Instructions for use CORTINEFF

Pharmacodynamics and pharmacokinetics

Pharmacodynamics

A synthetic fluorine-containing corticosteroid is an analogue of adrenal hormone . It has a stronger (100 times) mineralocorticoid effect than hydrocortisone . The use of Cortineff enhances the reabsorption of water and sodium and increases the excretion of potassium. Retention of sodium and fluid in the body leads to an increase in blood pressure .

In high doses, it can inhibit the activity of the adrenal cortex , thymus gland and the production of ACTH by the pituitary gland . If there is insufficient protein intake from food, it causes a negative nitrogen balance.

Intended for replacement therapy for adrenal insufficiency (acute or chronic).

Pharmacokinetics

When taken orally, it is completely absorbed. The active substance is determined in the blood after 10-20 minutes, and Cmax is reached after 1.7 hours. It binds to proteins by 70-80%. Metabolized in the liver and kidneys (partially). The half-life from the blood is 3.5 hours, from tissues - 18-36 hours. Excreted in urine.

Cortineff tablets 0.1 mg No. 20

Compound

Active substance: fludrocortisone acetate - 100 mcg. Excipients: lactose, potato starch, gelatin, magnesium stearate.

Pharmacokinetics

Suction

After oral administration, it is quickly and completely absorbed from the gastrointestinal tract. The active substance is detected in the blood serum 10-20 minutes after taking a dose of 0.1 mg. Cmax of the active substance in plasma is achieved approximately 1.7 hours after administration.

Distribution

Plasma protein binding is 70-80%.

Metabolism

Metabolized mainly in the liver, partially in the kidneys.

Removal

T1/2 - about 3.5 hours. Excreted in the urine in the form of inactive metabolites. T1/2 from tissues is 18-36 hours.

Indications for use

• primary insufficiency of the adrenal cortex (Addison's disease, a condition after complete adrenalectomy);
• secondary adrenal insufficiency;
• adrenogenital syndrome (congenital adrenal hyperplasia);
• hypovolemia and arterial hypotension of various origins.

Contraindications

• systemic mycoses;
• hypersensitivity to fludrocortisone or other components of the drug.

Cortineff should be prescribed with caution in patients with UC, intestinal diverticulosis, gastric or duodenal ulcers, acute or latent peptic ulcers, recently created intestinal anastomoses, esophagitis, gastritis, a history of gastrointestinal surgery, impaired liver function, renal failure, arterial hypertension, osteoporosis, myasthenia gravis, hypoalbuminemia and conditions predisposing to its occurrence, hyperlipidemia.

Fludrocortisone should be used with caution in diabetes mellitus (including impaired carbohydrate tolerance), hypothyroidism, Itsenko-Cushing's disease, thyrotoxicosis, obesity (III-IV degrees), acute psychosis and mental disorders, with poliomyelitis (except for the form of bulbar encephalitis).

Caution should be exercised when treating patients with cardiovascular diseases, incl. after a recent myocardial infarction (in patients with acute and subacute myocardial infarction, the necrosis focus may spread, the formation of scar tissue may slow down and, as a result, the heart muscle ruptures), with decompensated chronic heart failure.

Cortineff is prescribed with caution for parasitic and infectious diseases of a bacterial nature (currently or recently suffered, including recent contact with a patient) - herpes simplex, herpes zoster (viremic phase), chickenpox, measles, amoebiasis, strongyloidiasis (established or suspected); active and latent tuberculosis. The use of fludrocortisone in severe infectious diseases is permissible only against the background of specific therapy.

Caution should be exercised when treating patients in the post-vaccination period (a period of 8 weeks before and 2 weeks after vaccination), with lymphadenitis after BCG vaccination.

The decision to use corticosteroids in patients with HIV infection and AIDS should be made after a careful assessment of benefits and risks.

Directions for use and doses

Doses of the drug are set individually, depending on the indications, the effectiveness of therapy and the patient’s condition.
During treatment, when the clinical picture changes or during stressful situations such as surgery, trauma or infection, dose adjustment may be necessary. In adults, during replacement therapy, depending on the clinical picture, the dose varies from 100 mcg 3 times a week to 200 mcg/day.

For adrenogenital syndrome, children are prescribed an initial dose of 300 mcg/day, then over the course of several months the dose is reduced to 50-100 mcg/day.

The maintenance dose for infants is from 100 to 200 mcg/day, for children over one year old - 50-100 mcg/day.

The tablets should be taken orally in the morning after meals with plenty of liquid. When using large doses of Cortineff, it is recommended to take 2/3 of the dose in the morning and 1/3 in the afternoon.

If you miss a dose, take the drug as quickly as possible or, if the time for your next dose is approaching, do not take the missed dose. Do not take a double dose at once.

Cortineff should be used in minimally effective doses. If necessary, the dose of the drug should be reduced gradually.

Storage conditions

Store in a dry place, protected from light, at a temperature not exceeding 25°C.
Keep out of the reach of children.

Best before date

3 years. Do not use after the expiration date stated on the packaging.

special instructions

When taking Cortineff, the patient must strictly follow the doctor's instructions.
In case of stressful situations, patients taking Cortineff are recommended to receive parenteral corticosteroids.

Sudden cessation of treatment may cause the development of acute adrenal insufficiency, so the dose of Cortineff should be reduced gradually.

Cortineff may mask symptoms of infection and reduce resistance to infection and the ability to contain it.

Long-term use of Cortineff increases the risk of developing secondary fungal or viral infections.

Patients taking Cortineff should not be vaccinated with live viral vaccines. Administration of an inactivated viral or bacterial vaccine may not produce the expected increase in antibodies. In addition, patients taking corticosteroids are at increased risk of neurological complications during vaccination. If Cortineff is suddenly discontinued, especially after long-term use, the so-called withdrawal syndrome may develop, manifested by anorexia, fever, muscle and joint pain, and general weakness. These symptoms can appear even in cases where there is no adrenal insufficiency.

In patients with hypothyroidism or liver cirrhosis, the effect of Cortineff is enhanced.

During the use of Cortineff, mental disorders may appear, such as euphoria, insomnia, sudden mood changes, personality changes, severe depression, and symptoms of psychosis. Pre-existing emotional instability or psychotic tendencies may increase during treatment.

When treating patients with hypoprothrombinemia, Cortineff and acetylsalicylic acid should be prescribed simultaneously with caution.

During long-term treatment of children, their growth and development should be monitored.

Medicines should not be disposed of down the drain or in household waste containers. Ask your pharmacist about how to discard unused medication. These activities will help protect the environment.

Description

Adrenal cortex hormone. Mineralocorticoid.

Dosage form

The tablets are white with a creamy tint, round, flat, bevelled, with an embossed letter “F” on one side and a break notch on the other.

Use in children

With long-term use of Cortineff in children, careful monitoring of their growth and development is necessary.

Pharmacodynamics

A synthetic analogue of the adrenal cortex hormone, a fluorinated derivative of hydrocortisone.
Has high mineralocorticoid activity. Cortineff enhances the reabsorption of sodium and water in the renal tubules, and also increases the excretion of potassium and hydrogen ions. An increase in the volume of extracellular fluid and sodium retention in the body lead to an increase in blood pressure.

Cortineff in doses exceeding therapeutic levels can inhibit the activity of the adrenal cortex, the activity of the thymus gland and the secretion of ACTH by the pituitary gland. The drug can also increase the deposition of glycogen in the liver, and if there is insufficient protein in the diet, lead to a negative nitrogen balance.

Cortineff has a 100 times stronger mineralocorticoid effect and 10-15 times stronger anti-inflammatory effect than hydrocortisone.

Side effects

Side effects associated with the mineralocorticoid effect of the drug: arterial hypertension, peripheral edema, left ventricular hypertrophy, circulatory failure, hypokalemia, hypocalcemia.
When using Cortineff for a long time or simultaneously with other corticosteroids, the following side effects may develop:

From the musculoskeletal system: muscle weakness, steroid myopathy (more common in women, usually begins with the muscles of the femoral girdle and spreads to the proximal muscles of the arms; rarely affects the respiratory muscles), loss of muscle mass, tendon rupture, osteoporosis, vertebral compression fracture, aseptic necrosis of the heads of the femur and humerus, pathological fractures of long tubular bones.

From the cardiovascular system: arrhythmias, bradycardia (up to cardiac arrest), ECG changes characteristic of hypokalemia, hypercoagulation, thrombosis, obliterating endarteritis. In patients with acute and subacute myocardial infarction - the spread of necrosis, slowing down the formation of scar tissue, which can lead to rupture of the heart muscle.

From the digestive system: steroid ulcer with possible perforation and bleeding, pancreatitis, flatulence, ulcerative esophagitis, digestive disorders, increased or decreased appetite, vomiting, hiccups; rarely - increased activity of liver transaminases and alkaline phosphatase.

Dermatological reactions: atrophic stripes, acne, delayed wound healing, thinning of the skin; petechiae and hematomas, erythema, increased sweating, ecchymoses, hyper- or hypopigmentation, a tendency to develop pyoderma and candidiasis.

Allergic reactions: urticaria, allergic dermatitis, angioedema, anaphylactic reactions.

From the side of the central nervous system: convulsions, dizziness, headache, sleep disturbance, increased intracranial pressure with congestive optic papilla syndrome (pseudotumor cerebri - most often in children, usually after too rapid dose reduction, symptoms - headache, deterioration of visual acuity or double vision eyes); mental reactions that can mimic schizophrenia, mania or delirium (more often appear in women in the first two weeks of treatment); Possible euphoria, insomnia, sudden mood changes, personality changes, severe depression.

From the endocrine system: secondary adrenal and hypothalamic-pituitary insufficiency (especially during stressful situations such as illness, injury, surgery), Itsenko-Cushing syndrome, growth retardation in children; menstrual irregularities; decreased tolerance to carbohydrates, hyperglycemia, glucosuria; manifestation of latent diabetes mellitus and increased need for insulin or oral hypoglycemic drugs in patients with diabetes mellitus; hirsutism.

From the organ of vision: posterior subcapsular cataract (usually resolves after cessation of treatment, but surgical treatment may be required); increased intraocular pressure, glaucoma (usually after treatment for at least a year); exophthalmos, tendency to develop secondary bacterial, fungal or viral eye infections, trophic changes in the cornea.

Metabolism: negative nitrogen balance (as a result of protein catabolism), increased excretion of calcium, hypocalcemia; hypernatremia, gynokalemic syndrome caused by mineralcorticoid activity (hypokalemia, arrhythmia, myalgia or muscle spasm, unusual weakness and fatigue).

Other: weight gain, masking the symptoms of infectious diseases, fainting, development or exacerbation of infections (the appearance of this side effect is facilitated by jointly used immunosuppressants and vaccination), leukocyturia, withdrawal syndrome.

Use during pregnancy and breastfeeding

The use of corticosteroids by women of childbearing age and pregnant women is permissible only when their potential benefit to the mother outweighs the potential risk to the fetus.
In case of adrenal insufficiency, Cortineff should be continued during pregnancy, but the dose may be increased. If it is necessary to use the drug during breastfeeding, it is recommended to stop breastfeeding.

Interaction

• With simultaneous use of Cortineff with cardiac glycosides, the risk of developing heart rhythm disturbances increases and the toxicity of glycosides increases against the background of hypokalemia.
• When used simultaneously, barbiturates, antiepileptic drugs (phenytoin, carbamazepine), rifampicin, glutethimide weaken the effect of Cortineff by accelerating the metabolism of fludrocortisone.
• Antihistamines weaken the effect of Cortineff.
• Amphotericin B, carbonic anhydrase inhibitors, when used simultaneously with Cortineff, can cause hypokalemia, left ventricular hypertrophy, and circulatory failure.
• When Cortineff is used simultaneously with anabolic steroids and androgens, the risk of developing peripheral edema and acne increases (use with caution, especially in patients with liver and heart diseases).
• Oral contraceptives containing estrogens increase the serum level of corticosteroid binding globulins and enhance the effect of Cortineff by slowing down the metabolism of fludrocortisone and increasing its T1/2.
• Anticoagulants (coumarin derivatives, indadione, heparin), streptokinase, urokinase reduce (in some patients increase) the effectiveness of Cortineff. The dose should be determined based on prothrombin time and take into account the increased risk of ulcerative lesions and gastrointestinal bleeding.
• Tricyclic antidepressants may increase mental disorders associated with Cortineff (these drugs should not be used to treat these disorders).
• With simultaneous use, Cortineff weakens the effect of oral hypoglycemic drugs, insulin, potassium-sparing diuretics, increases the concentration of glucose in the blood (dosage adjustment of hypoglycemic drugs may be required).
• Cortineff reduces the effectiveness of laxatives and potassium-sparing diuretics, and the risk of hypokalemia increases.
• Ephedrine may accelerate the metabolism of fludrocortisone (cortineff dose adjustment may be required).
• When Cortineff is used simultaneously with immunosuppressive drugs, the risk of developing infection, lymphoma and other lymphoproliferative diseases increases.
• Cortineff, when used simultaneously with depolarizing muscle relaxants, can increase the duration of neuromuscular blockade, because hypocalcemia associated with the use of Cortineff may increase synaptic blockade.
• Cortineff reduces the effect of NSAIDs (including acetylsalicylic acid), which increases the risk of ulcerative lesions and bleeding from the gastrointestinal tract.
• With the simultaneous use of Cortineff and drugs and food containing sodium, peripheral edema and arterial hypertension are possible.
• When using vaccines containing live viruses, while using immunosuppressive doses of Cortineff, viral replication and the development of viral diseases and decreased antibody production are possible (the combination is not recommended).
• When used simultaneously with other vaccines, the risk of neurological complications increases and the production of antibodies decreases.

Overdose

Symptoms: arterial hypertension, peripheral edema, hypokalemia, significant increase in body weight, myocardial hypertrophy.
Treatment: discontinue the drug. Symptoms usually go away within a few days. Then treatment should be continued by reducing the dose of Cortineff. In case of muscle weakness associated with potassium loss, administration of potassium supplements is necessary. To prevent overdose, blood pressure and serum electrolyte concentrations should be regularly monitored.

Impact on the ability to drive vehicles and operate machinery

There is no data on the effect of Cortineff on the ability to drive vehicles and engage in other potentially hazardous activities that require increased concentration and speed of psychomotor reactions.

Contraindications

• increased sensitivity;
• systemic mycoses .

Prescribed with caution for peptic ulcer disease , intestinal diverticulosis , ulcerative , esophagitis , operations on the gastrointestinal tract , gastritis liver and kidney dysfunction, arterial hypertension , diabetes mellitus , osteoporosis , hypothyroidism , myasthenia gravis , thyrotoxicosis , acute psychosis , obesity (III-IV degrees) .

Use caution in patients with acute and subacute infarction , cardiovascular diseases, viral and bacterial diseases, and in patients with HIV infection .

special instructions

Fludrocortisone may mask symptoms of infection by reducing resistance to infection and the ability to contain it.

Patients taking drugs that suppress the immune system are more vulnerable to infections than healthy patients. The course of chickenpox, herpes zoster and measles can be very severe after the administration of GCS. Patients who have not previously had these diseases should beware of contracting them.

Patients who have not had chickenpox and are taking oral corticosteroids for reasons unrelated to replacement therapy should be considered at risk of developing a severe form of smallpox. Diseases such as pneumonia, hepatitis and DIC may worsen.

After contact with a patient with chickenpox, administration of Varicella zoster immunoglobulin (VZIG) is indicated for patients currently taking corticosteroids or those who have taken them during the 3 months preceding contact. VZIG must be administered for 3 days, but no later than 10 days after exposure to someone with chickenpox. You should not stop taking GCS; you should increase their dose. Immunoglobulin (IG) should be administered after exposure to someone with measles.

Patients undergoing fludrocortisone therapy should not be vaccinated with live viral vaccines.

Using an inactivated bacterial or viral vaccine may not produce the expected increase in antibodies. In patients taking the drug Cortineff for a long time, in severe stressful situations (trauma, surgery or severe illness), there may be a need for auxiliary treatment with GCS, both while taking the drug Cortineff and in the following years.

Special Cautions

In patients treated with GCS, in a stressful situation it is necessary to use an increased dose of fast-acting GCS.

Sudden cessation of long-term use of the drug can lead to adrenal insufficiency, hypotension and even death. GCS withdrawal syndrome may occur, which is manifested by fever, myalgia, arthralgia, significant deterioration in health, rhinitis, conjunctivitis, itchy skin thickening and weight loss. These symptoms can occur even if adrenal insufficiency is not detected. In this regard, cessation of long-term use of GCS should occur gradually and slowly.

Since fludrocortisone has a pronounced mineralocorticotropic effect, dosage and salt retention should be monitored, taking into account the risk of hypertension, edema and weight gain.

In case of prolonged use, the concentration of electrolytes in the blood serum should be periodically monitored.

Given the risk associated with sodium retention in the body, Cortineff should only be taken as prescribed by a doctor.

Considering that the drug Cortineff provides for long-term use, primarily as replacement therapy, to reduce the severity of side effects that may appear due to glucocorticotropic action, they should be used in the minimum effective dose.

During prolonged use of fludrocortisone, atrophy of the adrenal cortex develops, which can persist for many years after cessation of treatment.

In patients with thyroid insufficiency or liver cirrhosis, the effect of fludrocortisone is stronger. Patients with hypoprothrombinemia should take acetylsalicylic acid with caution in combination with fludrocortisone. Fludrocortisone should be used with caution in cases of fresh esophageal-intestinal anastomoses, intestinal diverticula, thrombophlebitis, and diseases accompanied by skin rash.

Fludrocortisone should be used with caution in cases of chronic nephritis or renal failure, osteoporosis (especially in postmenopausal women), active peptic ulcer or its remission, myasthenia gravis, local or systemic fungal or viral infections, glaucoma (or family history of glaucoma), hyperlipidemia , hypoalbuminemia.

The administration of fludrocortisone to patients with active tuberculosis should be limited to cases of disseminated tuberculosis or in cases of acute tuberculosis and only with simultaneous anti-tuberculosis therapy. Patients with latent forms of tuberculosis or a positive tuberculin test who receive fludrocortisone should be monitored for the risk of developing or exacerbating tuberculosis. With prolonged use of GCS, patients should receive anti-tuberculosis drugs for prophylactic purposes.

Caution should be exercised when using fludrocortisone in patients with hypertension, congestive heart failure, steroid myopathy, epilepsy, liver dysfunction, as well as acute psychosis and mental disorders. A history of emotional lability or psychotic disorders may be aggravated by the use of fludrocortisone.

In patients with diabetes mellitus, the course of the disease may worsen, which will require an increase in the dose of insulin. Fludrocortisone may cause the manifestation of latent diabetes mellitus.

Women are at risk for irregular menstrual bleeding.

Children born to mothers who took high doses of corticosteroids during pregnancy or breastfeeding should be examined to identify possible adrenal insufficiency. Children who take corticosteroids for a long time may experience slower growth and development.

In some cases, patients taking GCS, especially in cases of previously confirmed hypersensitivity to drugs, may experience anaphylactic reactions.

Cortineff contains lactose. Patients with rare hereditary galactose intolerance, Lapp lactase deficiency or glucose-galactose malabsorption syndrome should not take the drug.

Use during pregnancy and lactation. The use of fludrocortisone in women of reproductive age and during pregnancy in the absence of vital indications is prohibited. Patients who develop preeclampsia and fluid retention in the body should be under strict medical supervision.

Fludrocortisone is excreted in breast milk and can cause adverse reactions in the child: growth retardation or suppression of the secretion of endogenous hormones of the adrenal cortex, so breastfeeding should be stopped during treatment.

Children. Safety and effectiveness in children have not been officially established, so the drug is not used in pediatric practice.

The ability to influence reaction speed when driving vehicles or working with other mechanisms. There are no data regarding the effect on the psychophysical state of a person and the speed of neuromotor reactions.

Side effects

Cortineff may cause unwanted reactions:

• arterial hypertension;
• swelling;
• hypokalemia , hypocalcemia ;
• bradycardia;
• arrhythmias;
• muscle weakness, myopathy ;
• tendon rupture;
• loss of muscle mass;
• osteoporosis and pathological fractures;
• steroid ulcer and perforation;
• pancreatitis , ulcerative esophagitis , acne , petechiae , skin thinning;
• tendency to develop candidiasis ;
• urticaria , Quincke's edema ;
• dizziness , convulsions, sleep disturbances, severe depression ;
• Itsenko-Cushing syndrome , diabetes mellitus , hirsutism ;
• withdrawal syndrome;
• weight gain.

Side effects

Most side effects are associated with the mineralocorticotropic effect of fludrocortisone. These include fluid and electrolyte disturbances: sodium and fluid retention, hypertension, edema, congestive circulatory failure, potassium loss, hypokalemic alkalosis, arrhythmias or ECG changes associated with potassium deficiency, and increased calcium excretion. with short-term use of fludrocortisone, like other corticosteroids, side effects associated with glucocorticotropic activity are detected sporadically. The risk of developing the following side effects applies primarily to patients who take fludrocortisone for a long time or in combination with other corticosteroids.

From the musculoskeletal system: muscle weakness, steroid myopathy, muscle wasting, osteoporosis, compression fractures of the spine, aseptic necrosis of the head of the femur and humerus, pathological fractures of tubular bones.

From the gastrointestinal tract: peptic ulcer and its consequences: bleeding, perforation of the esophagus, stomach and duodenum, perforation of the large or small intestine, especially in patients with intestinal inflammation; pancreatitis; bloating; ulcerous inflammation of the esophagus, indigestion; candidiasis, increased appetite.

Skin: skin rash, delayed wound healing; thinning of the skin; ecchymoses and hematomas; erythema; excessive sweating, purpura, stretch marks on the skin, acne, skin manifestations similar to systemic lupus erythematosus, decreased response to skin tests.

From the central nervous system: euphoria, personality disorders, depression, sleep disturbance, convulsions; increased intracranial pressure with papillary edema (pseudotumor cerebri - usually after too rapid dose reduction); dizziness and headache, neuritis or paresthesia, increased severity of symptoms of psychosis, epilepsy.

From the endocrine system: menstrual irregularities; development of Cushing's syndrome; growth retardation in children; secondary insufficiency of the adrenal cortex and pituitary gland, especially in stressful situations (illness, injury, surgery), decreased tolerance to carbohydrates; manifestation of diabetes mellitus and increased need for insulin and antidiabetic drugs in patients with existing diabetes mellitus, hirsutism, weight gain, negative protein and calcium balance.

From the organ of vision: posterior subcapsular cataract; increased intraocular pressure; glaucoma; exophthalmos, thinning of the cornea or sclera, exacerbation of eye diseases of fungal and viral etiology.

Other disorders: necrotizing vasculitis or lymphangitis, thrombophlebitis and obliterating endarteritis, leukocytosis, insomnia, allergic reactions.

Cortineff, instructions for use (Method and dosage)

The dose depends on the disease and the effectiveness of therapy. During treatment, dose adjustments are made during stressful situations, infections, injuries or operations. Often it is necessary to increase the dose in the summer, which is associated with large losses of sodium and water by the body.

Adults are prescribed 0.05-0.1 mg once a day in the morning, after breakfast, with plenty of water. The maximum daily dose is 0.2 mg. When prescribing high doses, take 2/3 of the dose in the morning, and the remaining 1/3 of the dose in the afternoon. Do not take a double dose if you miss a dose.

For children with adrenogenital syndrome - 300 mcg/day, with a gradual dose reduction. Maintenance dose for children - 50-100 mcg/day. In children, growth and development must be monitored.

With long-term use, the patient should follow a diet with limited sodium and increased potassium and protein. Long-term use poses a risk of fungal infection. The dose is reduced gradually, since sudden cessation of treatment causes adrenal insufficiency.

Application

The dose of the drug is selected individually, depending on the severity of the disease and the response to the therapy. During treatment, it may be necessary to adjust the dose depending on the course of the disease or in a stressful situation - during surgery, trauma or an infectious disease.

Recommended doses for adults:

Usually 0.1–0.3 mg/day is used (1–3 tablets per day).

The tablets should be taken in the morning after meals with a glass of liquid. If you miss a dose, take the drug as quickly as possible or, if the time for your next dose is approaching, do not take the missed dose. Do not take two doses at the same time.

Interaction

When used with cardiac glycosides, their toxicity increases and the risk of hypokalemia and arrhythmias increases. Use with NSAIDs gastrointestinal ulcers .

Barbiturates, rifampicin , phenytoin , carbamazepine and antihistamines weaken the effect of Cortineff.

Hypokalemia and left ventricular hypertrophy are caused by concomitantly administered amphotericin B and carbonic anhydrase .

When used with androgens and anabolic steroids, the risk of edema and acne increases.

Estrogens slow down metabolism and enhance the effect of the active substance. Anticoagulants, urokinase and streptokinase , on the contrary, reduce effectiveness. Accelerates the metabolism of the drug ephedrine .

Tricyclic antidepressants increase mental disorders.

Cortineff weakens the effect of insulin , hypoglycemic drugs and potassium-sparing diuretics.

When used with muscle relaxants, the duration of neuromuscular blockade increases.

Increased edema and hypertension are observed when eating foods with large amounts of sodium.

When used with vaccines, there is a risk of neurological complications.

Drug interactions Cortineff

patients with hypoprothrombinemia should be prescribed fludrocortisone with caution in combination with acetylsalicylic acid. With simultaneous use of Cortineff with digitalis glycosides, the risk of developing cardiac arrhythmias and glycoside toxicity increases; with barbiturates, antiepileptic drugs (phenytoin, carbamazepine), rifampicin, glutethimide, antihistamines, the potency of fludrocortisone is weakened; with amphotericin B, carbonic anhydrase inhibitors - hypokalemia, myocardial hypertrophy, congestive circulatory failure; with anabolic steroids, androgens - the risk of developing edema and rash increases; with estrogens - metabolism slows down and the effect of fludrocortisone increases; with antithrombotic agents (coumarin and indadione derivatives, heparin, streptokinase, urokinase) - it decreases, and in some people the effectiveness of fludrocortisone increases; with tricyclic antidepressants - the development of mental disorders is possible; with immunosuppressants - increased risk of developing infections, lymphangiomas and lymphoproliferative diseases; with oral hypoglycemic drugs, insulin - weakening of the antidiabetic effect; with diuretics - decreased diuretic effect, hypokalemia; with laxatives - weakening of the effect, hypokalemia; with NSAIDs - decreased effectiveness, increased risk of ulcerogenic effects and gastrointestinal bleeding; with sodium salts - peripheral edema, increased blood pressure (it may be necessary to limit sodium in the diet); In some patients, the use of GCS sometimes requires additional sodium intake.

Reviews of Cortineffe

For adrenal insufficiency, hydrocortisone is prescribed , and with a slight decrease in mineralocorticoid function, taking one drug is sufficient. a corticosteroid with more pronounced mineralocorticoid activity is added to the treatment This combination ideally compensates for the lack of hormones and is used constantly. Minimum doses are prescribed that ensure satisfactory well-being, performance, and the required level of electrolytes and blood pressure . The adequacy of treatment is assessed by these parameters, as well as by ECG . Patients with adrenal dysfunction who receive adequate therapy live full lives. Severe course is observed only in untreated patients.

There are many reviews from patients with congenital dysfunction of the adrenal cortex or parents of children suffering from this pathology. Everyone reports that they take this drug together with Cortineff constantly, 2 times a day. Sometimes there are difficult situations when the drug is not available in the pharmacy chain. For such patients it is vital.

• “... Addison's disease, I take Cortineff and dexamethasone. When there were interruptions in the supply of this drug, they switched to prednisolone. I immediately realized that he was not a good fit: he had convulsions, his blood pressure dropped, and he gained weight.”
• “... The child has adrenogenital syndrome, a salt-wasting form. Lifelong replacement therapy is required. How difficult it is when Cortineff disappears from pharmacies. In order not to bring the child to a crisis, I look everywhere—friends bring them from Poland or I order from online pharmacies.”

Cortineffa price, where to buy

You can buy Cortineff in pharmacies in regional cities. The cost of 20 tablets ranges from 107-119 rubles.

• Online pharmacies in RussiaRussia
• Online pharmacies in UkraineUkraine

Pharmacy Dialogue

• Cortineff (0.1 mg tablet No. 20)Polfa
  RUB 114.order

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Pharmacy24

• Cortineff 0.1 mg N20 tablets Pub Yanitsky FZ, Polfa A.T., Poland
  131 UAH.order

Note!

Description of the drug Cortineff table. 0.1 mg No. 20 on this page is a simplified author’s version of the apteka911 website, created on the basis of the instructions for use.
Before purchasing or using the drug, you should consult your doctor and read the manufacturer's original instructions (attached to each package of the drug). Information about the drug is provided for informational purposes only and should not be used as a guide to self-medication. Only a doctor can decide to prescribe the drug, as well as determine the dose and methods of its use.