Cortisone Acetate
11-dehydro-17-hydroxycorticosterone acetate
Also known as: acetato de cortisona · compound E acetate · acétate de cortisone · cortisoni acetas · 11-dehydro-17hydroxycorticosterone acetate
Reviewed by the VetSheet Veterinary TeamUpdated Apr 5, 2026Evidence-based veterinary reference
Doses are a clinical reference for licensed veterinary professionals. Always confirm against the current label and the individual patient.
Dosing by species
🌎 NA — North America🌍 EU — Europe
Dogs
| Indication | Dose | Route | Frequency | Duration | Region |
|---|---|---|---|---|---|
| Long-term treatment of hypoadrenocorticism (changeover period) | 0.5-1 mg/kg PO q12-24h | PO | q12-24h | Initial stabilization | 🌎 NA |
| Long-term treatment of hypoadrenocorticism (maintenance) | 0.5 mg/kg PO q12-24h | PO | q12-24h | Long-term | 🌎 NA |
- Long-term treatment of hypoadrenocorticism (changeover period): Used initially with a semi-selective mineralocorticoid (fludrocortisone).
- Long-term treatment of hypoadrenocorticism (maintenance): Provides adequate additional glucocorticoid supplementation once stable.
Doses are a clinical reference for licensed veterinary professionals. Always confirm against the current label and the individual patient.
Overview
Cortisone acetate is an oral corticosteroid that possesses both glucocorticoid and mineralocorticoid effects.
Key clinical highlights:
- Prodrug Nature: It is biologically inactive until converted in vivo to cortisol (hydrocortisone) by the liver.
- Addison's Disease Management: It serves as a potential alternative to prednisolone for the oral treatment of hypoadrenocorticism (Addison's disease) in dogs. Because it provides both glucocorticoid and mineralocorticoid activity, it may reduce the dosage requirements for primary mineralocorticoid drugs (like fludrocortisone), potentially lowering overall treatment costs.
- Controversy: Its use in veterinary medicine is relatively uncommon, and whether its increased mineralocorticoid activity offers a clinically significant benefit over standard prednisolone therapy remains debated among endocrinologists.
- Safety Profile: When used at physiologic replacement doses for Addison's disease, it is generally very well tolerated. Supra-physiologic doses will induce typical corticosteroid adverse effects (e.g., PU/PD/PP, panting, immunosuppression).
Mechanism of action
Cortisone acetate is a prodrug. Upon oral absorption, it undergoes first-pass hepatic metabolism where the enzyme 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) converts it into the active hormone, cortisol.
- Glucocorticoid Action: Cortisol diffuses across cell membranes and binds to cytosolic glucocorticoid receptors (GR) → the receptor-ligand complex translocates to the nucleus → binds to glucocorticoid response elements (GREs) on DNA → alters gene transcription (transactivation of anti-inflammatory proteins and transrepression of pro-inflammatory cytokines).
- Mineralocorticoid Action: Cortisol also binds to mineralocorticoid receptors (MR) in the distal renal tubules → promotes sodium retention and potassium excretion, which is critical for patients with hypoadrenocorticism.
Safety & warnings
Contraindications
- Hypersensitivity to cortisone acetate
- Systemic fungal infections (general corticosteroid contraindication)
Adverse effects
- Vomiting
- Inappetence
- Diarrhea
- Hypersensitivity reactions (rare)
- Polyuria/Polydipsia/Polyphagia (at supra-physiologic doses)
- Panting (at supra-physiologic doses)
- Immunosuppression (at supra-physiologic doses)
Precautions
Laboratory Interference: Cortisone cross-reacts with cortisol in the ACTH stimulation test. Baseline testing must be performed before administering cortisone (Note: Dexamethasone does not cross-react).
- Pregnancy: FDA Category C. Excessive dosages early in pregnancy may lead to teratogenic effects. Glucocorticoids are necessary for normal fetal development, but high doses should be avoided.
- Nursing: Unbound glucocorticoids enter milk. High doses or prolonged use may inhibit the growth of nursing newborns.
- Supra-physiologic Doses: If used at higher than physiologic replacement doses, standard corticosteroid precautions apply (risk of iatrogenic Cushing's, immunosuppression, GI ulceration).
Drug interactions
Concomitant use may cause hypokalemia; risk of CHF and cardiac enlargement reported in humans.
Glucocorticoids may reduce salicylate blood levels and increase risk for GI ulceration/bleeding.
Concomitant administration may cause hypokalemia.
May potentiate the effects of hydrocortisone/glucocorticoids.
Insulin requirements may increase due to glucocorticoid-induced insulin resistance.
May alter steroid metabolism; higher doses of steroids may be needed to treat mitotane-induced adrenal insufficiency.
Increased risk of gastrointestinal ulceration and bleeding.
Virus replication may be augmented if given at immunosuppressive doses; diminished immune response to killed vaccines/toxoids.
May affect INR values; requires monitoring.
Monitoring
- Weight, appetite, signs of edema
- Serum and/or urine electrolytes (Na+, K+)
- Total plasma proteins, albumin
- Blood glucose
- Growth and development in young animals
- ACTH stimulation test (Note: Cortisone cross-reacts with cortisol assays; must test before administration)
Pharmacokinetics
Absorption
Absorbed orally. Oral bioavailability in humans ranges widely but is approximately 50%.
Distribution
Unbound glucocorticoids enter milk. Distributes widely to tissues.
Metabolism
Rapidly converted to the active hormone cortisol in vivo.
Elimination
Excreted primarily via the kidneys after hepatic metabolism.
Overdose
Acute ingestion is rarely a clinical problem, and severe clinical effects are unlikely with a single acute overdose. However, neuropsychiatric effects can occur. Cardiac arrhythmias and anaphylaxis are theoretically possible but very rare. Treatment is generally supportive.
Available products
Formulations
- Oral Tablets
Human-labeled
- Cortisone Acetate Oral Tablets: 25 mg
Regulatory status
No regulatory data for: 🇺🇸 US · 🇪🇺 EU · 🇬🇧 UK · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
Storage & stability
Store tablets in well-closed containers at a temperature less than 40°C, preferably at room temperature (15-30°C).
Client information
- Strict Adherence: It is critical to give this medication exactly as prescribed. Do not stop the medication abruptly, as this can trigger a life-threatening Addisonian crisis.
- Adverse Effects: Watch for signs of stomach upset (vomiting, diarrhea, loss of appetite). If your pet is receiving higher doses, you may notice increased thirst, urination, and appetite, as well as panting.
- Veterinary Visits: Keep all scheduled appointments for blood work (electrolytes) to ensure the dose is correct for your pet's needs.
- Stressful Events: Contact your veterinarian if your pet is facing a stressful event (surgery, boarding, illness), as their dose may temporarily need to be increased.
VetSheet drug reference is intended for licensed veterinary professionals as a clinical decision-support aid, not a substitute for professional judgement or the manufacturer’s current label.