Cortzee

Cortzee Uses, Dosage, Side Effects, Food Interaction and all others data.

Cortzee is a naturally occurring corticosteroid, which causes profound and varied metabolic effects. In addition, they modify body’s immune response to diverse stimuli. Cortzee sodium succinate has the same metabolic and anti-inflammatory actions as hydrocortisone.

Cortzee binds to the glucocorticoid receptor leading to downstream effects such as inhibition of phospholipase A2, NF-kappa B, other inflammatory transcription factors, and the promotion of anti-inflammatory genes.[A187463] Cortzee has a wide therapeutic index and a moderate duration of action. Patients should stop taking the medication if irritation or sensitization occurs.

Trade Name Cortzee
Availability Prescription only
Generic Hydrocortisone
Hydrocortisone Other Names 11beta-hydrocortisone, 17-Hydroxycorticosterone, Cortisol, Hidrocortisona, Hydrocortisone, Hydrocortisonum, Kendall's compound F, Reichstein's substance M
Related Drugs Entyvio, Humira, Zeposia, Colazal, prednisone, albuterol, dexamethasone, methylprednisolone, triamcinolone, prednisolone
Type Injection
Formula C21H30O5
Weight Average: 362.4599
Monoisotopic: 362.20932407
Protein binding

Corticosteroids are generally bound to corticosteroid binding globulin[A187439] and serum albumin[A187436] in plasma. Hydrocortisone is 90.1% bound to proteins in plasma, with 56.2% bound to albumin.

Groups Approved, Vet approved
Therapeutic Class Glucocorticoids
Manufacturer Zee Laboratories Ltd
Available Country India
Last Updated: September 19, 2023 at 7:00 am
Cortzee
Cortzee

Uses

Cortzee is used for the use in the following conditions: Primary or secondary adrenocortical insufficiency, Acute adrenocortical insufficiency, Shock unresponsive to conventional therapy, Congenital adrenal hyperplasia, Hypercalcemia associated with cancer, Nonsuppurative thyroiditis, Rheumatic Disorders, Dermatologic Diseases (Allergic States, Severe seborrheic dermatitis, Severe psoriasis, Pemphigus, Severe erythema multiforme), Control of severe or incapacitating allergic conditions (Bronchial asthma, Contact dermatitis, Atopic dermatitis, Serum sickness, Seasonal or perennial allergic rhinitis, Drug hypersensitivity reactions, Urticarial transfusion reactions, Acute noninfectious laryngeal edema), Ophthalmic Diseases (Herpes zoster ophthalmicus, Iritis, iridocyclitis, Chorioretinitis, Diffuse posterior uveitis and choroiditis, Optic neuritis), Gastrointestinal Diseases, Fulminating or disseminated pulmonary tuberculosis when used concurrently with appropriate antituberculous chemotherapy, Loeffler's syndrome, Aspiration pneumonitis, Hematologic Disorders (Acquired, autoimmune hemolytic anemia, Idiopathic thrombocytopenic purpura in adults, Secondary thrombocytopenia, Erythroblastopenia), Neoplastic Diseases (Leukemias and lymphomas in adults, Acute leukemia of childhood), Edematous States, Acute exacerbations of multiple sclerosis

Cortzee is also used to associated treatment for these conditions: Acute Gouty Arthritis, Acute Otitis Externa, Adrenal Insufficiency, Allergic Rhinitis (AR), Allergic corneal marginal ulcers, Anal Fissures, Ankylosing Spondylitis (AS), Anterior Segment Inflammation, Aspiration Pneumonitis, Asthma, Atopic Dermatitis (AD), Berylliosis, Bullous dermatitis herpetiformis, Chorioretinitis, Choroiditis, Congenital Adrenal Hyperplasia (CAH), Congenital Hypoplastic Anemia, Corneal Inflammation, Crohn's Disease (CD), Dermatitis, Dermatitis exfoliative generalised, Dermatitis, Contact, Dermatomyositis, Dermatosis, Drug hypersensitivity reaction, Epicondylitis, Erythroblastopenia, Hemorrhoids, Herpes Labialis, Hypercalcemia of Malignancy, Idiopathic Thrombocytopenic Purpura, Infection of the Fenestration Cavity, Infection of the Mastoidectomy Cavity, Iridocyclitis, Iritis, Itching caused by Hemorrhoids, Itching of the Anus, Leukemia, Acute, Leukemias, Loeffler's syndrome, Lymphomas NEC, Malignant Lymphomas, Mycosis Fungoides (MF), Ophthalmia, Sympathetic, Optic Neuritis, Pain caused by Hemorrhoids, Pemphigus, Post-traumatic Osteoarthritis, Primary adrenocortical insufficiency, Proctitis, Proteinuria, Psoriatic Arthritis, Rectal inflammations NEC, Rheumatic heart disease, unspecified, Rheumatoid Arthritis, Rheumatoid Arthritis, Juvenile, Seasonal Allergic Conjunctivitis, Secondary adrenocortical insufficiency, Secondary thrombocytopenia, Serum Sickness, Severe Seborrheic Dermatitis, Skin Diseases, Stevens-Johnson Syndrome, Synovitis, Systemic Lupus Erythematosus (SLE), Trichinosis, Tuberculous Meningitis, Ulcerative Colitis, Acquired immune hemolytic anemia, Acute Bursitis, Acute Tenosynovitis, Acute rheumatic carditis, Cryptitis, Disseminated Pulmonary Tuberculosis, Fulminating Pulmonary Tuberculosis, Itching skin, Non-suppurative Thyroiditis, Severe Erythema multiforme, Severe Psoriasis, Subacute Bursitis, Superficial infection of the external auditory canal with inflammation, Symptomatic Sarcoidosis, Systemic Dermatomyositis, Varicella-zoster virus acute retinal necrosis, Palliative

How Cortzee works

The short term effects of corticosteroids are decreased vasodilation and permeability of capillaries, as well as decreased leukocyte migration to sites of inflammation.[A187463] Corticosteroids binding to the glucocorticoid receptor mediates changes in gene expression that lead to multiple downstream effects over hours to days.[A187463]

Glucocorticoids inhibit neutrophil apoptosis and demargination; they inhibit phospholipase A2, which decreases the formation of arachidonic acid derivatives; they inhibit NF-Kappa B and other inflammatory transcription factors; they promote anti-inflammatory genes like interleukin-10.[A187463]

Lower doses of corticosteroids provide an anti-inflammatory effect, while higher doses are immunosuppressive.[A187463] High doses of glucocorticoids for an extended period bind to the mineralocorticoid receptor, raising sodium levels and decreasing potassium levels.[A187463]

Dosage

Cortzee dosage

Tablet: The initial dosage of Cortzee Tablets may vary from 20 mg to 240 mg of hydrocortisone per day depending on the specific disease entity being treated. In situations of less severity, lower doses will generally suffice, while in selected patients higher initial doses may be required. The initial dosage should be maintained or adjusted until a satisfactory response is noted. If after a reasonable period of time there is a lack of satisfactory clinical response, Cortzee Tablets should be discontinued and the patient transferred to other appropriate therapy. 

It should be emphasized that dosage requirements are variable and must be individualized on the basis of the disease under treatment and the response of the patients. After a favorable response is noted, the proper maintenance dosage should be determined by decreasing the initial drug dosage in small decrements at appropriate time intervals until the lowest dosage which will maintain an adequate clinical response. It should be kept in mind that constant monitoring is needed in regard to drug dosage. If, after long-term therapy the drug is to be stopped, it is recommended that it be withdrawn gradually, rather than abruptly.

Injection

  • Adult: By IM injection or slow IV injection or infusion. The initial dose of Cortzee sterile powder is 100 mg to 500 mg, depending on the severity of the condition. This dose may be repeated at intervals of 2, 4 or 6 hours as indicated by the patient's response and clinical condition.
  • Children: By slow IV injection, up to 1 year 25 mg, 1-5 years 50 mg, 6-12 years 100 mg.

Side Effects

Cortzee is generally well tolerated except in prolonged high doses. It may cause cardiac arrhythmia, esophageal candidiasis, menstrual irregularity, decreased carbohydrate & glucose tolerance, fluid retention, increased appetite, weight gain, euphoria, mood swings, depression, insomnia, acne etc.

Toxicity

Data regarding acute overdoses of glucocorticoids are rare. Chronic high doses of glucocorticoids can lead to the development of cataract, glaucoma, hypertension, water retention, hyperlipidemia, peptic ulcer, pancreatitis, myopathy, osteoporosis, mood changes, psychosis, dermal atrophy, allergy, acne, hypertrichosis, immune suppression, decreased resistance to infection, moon face, hyperglycemia, hypocalcemia, hypophosphatemia, metabolic acidosis, growth suppression, and secondary adrenal insufficiency. Overdose may be treated by adjusting the dose or stopping the corticosteroid as well as initiating symptomatic and supportive treatment.

Precaution

Cortzee should be used with caution in patients with a history of peptic ulceration as it increases the incidence of peptic ulceration. This drug should be used with caution in patients with congestive heart failure, hypertension, glaucoma, diabetic mellitus and epilepsy.

Interaction

Drug interaction of hydrocortisone has been reported with amphotericin B, potassium-depleting agents, macrolide antibiotics, warfarin, antidiabetics, isoniazid, digitalis glycosides, estrogens, barbiturates, phenytoin, carbamazepine, ketoconazole, aspirin etc.

Food Interaction

  • Avoid alcohol.

Cortzee Cholesterol interaction

[Moderate] Corticosteroids may elevate serum triglyceride and LDL cholesterol levels if used for longer than brief periods.

Patients with preexisting hyperlipidemia may require closer monitoring during prolonged corticosteroid therapy, and adjustments made accordingly in their lipid-lowering regimen.

Cortzee Hypertension interaction

[Moderate] Corticosteroids may cause hypernatremia, hypokalemia, fluid retention, and elevation in blood pressure.

These mineralocorticoid effects are most significant with fludrocortisone, followed by hydrocortisone and cortisone, then by prednisone and prednisolone.

The remaining corticosteroids, betamethasone, dexamethasone, methylprednisolone, and triamcinolone, have little mineralocorticoid activities.

However, large doses of any corticosteroid can demonstrate these effects, particularly if given for longer than brief periods.

Therapy with corticosteroids should be administered cautiously in patients with preexisting fluid retention, hypertension, congestive heart failure, and

Dietary sodium restriction and potassium supplementation may be advisable.

Volume of Distribution

Total hydrocortisone has a volume of distribution of 39.82L, while the free fraction has a volume of distribution of 474.38L.

Elimination Route

Oral hydrocortisone at a dose of 0.2-0.3mg/kg/day reached a mean Cmax of 32.69nmol/L with a mean AUC of 90.63h*nmol/L A 0.4-0.6mg/kg/day dose reached a mean Cmax of 70.81nmol/L with a mean AUC of 199.11h*nmol/L. However, the pharmacokinetics of hydrocortisone can vary by 10 times from patient to patient.

Topical hydrocortisone cream is 4-19% bioavailable[8546995] with a Tmax of 24h.

Cortzee retention enemas are have a bioavailability of 0.810 for slow absorbers and 0.502 in rapid absorbers. Slow absorbers take up hydrocortisone at a rate of 0.361±0.255/h while fast absorbers take up hydrocortisone at a rate of 1.05±0.255/h.

A 20mg IV dose of hydrocortisone has an AUC of 1163±277ng*h/mL.

Half Life

Total hydrocortisone via the oral route has a half life of 2.15h while the free fraction has a half life of 1.39h. A 20mg IV dose of hydrocortisone has a terminal half life of 1.9±0.4h.

Clearance

Total hydrocortisone by the oral route has a mean clearance of 12.85L/h, while the free fraction has a mean clearance of 235.78L/h. A 20mg IV dose of hydrocortisone has a clearance of 18.2±4.2L/h.

Elimination Route

Corticosteroids are eliminated predominantly in the urine.[A187436] However, data regarding the exact proportion is not readily available.

Pregnancy & Breastfeeding use

Pregnancy category C. Corticosteroids should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Use in nursing mother: Systemically administered corticosteroids appear in human milk and could suppress growth, interfere with endogenous corticosteroid production, or cause other untoward effects. Because of the potential for serious adverse reactions in nursing infants from corticosteroids, a decision should be made whether to continue nursing or discontinue the drug, taking into account the importance of the drug to the mother.

Contraindication

Cortzee is contraindicated in severe systemic fungal infections and patients with known hypersensitivity to any component of this product.

Special Warning

Use in elderly patients: Clinical studies were not done in patients’ aged 65 and above. In general dose selection for an elderly patients should be cautious, usually starting at the low end of the dosing range.

Storage Condition

Store at 15-30°C.

Innovators Monograph

You find simplified version here Cortzee

Cortzee contains Hydrocortisone see full prescribing information from innovator Cortzee Monograph, Cortzee MSDS, Cortzee FDA label

FAQ

What is Cortzee used for?

Cortzee topical is used to treat redness, swelling, itching, and discomfort of various skin conditions.It can also be used as hormone replacement for people who do not have enough of the natural stress hormone, cortisol. Uses include conditions such as adrenocortical insufficiency, adrenogenital syndrome, high blood calcium, thyroiditis, rheumatoid arthritis, dermatitis, asthma, and COPD. It is the treatment of choice for adrenocortical insufficiency.

How safe is Cortzee?

Mild Cortzee treatments are very safe. Most people do not have any side effects when they use them for less than 4 weeks. Some people get a burning or stinging feeling for a few minutes when they put the Cortzee on their skin. This stops happening after you've been using it for a few days.

How does Cortzee work?

Cortzee works by calming down your body's immune response to reduce pain, itching and swelling (inflammation).

What are the common side effects of Cortzee?

The most common side effects of Cortzee tablets are feeling dizzy, headaches, swollen ankles and feeling weak or tired. Taking hydrocortisone tablets can affect your immune system so you're more likely to get infections.

Is Cortzee safe during pregnancy?

Cortzee should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Topical corticosteroids should not be used extensively on pregnant patients, in large amounts or for extended periods of time.

Is Cortzee safe during breastfeeding?

Cortzee creams that you buy from a pharmacy can be used while you're breastfeeding. As a precaution, if you're breastfeeding, wash off any cream you put on your breasts before feeding your baby. Cortzee butyrate is not normally recommended for breastfeeding women.

Can I drink alcohol with Cortzee?

Yes, you can drink alcohol while taking Cortzee tablets. However, if Cortzee tablets make you feel dizzy, it's a good idea not to drink alcohol as it will make you feel worse.

When is the best time to take Cortzee?

Take the tablets just after eating a meal, or alternatively with a snack. It is usual to take one dose a day, 30 minutes before your breakfast.

How long does Cortzee take to work?

Your skin should start to get better after using Cortzee for a few days. If you're using a treatment you've bought from a pharmacy or shop, speak to your doctor if you still have symptoms after 1 week, or if your skin gets worse at any time.

Does Cortzee work instantly?

Cortzee shots start to work very quickly.

Can I take Cortzee for a long time?

For long-term skin problems such as eczema and psoriasis you may need to use Cortzee for longer. To reduce the risk of side effects your doctor may recommend that you only use Cortzee for a few weeks at a time. Once your skin is better, use moisturisers to keep it from becoming inflamed again.

Does Cortzee weaken the immune system?

Cortzee can weaken your body's response to infection because the drug weakens your immune system. Using this medication may also make it harder for you to know that you have an infection.

What happens when I stop taking Cortzee?

Do not stop taking Cortzee without talking to your doctor. Stopping Cortzee abruptly can cause loss of appetite, an upset stomach, vomiting, drowsiness, confusion, headache, fever, joint and muscle pain, peeling skin, and weight loss.

Can Cortzee make my gain weight?

Most doctors will say that the low doses of Cortzee given for cortisol replacement do not cause weight gain or increase in appetite.

Does Cortzee make me tired?

The most common side effects of Cortzee tablets are feeling dizzy, headaches, swollen ankles and feeling weak or tired.

What happen if I take too much Cortzee?

An overdose of Cortzee is not expected to produce life threatening symptoms. Long term use of high doses can lead to thinning skin, easy bruising, changes in body fat, increased acne or facial hair, menstrual problems, impotence, or loss of interest in sex.

What happen If I missed dose of Cortzee?

If you forget to take a dose, take it as soon as you remember. If you do not remember until the next dose is due, skip the missed dose. Never take 2 doses to make up for a forgotten one.

Does Cortzee make me sleepy?

Cortzee oral tablet doesn't cause drowsiness, but it can cause other side effects.

Does Cortzee help acne?

People often use Cortzee for any skin condition that causes redness and swelling, such as allergies, illness, injury, or acne. Topical Cortzee is not an official acne medication. It doesn't kill the bacteria that causes acne and it won't prevent breakouts.

Does Cortzee cause anxiety?

This study found that acute Cortzee increased anxiety without affecting fear.

Who should not take Cortzee?

You should not use Cortzee if you have a fungal infection anywhere in your body.
Tell your doctor about any illness or infection you have had within the past several weeks.

Does Cortzee clear eczema?

Cortzee  cream is one of the most common eczema treatments. It can help reduce the itching and swelling of eczema flare-ups.

*** Taking medicines without doctor's advice can cause long-term problems.
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