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CORTICOSTEROIDS are a class of steroid hormones that are produced in the adrenal cortex of vertebrates , as well as the synthetic analogues of these hormones. Two main classes of corticosteroids, glucocorticoids and mineralocorticoids , are involved in a wide range of physiologic processes, including stress response , immune response , and regulation of inflammation , carbohydrate metabolism , protein catabolism , blood electrolyte levels, and behavior.

Some common naturally occurring steroid hormones are cortisol (C 21H 30O 5), corticosterone (C 21H 30O 4), cortisone (C 21H 28O 5) and aldosterone (C 21H 28O 5). (Note that aldosterone and cortisone share the same chemical formula but the structures are different.) The main corticosteroids produced by the adrenal cortex are cortisol and aldosterone.

CONTENTS

* 1 Classes * 2 Medical uses

* 3 Pharmacogenetics

* 3.1 Asthma
Asthma

* 4 Adverse effects * 5 Biosynthesis

* 6 Classification

* 6.1 By chemical structure

* 6.1.1 Group A — Hydrocortisone type * 6.1.2 Group B — Acetonides (and related substances) * 6.1.3 Group C — Betamethasone
Betamethasone
type

* 6.1.4 Group D — Esters

* 6.1.4.1 Group D1 — Halogenated (less labile) * 6.1.4.2 Group D2 — Labile prodrug esters

* 6.2 By route of administration

* 6.2.1 Topical steroids * 6.2.2 Inhaled steroids * 6.2.3 Oral forms * 6.2.4 Systemic forms

* 7 History

* 8 Society and culture

* 8.1 Etymology

* 9 See also * 10 References

CLASSES

Cortisol
Cortisol
Corticosterone
Corticosterone
Cortisone Aldosterone
Aldosterone

* GLUCOCORTICOIDS such as cortisol affect carbohydrate, fat, and protein metabolism, and have anti-inflammator y, immunosuppressive , anti-proliferative , and vasoconstrictive effects. Anti-inflammatory effects are mediated by blocking the action of inflammatory mediators (transrepression) and inducing anti-inflammatory mediators (transactivation). Immunosuppressive effects are mediated by suppressing delayed hypersensitivity reactions by direct action on T-lymphocytes . Anti-proliferative effects are mediated by inhibition of DNA synthesis and epidermal cell turnover. Vasoconstrictive effects are mediated by inhibiting the action of inflammatory mediators such as histidine . * MINERALOCORTICOIDS such as aldosterone are primarily involved in the regulation of electrolyte and water balance by modulating ion transport in the epithelial cell s of the renal tubules of the kidney .

MEDICAL USES

Synthetic pharmaceutical drugs with corticosteroid-like effects are used in a variety of conditions, ranging from brain tumors to skin diseases . Dexamethasone
Dexamethasone
and its derivatives are almost pure glucocorticoids, while prednisone and its derivatives have some mineralocorticoid action in addition to the glucocorticoid effect. Fludrocortisone (Florinef) is a synthetic mineralocorticoid. Hydrocortisone (cortisol) is typically used for replacement therapy, e.g. for adrenal insufficiency and congenital adrenal hyperplasia .

Medical conditions treated with systemic corticosteroids:

* Allergy
Allergy
and respirology medicine

* Asthma
Asthma
(severe exacerbations) * Chronic obstructive pulmonary disease
Chronic obstructive pulmonary disease
(COPD) * Allergic rhinitis * Atopic dermatitis * Hives * Angioedema * Anaphylaxis * Food allergies * Drug allergies * Nasal polyps * Hypersensitivity pneumonitis * Sarcoidosis * Eosinophilic pneumonia * Interstitial lung disease

* Dermatology
Dermatology

* Pemphigus vulgaris * Contact dermatitis

* Endocrinology
Endocrinology
(usually at physiologic doses)

* Adrenal insufficiency * Congenital adrenal hyperplasia

* Gastroenterology
Gastroenterology

* Ulcerative colitis * Crohn’s disease * Autoimmune hepatitis

* Hematology

* Lymphoma
Lymphoma
* Leukemia
Leukemia
* Hemolytic anemia * Idiopathic thrombocytopenic purpura * Multiple Myeloma
Multiple Myeloma

* Rheumatology / Immunology
Immunology

* Rheumatoid arthritis
Rheumatoid arthritis
* Systemic lupus erythematosus * Polymyalgia rheumatica
Polymyalgia rheumatica
* Polymyositis * Dermatomyositis
Dermatomyositis
* Polyarteritis * Vasculitis

* Ophthalmology
Ophthalmology

* Uveitis
Uveitis
* Keratoconjunctivitis

* Other conditions

* Multiple sclerosis
Multiple sclerosis
* Organ transplantation
Organ transplantation
* Nephrotic syndrome * Chronic hepatitis (flare ups ) * Cerebral edema * IgG4-related disease * Prostate cancer
Prostate cancer
* Tendinosis

* Lichen planus

Topical formulations are also available for the skin , eyes (uveitis ), lungs (asthma ), nose (rhinitis ), and bowels . Corticosteroids are also used supportively to prevent nausea, often in combination with 5-HT3 antagonists (e.g. ondansetron ).

Typical undesired effects of glucocorticoids present quite uniformly as drug-induced Cushing\'s syndrome . Typical mineralocorticoid side-effects are hypertension (abnormally high blood pressure), hypokalemia (low potassium levels in the blood), hypernatremia (high sodium levels in the blood) without causing peripheral edema , metabolic alkalosis and connective tissue weakness. There may also be impaired wound healing or ulcer formation because of the immunosuppressive effects.

Clinical and experimental evidence indicates that corticosteroids can cause permanent eye damage by inducing central serous retinopathy (CSR, also known as central serous chorioretinopathy, CSC). A variety of steroid medications, from anti-allergy nasal sprays ( Nasonex , Flonase ) to topical skin creams, to eye drops ( Tobradex
Tobradex
), to prednisone have been implicated in the development of CSR.

Corticosteroids have been widely used in treating people with traumatic brain injury . A systematic review identified 20 randomised controlled trials and included 12,303 participants, then compared patients who received corticosteroids with patients who received no treatment. The authors recommended people with traumatic head injury should not be routinely treated with corticosteroids.

PHARMACOGENETICS

ASTHMA

There is some basis for genetic variation in patients' response to inhaled corticosteroids. Two genes of interest are CHRH1 (corticotropin-releasing hormone receptor 1) and TBX21 (transcription factor T-bet). Both genes display some degree of polymorphic variation in humans, which may explain how some patients respond better to inhaled corticosteroid therapy than others.

ADVERSE EFFECTS

Lower arm of a 47-year-old female showing skin damage caused by topical corticosteroid use.

Use of corticosteroids has numerous side-effects, some of which may be severe:

* Neuropsychiatric: steroid psychosis , and anxiety , depression . Therapeutic doses may cause a feeling of artificial well-being ("steroid euphoria"). The neuropsychiatric effects are partly mediated by sensitization of the body to the actions of adrenaline. Therapeutically, the bulk of corticosteroid dose is given in the morning to mimic the body's diurnal rhythm; if given at night, the feeling of being energized will interfere with sleep. An extensive review is provided by Flores and Gumina. * Cardiovascular: Corticosteroids can cause sodium retention through a direct action on the kidney, in a manner analogous to the mineralocorticoid aldosterone . This can result in fluid retention and hypertension . * Metabolic: Corticosteroids cause a movement of body fat to the face and torso, resulting respectively in "moon face " and "buffalo hump". and away from the limbs. Due to the diversion of amino-acids to glucose, they are considered anti-anabolic, and long term therapy can cause muscle wasting * Endocrine: By increasing the production of glucose from amino-acid breakdown and opposing the action of insulin, corticosteroids can cause hyperglycemia , insulin resistance and diabetes mellitus . * Skeletal: Steroid-induced osteoporosis may be a side-effect of long-term corticosteroid use. Use of inhaled corticosteroids among children with asthma may result in decreased height. * Gastro-intestinal: While cases of colitis have been reported, corticosteroids are therapeutically employed when the colitis has an auto-immune nature, e.g. ulcerative colitis and Crohn\'s disease . While the evidence for corticosteroids causing peptic ulceration is relatively poor except for high doses taken for over a month, the majority of doctors as of 2010 still believe this is the case, and would consider protective prophylactic measures. * Eyes: chronic use may predispose to cataract and retinopathy . * Vulnerability to infection: By suppressing immune reactions (which is one of the main reasons for their use in allergies), steroids may cause infections to flare up, notably candidiasis . * Pregnancy: Corticosteroids have a low but significant teratogenic effect, causing a few birth defects per 1,000 pregnant women treated. Corticosteroids are therefore contraindicated in pregnancy. * Habituation: Topical steroid addiction (TSA) has been reported in long-term users of topical steroids (users who applied topical steroids to their skin over a period of weeks, months, or years). TSA is characterised by uncontrollable, spreading dermatitis and worsening skin inflammation which requires a stronger topical steroid to get the same result as the first prescription. When topical steroid medication is lost, the skin experiences redness, burning, itching, hot skin, swelling, and/or oozing for a length of time. This is also called 'red skin syndrome' or 'topical steroid withdrawal'(TSW). After the withdrawal period is over the atopic dermatitis can cease or is less severe than it was before. * In children the short term use of steroids by mouth increases the risk of vomiting, behavioral changes, and sleeping problems.

BIOSYNTHESIS

Steroidogenesis
Steroidogenesis
, including corticosteroid biosynthesis.

The corticosteroids are synthesized from cholesterol within the adrenal cortex . Most steroidogenic reactions are catalysed by enzymes of the cytochrome P450 family. They are located within the mitochondria and require adrenodoxin as a cofactor (except 21-hydroxylase and 17α-hydroxylase ).

Aldosterone
Aldosterone
and corticosterone share the first part of their biosynthetic pathway. The last part is mediated either by the aldosterone synthase (for aldosterone ) or by the 11β-hydroxylase (for corticosterone ). These enzymes are nearly identical (they share 11β-hydroxylation and 18-hydroxylation functions), but aldosterone synthase is also able to perform an 18-oxidation. Moreover, aldosterone synthase is found within the zona glomerulosa at the outer edge of the adrenal cortex ; 11β-hydroxylase is found in the zona fasciculata and zona glomerulosa .

CLASSIFICATION

BY CHEMICAL STRUCTURE

In general, corticosteroids are grouped into four classes, based on chemical structure. Allergic reactions to one member of a class typically indicate an intolerance of all members of the class. This is known as the "Coopman classification", after S. Coopman, who defined this classification in 1989.

The highlighted steroids are often used in the screening of allergies to topical steroids.

Group A — Hydrocortisone Type

Hydrocortisone , methylprednisolone , prednisolone , prednisone , and triamcinolone (short- to medium-acting glucocorticoids).

Group B — Acetonides (and Related Substances)

Amcinonide , budesonide , desonide , fluocinolone acetonide , fluocinonide , halcinonide , and triamcinolone acetonide .

Group C — Betamethasone
Betamethasone
Type

Beclometasone
Beclometasone
, betamethasone , dexamethasone , fluocortolone , halometasone , and mometasone .

Group D — Esters

Group D1 — Halogenated (less Labile)

Alclometasone dipropionate , betamethasone dipropionate , betamethasone valerate , clobetasol propionate , clobetasone butyrate , fluprednidene acetate , and mometasone furoate .

Group D2 — Labile Prodrug Esters

Ciclesonide , cortisone acetate , hydrocortisone aceponate , hydrocortisone acetate , hydrocortisone buteprate , hydrocortisone butyrate , hydrocortisone valerate , prednicarbate , and tixocortol pivalate .

BY ROUTE OF ADMINISTRATION

Topical Steroids

Main article: Topical steroid

For use topically on the skin, eye, and mucous membranes .

Topical corticosteroids are divided in potency classes I to IV in most countries (A to D in Japan). There are seven categories used in the United States.

Inhaled Steroids

for use to treat the nasal mucosa, sinuses, bronchii, and lungs. This group includes:

* Flunisolide * Fluticasone furoate * Fluticasone propionate * Triamcinolone
Triamcinolone
acetonide * Beclomethasone dipropionate * Budesonide

There is also a combination preparation containing fluticasone propionate and salmeterol xinafoate (a long-acting bronchodilator). It is approved for children over 12 years old.

Oral Forms

Such as prednisone, prednisolone or dexamethasone .

Systemic Forms

Available in injectables for intravenous and parenteral routes.

HISTORY

Introduction of early corticosteroids CORTICOSTEROID INTRODUCED

Cortisone 1948

Hydrocortisone 1951

Fludrocortisone acetate 1954

Prednisolone 1955

Prednisone
Prednisone
1955

Methylprednisolone 1956

Triamcinolone
Triamcinolone
1956

Dexamethasone
Dexamethasone
1958

Betamethasone
Betamethasone
1958

Triamcinolone
Triamcinolone
acetonide 1958

Fluorometholone 1959

The first known use of corticosteroids was in 1944. Tadeusz Reichstein together with Edward Calvin Kendall and Philip Showalter Hench were awarded the Nobel Prize
Nobel Prize
for Physiology
Physiology
and Medicine
Medicine
in 1950 for their work on hormones of the adrenal cortex, which culminated in the isolation of cortisone .

Initially hailed as a miracle cure and liberally prescribed during the 1950s, steroid treatment brought about adverse events of such a magnitude that the next major category of anti-inflammatory drugs, the nonsteroidal anti-inflammatory drugs (NSAIDs), was so named in order to demarcate from the opprobrium.

Corticosteroids have been used as drug treatment for some time. Lewis Sarett of Merck -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;">

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* v * t * e

Pharmacology : major drug groups

Gastrointestinal tract / metabolism (A )

* stomach acid

* Antacids * H2 antagonists * Proton pump inhibitors

* Antiemetics * Laxatives * Antidiarrhoeals /Antipropulsives * Anti-obesity drugs * Anti-diabetics * Vitamins * Dietary minerals

Blood
Blood
and blood forming organs (B )

* Antithrombotics

* Antiplatelets * Anticoagulants * Thrombolytics/fibrinolytics

* Antihemorrhagics

* Platelets * Coagulants * Antifibrinolytics

Cardiovascular system (C )

* cardiac therapy/antianginals

* Cardiac glycosides * Antiarrhythmics * Cardiac stimulants

* Antihypertensives * Diuretics * Vasodilators * Beta blockers * Calcium channel blockers

* renin-angiotensin system

* ACE inhibitors * Angiotensin II receptor antagonists * Renin inhibitors

* Antihyperlipidemics

* Statins * Fibrates * Bile
Bile
acid sequestrants

SKIN (D )

* Emollients * Cicatrizants * Antipruritics * Antipsoriatics * Medicated dressings

Genitourinary system (G )

* Hormonal contraception * Fertility agents * SERMs * Sex hormones

Endocrine system (H )

* Hypothalamic-pituitary hormones

* Corticosteroids

* Glucocorticoids * Mineralocorticoids

* Sex hormones * Thyroid hormones /Antithyroid agents

Infections and infestations (J , P , QI )

* Antimicrobials : Antibacterials (Antimycobacterials ) * Antifungals * Antivirals

* Antiparasitics

* Antiprotozoals * Anthelmintics * Ectoparasiticides

* IVIG * Vaccines

Malignant disease (L01-L02 )

* Anticancer agents

* Antimetabolites * Alkylating * Spindle poisons * Antineoplastic * Topoisomerase inhibitors

Immune disease (L03-L04 )

* Immunomodulators

* Immunostimulants * Immunosuppressants

Muscles , bones , and joints (M )

* Anabolic steroids

* Anti-inflammatories

* NSAIDs

* Antirheumatics * Corticosteroids * Muscle
Muscle
relaxants * Bisphosphonates

Brain and nervous system (N )

* Analgesics

* Anesthetics

* General * Local

* Anorectics * Anti-ADHD Agents * Antiaddictives * Anticonvulsants * Antidementia Agents * Antidepressants * Antimigraine Agents * Antiparkinson\'s Agents * Antipsychotics * Anxiolytics * Depressants * Entactogens * Entheogens * Euphoriants

* Hallucinogens

* Psychedelics * Dissociatives * Deliriants

* Hypnotics /Sedatives * Mood Stabilizers * Neuroprotectives * Nootropics * Neurotoxins * Orexigenics * Serenics * Stimulants * Wakefulness-Promoting Agents

Respiratory system (R )

* Decongestants * Bronchodilators * Cough medicines * H1 antagonists

SENSORY ORGANS (S )

* Ophthalmologicals * Otologicals

OTHER ATC (V )

* Antidotes * Contrast media * Radiopharmaceuticals * Dressings * Senotherapeutics

* v * t * e

Endogenous steroids

PRECURSORS

* Cholesterol
Cholesterol
* 22R-Hydroxycholesterol * 20α,22R-Dihydroxycholesterol * Pregnenolone
Pregnenolone
* 11β-Hydroxypregnenolone * 17α-Hydroxypregnenolone * 21-Hydroxypregnenolone * 17α,21-Dihydroxypregnenolone * 11β,17α,21-Trihydroxypregnenolone

CORTICOSTEROIDS

GLUCOCORTICOIDS

* 3α,5α- Tetrahydrocorticosterone * 5α-Dihydrocorticosterone * 11-Deoxycorticosterone * 11-Deoxycortisol * 11-Ketoprogesterone * 21-Deoxycortisol * 21-Deoxycortisone * Corticosterone
Corticosterone
* Cortisol
Cortisol
* Cortisone * 17α-Hydroxypregnenolone * 17α-Hydroxyprogesterone * Pregnenolone
Pregnenolone
* Progesterone
Progesterone

MINERALOCORTICOIDS

* 5α-Dihydroaldosterone * 11-Dehydrocorticosterone (11-oxocorticosterone, 17-deoxycortisone)

* 11-Deoxycortisol * 11-Deoxycorticosterone * 11β-Hydroxyprogesterone (21-deoxycorticosterone) * 18-Hydroxy-11-deoxycorticosterone * 18-Hydroxycorticosterone * 18-Hydroxyprogesterone * Aldosterone
Aldosterone
* Corticosterone
Corticosterone
* Cortisol
Cortisol

SEX STEROIDS

ANDROGENS

* 11-Ketodihydrotestosterone * 11-Ketotestosterone * 7β-Hydroxyepiandrosterone * 11β-Hydroxyandrostenedione * Adrenosterone (11-ketoandrostenedione) * Androstenediol * Androstenedione * Androsterone * Dehydroandrosterone * DHEA * DHEA sulfate * Dihydrotestosterone
Dihydrotestosterone
* Epiandrosterone * Epitestosterone * 16α-Hydroxyandrostenedione * 16α-Hydroxy-DHEA * 16α-Hydroxy-DHEA sulfate * Testosterone
Testosterone

* Metabolites: 3α-Androstanediol
3α-Androstanediol
* 3α-Androstanediol
3α-Androstanediol
glucuronide * 3β-Androstanediol * 3α,5β-Androstanediol * 3β,5β-Androstanediol * 5β-Androstanedione * 5β- Dihydrotestosterone
Dihydrotestosterone
* Androstanetriols * Androstenediol sulfate * Androsterone glucuronide * Androsterone sulfate * Dihydrotestosterone
Dihydrotestosterone
glucuronide * Dihydrotestosterone
Dihydrotestosterone
sulfate * Etiocholanolone * Etiocholanolone glucuronide * Epietiocholanolone * Testosterone
Testosterone
glucuronide * Testosterone
Testosterone
sulfate

ESTROGENS

* Estranes: Estetrol * Estradiol
Estradiol
* Estrone * Estriol * 16β- Epiestriol (16β-hydroxyestradiol) * 17α- Epiestriol (16α-hydroxy-17α-estradiol) * 16β,17α- Epiestriol (16β-hydroxy-17α-estradiol) * 2-Hydroxyestradiol
2-Hydroxyestradiol
* 2-Hydroxyestriol * 2-Hydroxyestrone * 4-Hydroxyestradiol * 4-Hydroxyestriol * 4-Hydroxyestrone * 4-Methoxyestradiol * 16α-Hydroxyestrone

* Others: 27-Hydroxycholesterol * 3α-Androstanediol
3α-Androstanediol
* 3β-Androstanediol * 4- Androstenedione * 5- Androstenediol * DHEA * DHEA sulfate * 7-Keto-DHEA * 7α-Hydroxy-DHEA * 16α-Hydroxy-DHEA

* Metabolites: 2-Methoxyestradiol * 2-Methoxyestrone * 4-Methoxyestrone * Estradiol
Estradiol
glucuronide * Estradiol
Estradiol
sulfate * Estrone glucuronide * Estrone sulfate * Estriol glucuronide * Estriol sulfate * Lipoidal estradiol (e.g., estradiol stearate , estradiol palmitate )

PROGESTOGENS

* Progesterone
Progesterone
* 16α-Hydroxyprogesterone * 17α-Hydroxyprogesterone * 20α-Dihydroprogesterone
20α-Dihydroprogesterone
* 5α-Dihydroprogesterone * 11-Deoxycorticosterone * 5α-DHDOC

* Metabolites: Allopregnanediol * Pregnanediol * Pregnanediol glucuronide * Pregnanetriol

NEUROSTEROIDS

* Cholestanes: 24S-Hydroxycholesterol * Cholesterol
Cholesterol

* Pregnanes: 3α-Dihydroprogesterone * 3β-Dihydroprogesterone * 5α-Dihydrocorticosterone * 5α-Dihydroprogesterone * 5β-Dihydroprogesterone * Allopregnanolone * Corticosterone
Corticosterone
* DHC * DHDOC * Deoxycorticosterone * Epipregnanolone * Isopregnanolone * Pregnanolone * Pregnenolone
Pregnenolone
* Pregnenolone
Pregnenolone
sulfate * Progesterone
Progesterone
* THB * THDOC

* Androstanes: 3α-Androstanediol
3α-Androstanediol
* 3α-Androstenol * 7-Keto-DHEA * 7α-Hydroxy-DHEA * 7β-Hydroxy-DHEA * 7α-Hydroxyepiandrosterone * 7β-Hydroxyepiandrosterone * Androsterone * DHEA * DHEA sulfate * Etiocholanolone

* PHEROMONES : 3α-Androstenol * 3β-Androstenol * Androstadienol * Androstadienone * Androstenone * Androsterone * Estratetraenol

OTHERS

* VITAMIN D : 7-Dehydrocholesterol * Calcidiol/ Calcifediol * Calcitriol
Calcitriol
* Cholecalciferol
Cholecalciferol

* OTHERS: 7α-Hydroxycholesterol * 11α-Hydroxyprogesterone * 11β-Hydroxyprogesterone * Cholesterol
Cholesterol
sulfate

CORTICOSTEROIDS AND ANTICORTICOSTEROIDS

* v * t * e

Glucocorticoids and antiglucocorticoids (H02 )

GLUCOCORTICOIDS

NATURAL

* Cortisone

* Cortisone acetate

* Cortodoxone (cortexolone, 11-deoxycortisol)

* Desoxycortone (deoxycortone, cortexone, 11-deoxycorticosterone)

* Desoxycortone esters

* Hydrocortisone (cortisol )#

* Hydrocortisone esters

* Prebediolone acetate

* Pregnenolone
Pregnenolone

* Pregnenolone
Pregnenolone
acetate * Pregnenolone
Pregnenolone
succinate

SYNTHETIC

* Cortisol-like and related (16-unsubstituted): Chloroprednisone * Cloprednol * Difluprednate * Fludrocortisone * Flugestone acetate (flurogestone acetate) * Fluocinolone

* Fluorometholone

* Fluorometholone acetate

* Fluperolone

* Fluperolone acetate

* Fluprednisolone
Fluprednisolone

* Fluprednisolone
Fluprednisolone
esters

* Loteprednol * Medrysone

* Methylprednisolone

* Methylprednisolone esters

* Prednicarbate
Prednicarbate
* Prednisolone * Prednisone
Prednisone

* Tixocortol

* Tixocortol pivalate

* Methasones and related (16-substituted): Alclometasone

* Beclometasone
Beclometasone

* Beclometasone
Beclometasone
esters

* Betamethasone
Betamethasone

* Betamethasone
Betamethasone
esters

* Clobetasol

* Clobetasol propionate

* Clobetasone

* Clocortolone

* Clocortolone esters

* Cortivazol * Desoximetasone

* Dexamethasone
Dexamethasone

* Dexamethasone
Dexamethasone
esters

* Diflorasone

* Diflucortolone

* Diflucortolone valerate

* Fluclorolone * Flumetasone * Fluocortin

* Fluocortolone

* Fluocortolone esters

* Fluprednidene acetate

* Fluticasone
Fluticasone

* Fluticasone furoate * Fluticasone propionate

* Halometasone * Meprednisone

* Mometasone

* Mometasone furoate

* Paramethasone * Prednylidene * Rimexolone * Triamcinolone
Triamcinolone
* Ulobetasol (halobetasol)

* Cyclic ketals (16,17-cyclized): Amcinonide * Budesonide * Ciclesonide * Deflazacort * Desonide * Fluclorolone acetonide (flucloronide) * Fludroxycortide (flurandrenolone, flurandrenolide) * Flunisolide * Fluocinolone acetonide * Fluocinonide * Formocortal (fluoroformylone) * Halcinonide

* Triamcinolone
Triamcinolone
acetonide

* Triamcinolone
Triamcinolone
acetonide esters

ANTIGLUCOCORTICOIDS

* Antagonists: Aglepristone * Ketoconazole * Mifepristone * Ulipristal acetate

SYNTHESIS MODIFIERS

* Acetoxolone * Aminoglutethimide * Carbenoxolone * Enoxolone * Ketoconazole * Metyrapone * Mitotane * Trilostane

* #WHO-EM * ‡Withdrawn from market

* Clinical trials :

* †Phase III * §Never to phase III

SEE ALSO: Androgens and antiandrogens • Estrogens and antiestrogens • Progestogens and antiprogestogens • Mineralocorticoids and antimineralocorticoids

* v * t * e

Mineralocorticoids and antimineralocorticoids (H02 )

MINERALOCORTICOIDS

* Desoxycortone (desoxycorticosterone)

* Desoxycortone esters

* Hydrocortisone (cortisol)

* Hydrocortisone esters

* Fludrocortisone

* Fludrocortisone acetate

* Methylprednisolone

* Methylprednisolone esters

* Prednisolone

* Prednisolone esters

* Prednisone
Prednisone

* Prednisone
Prednisone
esters

ANTIMINERALOCORTICOIDS

* Steroidal: Canrenoate potassium (potassium canrenoate) * Canrenone * Drospirenone * Dydrogesterone * Eplerenone * Gestodene * Medrogestone * Progesterone
Progesterone
* Spironolactone
Spironolactone
* Trimegestone

* Nonsteroidal: Amlodipine
Amlodipine
* Apararenone
Apararenone
§ * Benidipine * Esaxerenone
Esaxerenone
† * Felodipine * Finerenone † * Nifedipine * Nimodipine * Nitrendipine

SYNTHESIS MODIFIERS

* Acetoxolone * Aminoglutethimide * Carbenoxolone * Enoxolone * Ketoconazole * Metyrapone * Mitotane * Trilostane

* #WHO-EM * ‡Withdrawn from market

* Clinical trials :

* †Phase III * §Never to phase III

SEE ALSO: Androgens and antiandrogens • Estrogens and antiestrogens • Progestogens and antiprogestogens • Glucocorticoids and antiglucocorticoids

CORTICOSTEROID RECEPTOR MODULATORS

* v * t * e

Glucocorticoid
Glucocorticoid
receptor modulators

GR

AGONISTS

* Cortisol-like and related (16-unsubstituted): 3α,5α- Tetrahydrocorticosterone * 5α-Dihydrocorticosterone * 9α-Fluorocortisone (alfluorone)

* 11-Dehydrocorticosterone (11-oxocorticosterone, 17-deoxycortisone)

* 11-Dehydrocorticosterone acetate

* 11-Deoxycorticosterone (desoxycortone, deoxycortone, desoxycorticosterone)

* Desoxycortone esters

* 11-Deoxycortisol (cortodoxone, cortexolone)

* Cortifen (cortiphen, kortifen) * Cortodoxone acetate

* 21-Deoxycortisol

* Δ7- Prednisolone

* Δ7- Prednisolone 21-acetate

* Amebucort

* Chloroprednisone

* Chloroprednisone acetate

* Cloprednol

* Cloprednol acetate

* Corticosterone
Corticosterone

* Corticosterone
Corticosterone
acetate * Corticosterone
Corticosterone
benzoate

* Cortisol
Cortisol
(hydrocortisone )

* Benzodrocortisone (hydrocortisone benzoate) * Hydrocortamate (hydrocortisone diethylaminoacetate) * Hydrocortisone esters

* Cortisone

* Cortisone acetate

* Deprodone

* Deprodone propionate

* Dichlorisone

* Dichlorisone acetate * Dichlorisone diacetate

* Difluprednate * Endrisone (endrysone)

* Etiprednol

* Etiprednol dicloacetate (etiprednol dichloroacetate)

* Fludrocortisone (fludrocortone)

* Fludrocortisone acetate

* Fluorometholone

* Fluorometholone acetate

* Fluperolone

* Fluperolone acetate

* Fluprednisolone
Fluprednisolone

* Fluprednisolone
Fluprednisolone
esters

* Halopredone

* Halopredone acetate (halopredone diacetate)

* Isoflupredone (9α-fluoroprednisolone)

* Isoflupredone acetate

* Loteprednol

* Loteprednol etabonate

* Mazipredone (depersolone) * Medrysone

* Methylprednisolone

* Methylprednisolone esters

* Prebediolone

* Prebediolone acetate

* Prednisolone

* Prednazate * Prednazoline * Prednicarbate
Prednicarbate
(prednisolone ethylcarbonate propionate) * Prednimustine * Prednisolamate (prednisolone diethylaminoacetate) * Prednisolone esters

* Prednisone
Prednisone

* Prednisone
Prednisone
esters

* Pregnenolone
Pregnenolone

* Pregnenolone
Pregnenolone
acetate * Pregnenolone
Pregnenolone
succinate (pregnenolone hemisuccinate)

* Resocortol * Tipredane

* Tixocortol

* Butixocort (tixocortol butyrate)

* Butixocort propionate

* Tixocortol pivalate

* Methasones and related (16-substituted): 16α-Methyl-11-oxoprednisolone

* Alclometasone

* Alclometasone dipropionate

* Amelometasone

* Beclometasone
Beclometasone
(beclomethasone)

* Beclometasone
Beclometasone
esters

* Betamethasone
Betamethasone
(betametasone)

* Betamethasone
Betamethasone
esters * Cortobenzolone
Cortobenzolone
(betamethasone salicylate)

* Ciclometasone
Ciclometasone
(ciclomethasone, cyclomethasone)

* Clobetasol

* Clobetasol propionate

* Clobetasone

* Clobetasone butyrate

* Clocortolone

* Clocortolone esters

* Cloticasone

* Cloticasone propionate

* Cormetasone (cormethasone)

* Cormetasone acetate

* Descinolone * Desoximetasone (desoxymethasone)

* Dexamethasone
Dexamethasone
(dexametasone)

* Dexamethasone
Dexamethasone
esters

* Diflorasone

* Diflorasone diacetate

* Diflucortolone

* Diflucortolone pivalate * Diflucortolone valerate

* Dimesone

* Dimesone acetate

* Doxibetasol (doxybetasol) * Fluclorolone

* Flumetasone (flumethasone)

* Flumetasone acetate * Flumetasone pivalate

* Fluocinolone

* Fluocortin

* Fluocortin butyl (fluocortin butylate)

* Fluocortolone

* Fluocortolone esters

* Fluprednidene (fluprednylidene)

* Fluprednidene acetate

* Fluticasone
Fluticasone

* Fluticasone furoate * Fluticasone propionate

* Halocortolone * Halometasone

* Icometasone

* Icometasone enbutate (icometasone butyrate acetate)

* Isoprednidene

* Locicortolone
Locicortolone
(locicortone)

* Locicortolone
Locicortolone
dicibate (locicortone dicibate)

* Meclorisone

* Meclorisone dibutyrate

* Meprednisone (methylprednisone)

* Meprednisone acetate * Meprednisone hydrogen succinate (methylprednisone hemisuccinate)

* Mometasone

* Mometasone furoate

* Paramethasone

* Paramethasone acetate * Paramethasone disodium phosphate * Paramethasone phosphate

* Prednylidene

* Prednylidene diethylaminoacetate

* Rimexolone

* Ticabesone

* Ticabesone propionate

* Timobesone

* Timobesone acetate

* Triamcinolone
Triamcinolone

* Triamcinolone
Triamcinolone
diacetate

* Ulobetasol (halobetasol)

* Ulobetasol propionate

* Vamorolone

* Cyclic ketals (16,17-cyclized): Acrocinonide (triamcinolone acroleinide) * Amcinafal (triamcinolone pentanonide) * Amcinafide (triamcinolone acetophenide) * Amcinonide (triamcinolone acetate cyclopentanonide) * Budesonide * Ciclesonide * Cicortonide * Deflazacort (azacort) * Descinolone acetonide

* Desonide (hydroxyprednisolone acetonide)

* Desonide disodium phosphate * Desonide pivalate

* Dexbudesonide

* Drocinonide

* Drocinonide phosphate

* Fluazacort * Fluclorolone acetonide (flucloronide) * Fludroxycortide (flurandrenolone, flurandrenolide) * Flumoxonide

* Flunisolide

* Flunisolide acetate

* Fluocinolone acetonide

* Ciprocinonide (fluocinolone acetonide cyclopropylcarboxylate) * Fluocinonide (fluocinolide, fluocinolone acetonide acetate) * Procinonide (fluocinolone acetonide propionate)

* Formocortal * Halcinonide * Itrocinonide

* Rofleponide

* Rofleponide palmitate

* Tralonide

* Triamcinolone
Triamcinolone
acetonide

* Flupamesone (triamcinolone acetonide metembonate) * Triamcinolone
Triamcinolone
acetonide esters

* Triamcinolone
Triamcinolone
aminobenzal benzamidoisobutyrate (TBI-PAB) * Triclonide

* Others/atypical (other expanded steroid ring systems, homosteroids, and non-pregnane steroids): Cortisuzol * Cortivazol * Domoprednate * Naflocort

* Nicocortonide

* Nicocortonide acetate

* Nivacortol (nivazol) * Oxisopred * RU-28362

* Non-corticosteroids with some glucocorticoid activity: 15β-Hydroxycyproterone acetate * 17α-Hydroxyprogesterone * Chlormadinone acetate * Cyproterone * Cyproterone acetate * Delmadinone acetate * Flugestone * Flugestone acetate (flurogestone acetate) * Fluoxymesterone * Gestodene * Medrogestone * Medroxyprogesterone acetate
Medroxyprogesterone acetate
* Megestrol acetate * Metribolone * Norgestomet * Osaterone acetate * Progesterone
Progesterone
* Promegestone * Quingestrone * Segesterone acetate (nestorone) * Tetrahydrogestrinone

* Nonsteroidal glucocorticoids: AZD-5423 * GSK-9027

MIXED (SEGRMS )

* Dagrocorat * Fosdagrocorat * Mapracorat

ANTAGONISTS

* 7α-Hydroxy-DHEA * 17α-Methylprogesterone * Aglepristone * Asoprisnil * Asoprisnil ecamate * C108297 * C113176 * CORT-108297 * Cyproterone acetate * Guggulsterone * Ketoconazole * Lilopristone * LLY-2707 * Miconazole * Mifepristone * Onapristone * ORG-34116 * ORG-34517 (SCH-900636) * ORG-34850 * Pregnenolone
Pregnenolone
16α-carbonitrile * RTI 3021–012 * RTI 3021–022 * Telapristone * Tibolone * Toripristone * Ulipristal acetate

See also Receptor/signaling modulators Androgenics Estrogenics Mineralocorticoidics Progestogenics Steroid metabolism modulators List of corticosteroids
List of corticosteroids

* v * t * e

Mineralocorticoid receptor modulators

MR

AGONISTS

* 11-Dehydrocorticosterone (11-oxocorticosterone, 17-deoxycortisone)

* 11-Dehydrocorticosterone acetate

* 11-Deoxycorticosterone (desoxycortone, deoxycortone, desoxycorticosterone)

* Desoxycortone esters

* 11-Deoxycortisol (cortodoxone, cortexolone)

* Cortifen (cortiphen, kortifen) * Cortodoxone acetate

* 11β-Hydroxyprogesterone * 16α,18-Dihydroxy-11-deoxycorticosterone * 17α-Hydroxyaldosterone * 18-Hydroxy-11-deoxycorticosterone * 19-Norprogesterone * Aldosterone
Aldosterone

* Corticosterone
Corticosterone

* Corticosterone
Corticosterone
acetate * Corticosterone
Corticosterone
benzoate

* Cortisol
Cortisol
(hydrocortisone )

* Benzodrocortisone (hydrocortisone benzoate) * Hydrocortamate (hydrocortisone diethylaminoacetate) * Hydrocortisone esters

* Cortisone

* Cortisone acetate

* Fludrocortisone (fludrocortone)

* Fludrocortisone acetate

* Mometasone

* Mometasone furoate

* Prednisolone

* Prednazate * Prednazoline * Prednicarbate
Prednicarbate
(prednisolone ethylcarbonate propionate) * Prednimustine * Prednisolamate (prednisolone diethylaminoacetate) * Prednisolone esters

* Prednisone
Prednisone

* Prednisone
Prednisone
esters

ANTAGONISTS

* Steroidal: 6β-Hydroxy-7α-thiomethylspironolactone * 7α-Thiomethylspironolactone (SC-26519) * 7α-Thioprogesterone (SC-8365) * 7α-Thiospironolactone (SC-24813) * 16α-Hydroxyprogesterone * 17α-Hydroxyprogesterone * 18-Deoxyaldosterone * Canrenoate potassium (potassium canrenoate) * Canrenoic acid (canrenoate) * Canrenone (canrenoate y-lactone) * Dicirenone * Dimethisterone * Drospirenone * Dydrogesterone * Eplerenone * Gestodene * Guggulsterone * Medrogestone * Mespirenone * Mexrenoate potassium * Mexrenoic acid (mexrenoate) * Mexrenone * Oxprenoic acid (oxprenoate) * Oxprenoate potassium (RU-28318) * Pregnenolone
Pregnenolone
* Progesterone
Progesterone
* Prorenoate potassium
Prorenoate potassium
* Prorenoic acid (prorenoate) * Prorenone * RO-14-9012 * RU-26752 * SC-5233 (spirolactone) * SC-8109 * SC-11927 (CS-1) * SC-19886 * SC-27169 * Spirorenone * Spironolactone
Spironolactone
* Spiroxasone * Tibolone * Trimegestone * ZK-91587 * ZK-97894

* Nonsteroidal: Amlodipine
Amlodipine
* Apararenone
Apararenone
* Benidipine * BR-4628 * Esaxerenone
Esaxerenone
* Felodipine * Finerenone * Nifedipine * Nimodipine * Nitrendipine * PF-03882845 * SM-368229

See also Receptor/signaling modulators Androgenics Estrogenics Glucocorticoidics Progestogenics Steroid metabolism modulators List of corticosteroids
List of corticosteroids

AUTHORITY CONTROL

* LCCN : sh85001012 * NDL

.