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SYSTEMIC HORMONAL PREPARATIONS, EXCL. SEX HORMONES AND INSULINS › CORTICOSTEROIDS FOR SYSTEMIC USE › CORTICOSTEROIDS FOR SYSTEMIC USE, PLAIN › Glucocorticoids
hydrocortisone
H02AB09
Forms & Strengths
- Oral tablets: 5 mg, 10 mg, 20 mg
- Injectable suspension (succinate/phosphate): 100 mg, 250 mg, 500 mg, 1000 mg
- Topical creams, ointments, lotions: 0.5%, 1%, 2.5%
- Rectal suppositories and enemas: 10 mg to 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 the morning, 5 mg at noon, 5 mg in the evening)
- Severe inflammation / hypersensitivity: 100 mg to 500 mg IV/IM every 2 to 6 hours as needed
- Topical: Apply thinly to affected areas 2 to 4 times daily
Pediatric Dosing
- Adrenal insufficiency (replacement): 0.5 to 0.75 mg/kg/day orally divided in 3 doses
- Congenital adrenal hyperplasia: 10 to 20 mg/m²/day orally divided in 3 or 4 doses
- Severe inflammation / asthma exacerbation: 1 to 2 mg/kg/IV/IM bolus, then 0.6 to 3 mg/kg/day divided every 6 hours
Indications
- Primary and secondary adrenocortical insufficiency (Addison's disease)
- Congenital adrenal hyperplasia
- Severe inflammatory and allergic conditions
- Acute exacerbations of asthma and COPD
- Pruritic and inflammatory dermatoses (topical)
- Ulcerative colitis and proctitis (rectal)
Mechanism of Action
- Synthetic glucocorticoid that binds to intracellular glucocorticoid receptors
- Modulates gene transcription to reduce synthesis of pro-inflammatory cytokines, prostaglandins, and leukotrienes
- Suppresses neutrophil and monocyte migration and reverses capillary permeability
Contraindications
- Systemic fungal infections
- Hypersensitivity to hydrocortisone or any component of the formulation
- Administration of live or live-attenuated vaccines while receiving immunosuppressive doses
Adverse Reactions
- Fluid retention, hypertension, and hypokalemia
- Hyperglycemia and increased risk of infection
- Osteoporosis, muscle weakness, and myopathy
- Adrenal suppression and Cushingoid appearance with prolonged use
- Peptic ulcer disease, dyspepsia, and mood changes
Drug Interactions
- CYP3A4 inducers (e.g., rifampin, phenytoin, barbiturates) decrease hydrocortisone concentrations
- CYP3A4 inhibitors (e.g., ketoconazole, ritonavir) increase systemic exposure
- Co-administration with NSAIDs increases risk of GI ulceration
- Antagonizes hypoglycemic effects of antidiabetic agents
- Enhances hypokalemic effects of diuretics (e.g., furosemide, thiazides)
Curated Content: Needs Vetting Before Put to Clinical Use