Hydrocortisone

Indications
 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 hr after moderate surgery or 48-72 hr 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 yr: 25 mg; 1-5 yr: 50 mg; 6-12 yr: 100 mg. 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.
Injection
Soft tissue inflammation
Adult: As Na phosphate or Na succinate esters: 100-200 mg as local inj.
Intra-articular
Joint inflammations
Adult: As acetate: 5-50 mg depending on size of affected joint.
Topical/Cutaneous
Corticosteroid-responsive dermatoses
Adult: Apply a 0.1-2.5% cream/ointment/lotion onto affected area.
Contraindications
 Viral/fungal infections, tubercular or syphilitic lesions, bacterial infections unless used in conjunction with appropriate chemotherapy.
Warnings / Precautions
 CHF, hypertension, DM, epilepsy, elderly, patients on prolonged therapy. Gradual withdrawal, pregnancy and lactation.
Adverse Reactions
 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 Inj may cause CV collapse.
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.
See Below for More hydrocortisone Drug Interactions
Food Interactions
 Interferes with calcium absorption.
Mechanism of Actions
 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).
Administration
 Should be taken with food.
Storage Conditions
 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.
ATC Classification
 C05AA01 - hydrocortisone ; Belongs to the class of products containing corticosteroids for topical use. Used in the treatment of hemorrhoids and anal fissures.
D07AA02 - hydrocortisone ; Belongs to the class of weak (group I) corticosteroids. Used in the treatment of dermatological diseases.
D07XA01 - hydrocortisone ; Belongs to the class of weak (group I) corticosteroids in other combinations. Used in the treatment of dermatological diseases.
H02AB09 - hydrocortisone ; Belongs to the class of glucocorticoids. Used in systemic corticosteroid preparations.
A01AC03 - hydrocortisone ; Belongs to the class of local corticosteroid preparations. Used in the treatment of diseases of the mouth.
A07EA02 - hydrocortisone ; Belongs to the class of corticosteroids acting locally. Used in the treatment of intestinal inflammation.
S01BA02 - hydrocortisone ; Belongs to the class of corticosteroids. Used in the treatment of inflammation of the eye.
S01CB03 - hydrocortisone ; Belongs to the class of corticosteroids/antiinfectives/mydriatics combinations. Used in the treatment of eye diseases.
S02BA01 - hydrocortisone ; Belongs to the class of corticosteroids used in the treatment of inflammation of the ear.
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.
Available As
  • Hydrocortisone 0.02%
  • Hydrocortisone 0.1%
  • Hydrocortisone -17 Butyrate 0.1%
  • Hydrocortisone Acetate 0.1%
  • Hydrocortisone 0.25%
  • Hydrocortisone Acetate 0.25%
  • Hydrocortisone Acetate 0.25% w/w
  • Hydrocortisone Acetate 0.5%
  • Hydrocortisone 0.5%
  • Hydrocortisone Acetate 0.5% w/v
  • Hydrocortisone Acetate 0.5% w/w
  • Hydrocortisone 0.5% w/w
  • Hydrocortisone Acetate 1%
  • Hydrocortisone 1%
  • Hydrocortisone Acetate 1% w/v
  • Hydrocortisone Acetate IP 1% w/w
  • Hydrocortisone Acetate 1% w/w
  • Hydrocortisone 1% w/w
  • Hydrocortisone Acetate 1.0% w/w
  • Hydrocortisone 1.5%
  • Hydrocortisone 10 mg
  • Hydrocortisone Acetate 100 mg
  • Hydrocortisone Sodium Succinate 100 mg
  • Hydrocortisone 100 mg
  • Hydrocortisone Sodium Succinate IP 100 mg
  • Hydrocortisone Acetate 2 gm
  • Hydrocortisone Acetate 2.5 mg
  • Hydrocortisone Acetate 2.5%
  • Hydrocortisone 2.5%
  • Hydrocortisone Acetate 2.79 mg
  • Hydrocortisone 20 mg
  • Hydrocortisone 200 mg
  • Hydrocortisone Acetate 25 mg
  • Hydrocortisone 25 mg
  • Hydrocortisone 400 mg
  • Hydrocortisone 5 mg
  • Hydrocortisone Acetate 5 mg
  • Hydrocortisone Acetate 5.58 mg

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