Derisone 1% Cream

Corticosteroid used as:

• Injection (sodium succinate): emergencies — anaphylaxis, severe asthma attack, adrenal crisis, shock; acute adrenal insufficiency
• Tablets: replacement therapy in adrenal insufficiency (Addison's disease, congenital adrenal hyperplasia, after pituitary/adrenal surgery)
• Cream/ointment 1% (mild steroid): eczema, dermatitis, insect bites, nappy rash with inflammation; 0.1% butyrate (moderately potent)
• Rectal foam/suppository: proctitis, ulcerative colitis, haemorrhoids (with other agents)

Emergency injection (adults): 100–200 mg IV/IM (anaphylaxis/asthma); adrenal crisis 100 mg IV then 200 mg/24 h. Children: under 6 months 25 mg, 6 months–5 years 50 mg, 6–11 years 100 mg (emergency doses).

Adrenal replacement (adults): usually 15–25 mg daily in 2–3 divided doses (largest dose on waking, e.g. 10 mg + 5 mg + 5 mg); double the dose during fever or illness (sick-day rules).

Cream 1%: apply thinly 1–2 times daily; usually up to 1–2 weeks on the face/children.

• Systemic infections untreated (for high doses, except emergencies)
• Skin: untreated bacterial, viral (herpes, chickenpox) or fungal skin infections, acne, rosacea, perioral dermatitis
• Live vaccines during high-dose systemic use

Topical (mild): rarely irritation; skin thinning only with prolonged use on the face or under occlusion.

Systemic high doses or long-term: raised blood sugar and blood pressure, mood changes, insomnia, fluid retention, weight gain, osteoporosis, infections, peptic ulcer, adrenal suppression, cataract.

Replacement doses: usually well tolerated if correct; over-replacement causes Cushingoid effects, under-replacement causes tiredness, dizziness, adrenal crisis.

• Adrenal insufficiency: never stop suddenly; carry a steroid emergency card and injection kit; increase dose during illness, vomiting or surgery.
• Diabetes, hypertension, TB, peptic ulcer, psychiatric illness: caution with high doses.
• Avoid long use of creams on the face or in infants.

Replacement therapy must continue in pregnancy (dose may be adjusted late in pregnancy). Topical use on small areas is safe. Compatible with breastfeeding.

• Rifampicin, carbamazepine, phenytoin, phenobarbital (lower levels — replacement dose may need increasing)
• Ritonavir, ketoconazole, itraconazole, clarithromycin (raise levels)
• NSAIDs (ulcers); diuretics (low potassium); diabetes medicines (higher sugar); warfarin (INR changes)

Single overdose rarely dangerous. Long-term excess: Cushing's features.

Store below 25–30°C. Injection: use promptly after reconstitution.