Tell your doctor before starting the medicine if you: Hydrocortisone tablets come as standard or slow-release tablets. What, if anything, makes your symptoms better? If you do have low cortisol due to adrenal dysfunction is hydrocortisone something you should consider? Hydrocortisone is instrumental for immune system function A deficiency of itis the major reason why many people cannot stop getting repeated colds and flus. Monitor growth velocity and development in pediatric patients, Monitor intraocular pressure if therapy is continued for more than 6 weeks; regular eye exams should be encouraged, Routine laboratory studies (including 2-hour postprandial blood glucose and serum potassium), blood pressure, weight, bone mineral density, and chest x-rays should be performed at regular intervals for patients on long-term corticosteroid therapy, Monitor for hypothalamic-pituitary-adrenal (HPA) axis suppression, Cushing's syndrome, and hyperglycemia with chronic steroid users. ACTH tells the adrenal glands to make cortisol. I would be interested to hear from anyone who has treated their adrenal issues by this method with any advice if pos. You could be having a serious allergic reaction and may need immediate treatment in hospital. information submitted for this request. Although small, these glands control much of what happens in the body. Is my condition likely temporary or long-lasting? These are present in Addisons, but not in the case of adrenal dysfunction. Follow with: Infants: 1 to 5 mg/kg IV/IO every 6 hours. Visit Yellow Card for further information. REFS: Jefferies, William McK. What, if anything, makes your symptoms worse? If you start taking the combined pill your dose of hydrocortisone may need adjusting. We comply with the HONcode standard for trustworthy health information. Avoid being near people who are sick or have infections. For Addison's disease, questions might include: Don't hesitate to ask other questions as well. Patients should be closely monitored for signs requiring dose adjustments; if therapy is to be stopped after more than a few days, it should be gradually withdrawn. So two common signs of a deficiency are low blood pressure, which manifests as dizziness, and low blood sugar, which manifests as fatigue. If a beneficial response is not achieved within a couple of days, treatment should be discontinued and an alternative therapy considered. the unsubscribe link in the e-mail. The card is the size of a credit card so it fits into your wallet or purse. Try to remember to take your tablets every day. Mayo Clinic is a not-for-profit organization. Mayo Clinic; 2022. Hydrocortisone is also used in the treatment of certain cancers such as leukemia, lymphoma, and multiple myeloma. health information, we will treat all of that information as protected health You may report side effects to FDA at 1-800-FDA-1088. It's 4 times weaker than another widely used steroid called prednisolone. This includes mental fatigue, along with a decreased ability to concentrate, remember, and focus. Some treatments include oral corticosteroids such as: You likely need plenty of salt in your diet. This is because the adrenal gland itself is not broken and the body desperately trying to regulate itself. If you are interested in safe and/or natural treatments, please contact us at Integrative Health today (Click Here). People with Addison's disease are more likely than are other people to have another autoimmune disease as well. This content does not have an Arabic version. Hydrocortisone tablets are a type of medicine known as a steroid(or corticosteroid). Located on top of each kidney, the adrenal glands make hormones that help regulate metabolism, the immune system, blood pressure and other important functions. information and will only use or disclose that information as set forth in our notice of Adrenal insufficiency. Can you put hydrocortisone cream on hemorrhoids? Swallow the mixture right away without chewing. For example: 10mg before getting out of bed in the morning, 5mg at mid-day and 5mg no later than 6pm. Tell your doctor if you get an infection, such as coronavirus (COVID-19), or if you come into contact with anyone who has. Too little will not work. Oct. 17, 2022. 10 mg hc and 1mg pred at noon. McGraw Hill; 2023. https://accessmedicine.mhmedical.com. Safe Uses of Cortisol, 3rd Edition 2004, Charles C. Thomas, Publisher, Ltd. 2600 South First Street, Springfield, IL 62704. It is at this point that the stressors become overwhelming, and the body loses its potential to heal. You could also ask your pharmacist for advice on other ways to remember your medicine. Make a donation. This means that if you take hydrocortisone, you may be more likely to get infections than a person who is not taking it. only correct dose is dose that makes YOU feel better, there is not one formula for all. General Enquiries: Hydrocortisone (HC) is a steroid hormone produced by the adrenal gland. Are there other steroid tablets available? In the case of true adrenal disease, prescribing hydrocortisone is imperative as your body is unable to make cortisol itself due to the actual gland being faulty1,5,6. When cortisol is prescribed it should only be done so in patients with a proven deficiency - 5-10mgs (rarely 15mgs . Generic name: hydrocortisone (oral) [HYE-droe-KOR-ti-sone] If you have adrenal insufficiency (low adrenal function or adrenal fatigue), you may be producing much less and have symptoms as a consequence. Support our work! If you've never had these illnesses they could make you very ill. Tell your doctor straight away if you come into contact with someone who has chickenpox, shingles or measles. After long-term therapy, this drug should be gradually withdrawn. Hydrocortisone tablets are a type of medicine known as a steroid (or corticosteroid). Nippoldt TB (expert opinion). http://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/adrenal-disorders/addison-disease. You should not stop taking hydrocortisone suddenly. So if you have any of the symptoms Ive mentioned here, talk to your doctor about hydrocortisone therapy. Advertising revenue supports our not-for-profit mission. I have just received my adrenal saliva test results from Dr Myhill. However, with persistent stress, for example a long-term illness, the adrenal glands will often become exhausted, and will not be able to keep up with the bodys needs. This is going to be a very tactic. Recommendations from the International Guidelines for Management of Severe Sepsis and Septic Shock 2016: 100 mg IV every 8 hours during surgical period; dose should be rapidly reduced within 24 hours after surgery It is important not to under dose during an adrenal crisis. There are many medicines that can affect the way hydrocortisone tablets work. The investigators hypothesize that withholding hydrocortisone during the peri-operation in patients with pituitary adenomas whose hypothalamus pituitary adrenal axis are intact are safe. Too little ACTH can cause the adrenal glands to make too little glucocorticoids and androgens. Fifty-six batches containing 1125 capsules were evaluated. It may not be as simple as low cortisol either. Clinical manifestations of adrenal insufficiency in adults. Keep taking the medicine, but tell your doctor if the side effects bother you or don't go away: Serious side effects are rare and happen in less than 1 in 1,000 people. Many drugs can affect hydrocortisone, especially: birth control pills or hormone replacement therapy; a blood thinner such as warfarin (Coumadin, Jantoven); or. The strength your doctor prescribes depends on what condition is being treated and how your body responds. Conclusions: Compounded medication is a possible cause of variation of steroid doses in children with adrenal insufficiency or . Find out more about other ways you can use hydrocortisone to treat different health problems. However, using this medicine during pregnancy may cause a hormone deficiency in the newborn. Hydrocortisone is not a drug, it is a hormone. Hydrocortisone comes as 5mg, 10mg and 20mg tablets. Is instrumental in energy production Without it, the body would not be able to produce the energy it needs to live, and it would quickly die. 2014;383(9935):2152-2167. doi:10.1016/S0140-6736(13)61684-0, 2. For these people, the first step in restoring health must be to support adrenal hormone output. Ask a doctor if it is safe to breastfeed while using this medicine. Lancet. Youll usually take them 2 or 3 times a day. If youre taking a total dose of more than 160mg of hydrocortisone each day for a long time, your baby may need extra monitoring. prednisone, albuterol, dexamethasone, methylprednisolone, triamcinolone, hydrocortisone, budesonide, Humira, epinephrine, Medrol. Hydrocortisone is also used to replace steroids in people with adrenal insufficiency (decreased production of natural steroids by the adrenal glands). Hydrocortisone is a synthetic form of cortisol that can be used for adrenal fatigue. Hydrocortisone is also used to replace steroids in people with adrenal insufficiency (decreased production of natural steroids by the adrenal glands). Can you use hydrocortisone cream on babies? Curtis JR, Westfall AO, Allison J, et al. Common side effects of hydrocortisone may include: thinning skin, bruising or discoloration; This is not a complete list of side effects and others may occur. AskMayoExpert. Best Pract Res Clin Endocrinol Metab. There are different types of hydrocortisone, including skin treatments and injections. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. 21.4% of the batches revealed insufficiency in uniformity of net mass or drug content and additional 3.6% failed because they did not contain the labelled drug. Why do I need to be careful of infections? It relieves inflammation (swelling, heat, redness, and pain) and is used to treat certain forms of arthritis; skin, blood, kidney, eye, thyroid, and intestinal . The immediate release outer coating provides physiological cortisol concentrations within 20 minutes of intake; the extended release core provides a smooth serum cortisol level with reduced exposure in the late afternoon and over the 24-hour period. Patients on immunosuppressant doses of corticosteroids should understand that a greater risk of infection exists; they should avoid exposure to chickenpox or measles and if exposed, they should consult their healthcare professional promptly. Lifestyle changes are also needed in order to heal adrenal fatigue. Corticosteroids are not the same as anabolic steroids. Barthel A, et al. World Alliance of Pituitary Organisations, Adrenal Insufficiency - Emergency Information, Hydrocortisone advice for the pituitary patient, purchase and wear a medical necklace or bracelet, such as MedicAlert, Hydrocortisone advice for parents leaflet, Hydrocortisone advice pituitary patient leaflet, Hydrocortisone factsheet for ambulance personnel, Living with diabetes insipidus - for teenagers, Male hormones and infertility issues booklet, Pituitary surgery and radiotherapy booklet, Psychological impact of a pituitary condition booklet, To A&E and Hospital staff - Adrenal Insufficiency, To A&E and Hospital staff - Diabetes Insipidus, How to give an emergency injection of Hydrocortisone. Take a family member or friend with you to help you remember the information you get. McGraw Hill; 2023. https://accessmedicine.mhmedical.com. Further, we can provide you with a Pituitary Foundation Patient Care Card which is small enough to fit in yourbag, or pocket and displays your hydrocortisone needs and information on emergency replacement should you need this. Like all medicines, hydrocortisone tablets can cause side effects although not everyone gets them. What websites do you recommend? Replacement therapy is also required for people who have congenital adrenal hyperplasia, which is a birth defect. http://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/adrenal-disorders/addison-disease. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. ACTH is a signal from the brain to the adrenal glands. Nippoldt TB (expert opinion). and now she is showing weakness Sister viagra without a prescrip How can you call me a sister Do you know the rules This is how Zhong Zuo taught you rules.It took . Hahner S, Allolio B. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. Addison's disease is caused by damage to the adrenal glands. Is often needed on a continuous basis In many cases, after a combination of using hydrocortisone for several months, along with eliminating the stresses that depleted the adrenal gland in the first place, the adrenal gland will be able to manufacture enough hydrocortisone by itself, and there will be no need to continue taking the hormone. Follow with: Dosing should be individualized on the basis of disease and patient response, Use with caution; no dose adjustments recommended. You can do this by asking if hes ever prescribed it and what kind of success hes seen. blurred vision burning, dry, or itching eyes decrease in the amount of urine discharge, excessive tearing dizziness dry mouth ear congestion fast, slow, pounding, or irregular heartbeat or pulse fever headache irregular heartbeats irritability mental depression mood changes noisy, rattling breathing numbness or tingling in the arms or legs When do I know that I would need an emergency injection? Petrkov J, Pura M, Lazrov I. Antibodies to Gonadal and Adrenal Tissue. Will you donate 2 now to help fund our publications? This is usually the result of an autoimmune disease, in which the body attacks itself. 66th ed. This includes prescription and over-the-counter medicines, vitamins, and herbal products. However, people with secondary adrenal insufficiency don't have darkened skin and are less likely to have severe dehydration or low blood pressure. You may take hydrocortisone tablets if your body does not make enough cortisol for example if you have Addison's disease or if you've had your adrenal glands taken out. For Plenadren, the dose must be increased temporarily and your doctor may advise you to use other hydrocortisone tablets instead of, or in addition to Plenadren. 32 patients met our strict criteria for chronic fatigue syndrome without co-morbid psychiatric disorder. HypothalamicPituitaryAdrenal Suppression. All rights reserved. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. Check with your doctor immediately if any of the following side effects occur while taking hydrocortisone: More common Aggression anxiety blurred vision burning, dry, or itching eyes decrease in the amount of urine discharge, excessive tearing dizziness dry mouth ear congestion fast, slow, pounding, or irregular heartbeat or pulse fever headache 2003;361(9372):1881-1893. doi:10.1016/S0140-6736(03)13492-7, 3. Papadakis MA, et al., eds. The daily dose of Plenadren may have to be doubled or tripled in milder conditions such as a mild infection or stress. Q&A Hydrocortisone side effects and how to improve adrenal function http://drchristian.com/blogDr. If you take hydrocortisone tablets because you have been diagnosed with Addisons disease or adrenal insufficiency, you will need to carry a steroid emergency card. If you stop taking hydrocortisone tablets suddenly it may cause your symptoms to come back. Acute adrenal failure can lead to life-threatening shock. Sometimes it is not safe to use certain medications at the same time. Grapefruit can change the way hydrocortisone works and increases the risk of side effects. This includes prescription medicines and ones that you buy such as paracetamol and ibuprofen. Get Pain Relief With the Most Common Arthritis Medications, Hydrocortisone systemic 20 mg (West-Ward 254). Addison's disease, also called adrenal insufficiency, is an uncommon illness that occurs when the body doesn't make enough of certain hormones. This will help them spot any slowing down of your child's growth and change their treatment if needed. Mayo Clinic does not endorse companies or products. The key to maintaining this balance is the hormone hydrocortisone. When you are prescribed your medication you will be given a blue steroid card from the hospital to carry. Mayo Clinic on Incontinence - Mayo Clinic Press, NEW Mayo Clinic on High Blood Pressure - Mayo Clinic Press, Mayo Clinic on Hearing and Balance - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Book: Mayo Clinic Family Health Book, 5th Edition, Newsletter: Mayo Clinic Health Letter Digital Edition. What is likely causing my symptoms or condition? Over many years hydrocortisone can have several harmful effects on your body. If giving this medicine to a baby, give infant formula or breast milk. You may have heard of hydrocortisone by a different name: cortisol. You may need a higher dose of hydrocortisone for a while. Applies to the following strengths: 10 mg; 20 mg; acetate 50 mg/mL; sodium phosphate 50 mg/mL; 1000 mg preservative-free; 100 mg preservative-free; 5 mg; 250 mg preservative-free; 500 mg preservative-free; cypionate 10 mg/5 mL; 100 mg; 250 mg; 500 mg; 1 g; 10%; 100 mg/60 mL; acetate 25 mg/mL; acetate; hemisuccinate; sodium phosphate; 0.5 mg; 1 mg; 2 mg, Acute Adrenal Crisis: If you take hydrocortisone tablets because your body cannot make enough cortisol (if you have Addisons disease, for example), youll usually need to take them for the rest of your life. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. This is a medical emergency called an adrenal crisis. National Institute of Diabetes and Digestive Health and Kidney Disease. 8. Administration advice: Accessed Oct. 14, 2022. https://www.uptodate.com/contents/search. Hydrocortisone is available as tablets under the trade name Hydrocortisone, containing 10mg or 20mg. Not tolerating oral medication due to gastroenteritis or trauma: 50 mg/m2 IM or estimate (e.g., infants: 25 mg; school-age: 50 mg; adolescents 100 mg), Minor to moderate surgical stress: 50 mg/m2 IM or double or triple oral replacement dose, Major surgery with anesthesia, trauma, delivery, or ICU care: 50 mg/m2 IM followed by 50 to 100 mg/m2 IM in divided doses every 6 hours; rapidly taper and switch to oral regimen as soon as clinical state allows, Initial dose: 0.56 to 8 mg/kg/day oral or IV in 3 or 4 divided doses (20 to 240 mg/m2/day), Increased doses may be needed during periods of stress (e.g., surgery, infection, trauma) or, exacerbations of condition, Dose reductions should occur once an adequate response is obtained. Make sure youre talking to a doctor who understands the proper use of this hormone. Adrenal insufficiency and Addison's disease. 2009;23(2):167-179. doi:10.1016/J.BEEM.2008.09.009, 6. Not all possible drug interactions are listed here. Find out more about other ways you can use hydrocortisone to treat different health problems, Visit Yellow Card for further information, read this leaflet on steroids on the Best Use of Medicines in Pregnancy (BUMPs) website, Addison's Disease Self-Help Group: charity, Pituitary Foundation: patient support organisation, Who can and cannot take hydrocortisone tablets, How and when to take hydrocortisone tablets, How to cope with side effects of hydrocortisone, Common questions about hydrocortisone tablets. For safety, tell your doctor if you're trying to get pregnant, are already pregnant or if you're breastfeeding. How to administer an emergency HC injection > Do you have symptoms all the time or only sometimes? If your adrenal glands are not making enough cortisol, hydrocortisone tablets work by replacing the hormone and bringing your levels up to normal. An addisonian crisis is a medical emergency. If you cannot absorb your tablets, or your usual replacement wasnt sufficientfor an acute shock or illness, then gradually or perhaps quite quickly, youwould feel weak, sickly and light headed. How long does it take for neomycin, polymyxin b and hydrocortisone ear drops to work? The adrenal glands sit on top of your kidneys. In Addison's disease, the adrenal glands make too little cortisol and, often, too little of another hormone, aldosterone. Medical concerns? The usual dose for hydrocortisone is 15-20mg by mouth, split over twoor three times daily, and depending on your individual endocrinologists recommendations. Addison disease. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. Take with food if hydrocortisone upsets your stomach. Hydrocortisone should ideally be taken with water and is better absorbed if taken before food. Do not break or crush the tablets, as they will not work properly. Your body will be unable to produce a hormone normally produced in stress situations such as being unwell or receiving dental treatment. Inactive vaccinations, like the injected flu vaccine, are safe. Keep away from people with an infectious disease, especially chickenpox, shingles or measles. These conditions can be serious or even fatal in people who are using hydrocortisone. Prednisolone is available as tablets under the trade name Deltacortrilcontaining 2.5mg or 5mg or Prednisolone 1mg or 5mg. They are also available as a soluble tablet that you dissolve in water before use. Patients should understand that during times of stress, such as surgery or infection, additional supplementation doses may be necessary; they should discuss with their healthcare professional whether they need to carry a medical identification card that identifies their corticosteroid use. Clinical manifestations of adrenal insufficiency in adults. Hydrocortisone suppresses, or lowers, your immune system. Hydrocortisone (HC) is a steroid hormone produced by the adrenal gland. Third, they falsely believe that a deficiency of hydrocortisone is rare. Follow your doctor's dosing instructions very carefully. Steroids can weaken your immune system, making it easier for you to get an infection or worsening an infection you already have. Chances are if you are feeling fatigued it probably isnt Addisons disease, but to confirm physicians run lab testing. Many doctors and pharmacists mistakenly equate itwith steroid drugs like prednisone. Wilson, Jean, MD and Daniel Foster, MD (editors). Nieman LK. Elderly: The serious consequences of corticosteroid side effects should be carefully considered when initiating therapy. Patients should check with their healthcare provider before receiving any vaccinations. Is instrumental for thyroid metabolism The thyroid hormones cannot function without enough it. Hydrocortisone tablets work as a hormone replacement for a natural hormone called cortisol. This would include things such as: Addisons cortisol is always low1. Hydrocortisone, a corticosteroid, is similar to a natural hormone produced by your adrenal glands. The eligible patients received consecutive treatment with low-dose hydrocortisone (5 mg or 10 mg daily) for 1 month and placebo for 1 month; the order . Continue reading, Cortef, Solu-Cortef, Cortenema, Cortifoam, +3 more. no side f/x 20 yrs. Tell your doctor if you are pregnant or plan to become pregnant. But if your body cannot make enough, then the appropriate dose will dramatically improve your health. Take them in the morning, around half an hour before breakfast. 2009;23(2):147-157. doi:10.1016/j.beem.2008.09.004, 4. Use of these hormone supplements can help people get out of a severe state of adrenal dysfunction, and are life saving for those with Addison's disease. Hydrocortisone systemic 20 mg (West-Ward 254). Glucocorticoid replacement therapy should be adjusted based on clinical response. Hydrocortisone is also used to replace steroids in people with adrenal insufficiency (decreased production of natural steroids by the adrenal glands). Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. An addisonian crisis is a life-threatening situation that results in low blood pressure, low blood levels of sugar and high blood levels of potassium. 2023 HealthyDoctors Teach You How To Be Healthy, Glucosamine and Chondroitin Continue To Be Attacked By Conventional Medicine. Wear a medical alert tag or carry an ID card to let others know you use steroid medication. Hydrocortisone may cause serious side effects. Accessed Oct. 14, 2022. If you need emergency treatment, this will tell medical staff about your condition and how to treat you. If you're taking hydrocortisone tablets for Addison's disease, it's important to carry on taking the medicine throughout pregnancy. The Pituitary Foundation suggests that you purchase and wear a medical necklace or bracelet, such as MedicAlerttoshow your cortisol replacement therapy. Oral Viagra (known generically as sildenafil), which has been approved for use in men since 1998, is a vasodilator that increases blood flow to the penis leading to an erection. Adrenal insufficiency (adult). How can I best manage them together? It is also the single most common cause of allergies and chronic infections. Can you put hydrocortisone cream on hemorrhoids? "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. So when hydrocortisone levels are low, some of the first symptoms reflect decreased brain metabolism. Do not take two doses at one time. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. HealthyDoctors Heroes Journey Questions Help You Have a Healthy Outlook On Your Life, Understanding PTSD Part 60: Adrenal Exhaustion Responds Well To Correct Treatments, Understanding PTSD Part 59: Fingernails, Toenails & Tongue Show Health Or Disease. Always follow the instructions that come with your medicine. Call your doctor for medical advice about side effects. Most patients with PAI will require mineralocorticoid supplementation. You can also see a lecture I gave on hydrocortisone and adrenal function by going to the video page of the clinic website www.antiagingmedicine.com. If you forget to take a dose, take it as soon as you remember. Do You Need Hydrocortisone For Low Adrenals? Other causes of adrenal gland failure may include: The pituitary gland makes a hormone called adrenocorticotropic hormone (ACTH). Drug class: Glucocorticoids. Merck Manual Professional Version. Damage to these glands results in too little of the hormone cortisol and, often, the hormone aldosterone. Do not stop taking hydrocortisone tablets without talking to your doctor. Seek emergency treatment for the following: See a health care provider if you have common symptoms of Addison's disease, such as: There is a problem with If you need any medical or dental treatment, show your steroid card to the doctor or dentist. This product is available in the following dosage forms: Lotion Tell anyone who is giving you medical or dental treatment that you're taking hydrocortisone tablets. Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. other information we have about you. For the treatment of primary adrenocortical insufficiency, first dose should be taken in the morning at awakening and the last dose approximately 4 to 6 hours before bed, IV: Administer over 30 seconds (e.g., 100 mg) to 10 minutes (e.g., 500 mg or more); may also administer by IV infusion, Shake container vigorously for 5 to 10 seconds before use; do not remove container cap during use, With container upright, gently place tip of applicator onto the nose of the container cap; pull plunger past fill line on the applicator barrel, Fill applicator barrel by pressing down firmly on cap flanges, hold for 1 to 2 seconds and release; pause 5 to 10 seconds to allow foam to expand in barrel; repeat until foam reaches fill line; remove applicator from container cap (allow some foam to remain on applicator tip), Hold applicator firmly by barrel; gently insert tip into anus; once in place push plunger to expel foam, then withdraw applicator, Apply to anus only with the enclosed applicator; do not insert any part of aerosol container directly into the anus, Dissemble and rinse after each use to prevent foam build-up and possible blockage, Shake bottle well to ensure suspension is homogeneous, Remove protective sheath from applicator tip; hold the bottle up so as not to lose any medication, Assume correct body position (see illustrations on labeling), Insert lubricated applicator tip into rectum; it should tilt slightly towards back; squeeze slowly to instill medication, Remain in position for at least 30 minutes to allow thorough distribution of medication; retain enema all night if possible, Store at room temperature; do not refrigerate; do not autoclave as steroids are sensitive to heat, Consult manufacturer product information for reconstitution and stability information, Rectal Foam with applicator: Store upright; when used correctly the container will deliver a minimum of 14 applications.