Cortisone - effect and side effects

Medical application

Cortisone preparations are used for a variety of diseases, especially inflammatory and allergic processes.

Common areas of application are

• rheumatic diseases,
• allergies,
• asthma,
• inflammatory skin diseases and
• chronic inflammatory bowel diseases.

The medication can be administered in various forms, such as tablets, ointments, sprays or injections. The dosage and duration of use is determined individually by the treating doctor. A higher dose is often required at the beginning, which is then gradually reduced. For longer-term use, the lowest possible dose is aimed for in order to minimise side effects.

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Dosage forms

Cortisone can be administered in various ways and dosage forms. The choice of dosage form depends on the disease to be treated. Systemic applications (oral, parenteral) generally have stronger side effects than local applications (topical, inhalation).

The practitioner selects the appropriate form and dosage of cortisone individually in order to achieve an optimal effect with as few side effects as possible. A distinction is made between the following dosage forms:

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Oral application

Cortisone is taken orally as tablets or capsules. Frequently used active ingredients are prednisolone and dexamethasone. These are usually taken in the morning between 6 and 8 a.m. to mimic the natural cortisol rhythm within the circadian cycle.

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Topical application

If cortisone is used in the form of ointments, creams and lotions for application to the skin, this is referred to as topical application. Cortisone for topical application has a localised effect on skin diseases such as neurodermatitis or psoriasis.

Inhalative application

For inhaled use, cortisone is taken via the respiratory tract or by inhalation. Cortisone is administered in the form of sprays for inhalation or as a nasal spray. Inhaled cortisone preparations are mainly used for respiratory diseases such as asthma.

Parenteral application

Parenteral literally means ‘past the intestine’. In clinical usage, parenteral application refers to the direct administration of drugs or nutrients into the bloodstream. Injections, infusions or inhalations are used for this purpose.

Cortisone is administered parenterally if a rapid and high-dose systemic effect is to be achieved, for example in acute rheumatic attacks.

Intra-articular application

Intra-articular is an anatomical description of the position of structures within a joint or the joint cavity/capsule. Intra-articular application is therefore usually the injection of a mostly liquid substance into a joint.

Cortisone is administered intra-articularly if, for example, localised joint inflammation is causing discomfort.

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Mechanism of action

The human organism releases endogenous cortisol in order to be able to perform in important, stressful or dangerous situations.

In the days of man as a hunter-gatherer, for example, cortisol was released when man was faced with danger, such as a predator. The release of cortisol puts the body on alert. All bodily functions are geared towards fleeing and surviving. The sugar and fat metabolism is influenced in order to provide energy in the short term, blood pressure, respiratory rate and heart rate increase.

Although people today are less likely to face early dangers such as predators, the mode of action of cortisol in the human body has not changed:

Among other things, cortisol interferes with sugar and fat metabolism and influences blood pressure, respiratory rate and heart rate. In higher doses, cortisol also inhibits the activity of the immune system, which is utilised by medical cortisone preparations.

Synthetic cortisone preparations dampen inflammatory reactions more strongly and effectively than the body's own cortisol. Synthetic cortisone preparations such as glucocorticoids or hydrocortisone therefore act in a variety of ways in the human body.

Anti-inflammatory, immunosuppressive and anti-allergic effects are utilised in medicine. However, effects on the metabolism are considered an unpleasant side effect, especially with long-term use.

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Anti-inflammatory effect

Cortisone has a strong anti-inflammatory effect. It inhibits the production of inflammatory messengers and thus reduces swelling, redness and pain caused by inflammatory processes in the body.

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Immunosuppressive effects

Glucocorticoids suppress excessive immune reactions. They inhibit the activity of certain immune cells such as T cells and thus reduce autoimmune and allergic reactions.

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Antiallergic effect

Allergic reactions are basically reactions of the immune system to allergens such as pollen, dust, mites and others.

Cortisone suppresses the formation of messenger substances, thereby preventing inflammatory reactions. The active ingredient therefore prevents allergy symptoms such as sneezing, itchy eyes, skin rashes and shortness of breath from occurring. The immune system is inhibited for a short time, which quickly calms down hay fever or itching, for example, and allows those affected to breathe freely again.

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Metabolic effects

Cortisone affects the metabolism in various ways:

• It increases blood sugar levels
• It promotes the breakdown of proteins and fats
• It influences the water and electrolyte balance
• It influences bone metabolism and can lead to bone loss (osteoporosis) if taken over a longer period of time.

Cortisone preparations have a strong anti-inflammatory, anti-allergic and immunosuppressive effect. They suppress inflammatory processes and allergic reactions by dampening the activity of the immune system. The effect usually occurs rapidly within hours to days, although the exact duration of action varies depending on the preparation. Due to its broad effect on almost all cells in the body, cortisone can also cause undesirable side effects if used for long periods or in high doses.

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Side effects

Due to its mode of action in the human body, cortisone can be associated with a number of undesirable side effects. These occur particularly with long-term use or high doses. With short-term or localised use, the side effects are generally less severe. Careful medical supervision and the use of the lowest possible effective dose can help to minimise side effects.

The possible side effects of cortisone include

• Weight gain: Cortisol influences numerous metabolic processes in the body, including carbohydrate, fat and protein metabolism. Increased appetite and water retention can lead to weight gain.
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• Increased blood sugar: Can lead to diabetes or worsen existing diabetes
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• High blood pressure: Cortisol affects the composition of minerals in the blood (especially sodium and potassium). This also influences blood pressure, known as water and sodium retention. This is also referred to as the mineralocorticoid effect of cortisol.
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• Increased susceptibility to infection: Cortisone suppresses the natural immune defence. This immunosuppressive effect inhibits inflammatory reactions in the body, for example, but at the same time makes the body more susceptible to infections.
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• Stomach problems
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• Osteoporosis: increased risk of bone loss with long-term use
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• Skin changes such as thinning of the skin, acne or striae
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• Muscle weakness and muscle atrophy (myopathy)
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• Visual disturbances, e.g. increased intraocular pressure
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• Skin thinning (with prolonged topical application)
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• Degradation of joint cartilage with repeated joint injections
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• Sleep disorders, as the natural cortisol influences the circadian rhythm
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• Psychological changes such as mood swings

Medications with a cortisol effect are among the most frequently prescribed. In principle, these drugs can differ in their structure and authorised use. The side effects associated with these medications can also vary. For this reason, you should always read the package leaflet and consult your doctor or pharmacist if you notice any side effects.

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