Indications & Dose: ADRENOCORTICAL INSUFFICIENCY Chronic PO Adult 20-30mg/day | Acute IV Adult 100mg bolus, then 300mg/day in divided doses q8h or as continuous inf for 48h. Once patient is stable change to oral therapy 50mg TID for 6 doses then taper to 30-50mg/day in divided doses (as succinate) Child Neonate: Initially 10mg as slow Inj, then 100mg/m2 daily by continuous inf or in divided doses q6-8h, adjusted according to response. When stable reduce over 4-5 days to oral MD, 1 month-12 yr: Inj/inf: Initially 2-4mg/kg, then 2-4mg/kg QID, adjusted according to response. When stable reduce over 4-5 days to oral MD, 12-18 yr: 100mg q6-8h | IM Adult Same as IV dose | ANTI-INFLAMMATORY/IMMUNOSUPPRESSIVE PO Adult 15-240mg BID (as succinate) Child 2.5-10mg/kg/day or 75-300mg/m2/day q6-8h | IV/IM Adult 15-240mg BID (as succinate) Child 1-5mg/kg/day or 30-150mg/m2/day divided q12-24h (as succinate) | CORTICOSTEROID-RESPONSIVE DERMATOSES/SKIN IRRITATION TP Adult Cream/gel/lotion/ointment: Apply sparingly as thin film & rub gently into the affected area 1-4 times/day | INFLAMMATION Intrasynovial/Intrabursal/IA Adult Large joints (knee): 25-50mg, small joints: 10-25mg, may be repeated q1 or 2 wk (as acetate) | INTERNAL HEMORRHOIDS Adjunct therapy/Symptomatic therapy RECTAL Adult 10mg suppository in the morning & at night for 2-6 days | POSTIRRADIATION/FACTITIAL PROCTITIS Adjunct therapy RECTAL Adult 25mg suppository BID 6-8 wk | STATUS ASTHMATICUS IV Adult 1-2mg/kg/dose q6h for 24h, MD 0.5-1mg/kg q6h (succinate) Child Same as adult dose | STRESS DOSING (SURGERY) IV Adult Given as supplements in patients known to be suppressed or on chronic systemic steroids. Minor stress (inguinal herniorrhaphy): 25mg/day for 1 day, moderate stress (joint replacement, cholecystectomy): 50-75mg/day (25mg BID/TID) for 1-2 days, major stress (pancreatoduodenectomy, esophagogastrectomy, cardiac surgery): 100-150mg/day (50mg BID/TID) for 2-3 days | ULCERATIVE COLITIS OF RECTUM Adjunct therapy RECTAL Adult 25mg suppository in the morning & HS 2 wk or 100mg enema BID followed by 100mg nightly 3 wk | ULCERATIVE PROCTITIS OF DISTAL RECTUM RECTAL Adult 90mg (1 applicatorful of 10% aerosol foam suspension, as acetate) 1 or 2 times daily for 2-3 wk, then continued every other day till improvement

Precautions: CVD, DM, GI diseases, head injury, myasthenia gravis, hepatic/renal impairment, MI, seizures, thyroid disease, cataracts/glaucoma, osteoporosis, during drug withdrawal

ADR: Serious: Cushing’s Syndrome, hypersensitivity reactions, hypopigmentation, reduced visual function, raised IOP, arrhythmias, bradycardia, CHF, thromboembolism, edema, Churg-Strauss syndrome, osteoporosis, hyperglycemia, Others: menstrual irregularities, mental & neurological disturbances, muscle wasting & nitrogen depletion, depression, hallucinations, psychic disorders, allergic dermatitis, acne, growth suppression, carbohydrate intolerance, weight gain, dryness, increased susceptibility to infect, delayed wound healing, loss of skin collagen, atrophy

DDI: Serious Neuromuscular blockers increase the risk of myopathy, Colestyramine/Colestipol reduces absorption of oral drug, Rifampicin reduces systemic effects of drug

Diet: With food

Monitor: Serum glucose, electrolytes, BP, weight, presence of infect, IOP with therapy >6 wks, bone mineral density, growth in children