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Hydrocortisone information from DrugsUpdate  

See Available Brands of Hydrocortisone in India

P - Caution when used during pregnancy
L - Caution when used during lactation
FI - Food *

Hydrocortisone is the most well-known of the natural metabolic intermediary of cortisols. Cortisol is corticosteroid hormone or glucocorticoid produced by zona fasciculata of the adrenal cortex, which are a part of the adrenal gland. It is usually referred to as the "stress hormone" as it is involved in response to stress and anxiety, controlled by CRH. It increases blood pressure and blood sugar, and reduces immune responses. Various synthetic forms of cortisol are used to treat a variety of different illnesses. When first introduced as a treatment for rheumatoid arthritis, hydrocortisone was referred to as Compound E.

Pharmacodynamics

Pharmacokinetics

Hydrocortisone is a corticosteroid used for its anti-inflammatory and immunosuppressive effects. Its anti-inflammatory action is due to the suppression of migration of polymorphonuclear leukocytes and reversal of increased capillary permeability. It may also be used as replacement therapy in adrenocortical insufficiency.

Absorption
Readily absorbed from the GI tract (oral); sodium phosphate and sodium succinate esters are rapidly absorbed but the free alcohol and its lipid soluble ester are slowly absorbed (IM); Acetate is slowly absorbed (intra-articular inj); absorbed from the skin (denuded areas).

Distribution
Crosses the placenta. Protein-binding: >90%.

Metabolism
Hepatic (metabolised to hydrogenated and degraded forms).

Excretion
Via urine (as conjugates and glucuronide, with small portion as unchanged drug).

Hydrocortisone Indications / Hydrocortisone Uses

Information Not Available

Hydrocortisone Adverse Reactions / Hydrocortisone Side Effects

Sodium and fluid retention. Potassium and calcium depletion. Muscle wasting, weakness, osteoporosis. GI disturbances and bleeding. Increased appetite and delayed wound healing. Bruising, striae, hirsutism, acne, flushing. Raised intracranial pressure, headache, depression, psychosis, menstrual irregularities. Hyperglycaemia, glycosuria, DM, obesity, moon-face, buffalo hump. Suppression of pituitary-adrenocortical system. Growth retardation in childn (prolonged therapy). Increased susceptibility for infection. Topical use: Dermal atrophy, local irritation, folliculitis, hypertrichosis. Inhaled corticosteroids: May cause hoarseness, candidiasis of mouth and throat. Topical application to the eye: Can produce corneal ulcers, raised IOP and reduced visual function. Intralesional injection: Local hypopigmentation of deeply pigmented skin. Intra-articular injection: Joint damage, fibrosis esp in load bearing joints.

Potentially Fatal: Abrupt withdrawal leading to acute adrenal insufficiency. Rapid IV Injection may cause CV collapse.

Precautions

Information Not Available

Special Precautions

CHF, hypertension, DM, epilepsy, elderly, patients on prolonged therapy. Gradual withdrawal, pregnancy and lactation

Other Drug Interactions

Thiazides may enhance hyperglycaemia and hypokalaemia caused by corticosteroids. Increased incidence of peptic ulcer or GI bleeding with concurrent NSAIDs admin. Response to anticoagulants altered. Dose of antidiabetics and antihypertensives needs to be increased. Decreases serum conc of salicylates and antimuscarinic agents. Ethanol may enhance gastric mucosal irritation. Reduced efficacy with concurrent use of carbamazepine, phenytoin, primidone, barbiturates and rifampicin. Mutual inhibition of metabolism between ciclosporin and corticosteroids increase plasma conc of both drugs. Enhanced effect in women taking oestrogens or oral contraceptives.

Other Interactions

Food Interaction
Interferes with calcium absorption

Dosage

Oral
Replacement therapy in adrenocortical insufficiency
Adult: 20-30 mg daily in 2 divided doses.
Child: 400-800 mcg/kg/day, in 2-3 divided doses.

Intravenous

As supplement in adrenal insufficiency during minor surgery under general anaesthesia
Adult: In patients taking >10 mg of prednisolone or its equivalent by mouth daily. 25-50 mg at induction. Resume with usual oral corticosteroid after surgery.

Intravenous
As supplement in adrenal insufficiency during moderate or major surgery
Adult: In patients taking >10 mg of prednisolone or its equivalent by mouth daily. Usual oral corticosteroid dose on the morning of the surgery followed by 25-50 mg at induction, then similar doses of hydrocortisone tid for 24 hours after moderate surgery or 48-72 hours after major surgery. Resume oral therapy once injections are stopped.

Intravenous
Acute adrenocortical insufficiency
Adult: 100-500 mg 3-4 times/24 hr according to the severity of the condition and patient response. Fluids and electrolytes should be administered as needed to correct any metabolic disorder. Doses may also be given via IM inj but the response may be slower.
Child: <1 year: 25 mg; 1-5 years: 50 mg; 6-12 years: 100 mg. Fluids and electrolytes should be administered as needed to correct any metabolic disorder. Doses may also be given via IM injection but the response may be slower.

Topical/Cutaneous
Corticosteroid-responsive dermatoses
Adult: Apply a 0.1-2.5% cream/ointment/lotion onto affected area.

Intra-articular
Joint inflammations
Adult: As acetate: 5-50 mg depending on size of affected joint.

Injection
Soft tissue inflammation
Adult: As Na phosphate or Na succinate esters: 100-200 mg as local injection.

Food(before/after)

Should be taken with food

List of Contraindications

Hydrocortisone and Pregnancy

Caution when used during pregnancy

Category C: Either studies in animals have revealed adverse effects on the foetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the foetus.

in 1st trimester.

Category D: There is positive evidence of human foetal risk, but the benefits from use in pregnant women may be acceptable despite the risk (e.g., if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective).

Hydrocortisone and Lactation

Caution when used during lactation

Hydrocortisone and Children

Children may absorb proportionally larger amounts of topical corticosteroids and thus be more susceptible to systemic toxicity. Observe growth and development of infants and children on prolonged therapy.

Hydrocortisone and Geriatic

May require lower doses

Hydrocortisone and Other Contraindications

Viral/fungal infections, tubercular or syphilitic lesions, bacterial infections unless used in conjunction with appropriate chemotherapy.

Storage

Injection
Store at 15-30°C.

Intra-articular
Store at 15-30°C.

Intravenous
Store at 15-30°C.

Oral
Store at 15-30°C.

Topical/Cutaneous
Store at 15-30°C.

Lab interference

Injection
Store at 15-30°C.

Intra-articular
Store at 15-30°C.

Intravenous
Store at 15-30°C.

Oral
Store at 15-30°C.

Topical/Cutaneous
Store at 15-30°C.

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