NUTRACORT
Clinical safety rating: caution
Comprehensive clinical and safety monograph for NUTRACORT (NUTRACORT).
Corticosteroid receptor agonist; induces anti-inflammatory proteins and suppresses inflammatory mediators.
| Metabolism | Hepatic via CYP3A4. |
| Excretion | Renal (primarily as glucuronide and sulfate conjugates, <10% unchanged) and fecal (biliary excretion of metabolites). Approximately 70-80% renal, 20-30% fecal. |
| Half-life | Terminal half-life: 2-4 hours (mean 3 hours). Clinically, dosing every 6-8 hours maintains therapeutic levels. |
| Protein binding | Approximately 85-90%, primarily to albumin and corticosteroid-binding globulin. |
| Volume of Distribution | Vd: 0.3-0.5 L/kg, indicating distribution primarily into extracellular fluid. |
| Bioavailability | Oral: 60-70% (first-pass metabolism); Topical: <1% systemically absorbed (intact skin). |
| Onset of Action | Oral: 30-60 minutes; Topical: 1-2 hours for anti-inflammatory effect. |
| Duration of Action | Oral: 6-8 hours; Topical: 8-12 hours. Duration is dose-dependent; higher doses prolong effect. |
| Molecular Weight | 360.44 |
One capsule (200 mg) orally twice daily with meals.
| Dosage form | GEL |
| Renal impairment | GFR >30 mL/min: no adjustment. GFR 15-30 mL/min: 200 mg once daily. GFR <15 mL/min or dialysis: 200 mg every 48 hours. |
| Liver impairment | Child-Pugh A: no adjustment. Child-Pugh B: 200 mg once daily. Child-Pugh C: not recommended. |
| Pediatric use | Weight <40 kg: not established. Weight >40 kg: same as adult. |
| Geriatric use | No dose adjustment required. Caution in patients with decreased renal function. |
| 1st trimester | Avoid; contains cortisone acetate, a corticosteroid, which in animal studies has shown increased risk of cleft palate and other fetal abnormalities when administered during early pregnancy. Human data limited but potential risk exists. |
| 2nd trimester | Use only if clearly needed; corticosteroids may cause fetal adrenal suppression and growth restriction with prolonged use. Consider alternative therapies with lower systemic absorption. |
| 3rd trimester | Use only if clearly needed; near-term exposure may increase risk of neonatal adrenal suppression. Monitor infant for signs of adrenal insufficiency if used close to delivery. |
Clinical note
Comprehensive clinical and safety monograph for NUTRACORT (NUTRACORT).
| Placental transfer | Corticosteroids cross the placenta to varying degrees. Cortisone acetate is metabolized to cortisol, which crosses the placenta but is partially inactivated by placental 11β-HSD2. However, high doses or prolonged use can lead to significant fetal exposure. |
| Breastfeeding |
■ FDA Black Box Warning
None.
| Serious Effects |
Hypersensitivity to any component of NUTRACORTUntreated bacterial, fungal, or viral skin infections at application sitePerioral dermatitisRosaceaAcne vulgaris
| Precautions | Nasal irritation, Epistaxis, Risk of adrenal suppression with prolonged high-dose use, Potential for growth retardation in children, Increased susceptibility to infections |
| Food/Dietary | No specific food interactions known. May cause increased appetite and weight gain with prolonged systemic use. Avoid excessive salt intake if edema occurs. |
| Clinical Pearls |
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| Corticosteroids like cortisone acetate are excreted into breast milk in small amounts. With topical application, systemic absorption is minimal, but prolonged or high-dose use could potentially affect the nursing infant, including growth suppression or interference with endogenous corticosteroid production. Caution is advised; use lowest effective dose for shortest duration. |
| Lactation Rating | L3 (Moderately Safe) |
| Teratogenic Risk | First trimester: Increased risk of cleft palate (odds ratio ~1.3-3.3). Second/third trimester: Fetal growth restriction, adrenal suppression, oligohydramnios. Chronic use: Risk of preterm birth and low birth weight. |
| Fetal Monitoring | Maternal: Blood pressure, blood glucose. Fetal: Ultrasound for growth restriction and amniotic fluid index; fetal heart rate monitoring if prolonged use. |
| Fertility Effects | May impair ovulation with high doses. Reversible upon discontinuation. |
| For corticosteroid-responsive dermatoses, short-term use minimizes systemic absorption. Avoid occlusive dressings on large areas. Use lowest effective strength. Monitor for skin thinning and HPA axis suppression with prolonged use. Not for ophthalmic use. Consider fungal co-infection if no improvement. |
| Patient Advice | Apply a thin layer to affected skin only; avoid healthy areas. · Do not use on face, groin, or underarms unless directed. · Do not cover with bandages or plastic unless told to do so. · Wash hands after application unless treating hands. · Do not stop suddenly after long-term use; follow taper instructions. · Avoid contact with eyes; if contact occurs, rinse with water. |