Hydrocortisone - oral


Concise Prescribing Info
Indications/Uses
Listed in Dosage.
Dosage/Direction for Use
Adult : PO Adrenocortical insufficiency 20-30 mg/day in 2 divided doses. IV Supplement in adrenal insufficiency during surgery under general anesth Patients taking >10 mg/day prednisolone or its equivalent by mouth: 25-50 mg at induction. Minor surgery: Resume usual oral dose after surgery; Moderate and major surgery: Administer usual oral corticosteroid dose on the morning of the surgery, then IV induction dose,continue w/ similar IV doses 3 times/day for 24 hr after moderate surgery or 48-72 hr after major surgery; resume usual oral dose after inj are stopped. Acute adrenocortical insufficiency 100-500 mg 3-4 times/24 hr depending on severity and response. Inj Soft-tissue inflammation As Na phosphate or Na succinate esters: 100-200 mg as local inj. Topical Corticosteroid-responsive dermatoses As 0.1-2.5% oint/cream/lotion: Apply  thinly onto affected area(s) once daily - bid. Intra-articular Joint inflammations As acetate: 5-50 mg depending on size of affected joint.
Dosage Details
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.

Intravenous
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
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.

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.

Topical/Cutaneous
Corticosteroid-responsive dermatoses
Adult: As 0.1-2.5 % cream/ointment/lotion: Apply  thinly onto affected area(s) once daily - bid.
Administration
Should be taken with food.
Contraindications
Viral/fungal infections, tubercular or syphilitic lesions, bacterial infections unless used in conjunction with appropriate chemotherapy.
Special 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.
IM/IV/Parenteral/PO/Rectal/Topical: C
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.
Food Interaction
Interferes with calcium absorption.
Action
Description: 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.
Pharmacokinetics:
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).
Chemical Structure

Chemical Structure Image
Hydrocortisone

Source: National Center for Biotechnology Information. PubChem Database. Hydrocortisone, CID=5754, https://pubchem.ncbi.nlm.nih.gov/compound/Hydrocortisone (accessed on Jan. 21, 2020)

Storage
Store at 15-30°C.
Disclaimer: This information is independently developed by MIMS based on Hydrocortisone from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
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