17-ketosteroids and Substance-Related-Disorders

Beclomethasone dipropionate is a topically active corticosteroid used as an adjuvant in the control of chronic asthma when given by inhalation as an aerosol. It is not intended for treatment of acute attacks. It appears that the main difference between beclomethasone dipropionate and other corticosteroids previously used by inhalation is its high topical activity together with a lower systemic activity due to metabolic inactivation of the swallowed portion of the dose. Clinical experience has shown that at doses of 200 to 600mug daily, beclomethasone dipropionate inhaler is preferable to oral corticosteroids, because of lack of side-effects, when adult patients and children who are inadequately controlled by full doses of sodium cromoglycate and bronchodilators, are first considered to need maintenance corticosteroids. Inhaled beclomethasone dipropionate can allow a worthwhile reduction in maintenance doses of systemic corticosteroids in many patients already receiving these drugs and can replace systemic steroids entirely in some patients, particularly when their initial dose of steroids is less than 10mg daily of prednisone or its equivalent. Substitution should be attempted when the patient's asthma is well controlled on their usual doses of systemic steroids and full doses of other adjuvant therapy. Withdrawal of systemic corticosteroids should be performed slowly and carefully. Because recovery from impaired adrenocortical function caused by prolonged systemic steroid therapy is usually slow, special care is necessary for 9 to 12 months after transfer to beclomethasone dipropionate aerosol until the hypothalamo-pituitary-adrenal axis has sufficiently recovered to cope with emergencies such as trauma, surgery, severe infections or an acute attack of asthma. It is essential that additional therapy including high doses of systemic corticosteroids be used immediately to control any acute exacerbation of asthma which occurs during maintenance therapy with beclomethasone dipropionate aerosol. Tests of adrenal function suggest that beclomethasone dipropionate at dosages of 400 to 800 mug daily has little or no adverse effect. The most common side-effect associated with the continuous use of beclomethasone dipropionate inhaler has been oropharyngeal candidiasis, which appears to be dose-related and more common in women than in men. Systemic steroid withdrawal effects, like being generally unwell, and exacerbation of underlying allergic diseases such as aller

Topics: 17-Ketosteroids; Administration, Oral; Adrenal Cortex Hormones; Adrenocorticotropic Hormone; Adult; Aerosols; Asthma; Beclomethasone; Child; Clinical Trials as Topic; Drug Evaluation; Forced Expiratory Volume; Half-Life; Humans; Hydrocortisone; Kinetics; Methylprednisolone; Middle Aged; Substance-Related Disorders

Topics: 17-Ketosteroids; Administration, Topical; Adult; Aerosols; Aged; Anti-Inflammatory Agents; Asthma; Beclomethasone; Blood Pressure; Body Weight; Clinical Trials as Topic; Female; Humans; Hydrocortisone; Hydroxysteroids; Lung; Male; Middle Aged; Spirometry; Steroids; Substance-Related Disorders

15 adult chronic asthmatic patients who were on daily maintenance dose of oral steroid for at least 6 months were studied. Following an investigation period of 2 weeks, the patients were started on BDA, 100 microgram four times daily. The daily oral steroid dose, which averaged 12 mg of prednisone or its equivalent, was gradually reduced by about 1 mg per day. The trial lasted 8 weeks, at the end of which, ten patients were as good or better on BDA than on oral steroids. Two patients had to return to oral corticosteroid therapy before the trial ended and three patients were unable to discontinue their oral steroid treatment. The lack of systemic effects of BDA was demonstrated by the appearance of symptoms which were apparently previously suppressed by the oral steroids and the excretion of normal amounts of 17-OHCS in the urine in some to the patients who had evidence of adrenal suppression while on oral steroids.

Topics: 17-Ketosteroids; Adrenal Cortex Hormones; Aerosols; Asthma; Beclomethasone; Chronic Disease; Humans; Respiratory Function Tests; Substance-Related Disorders

Topics: 17-Ketosteroids; Acetaldehyde; Adrenal Glands; Adult; Aged; Alcoholism; Blood Proteins; Ethanol; Female; Humans; Iodine; Male; Middle Aged; Protein Binding; Substance-Related Disorders; Thyroid Gland; Time Factors

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adolescent; Adrenocorticotropic Hormone; Adult; Age Factors; Birth Weight; Dexamethasone; Estriol; Female; Heroin; Humans; Infant, Newborn; Methadone; Metyrapone; Parity; Pregnancy; Pregnancy Complications; Substance Withdrawal Syndrome; Substance-Related Disorders

Topics: 17-Ketosteroids; Aspirin; Diagnosis, Differential; Hypnotics and Sedatives; Hypopituitarism; Hypothyroidism; Meprobamate; Phenobarbital; Substance-Related Disorders; Thyroid Function Tests; Toxicology