Cortisone: Effects, Uses and Tips

What is cortisone?

Cortisone is a colloquial term for synthetically produced medicines from the group of glucocorticoids, which are modelled on the body’s own hormone, cortisol. Cortisol is produced in the adrenal cortex and performs a variety of functions in the body.

It is also often referred to as the ‘stress hormone’, as it is released in greater quantities during times of stress to prepare the body for an appropriate response. Furthermore, it regulates metabolism and influences the immune system, blood pressure, blood sugar levels, mood and cognitive functions such as concentration and attention. Cortisone medicines perform all these functions. In medicine, they are primarily used for their anti-inflammatory, anti-allergic and immunosuppressive effects and help to treat the symptoms of many diseases.

How does cortisone work in the body?

Cortisone is a complex medication with a wide range of effects in the body. The most important effects include:

• Increased heart rate and blood pressure
• Increasing blood sugar levels
• Suppression of the immune system
• Regulation of metabolism
• Effects on mood and concentration

When is cortisone used?

Cortisone is used to treat numerous conditions in which inflammatory processes or excessive immune responses play a role. These include:

• Rheumatic conditions: rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis
• Inflammation of joints and bursae
• Autoimmune diseases: multiple sclerosis, psoriasis, Crohn’s disease
• Respiratory conditions: Asthma, COPD
• Skin conditions: atopic dermatitis, eczema
• Allergic reactions: allergic rhinitis, anaphylactic shock
• Cancer: For tumour-related inflammation, to dilate the airways
• Premature birth: To accelerate lung maturation in an unborn baby in the event of a threatened premature birth
• Post-transplant: To prevent rejection reactions

In what forms is cortisone used?

Cortisone is available in numerous dosage forms. A basic distinction is made between forms for local application (topical), such as ointments, creams or sprays, and forms that act throughout the body (systemic), such as tablets or injections.

Topical forms:

• Ointments and creams (e.g. for skin conditions)
• Nasal sprays (e.g. for hay fever)
• Inhalers (e.g. for asthma)
• Eye drops (e.g. for inflammatory eye conditions)
• Solutions for topical application (e.g. for inflammatory skin conditions such as psoriasis of the scalp)

Systemic forms:

(e.g. for rheumatic conditions, autoimmune diseases, severe forms of allergic and skin conditions, COPD, chronic inflammatory bowel diseases)

• Tablets
• Injections
• Infusions
• Suppositories
• Syrup
• Rectal foam, rectal solution

How long does cortisone last?

The duration of action of cortisone depends on the dosage form and the dose. Generally speaking, the effect can last from six to eight hours up to several weeks.

What are the benefits of cortisone?

Compared to many other medicines, cortisone acts very quickly. At higher doses, the effect can be felt within a few seconds; normally, it takes effect within hours or days. This is particularly helpful during acute flare-ups or severe allergic reactions. Furthermore, cortisone is available in many different forms and has a very broad spectrum of activity, making it highly versatile.

What are the side effects of cortisone?

Unfortunately, cortisone’s high efficacy also carries a high potential for side effects. This applies to both preparations for topical use and those, such as tablets, which act systemically throughout the body. Here are some examples of side effects caused by cortisone:

Local side effects:

• Skin irritation, allergic reactions, thinning of the skin: when ointments or creams are applied to the skin
• Hoarseness, fungal infections in the mouth: e.g. when using sprays and inhalers
• Eye symptoms such as redness, itching or watering: when using eye drops
• Nosebleeds: when using nasal sprays
• Joint and tendon damage: when injections are administered in this area
• Gastrointestinal complaints: when using suppositories or rectal foam

Systemic side effects:

• Weight gain
• Fluid retention, particularly in the legs and face
• Central obesity, as well as fat deposits in the face (moon face) and on the neck (bull neck)
• High blood pressure
• Decreased bone density (risk of osteoporosis)
• Gastrointestinal complaints
• Mood swings
• Sleep disturbances
• Increased blood sugar levels (risk of diabetes)
• Impaired wound healing
• Increased susceptibility to infection

How can side effects be minimised?

To minimise side effects, it is important to follow your doctor’s instructions and the prescribed dosages exactly. As a general rule, short-term use of cortisone does not usually cause any serious side effects, even at high doses. However, harmful side effects can occur if cortisone is used at high doses over a prolonged period.

What interactions with other medicines are there?

Cortisone preparations can also lead to numerous interactions with other medicines. This can result in either a reduction or an increase in the effect of other medicines. Important examples of this include:

Reduced effect:

• Antidiabetics
• Anticoagulants
• Antibiotics

Enhanced effect:

• Cardiac glycosides
• Some antispasmodics
• Certain antibiotics
• NSAIDs (increased risk of gastrointestinal bleeding and ulcers)
• Certain anticholinergics
• Oestrogens
• ACE inhibitors

What are the possible consequences of an overdose?

The consequences of a cortisone overdose can vary depending on the dose, duration of use and individual sensitivity. On the one hand, there are short-term side effects, such as an intensification of typical cortisone side effects like thinning of the skin, increased blood pressure or elevated blood sugar levels; on the other hand, there are long-term side effects that can arise from taking high doses of cortisone over an extended period. One serious such side effect is Cushing’s syndrome, which is characterised by central obesity with a ‘bull’s neck’ and a ‘moon face’, osteoporosis, loss of muscle mass, high blood pressure and thinning of the skin.

What should be borne in mind during pregnancy and whilst breastfeeding?

During pregnancy and breastfeeding, cortisone should only be used after a careful risk-benefit assessment. Cortisone for topical use, such as in ointments or creams, is preferable as it acts mainly locally. If systemic treatment, for example with tablets, is necessary, weaker cortisone preparations should be used. In the case of long-term, high-dose systemic cortisone therapy, the growth of the embryo should be monitored regularly by ultrasound.

What should be borne in mind when coming off cortisone?

Cortisone should not be stopped abruptly, but rather tapered off gradually over a longer period. This is important because the administration of synthetic cortisone suppresses the body’s own production of cortisol in the adrenal cortex. Abrupt withdrawal can lead to a cortisone deficiency, which manifests as symptoms such as weakness, tiredness, nausea, joint pain or a drop in blood pressure. Furthermore, the condition being treated with cortisone may flare up again if the medication is stopped abruptly. For patients with osteoporosis, it is also important to have a bone density scan carried out following cortisone therapy.

What do experts say about the long-term use of cortisone?

Side effects are certainly to be expected with long-term cortisone treatment, although people with pre-existing conditions such as high blood pressure or severe obesity are at greater risk. Regular monitoring of blood sugar levels, bone density and intraocular pressure is also important during long-term systemic therapy.

What are the key tips for use?

• Follow your doctor’s instructions and adhere strictly to the prescribed dosage and duration of treatment.
• Never increase the dose without consulting your doctor.
• Use cortisone only for as long as necessary and, in consultation with your doctor, gradually taper off the medication once the symptoms have subsided.
• Apply cortisone ointments or creams only to the affected areas of skin and avoid contact with healthy skin.
• Tell your doctor about any other medicines you are taking.
• Monitor for any side effects and report them to your doctor immediately.