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When using cortisone, it is crucial to be aware of several important safety considerations to ensure your health and well-being. Here is a concise summary of the potential risks and necessary precautions associated with cortisone use:

• Infection Risk: Long-term cortisone use may increase the likelihood of infections or mask their symptoms, including serious fungal, viral (e.g., chickenpox, measles), or bacterial (e.g., tuberculosis) infections. Avoid contact with individuals with a history of these infections. Inform your healthcare provider if you have had tuberculosis or parasitic infections, as monitoring may be required. Consult your provider before receiving vaccinations, as live vaccines may pose a risk during high-dose cortisone treatment. Risks include concurrent use of other immune-weakening drugs, long-term cortisone use, lack of vaccination against viral illnesses, and exposure to viral infections.

• Mood and Behavioral Changes: Cortisone may affect mood and behavior, especially in those with a history of mental health issues. Report any signs of depression, mood swings, insomnia, anxiety, or hallucinations to your healthcare provider immediately.

• Adrenal Gland Health: Prolonged cortisone use can lead to adrenal suppression, where your body stops producing natural hormones. Abrupt cessation may cause withdrawal symptoms like fever, joint or muscle pain, and fatigue. Your provider will aim to prescribe the lowest effective dose for the shortest period. If long-term use is necessary, blood tests may be required to monitor adrenal function. Do not stop cortisone suddenly without consulting your provider.

• Heart and Kidney Function: Cortisone can affect fluid and electrolyte balance, potentially leading to high blood pressure, swelling, and kidney issues. It may also harm the heart post-heart attack. Inform your provider of any history of heart failure, heart attack, high blood pressure, or kidney problems before starting treatment.

• Stomach Issues: Cortisone increases the risk of stomach damage, such as irritation, ulcers, and bleeding, especially with a history of stomach problems or concurrent use of NSAIDs. Avoid alcohol as it may exacerbate stomach irritation. Seek immediate medical attention for persistent stomach pain or bloody/dark stools.

• Eye Health: Long-term cortisone use may increase the risk of cataracts, glaucoma, and eye infections. Report any vision changes, eye pain, or infections, and consider regular eye exams.

• Bone Health: Prolonged cortisone use can weaken bones and slow growth in children. Discuss any history of fractures or osteoporosis with your provider.

• Blood Sugar Levels: Extended cortisone use may elevate blood sugar levels, potentially leading to diabetes. Watch for symptoms such as confusion, drowsiness, unusual thirst or hunger, frequent urination, flushing, rapid breathing, or fruity-smelling breath. If diabetic, monitor blood sugar levels regularly.

Contraindications:

• Do not use cortisone if you currently have a fungal infection or are receiving live vaccines, especially at high doses.

Always consult with your healthcare provider to address any concerns or questions regarding cortisone treatment.

Common side effects:

• stomach upset
• headache
• dizziness
• trouble sleeping
• increased appetite
• weight gain
• menstrual changes

Less common but important to monitor:

• swelling
• muscle weakness
• nausea
• stomach pain
• bloating
• rash
• skin thinning
• sweating
• infections
• blurry vision
• eye pain
• redness

Serious side effects:

• bone or joint pain
• easy bruising or bleeding
• fast or irregular heartbeat
• increased thirst or urination
• mental or mood changes
• ongoing weight gain
• puffy face
• slow wound healing
• seizures
• signs of stomach bleeding
• swelling of the ankles or feet
• unusual hair or skin growth
• red or purple spots on the skin
• serious allergic reaction
• withdrawal symptoms

Interactions with high risk of serious adverse effects and should be avoided:

• Adenovirus Vaccine Type 4, Live
• Adenovirus Vaccine Type 7, Live
• Bacillus of Calmette and Guerin Vaccine, Live
• Dengue Tetravalent Vaccine, Live
• Measles Virus Vaccine, Live
• Mumps Virus Vaccine, Live
• Poliovirus Vaccine, Live
• Rotavirus Vaccine, Live
• Rubella Virus Vaccine, Live
• Smallpox Vaccine
• Typhoid Vaccine, Live
• Varicella Virus Vaccine, Live
• Yellow Fever Vaccine
• Zoster Vaccine, Live

Interactions with moderate risk that may require dose adjustment, closer monitoring, or timing changes:

• aldesleukin
• birth control pills
• diabetes medications
• estrogen hormone replacement
• Mifepristone
• drugs that can cause bleeding/bruising (including antiplatelet drugs such as Clopidogrel, 'blood thinners' such as Dabigatran/Warfarin, NSAIDs such as Aspirin/Celecoxib/Ibuprofen)
• azole antifungals (such as Ketoconazole)
• rifamycins (such as Rifabutin)
• drugs used to treat seizures (such as Phenytoin)