Fludrocortisone has much greater mineralocorticoid vs. Because these agents have both mineralocorticoid and GC activity, they are generally preferred for use in patients with adrenal insufficiency. Ĭortisone and hydrocortisone are the least potent GCs. Also, its long duration of action makes it unsuitable for alternate-day therapy. Given its high potency, long-term treatment with dexamethasone is associated with severe hypothalamic-pituitary-adrenal (HPA) axis suppression therefore, it is generally reserved for short-term use in very severe, acute conditions. Dexamethasone also has minimal mineralocorticoid activity, but it is much more potent and has a longer duration of action than prednisone and prednisolone. Although similar to prednisone and prednisolone, methylprednisolone has even less mineralocorticoid activity and, therefore, may be preferred when mineralocorticoid effects (e.g., water retention) are particularly undesirable. Given its high GC activity relative to mineralocorticoid activity, it is generally used as an anti-inflammatory and immunosuppressive agent. Prednisone is perhaps the most widely used of the systemic corticosteroids. **Glucocorticoid doses which provide a mineralocorticoid effect that is approximately equivalent to 0.1 mg of fludrocortisone are: prednisone or prednisolone 50 mg, or hydrocortisone 20 mg. Relative potency for intra-ocular or intramuscular administration may vary considerably. *Equivalent dose shown is for oral or IV administration. Table adapted from NICE, 2012 Furst et al., 2012. Usually reserved for short-term use in severe, acute conditions given its high potency and long-duration of action.Anti-inflammatory/immunosuppressant used especially when water retention is undesirable given its minimal mineralocorticoid activity.High glucocorticoid activity makes it useful for long-term treatment, and as an anti-inflammatory/ immunosuppressant.Relatively high mineralocorticoid activity makes it suitable for use in adrenal insufficiency.Acute and chronic eosinophilic pneumonia.Acute exacerbations of chronic obstructive pulmonary disease.Moderate to severe asthma exacerbations.
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