Posology : מינונים

4.2   Posology and method of administration

The initial dosage of Celestone Chronodose suspension may vary from 0.5 to 9.0 mg per day depending on the specific disease entity being treated. In situations of less severity, lower doses will generally suffice while in selected patients higher initial doses may be required.
Usually the parenteral dosage ranges are one-third to one-half the oral dose given every 12 hours. However, in certain overwhelming, acute, life-threatening situations, administration in dosages exceeding the usual dosages may be justified and may be in multiples of the oral dosages.

The initial dosage should be maintained or adjusted until a satisfactory response is noted. If after a reasonable period of time there is a lack of satisfactory clinical response, Celestone Chronodose suspension should be discontinued and the patient transferred to other appropriate therapy.
It should be emphasized that dosage requirements are variable and must be individualized on the basis of the disease under treatment and the response of the patient.
After a favorable response is noted, the proper maintenance dosage should be determined by decreasing the initial drug dosage in small decrements at appropriate time intervals until the lowest dosage which will maintain an adequate clinical response is reached. It should be kept in mind that constant monitoring is needed in regard to drug dosage.
Included in the situations which may make dosage adjustments necessary are changes in clinical status secondary to remissions or exacerbations in the disease process, the patient’s individual drug responsiveness, and the effect of patient exposure to stressful situations not directly related to the disease entity under treatment; in this latter situation it may be necessary to increase the dosage of Celestone Chronodose suspension for a period of time consistent with the patient’s condition. If after long-term therapy the drug is to be stopped, it is recommended that it be withdrawn gradually rather than abruptly.

If coadministration of a local anesthetic is desired, CELESTONE CHRONODOSE Suspension may be mixed with 1% or 2% lidocaine hydrochloride, using the formulations which do not contain parabens. Similar local anesthetics may also be used. Diluents containing methylparaben, propylparaben, phenol, etc., should be avoided since these compounds may cause flocculation of the steroid. The required dose of CELESTONE CHRONODOSE Suspension is first withdrawn from the ampule into the syringe. The local anesthetic is then drawn in, and the syringe shaken briefly.
Do not inject local anesthetics into ampule of Celestone Chronodose suspension.

Bursitis. Tenosynovitis, Peritendinitis. In acute subdeltoid, subacromial, olecranon, and prepatellar bursitis, one intrabursal injection of 1.0 ml Celestone Chronodose suspension can relieve pain and restore full range of movement. Several intrabursal injections of corticosteroids are usually required in recurrent acute bursitis and in acute exacerbations of chronic bursitis. Partial relief of pain and some increase in mobility can be expected in both conditions after one or two injections. Chronic bursitis may be treated with reduced dosage once the acute condition is controlled. In tenosynovitis and tendonitis, there or four local injections at intervals of one to two weeks between injections are given in most cases.
Injections should be made into the affected tendon sheaths rather than into tendons themselves. In ganglions of joint capsules and tendon sheaths, injections of 0.5 ml directly into the ganglion cysts has produced marked reduction in the size of the lesions.

Rheumatoid arthritis and osteoarthritis. Following intra-articular administration of 0.5 to 2.0 ml of Celestone Chronodose suspension, relief of pain, soreness, and stiffness may be experienced. Duration of relief varies widely in both diseases.

Intra-articular Injection - Celestone Chronodose suspension is well tolerated in joints and periarticular tissues. There is virtually no pain on injection, and the “secondary flare” that sometimes occurs a few hours after intra-articular injection of corticosteroids has not been reported with CELESTONE CHRONODOSE Suspension. Using sterile technique, a 20- to 24-gauge needle on an empty syringe is inserted into the synovial cavity, and a few drops of synovial fluid are withdrawn to confirm that the needle is in the joint.
The aspirating syringe is replaced by a syringe containing Celestone Chronodose suspension and injection is then made into the joint.

Recommended Doses for Intra-articular Injection

Size of joint                                 Location                      Dose (ml) Very Large                                    Hip                           1.0-2.0 Large                                         Knee, Ankle, Shoulder         1.0 
Medium                                        Elbow, Wrist                  0.5-1.0 Small
(Metacarpophalangeal,
Interphalangeal)                          Hand,                         0.25-0.5 (Sternoclavicular)                        Chest

A portion of the administered dose of Celestone Chronodose suspension is absorbed systemically following intra-articular injection. In patients being treated concomitantly with oral or parenteral corticosteroids, especially those receiving large doses, the systemic absorption of the drug should be considered in determining intra- articular dosage.

Dermatologic conditions: In intralesional treatment, 0.2 ml/sq. cm. of Celestone Chronodose suspension injected intradermally (not subcutaneously) using a tuberculin syringe with a 25- gauge, ½-inch needle. Care should be taken to deposit a uniform depot of medication intradermally. A total of no more than 1.0 ml at weekly intervals is recommended.

Disorders of the foot: A tuberculin syringe with a 25-gauge, ¾-inch needle is suitable for most injections into the foot. The following doses are recommended at intervals of three days to a week.

Celestone Chronodose

Diagnosis                                                                    Suspension Dose (ml)
Bursitis
Under heloma durum or heloma molle                                             0.25-0.5 Under calcaneal spur                                                                0.5 Over hallux rigidus or digiti quinti varus                                          0.5 Tenosynovitis, periostitis of cuboid                                                   0.5 Acute gouty arthritis                                                              0.5-1.0