EPICORT
Clinical safety rating: caution
Comprehensive clinical and safety monograph for EPICORT (EPICORT).
Epicort is a corticosteroid that exerts anti-inflammatory and immunosuppressive effects by binding to the glucocorticoid receptor, leading to modulation of gene expression and inhibition of phospholipase A2, thereby reducing prostaglandin and leukotriene synthesis.
| Metabolism | Primarily hepatic via CYP3A4-mediated hydroxylation; metabolites largely inactive. |
| Excretion | Renal (70% as unchanged drug and inactive metabolites), biliary/fecal (30%) |
| Half-life | Terminal half-life is 1.5–2 hours in adults; prolonged to 3–4 hours in severe hepatic impairment |
| Protein binding | 98% bound primarily to corticosteroid-binding globulin (CBG) and albumin |
| Volume of Distribution | Approximately 2.5 L/kg; indicates extensive tissue distribution and high lipophilicity |
| Bioavailability | Oral: 25–40% due to extensive first-pass metabolism; Topical: approximately 1% systemically absorbed through intact skin |
| Onset of Action | Oral: 30–60 minutes; IV: 5–10 minutes; Topical: 2–4 hours for systemic effect |
| Duration of Action | Oral/IV: 8–12 hours; Topical: 12–24 hours depending on formulation and site |
| Action Class | Glucocorticoids |
| Brand Substitutes | Mahacort DZ 6 Tablet, Ronicort 6mg Tablet, Defsure 6mg Tablet, Flacort 6mg Tablet, Deflawok 6mg Tablet |
IV: 50 mg every 8 hours over 30 minutes.
| Dosage form | LOTION |
| Renal impairment | GFR <30 mL/min: reduce to 25 mg every 12 hours. |
| Liver impairment | Child-Pugh class B or C: not recommended; class A: 25 mg every 8 hours. |
| Pediatric use | 2 mg/kg/dose IV every 8 hours, max 50 mg/dose. |
| Geriatric use | No specific adjustment; monitor renal function and reduce dose if CrCl <30. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for EPICORT (EPICORT).
| Breastfeeding | Enters breast milk; M/P ratio approximately 0.25. Avoid high-dose or prolonged use due to potential adrenal suppression in infant. |
| Teratogenic Risk | First trimester: increased risk of orofacial clefts (odds ratio 1.3–3.3). Second/third trimester: fetal adrenal suppression, intrauterine growth restriction, oligohydramnios (prolonged/high-dose use). |
| Fetal Monitoring |
■ FDA Black Box Warning
None.
| Serious Effects |
["Systemic fungal infection","Hypersensitivity to any component","Administration of live or live-attenuated vaccines","Idiopathic thrombocytopenic purpura (for intramuscular use)"]
| Precautions | ["Immunosuppression and increased infection risk","Hypothalamic-pituitary-adrenal (HPA) axis suppression","Osteoporosis with long-term use","Hyperglycemia and diabetes exacerbation","Psychiatric disturbances (e.g., euphoria, depression)","Cushing's syndrome with excessive dosing"] |
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| Maternal: blood pressure, blood glucose, signs of adrenal suppression. Fetal: growth ultrasound every 4–6 weeks if repeated doses; consider fetal adrenal function if high-dose near term. |
| Fertility Effects | May suppress ovulation at high doses (hypothalamic-pituitary-adrenal axis disruption). Reversible upon dose reduction or discontinuation. |