PERCORTEN

Clinical safety rating: caution

Comprehensive clinical and safety monograph for PERCORTEN (PERCORTEN).

How it works

Percorten (desoxycorticosterone pivalate) is a synthetic mineralocorticoid that binds to and activates the mineralocorticoid receptor (MR) in the renal distal tubule, leading to increased sodium reabsorption, increased potassium and hydrogen ion excretion, and water retention, thereby expanding extracellular fluid volume and increasing blood pressure.

What the body does with it

Metabolism	Primarily hepatic via reduction and conjugation; excreted in urine as metabolites. Desoxycorticosterone pivalate is a prodrug that is hydrolyzed to desoxycorticosterone, which is then metabolized.
Excretion	Renal (biliary/fecal negligible). Approximately 50-70% of a dose is excreted as metabolites in urine; <5% unchanged.
Half-life	Terminal elimination half-life is approximately 30-40 minutes. Clinically, the short half-life necessitates frequent dosing (e.g., every 6-12 hours) to maintain therapeutic effect in mineralocorticoid replacement.
Protein binding	Approximately 90-94% bound to albumin and corticosteroid-binding globulin (CBG).
Volume of Distribution	Vd approximately 0.5-0.8 L/kg. Clinical meaning: Distributes primarily into extracellular fluid; low Vd indicates limited tissue penetration.
Bioavailability	Oral: Approximately 50-70% (high first-pass metabolism). IM/SC: 100% (assumed).
Onset of Action	Intramuscular injection: Onset within 1-2 hours. Oral: Onset within 2-4 hours. Subcutaneous: Similar to IM, about 1-2 hours.
Duration of Action	Intramuscular: Duration of effect approximately 12-24 hours. Oral: Duration about 6-8 hours. Clinical note: Dose adjustments are guided by serum electrolytes and blood pressure response.

Classification & Brands

Dosing & administration

1-5 mg intramuscularly or subcutaneously daily with dose adjusted based on clinical response and electrolyte monitoring.

Dosage form	PELLET
Renal impairment	No specific GFR-based dose adjustments established; use with caution in renal impairment due to potential for fluid retention and hypertension.
Liver impairment	No specific Child-Pugh based dose adjustments; caution in severe hepatic impairment due to reduced metabolism and increased risk of adverse effects.
Pediatric use	0.1-0.3 mg/kg intramuscularly or subcutaneously daily, divided every 12-24 hours, with titration based on clinical response.
Geriatric use	Initiate at lower end of adult dose (1 mg daily) with careful monitoring for fluid overload and electrolyte disturbances due to age-related renal and cardiovascular changes.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for PERCORTEN (PERCORTEN).

Breastfeeding	Corticosteroids are excreted in breast milk in small amounts. Desoxycorticosterone pivalate specific data are lacking. M/P ratio not determined. At high maternal doses, monitor infant for signs of adrenal suppression. Use with caution.
Teratogenic Risk	Percorten (desoxycorticosterone pivalate) is a mineralocorticoid. Data in pregnant women are limited. In animal studies, corticosteroids have been shown to be teratogenic. Use during pregnancy only if clearly needed. First trimester: Possible increased risk of cleft palate and intrauterine growth restriction. Second and third trimesters: Potential for adrenal suppression in the fetus/newborn.

Warnings & precautions

■ FDA Black Box Warning

None

Side Effect Profile

Serious Effects

Absolute Contraindications

["Hypersensitivity to desoxycorticosterone or any component","Severe hypertension","Hyperkalemia","Edema or fluid overload states","Congestive heart failure","Severe renal impairment"]

Clinical Precautions

Precautions

May cause severe hypertension, edema, congestive heart failure, hypokalemia, or metabolic alkalosis. Monitor blood pressure, serum electrolytes, and body weight. Use with caution in patients with cardiac disease, renal impairment, or hepatic disease. Avoid excessive sodium intake.

Clinical Tips & Counseling

Drug interactions

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PERCORTEN

Clinical safety rating: caution

Comprehensive clinical and safety monograph for PERCORTEN (PERCORTEN).

How it works

What the body does with it

Metabolism	Primarily hepatic via reduction and conjugation; excreted in urine as metabolites. Desoxycorticosterone pivalate is a prodrug that is hydrolyzed to desoxycorticosterone, which is then metabolized.
Excretion	Renal (biliary/fecal negligible). Approximately 50-70% of a dose is excreted as metabolites in urine; <5% unchanged.
Half-life	Terminal elimination half-life is approximately 30-40 minutes. Clinically, the short half-life necessitates frequent dosing (e.g., every 6-12 hours) to maintain therapeutic effect in mineralocorticoid replacement.
Protein binding	Approximately 90-94% bound to albumin and corticosteroid-binding globulin (CBG).
Volume of Distribution	Vd approximately 0.5-0.8 L/kg. Clinical meaning: Distributes primarily into extracellular fluid; low Vd indicates limited tissue penetration.
Bioavailability	Oral: Approximately 50-70% (high first-pass metabolism). IM/SC: 100% (assumed).
Onset of Action	Intramuscular injection: Onset within 1-2 hours. Oral: Onset within 2-4 hours. Subcutaneous: Similar to IM, about 1-2 hours.
Duration of Action	Intramuscular: Duration of effect approximately 12-24 hours. Oral: Duration about 6-8 hours. Clinical note: Dose adjustments are guided by serum electrolytes and blood pressure response.

Classification & Brands

Dosing & administration

1-5 mg intramuscularly or subcutaneously daily with dose adjusted based on clinical response and electrolyte monitoring.

Dosage form	PELLET
Renal impairment	No specific GFR-based dose adjustments established; use with caution in renal impairment due to potential for fluid retention and hypertension.
Liver impairment	No specific Child-Pugh based dose adjustments; caution in severe hepatic impairment due to reduced metabolism and increased risk of adverse effects.
Pediatric use	0.1-0.3 mg/kg intramuscularly or subcutaneously daily, divided every 12-24 hours, with titration based on clinical response.
Geriatric use	Initiate at lower end of adult dose (1 mg daily) with careful monitoring for fluid overload and electrolyte disturbances due to age-related renal and cardiovascular changes.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for PERCORTEN (PERCORTEN).

Breastfeeding	Corticosteroids are excreted in breast milk in small amounts. Desoxycorticosterone pivalate specific data are lacking. M/P ratio not determined. At high maternal doses, monitor infant for signs of adrenal suppression. Use with caution.
Teratogenic Risk	Percorten (desoxycorticosterone pivalate) is a mineralocorticoid. Data in pregnant women are limited. In animal studies, corticosteroids have been shown to be teratogenic. Use during pregnancy only if clearly needed. First trimester: Possible increased risk of cleft palate and intrauterine growth restriction. Second and third trimesters: Potential for adrenal suppression in the fetus/newborn.

Warnings & precautions

■ FDA Black Box Warning

None

Side Effect Profile

Serious Effects

Absolute Contraindications

["Hypersensitivity to desoxycorticosterone or any component","Severe hypertension","Hyperkalemia","Edema or fluid overload states","Congestive heart failure","Severe renal impairment"]