← Search & browse all drugs
ALIMENTARY TRACT AND METABOLISM › ANTIDIARRHEALS, INTESTINAL ANTIINFLAMMATORY/ANTIINFECTIVE AGENTS › INTESTINAL ANTIINFLAMMATORY AGENTS › Corticosteroids acting locally
hydrocortisone
A07EA02
Forms & Strengths
- Oral tablets: 5 mg, 10 mg, 20 mg
- Injectable suspension (sodium succinate): 100 mg, 250 mg, 500 mg, 1000 mg
- Topical cream/ointment/lotion: 0.5%, 1%, 2.5%
- Rectal suppositories/enema: 10 mg, 25 mg, 100 mg/60 mL
Adult Dosing
- Adrenal insufficiency (replacement): 15 to 25 mg daily orally in divided doses (e.g., 10 mg in morning, 5 mg at noon, 5 mg in late afternoon)
- Severe inflammation/immunosuppression: 100 to 500 mg IV/IM every 2 to 6 hours as needed
- Ulcerative colitis (rectal): 100 mg enema nightly for 21 days or until remission
- Topical: Apply thin layer to affected area 1 to 4 times daily
Pediatric Dosing
- Adrenal insufficiency (replacement): 0.4 to 0.7 mg/kg/day orally divided TID
- Severe inflammation/asthma exacerbation (IV): 1 to 2 mg/kg IV bolus, then 0.6 to 3 mg/kg/day divided every 6 hours
- Topical (children > 2 years): Apply thin layer 1 to 2 times daily sparingly
Indications
- Primary or secondary adrenocortical insufficiency (Addison's disease)
- Congenital adrenal hyperplasia
- Severe allergic reactions and anaphylaxis
- Acute exacerbations of asthma and COPD
- Inflammatory dermatoses
- Ulcerative proctitis and colitis
Mechanism of Action
- Synthetic glucocorticoid with short duration of action
- Binds to cytosolic glucocorticoid receptors, modulating gene transcription
- Suppresses neutrophil migration, decreases production of inflammatory cytokines, and reverses capillary permeability
Contraindications
- Systemic fungal infections
- Known hypersensitivity to hydrocortisone or components
- Administration of live or live-attenuated vaccines while on immunosuppressive doses
Adverse Reactions
- Fluid retention, hypertension, and hypokalemia
- Hyperglycemia and increased risk of infection
- Osteoporosis, myopathy, and growth suppression in children
- Adrenal suppression upon abrupt withdrawal
- Skin atrophy, striae, and hypopigmentation (topical)
Drug Interactions
- Strong CYP3A4 inducers (e.g., rifampin, phenytoin, phenobarbital) decrease hydrocortisone concentrations
- CYP3A4 inhibitors (e.g., ketoconazole, ritonavir) increase systemic exposure
- Coadministration with NSAIDs increases risk of GI ulceration
- Antidiabetic agents: glucocorticoids antagonize hypoglycemic effects
- Potassium-depleting diuretics increase risk of severe hypokalemia
Curated Content: Needs Vetting Before Put to Clinical Use