy, corticosteroids are prescribed in exceptional cases, when the result of the application outweighs the possible risks to the fetus.

These are the following situations:

• the threat of premature birth of a baby;
• active form of rheumatism;
• intrauterine hyperplasia of the adrenal cortex in the fetus.

Corticosteroids with local short-term use practically do not penetrate into breast milk.

If the doses of drugs are high, then this can cause a violation of the development of the child and inhibition of the hormonal system.

With bronchial asthma

Corticosteroids are effective in bronchial asthma. They relieve the symptoms of inflammation, but do not dilate the bronchi. These medicines are used during attacks when other means are not effective. After stopping the attack, the dose of the active component is reduced gradually (2 times every 4 days). In bronchial asthma, corticosteroids are indicated in the form for inhalation. These are: Becloson Eco, Budesonide Forte, Pulmicort, Pulmicort Turvuhaler, Fluticonazole Propionate.

For allergies

In complex forms of allergy, corticosteroids are effective, they are prescribed systemically and locally. List of drugs: "Betamethasone", "Prednisolone", "", as well as their analogues.

With hay fever and allergic rhinitis, intranasal aerosols (Flukatisone, Baconase, Propionate) help.

With psoriasis

Tatjana Mihaela

Corticosteroid drugs are very popular in the treatment of many diseases accompanied by inflammatory processes. They are commonly used in the treatment of rheumatoid arthritis and other types of arthritis, inflammatory processes in the liver (hepatitis), asthma, ulcerative colitis, Crohn's disease, allergies, various skin diseases and dermatitis, psoriasis, eczema, they are used in pneumonia, in the treatment of wounds, tumors, some types of cancer, in cases of various autoimmune diseases such as lupus and multiple sclerosis. The list is very long. I am sure that I have listed most of the diseases that doctors at one time or another try to cure with the use of corticosteroids.

They come in the form of tablets, creams, injections, syrups, and even rectal gels. Probably most of us have ever used them, in one form or another, or used a milder variety - hydrocortisone creams for eye and skin care.

What are corticosteroids?

Corticosteroids are hormones. Produced by our adrenal glands, the glands located on top of our kidneys, they perform many important functions in our body, such as:

Support for metabolic processes, for example, raising blood sugar levels at the right time;

Regulation of salt and water balance (mineralocorticoids), and control of blood pressure;

Controlling the fight-or-flight response that occurs in response to stress is manifested by increased blood sugar levels, increased blood pressure, suppression of inflammation during periods of stress;

Contribute to the normal course of pregnancy;

Control the process of puberty in childhood and adolescence;

Control the normal functioning of the kidneys.

What is important to know about the work of the adrenal glands

The most interesting of the whole range of hormones that the adrenal glands produce are the stress hormones, these are adrenaline and cortisol. They help us cope with potentially dangerous situations when the body's normal reactions stop, and the body goes into a tense state of readiness to instantly respond to potential danger - in this state, we can only do two things: fight or run away from danger. In this highly stressed state, blood sugar rises, blood pressure rises, the heart begins to pump more blood, increased levels of adrenaline and cortisol give the body additional energy, which immediately suppresses inflammation, since at this time the body has to perform completely different tasks, and not engage in the process of self-healing. Remember, if you're in danger, you don't have time to be sick or relaxed, so the inflammatory processes are temporarily suspended (as I mentioned, they are suppressed).

But as soon as the danger has passed, the body gradually returns to a relaxed state, the blood sugar level drops, the pressure returns to normal, and after that it very often happens that the inflammatory processes resume again, we all know that after life periods full of stressful situations As things gradually return to normal, we often experience minor health problems or depression that were suppressed during the period of time we were under stress.

Synthetic corticosteroids in action

Synthetic corticosteroids work on the same basis as natural corticosteroids - they give the body the ability to temporarily suppress inflammation. Usually they do not cure them, but only suppress the natural mechanisms of resistance to infections. Once corticosteroid use is stopped, the infection usually returns, often in an even worse form, because the body has time to get used to the drug and requires more and more doses without solving the primary problem that caused the infection. A vicious circle is formed.

Corticosteroids bring the body into a constant state of stress and tension, as a result of which the natural mechanisms of immunity are suppressed, since the immune system can only work when the body is in a relaxed state. Thus, even doctors admit that their use actually delays the treatment process. So, they only temporarily mask the inflammatory process, and as soon as their action ends (the pill lasts for several hours), the problem returns in an even worse form.

In addition to this, synthetic corticosteroids block the ability of natural corticosteroids to do their job, leading to malfunctions in the functioning of the adrenal glands at all levels, which is already a serious danger.

Synthetic corticosteroids (cortisol) also mislead other hormonal glands, most notably the pituitary gland, which is located in the brain. Her duty is to give orders to the body to produce corticosteroids. All this looks like external aggression for our body, and all hormonal glands begin to send and receive the wrong commands, the execution of which leads to a general hormonal imbalance of the body, but this is a really serious danger.

Synthetic corticosteroids (just like natural corticosteroids) hijack nerve receptors in the body (remember that in times of extreme danger, you don't have time for anything else), so there is no chance of success with natural medicine methods. Natural remedies simply cannot find free receptors that they could act on, the nerves are constantly tense (and when the nerves are tense, no healing is possible), the body does not regenerate (with a high level of corticosteroids, not one cell, not one tissue can go regeneration process), instead of regeneration, all organs, tissues, and cells are in a disoriented state and do not function correctly.

Since corticosteroids block the natural immune response and prevent the healing process from starting, doctors additionally prescribe additional drugs, such as antibacterial and antiviral agents, and even immunosuppressants (don't even ask me why immunosuppressants are very likely to completely destroy the immune system), and all kinds of other combinations. medications that continue to destroy an already depleted body.

Long-term use of corticosteroids is the destruction of the body in its purest form, it is a fast road to death.

As a result of their use, a completely new disease arises, called Cushing's syndrome, which I will briefly describe below.

Exposure to corticosteroids leads to serious side effects, causing Cushing's syndrome, a serious disorder of the adrenal glands, manifested by excessive production of cortisol (the stress hormone). The list of possible side effects is huge, and without boring you with boring terminology, I will highlight the following:

Increased appetite and weight gain;

Deposition of fat in the chest, face, upper back, stomach;

Retention of water and salts, causing swelling and swelling;

high blood pressure;

Diabetes;

Black and blue markings (destruction of blood vessels);

Delayed wound healing;

Osteoporosis;

Cataracts, glaucoma - yes, a person can go blind;

Acne disease;

muscle weakness;

Skin thinning;

Increased susceptibility to infections;

stomach ulcer;

increased sweating;

Unstable mood, occurrence of psychological problems, such as depression;

Suppression of the adrenal glands

Since corticosteroids reduce resistance to infection, any infection that occurs will be more difficult to treat.

A partial list of possible side problems includes the following diseases: glaucoma, cataracts, bleeding in the gastrointestinal tract, ulcers, pancreatitis, aseptic bone necrosis, osteoporosis, myopathy, obesity, edema, hypertension, diabetic changes in metabolic processes, sleep disturbances, mental disorders, the withdrawal of potassium from the body, fragility of the skin. With prolonged use, these drugs inhibit the interaction between the pituitary gland and the adrenal glands. Even one to two years after stopping these drugs, there may be a weakened response to stress.

Treatment of side effects caused by taking corticosteroids.

I hope by now you understand why natural healers are shocked when they hear that someone is taking corticosteroids and refuse to treat people while they are taking them, simply because there is no treatment at that moment. simply impossible! Recovery after taking corticosteroids can take up to two years. Naturopathic treatments can help the recovery process, but trust me, even then it takes a significant amount of time. For example, we can use the following homeopathic remedies:

Anti-stress preparations intended for the regeneration of nerves;

Various preparations for hormonal balancing;

Various organic preparations for the restoration of those organs that have received damage;

Means for restoring immunity, depending on the condition of each individual patient;

At a certain stage of treatment, it would be advisable to use a DNA repair agent.

Natural ways to treat infections and inflammation.

There are a huge number of remedies and medicinal herbs that have a strong anti-inflammatory effect. I will only mention my favorite plant - Sage.

In homeopathic treatment, we use combinations of various vibrations that heal inflammation on many levels, destroy pathogenic microorganisms, alleviate inflammation in tissues, and strengthen the immune system. Therefore, as a rule, an anti-inflammatory agent consists of a number of components:

An antiviral component that destroys all kinds of viruses that cause bacterial infections;

Drugs against streptococci and against staphylococci - these two types of bacteria are the root cause of most inflammatory processes in the human body, including inflammation of the bones and joints (staphylococcus is able to penetrate deep into the bone marrow and cause serious problems), streptococcus is usually present in rheumatism and is often the cause rheumatoid arthritis. These bacteria are always present in the human body, they become dangerous only in conditions of weakened immunity, which loses the ability to cope with the infection.

Other antibacterial components to cope with other types of infections.

Interferon vibration, and other vibrations that strengthen the immune system.

Other components may be prescribed depending on the condition of the individual patient.

The homeopathic remedy Belladonna is a very interesting anti-inflammatory agent. This amazing herb, when used as a homeopathic remedy, is very good at helping with inflammation as well as high blood pressure, but the use of this remedy depends on a number of factors and the individual symptoms of the patient.