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    Fludrocortisone (Florinef) is used for its mineralocorticoid activity (causing increased reabsorption of sodium and loss of potassium/hydrogen). Although fludrocortisone technically possesses a small degree of anti-inflammatory activity (1/10th that of hydrocortisone), this effect is negibile at normal therapeutic doses of fludrocortisone (such as 0.05 to 0.2 mg per day). For this reason, fludrocortisone cannot realistically be converted to another corticosteroid on the basis of anti-inflammatory potency. The effects of GCs are widespread and include alterations in carbohydrates (increased blood glucose levels), stimulation of amino acid release, maintenance of fluid and electrolyte balance, preservation of normal cardiovascular system function, immune system suppression, and decreased bone formation. They should not be confused with muscle-building anabolic steroids (eg, testosterone). 8 Glucocorticoids (GCs), often referred to as corticosteroids, systemic steroids, or steroids, primarily are synthetic, biologically active derivatives of the cortisol secreted by the adrenal cortex. Indications GCs possess potent anti-inflammatory properties and are used to treat a variety of inflammatory and autoimmune disorders, placing them among the most frequently prescribed classes of drugs. In the United States, GCs are prescribed to 1 million patients per year, with approximately 2.5% of patients between the ages of 70 and 79 estimated as using them.1 Conditions commonly treated with steroids include asthma; arthritis (eg, rheumatoid arthritis); autoimmune disorders such as irritable bowel syndrome, lupus, and multiple sclerosis; skin conditions such as eczema and rashes; some types of cancer; and Addison’s disease (insufficient cortisol production) as well as the prevention of organ rejection in transplant recipients.2 Steroid Formulations The American Academy of Allergy, Asthma, and Immunology website provides useful online drug guides that include information on many of the most commonly available steroid products and formulations ( Oral formulations of steroids, such as prednisone (Deltasone), prednisolone (Prelone), dexamethasone (Decadron), and methylprednisolone (Medrol), typically are used to treat inflammation and pain associated with chronic conditions such as rheumatoid arthritis and lupus.3 Some steroids formulated for injection or IV infusion include methylprednisolone (Solu-Medrol) and dexamethasone (Dexasone). Steroids also may be injected directly into affected joints to reduce inflammation (synovitis).

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