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Adrenal insufficiency
Published in Nadia Barghouthi, Jessica Perini, Endocrine Diseases in Pregnancy and the Postpartum Period, 2021
Hydrocortisone is the preferred glucocorticoid replacement during pregnancy at a physiologic dose of 12–15 mg/m2 of body surface area.37 Two-thirds of the total hydrocortisone dose should be administered upon awakening and the remaining one-third should be dosed in the late afternoon to mimic normal diurnal variation. Some patients may prefer to take three daily doses but adherence may decrease with this regimen and no morbidity or mortality improvements have been proven as compared to twice-daily dosing.38
Medicines in neonates
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
Sub-group analyses show that reduction in the risk of RDS occurs in all pre-term babies except those less than 28 weeks’ gestation [7] (Table 2) but this may relate to the very small numbers available for analysis at this gestation. There is a trend towards a reduction in RDS in babies born less than 24 hours after treatment, but a significant effect is not seen until 48 hours have elapsed [7] (Table 2). The treatment effect in babies born after 7 days is of borderline significance. Betamethasone and dexamethasone are both associated with a significant reduction in incidence of RDS (Table 2). The evidence from the small trials in which hydrocortisone was used does not support its use in preterm birth. The response to prenatal glucocorticoid therapy is not affected by fetal gender. In the small number of babies from twin and triplet pregnancies treated, it is not possible to show a significant benefit from prenatal glucocorticoid treatment (Table 2).
Monographs of Topical Drugs that Have Caused Contact Allergy/Allergic Contact Dermatitis
Published in Anton C. de Groot, Monographs in Contact Allergy, 2021
Iodoquinol is one of the halogenated 8-quinolinols, which is widely used as an intestinal antiseptic, especially as an anti-amebic agent. It is also used topically in other infections, often in combination with hydrocortisone acetate.
Microfluidics in drug delivery: review of methods and applications
Published in Pharmaceutical Development and Technology, 2023
Mutasem Rawas-Qalaji, Roberta Cagliani, Noor Al-hashimi, Rahma Al-Dabbagh, Amena Al-Dabbagh, Zahid Hussain
On the other hand, Ali et al. (2011) developed nanosuspension for pulmonary delivery of hydrocortisone via bottom-up (building up NPs from drug molecules via precipitation) approach using the microfluidic reactors (Figure 9). Hydrocortisone is a steroidal drug which is widely used as an anti-inflammatory agent for treatment of many diseases; however, its low aqueous solubility, dissolution rate, and low bioavailable limit its delivery routes and therapeutic efficacy. Moreover, rapid expulsion of conventional eye drops from the corneal surface due to eye blinking and washout due to lachrymal fluid also lead to shorter retention time and low bioavailability. Therefore, frequent administrations are necessary in order to maintain the therapeutic effect. Though, several approaches such as using viscosity-enhancing agents, penetration enhancers, and mucoadhesive materials have been employed to improve ocular permeability and bioavailability; however, results were still unsatisfactory. Encapsulation of hydrocortisone in nanosuspension produced via employing microfluidic devices have significantly improved aqueous solubility, dissolution rate, permeability efficiency, and therapeutic efficacy of hydrocortisone compared to hydrocortisone solution (Davies et al. 1997; Nagarwal et al. 2009; Ali et al. 2011) have also developed hydrocortisone nanosuspension for ophthalmic delivery via anti-solvent precipitation method using the microfluidic reactors.
Practical use and prescription of ocular medications in children and infants
Published in Clinical and Experimental Optometry, 2021
Ann L Webber, Phillipa Sharwood
Severe acute flares or recalcitrant chronic disease may require the use of topical steroids. Fluorometholone, e.g. FML or Flarex, provides ocular surface anti-inflammatory action with reduced intraocular penetration so it is less likely to lead to an IOP rise or cataract formation than more potent steroids such as dexamethasone or prednisolone. This is usually commenced at 2–3x day instillation and then weaned over a couple of weeks as symptoms improve. Topical hydrocortisone ointment (Hycor 1%) is useful to instil at night-time while asleep in children who are resistant to eye drop instillation or to apply for a short period to the eyelids in children with associated periocular eczema. Although hydrocortisone 1% is a mild steroid, the ointment form has prolonged contact with the eye and more intraocular penetration, thus has a higher risk of intraocular pressure rise.
Use of medications during pregnancy and breastfeeding for Crohn’s disease and ulcerative colitis
Published in Expert Opinion on Drug Safety, 2021
Robyn Laube, Sudarshan Paramsothy, Rupert W Leong
Corticosteroids are highly protein-bound therefore poorly excreted into breastmilk and generally considered to be compatible with lactation [66]. Excretion into breastmilk is dose-dependent as the proportion of unbound serum prednisolone increases at higher doses, therefore women ingesting >20 mg/day may consider delaying breastfeeding for four hours after administration to reduce neonatal exposure [66–69]. Prednisolone concentrations in breastmilk peak one hour after administration before rapidly equilibrating with unbound prednisolone levels in maternal serum and following a similar elimination curve [67,68]. Ost et al [68] calculated that breastfed infants consuming 100 mL/kg/day would ingest <0.1% of an 80 mg/day dose of prednisolone. Prednisolone reaches lower serum and breastmilk levels than prednisone, therefore may be preferable particularly when higher dose therapy is required [69]. Budesonide has low oral bioavailability and is thought to be compatible with breastfeeding, however data is limited [66,70,71]. There is also limited data on the use of hydrocortisone during lactation, the exogenous formulation of cortisol which is normally present in breastmilk [72]. No adverse effects have been noted in breastfed infants of mothers taking corticosteroids, including prednisone doses up to 40 mg/day with 3 years follow-up [73,74].