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Medicines > classes : Dissociative or Research material or [[:Category:Glucocorticoids|Glucocorticoid]]

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generic:
brand:
None (137) · (none, never marketed) (1) · DXM (1) · DXO (1) · Flonase (intranasal, OTC); Flovent (inhaled, asthma); Cutivate (topical) (1) · Nasonex (intranasal), Asmanex (inhaled), Elocon (topical), Sinuva (sinus implant); with formoterol as Dulera (1) · O-DSMT (1) · Pulmicort (inhaled), Rhinocort (intranasal), Entocort EC and Uceris (enteric-coated oral for IBD), Symbicort (with formoterol) (1) · Spravato (1) · Temovate, Clobex, Cormax, Olux, Olux-E, Impoyz (1)
classes: (Click arrow to add another value)
mechanism:
5-HT2A agonist (26) · Monoamine releasing agent (9) · GABAA positive allosteric modulator (8) · CB1/CB2 agonist (7) · None (5) · Dopamine/norepinephrine reuptake inhibitor (5) · Potent 5-HT2A agonist (5) · LSD analogue; 5-HT2A agonist (4) · Prodrug of LSD; 5-HT2A agonist (4) · NMDA antagonist (3) · Serotonin/norepinephrine/dopamine releasing agent (3) · Cathinone analogue; monoamine reuptake inhibitor (2) · Dopamine and norepinephrine reuptake inhibitor (2) · NMDA antagonist; sigma receptor agonist (2) · Prodrug of GHB (2)
uses:
None (140) · No approved medical problem. Encountered as a designer/research benzodiazepine and, increasingly, as an adulterant in illicit opioid supplies. (1) · Treatment-resistant depression (TRD) in adults, as adjunct to oral antidepressant (FDA-approved March 2019). Depressive symptoms in adults with MDD with acute suicidal ideation or behavior (FDA-approved Aug 2020). (1) · '"`UNIQ--vote-000001D9-QINU`"', '"`UNIQ--vote-000001DA-QINU`"', '"`UNIQ--vote-000001DB-QINU`"', '"`UNIQ--vote-000001DC-QINU`"' (1) · '"`UNIQ--vote-0000079C-QINU`"', '"`UNIQ--vote-0000079D-QINU`"' (1) · '"`UNIQ--vote-0000099F-QINU`"', '"`UNIQ--vote-000009A0-QINU`"', '"`UNIQ--vote-000009A1-QINU`"', '"`UNIQ--vote-000009A2-QINU`"', '"`UNIQ--vote-000009A3-QINU`"', '"`UNIQ--vote-000009A4-QINU`"' (1) · '"`UNIQ--vote-00000F98-QINU`"', '"`UNIQ--vote-00000F99-QINU`"', '"`UNIQ--vote-00000F9A-QINU`"', '"`UNIQ--vote-00000F9B-QINU`"' (1)
starting dose:
None (140) · Apply a thin film to affected area BID; '''limit to 2 weeks''' continuous use and ≤50 g/week (cream/ointment); ≤50 mL/week (foam/solution); avoid face, intertriginous areas (1) · ICS Pulmicort Flexhaler 180-360 mcg BID; intranasal Rhinocort 64 mcg/spray, 1-2 sprays/nostril daily; Entocort EC 9 mg PO daily for active Crohn's; Symbicort 80/4.5 or 160/4.5 mcg, 2 puffs BID (1) · Induction (TRD): 56 mg intranasal twice weekly × 4 weeks. Maintenance: 56-84 mg once weekly × 4 weeks, then 56-84 mg every 1-2 weeks. For acute suicidality: 84 mg twice weekly × 4 weeks. Administered under medical supervision in REMS-certified site. (1) · Inhaled (Flovent HFA) 88 mcg BID; intranasal (Flonase) 2 sprays/nostril daily; topical (Cutivate) 0.05% cream BID (1) · Intranasal Nasonex 2 sprays/nostril daily (50 mcg/spray); inhaled Asmanex 220 mcg DPI 1-2 inhalations daily/BID; topical Elocon 0.1% cream daily (1) · No medical dose. Active recreational doses reported in the 0.5–1.5 mg range (similar potency to alprazolam). (1)
preparations:
None (140) · 28 mg/device (each dose uses 2 devices) (1) · Cream, ointment, lotion, foam, solution, shampoo, spray at 0.025-0.05%; emollient and non-emollient bases (1) · Illicit tablets ("bars"), powders, blotter, occasionally solutions. No pharmaceutical product exists. (1) · Inhaled MDI 44/110/220 mcg per actuation; DPI (Diskus) 50/100/250 mcg; nasal spray 50 mcg/actuation; cream/ointment 0.005%, 0.05% (1) · Nasonex 50 mcg/actuation intranasal; Asmanex HFA MDI 100/200 mcg; Asmanex Twisthaler DPI 110/220 mcg; Elocon 0.1% cream/ointment/lotion; Sinuva sinus implant; Dulera (with formoterol) (1) · Pulmicort Flexhaler DPI 90, 180 mcg/dose; Pulmicort Respules 0.25, 0.5, 1 mg/2 mL nebulized; Rhinocort intranasal 32 mcg/spray; Entocort EC 3 mg capsules; Uceris 9 mg ER tablets and rectal foam (1)
fda max:
None (140) · 50 g/week (cream/ointment); 2-week continuous limit; 4-week maximum cumulative (1) · 84 mg per session (1) · ICS 880 mcg/d (asthma); intranasal 200 mcg/d (1) · ICS ~1280 mcg/d; intranasal 256 mcg/d; Entocort 9 mg/d standard (1) · Intranasal 200 mcg/d (adults); inhaled 880 mcg/d (1) · N/A (never approved) (1)
routes:
None (140) · Inhaled (3) · Intranasal (3) · Intranasal (under direct medical supervision) (1) · intranasal sinus implant (1) · intranasal; rectal and IV reported. (1) · nebulized (1) · Oral (1) · oral (enteric-coated (1) · rectal foam) (1) · sublingual (1) · topical (3)
onset:
None (140) · Hours to days for inflammation; substantial improvement within 1 week (1) · Inhaled: bronchial effect 1-2 weeks; nasal: symptom relief 12-24 hours; topical: hours (1) · Inhaled: bronchial effect 1-2 weeks; oral GI effect 1-2 weeks (1) · Intranasal: symptom relief 12-24 hours; inhaled: bronchial effect 1-2 weeks (1) · Within hours of first administration (1) · ~20–40 min PO; faster sublingual/intranasal. (1)
duration:
None (140) · 12-24 hours (1) · 12-24 hours per dose (1) · 24 hours (1) · 6–10 h subjective; full pharmacologic effect considerably longer. (1) · Acute effect ~24 hours; cumulative effect builds with repeated dosing (1) · Hours to days per application (1)
halflife:
None (140) · Estimated ~12–17 h (some sources cite up to ~21 h); active metabolites prolong effect. (1) · Not meaningfully described for topical use (systemic exposure varies with surface area, occlusion, skin integrity)'"`UNIQ--ref-0000079E-QINU`"' (1) · ~2-3.6 hours (plasma)'"`UNIQ--ref-000009A5-QINU`"' (1) · ~5 hours (plasma)'"`UNIQ--ref-00000F9C-QINU`"' (1) · ~7-12 hours (1) · ~7.8 hours (fluticasone propionate, inhaled systemic exposure)'"`UNIQ--ref-000001DD-QINU`"' (1)
bioavailability:
None (140) · <1% oral (extensive first-pass via CYP3A4); ~30% inhaled lung deposition'"`UNIQ--ref-000001DE-QINU`"' (1) · Intranasal: <1% systemic; inhaled lung deposition with extensive first-pass clearance'"`UNIQ--ref-00000F9D-QINU`"' (1) · Not formally characterized in humans. (1) · Topical with variable systemic absorption depending on body site, occlusion, and skin integrity; HPA-axis suppression is documented even with brief courses to large areas'"`UNIQ--ref-0000079F-QINU`"' (1) · ~48% intranasal (1) · ~6-13% inhaled lung deposition; ~10% oral (Entocort EC; extensive first-pass via CYP3A4 — this is the basis of the favorable hepatic-targeted local-effect profile in IBD)'"`UNIQ--ref-000009A6-QINU`"' (1)
pregnancy:
None (140) · Avoid. Benzodiazepines are associated with neonatal sedation, floppy-infant syndrome, and withdrawal; teratogenic signal weak but non-zero. Designer benzo with no safety data, assume worst-case. (1) · Avoid; may cause fetal harm (1) · Inhaled and intranasal generally considered safe; widely used in asthma in pregnancy.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Intranasal long considered acceptable; widely used in obstetric rhinitis.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Long the preferred ICS in pregnancy (Pulmicort) due to the most pregnancy data among the class.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Topical corticosteroids in pregnancy: use lowest potency and smallest area; super-potent agents like clobetasol are reserved for compelling indications.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1)
legal:
None (141) · OTC (intranasal Flonase) and [[USLegal:Prescription only|Rx-only]] (inhaled, topical) in US (1) · OTC (intranasal Rhinocort Allergy) and [[USLegal:Prescription only|Rx-only]] (other forms) in US (1) · OTC (Nasonex 24HR) and [[USLegal:Prescription only|Rx-only]] (other forms) in US (1) · Rx, Schedule III (US). REMS program required. (1) · [[USLegal:Prescription only|Rx-only]] in US (1)

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