Suppression of 17-Hydroxycorticosteroids in Plasma and Urine by Single and Divided Doses of Triamcinolone

Grant, Sylvia D.; Forsham, Peter H.; DiRaimondo, Vincent C.

doi:10.1056/nejm196511182732101

Cited by 86 publications

(22 citation statements)

References 15 publications

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“…Administration of the total prednisolone dose in the morning may cause less adrenocortical suppression [3,4], which is important since adrenocortical suppression has been reported to increase the risk of relapse in patients with nephrotic syndrome [12]. We found no significant differences in side effects in patients treated with prednisolone in single or divided doses.…”

Section: Discussionmentioning

confidence: 55%

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Single- versus divided-dose prednisolone therapy for relapses of nephrotic syndrome

Ekka

Bagga

1997

Pediatric Nephrology

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Relapses of nephrotic syndrome are usually treated with prednisolone, initially in three to four daily divided doses. The divided-dose regimen may cause poor patient compliance and greater adrenal suppression. In a prospective randomized controlled trial, we compared the efficacy of prednisolone in inducing remission of nephrotic syndrome, when given either as a single dose or in divided doses. Patients with steroid-responsive nephrotic syndrome with relapse were randomized to receive prednisolone 2 mg/kg per day, either as a single morning dose or in three divided doses for 2 weeks, followed by 1.5 mg/kg on every alternate day for 4 weeks. Parents tested the urine for protein daily until remission (nil proteinuria for 3 consecutive days). The duration between initiation of treatment and achievement of remission was recorded. Of 106 patients, 94 (47 each in single-dose and divided-dose groups) completed the study. The patients in the two groups were similar in relation to age, sex, number of relapses in the preceding year, and blood levels of creatinine, albumin, and cholesterol. The mean time for achievement of remission in the single- and divided-dose groups was 8.6 and 8.5 days, respectively (P = 0.94, power 96%). After 9 months' follow-up, there were no differences in the frequency of relapses and cumulative dose of prednisolone received in the two groups. The observations suggest that prednisolone administered in a single daily dose or in divided doses is equally effective in inducing remission in patients with relapsing nephrotic syndrome.

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Section: Discussionmentioning

confidence: 55%

“…The use of corticosteroid therapy in divided doses is associated with significant adrenocortical suppression [3,4]. The compliance of patients in taking drugs three to four times a day also may be unsatisfactory [5].…”

Section: Introductionmentioning

confidence: 99%

Single- versus divided-dose prednisolone therapy for relapses of nephrotic syndrome

Ekka

Bagga

1997

Pediatric Nephrology

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“…As it has been well established that the circadian cortisol rhythm is least affected when a single dose of glucocorticoids is administered in the morning (Nichols et al, 1965;Grant et al, 1965), the acute effect on the HPA function was studied by means of a single administration at 08:00 hr in the present study. The present findings based on the changes in the circadian rhythm of plasma cortisol or ACTH indicate that the acute suppressive effect of a single administration of prednisolone on the HPA system is mild and continues no longer than 24hrs, even when doses as large as 30mg are administered.…”

Section: Discussionmentioning

confidence: 99%

Relative potency in acute and chronic suppressive effects of prednisolone and betamethasone on the hypothalamic-pituitary-adrenal axis in man.

et al. 1980

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The relative potency in the hypothalamic-pituitary-adrenal (HPA) suppression of both prednisolone and betamethasone was examined in an acute study with normal volunteers and in a chronic study with glucocorticoid-treated patients. Circadian rhythm of plasma cortisol was studied after a single dose administration of 5 to 30 mg prednisolone or 0.5 to 3.0 mg betamethasone at 08 : 00 hr. Morning-rise of plasma cortisol occurred on the morning after the administration of 30 mg or less prednisolone but no morning rise was noted after the administration of 1.0 mg or more betamethasone. Plasma ACTH was slightly elevated on the morning after 30 mg prednisolone administration but showed low levels throughout the night after 3.0 mg betamethasone administration.Plasma cortisol responsiveness to ACTH was examined in patients before and during therapy with either prednisolone or betamethasone.The basal cortisol level was not suppressed and the responsivenessto ACTH remained nearly normal during long-term 5 mg prednisolone therapy, but these were completely suppressed during long-term 0.5 mg betamethasone therapy.The responsiveness to ACTH was nearly normal in patients receiving alternate-day therapy with prednisolone in such large doses as 50 or 60 mg every other day, but was completely suppressed in patients receiving 1.0 mg betamethasone every other day. The relative potency of betamethasone in acute and chronic suppressive effects on the HPA system seems to be much stronger than that of prednisolone inequivalent doses with comparable anti-inflammatory effects. It is also suggested that the alternate-day therapy with such long-acting steroids as betamethasone are useless in preventing HPA suppression.

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“…In order to achieve better therapeutic efficacy and least side-effects, repeated dosage of small amounts of the drug in standard tablet form or the use of sustained release formulations has been recommended (Wagner, Carpenter & Collins, 1960;Harter, Reddy & Thorn, 1963;Grant, Forsham & di Raimondo, 1965;Ackerman & Nolan, 1968;D'Arcy et al, 1971). Because of the paucity of information on the plasma concentration after small doses of prednisolone in the clinical situation, the size of dose used and its frequency remains arbitrary.…”

Section: Introductionmentioning

confidence: 99%

Prednisolone levels in the plasma and urine: a study of two preparations in man.

English¹,

Chakraborty²,

Trigger³

et al. 1975

Brit J Clinical Pharma

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1. A competitive protein binding method was used to measure prednisolone and cortisol in blood and urine of volunteers given prednisolone by mouth (15 mg) in the standard tablet form and a fortnight later a regulated release formulation of prednisolone metasulphobenzoate containing an equivalent amount of prednisolone. 3. Plasma prednisolone levels rose rapidly after the standard tablet and more slowly after the regulated release form. The normal activity of the hypothalamic‐pituitary‐adrenal axis as measured by the 09.00 h plasma cortisol concentration was present 24 h after ingestion of the regulated release preparation. In contrast, the 09.00 h plasma cortisol level was reduced in subjects 24 h after receiving prednisolone in the standard tablet form.

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Suppression of 17-Hydroxycorticosteroids in Plasma and Urine by Single and Divided Doses of Triamcinolone

Cited by 86 publications

References 15 publications

Single- versus divided-dose prednisolone therapy for relapses of nephrotic syndrome

Single- versus divided-dose prednisolone therapy for relapses of nephrotic syndrome

Relative potency in acute and chronic suppressive effects of prednisolone and betamethasone on the hypothalamic-pituitary-adrenal axis in man.

Prednisolone levels in the plasma and urine: a study of two preparations in man.

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