What to Know About Oral Cortisone

Cortisone, taken orally as pills or capsules, is a fast-acting anti-inflammatory medication used to treat the inflammation associated with a variety of medical diagnoses, including arthritis.

As a corticosteroid, cortisone reduces the body's natural defensive response also causing a decrease in immunity. Because of the effects on immune response, you are more susceptible to infection.

Uses

Oral cortisone is most commonly used for the treatment of different arthritis conditions. These include the management of rheumatoid arthritis, osteoarthritis, juvenile arthritis, and psoriatic arthritis.It is an anti-inflammatory that also treats the inflammation associated with:

• Asthma
• Allergies
• Lupus
• Multiple sclerosis
• Eczema
• Severe rashes
• Ulcerative colitis
• Severe psoriasis
• Sarcoidosis

It can also be used for in the treatment of:

• Diseases of the adrenal glands
• Anemia

These fast-acting anti-inflammatories reduce inflammation because they are chemically similar to cortisol, one of your body’s natural anti-inflammatory hormones, made in the adrenal glands.

Once extremely popular, there are now studies that show the seriousness of possible side effects. As a result, long term use of cortisone is decreasing except in patients that medically require it.

Off-Label Uses

Currently, cortisone has been used off-label in the treatment of COVID-19. Some studies have reported that corticosteroid use in patients with novel coronavirus has reduced the mortality of patients requiring mechanical ventilation and oxygen therapy.

Unfortunately, the true effectiveness, safety, and potential side effects in these patients have not thoroughly been studied.

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Before Taking

Oral cortisone is part of the treatment options against arthritis in combination with other medications. This medication is rarely used without other pharmacological treatment options. Rheumatoid arthritis is managed through a combination of medications and self-management.

Pharmacologic and non-pharmacologic management do not cure arthritis, rather they can slow the progression of the disease. Disease-modifying antirheumatic drugs (DMARDs) and biological response modifiers (biologicals) are effective treatment options.  

Self-management options that are recommended once a diagnosis has been confirmed include:

• Physical activity
• Quit smoking
• Maintain a healthy weight
• Hot and cold treatments
• Stress reduction
• Massage
• Supplements

Healthcare providers follow three strategies when treating patients with arthritic conditions. The goal of treatment is to reduce or stop inflammation, relieve symptoms, prevent joint and organ damage, improve overall well being, and reduce any long term complications.

To accomplish this, your healthcare professional will follow these three treatment guidelines for rheumatoid arthritis:

• Early, aggressive treatment to reduce or stop inflammation as quickly as possible.
• Targeting remission or another goal (treat-to-target) works toward little or no signs or symptoms of active inflammation.
• Tight control keeps inflammation at the lowest level possible.

Precautions and Contraindications

It’s important to discuss with your medical provider all allergies to medications prior to taking cortisone pills. Do not use this medicine if you are allergic to cortisone or other corticosteroids. Other precautions and contraindications include:

• Discuss with your healthcare provider if you are pregnant, planning on becoming pregnant, or breastfeeding.
• Cortisone increases the risk of infection. Getting a yearly flu shot is important for your overall preventative health.
• You may need to start a calcium and/or vitamin D supplement while on cortisone.
• Notify your healthcare provider if you smoke or drink alcohol.
• Notify your healthcare provider if you have an untreated active fungal infection.
• Discuss all future needed vaccinations with your healthcare provider. Live vaccines can cause serious infection. Notify your healthcare provider if you need a vaccination.
• If you have diabetes, cortisone can make it harder to monitor your blood sugar accurately.
• Lifestyle changes may help reduce the risk of osteoporosis, a possible side effect of cortisone. Changes include doing weight-bearing exercise, quitting smoking, supplementation of calcium and vitamin D, and limiting alcohol.
• Notify your healthcare provider if you are currently taking any of the following medication: aldesleukin, birth control pills, diabetes medications, estrogen hormone replacement, mifepristone, azole antifungals, barbiturates, rifamycins, phenytoin, blood thinners, and/or NSAIDs.
• Before taking cortisone, notify your healthcare provider if you have had any of the following in your medical history: bleeding problems, history of blood clots, osteoporosis, diabetes, eye diseases, heart problems, hypertension, other infections, kidney disease, liver problems, mental/mood conditions, hypokalemia, hypocalcemia, stomach/intestinal problems, and/or thyroid problems.

Talk to your healthcare provider about all medications, supplements, and vitamins that you currently take. While some drugs pose minor interaction risks, others may outright contraindicate use or prompt careful consideration as to whether the pros of treatment outweigh the cons in your case.

Other (Drug Class Names)

Cortisone is an oral corticosteroid. Other corticosteroids include:

• Dexamethasone (Decadron)
• Hydrocortisone
• Methylprednisolone
• Prednisolone
• Prednisone

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Dosage

All listed dosages are according to the drug manufacturer. Check your prescription and talk to your healthcare provider to make sure you are taking the right dose for you. Cortisone pills come in 5 milligram (mg), 10 mg, and 25 mg tablets.

The initial dosage varies from 25 to 300 mg a day depending on the disease being treated. In less severe diseases doses lower than 25 mg, while in severe diseases doses higher than 300 mg may be required. Exact dosages will be determined by your healthcare provider.

How to Take and Store

Exact dosage and frequency will be determined by your healthcare provider but the FDA suggests:

• Comes in tablet form.
• Take after a full meal.
• If taking once a day, take prior to 9 a.m. to decrease the risk of insomnia.
• Take with an antacid to decrease GI upset.
• Take with a full glass of liquid to decrease GI upset.
• Take exactly as directed even if feeling better. Finish the entire prescription.
• Take a missed dose as soon as you think about it.
• Do not take two doses at the same time or extra doses.
• Steroids should be tapered slowly following your healthcare provider's recommendations.

Follow these guidelines for storage:

• Store in the airtight original container
• Protect from light, extreme heat, and extreme cold
• Keep away from moisture (i.e. bathroom)
• All unused and/or expired medication should be disposed of properly.
• Keep out of reach of children.
• Make sure the safety cap is locked at all times.
• Do not flush extra tablets down the drain or toilet.

Side Effects

As with all medications, there are possible side effects you may experience while taking cortisone. Cortisone has a variety of possible side effects that increase in severity the longer you have been on the medication. Furthermore, if cortisone is not properly tapered off, you may suffer from additional side effects.

Possible side effects include:

• Elevated eye pressure (glaucoma)
• Fluid retention
• Hypertension
• Weight gain
• Moodiness
• Problems with memory and behavior
• Cataracts
• Infections
• Osteoporosis
• High blood sugar levels in patients with diabetes
• Thin skin
• Bruising
• Slower healing process for wounds
• GI upset
• Insomnia
• Aseptic necrosis
• Atherosclerosis

Warnings and Interactions

Be aware of these:

• Avoid contact with individuals that have recently received a live vaccine including the oral polio vaccine and live influenza vaccine.
• Avoid contact with individuals with active chickenpox, shingles, or herpes infections. Notify your healthcare provider if you come in contact with an individual.
• Insomnia is a common side effect of corticosteroids, so you may want to talk to your healthcare provider about taking the whole dose in the morning.
• Side effects of corticosteroids can persist long after you stop taking them so continue seeing your healthcare provider regularly.
• It is unknown if cortisone passes through breast milk and the placenta. Previous studies linked cortisone pills to birth defects including low birth weight, cleft lip/palate, and premature delivery. Research is not as conclusive but it is still recommended to use alternative means of birth control as cortisone might interact with birth control pills.