Concise Prescribing Info
Adrenal replacement therapy, primary adrenocortical insufficiency, congenital adrenal hyperplasia & Addison's disease.
Dosage/Direction for Use
Adult Maintenance dose: 20-30 mg/day divided to more closely mimic normal cortisol secretion. BID regimen: 20 mg in the morning & 10 mg in the evening. TID regimen: 10 mg in the morning, 5 mg in the afternoon & 5 mg in the evening. Daily dose should be doubled during periods of minor stress & may be increased to 200-300 mg daily during periods of major stress eg, surgical procedure. Stress Minor febrile illness or stress: Increase dose from 2-fold to 3-fold for the few days of illness. Moderate illness: 50 mg bid. Taper rapidly to maintenance dose as patient recovers. Severe illness, severe stresses or surgery: Increase dose up to 10-fold. Patients who cannot take oral medications or who experience a significant stress & potential instability should receive IV corticosteroid supplementation. Switch therapy from IV to PO then taper rapidly to maintenance dose. Childn 1 mth to 18 yr Maintenance dose: 5-6.5 mg/m2 every 8 hr & adjusted according to response. Neonates Maintenance dose: 6-7 mg/m2 every 8 hr adjusted according to response. Stress 30-50 mg/m2/day divided into 3 or 4 doses over the day. Childn who are unable to tolerate oral maintenance or stress doses during an illness require parenteral glucocorticoid administration.
Should be taken with food.
Hypersensitivity. Serious infections except septic shock or tuberculous meningitis. Viral, fungal or tubercular skin lesions. Patients vaccinated w/ live vaccines. Patients w/ peptic or intestinal ulcer, DM, TB or viral infection.
Special Precautions
Patients w/ thyroid disease, hepatic & renal impairment, heart failure, HTN, diabetes, glaucoma, cataracts, myasthenia gravis; at risk for osteoporosis, seizures or GI diseases (diverticulitis, peptic ulcer, ulcerative colitis) due to perforation risk. Acute MI. May cause hypercorticism or suppression of hypothalamic-pituitary-adrenal axis particularly in younger childn or in patients receiving high doses for prolonged periods. W/drawal & discontinuation should be done slowly & carefully. Patients transferred from corticosteroids to inhaled products. Patients w/ neuromuscular transmission disorders. Monitor creatinine kinase. Preexisting psychiatric conditions may be exacerbated. Prolonged exposure may increase the incidence of secondary infection, mask acute infection (including fungal infections), prolong or exacerbate viral infections or limit response to vaccines; Kaposi's sarcoma. Avoid exposure to chickenpox. Should not be used for ocular herpes simplex, cerebral malaria or viral hepatitis. Closely observe patients w/ latent TB &/or TB reactivity. Pregnancy & lactation. Ped patients (Carefully observe growth & development in prolonged therapy). Elderly.
Adverse Reactions
Arrhythmias, bradycardia, cardiac arrest, cardiomegaly, circulatory collapse, CHF, edema, fat embolism, HTN, hypertrophic cardiomyopathy (premature infants), myocardial rupture (post MI), syncope, tachycardia, thromboembolism, vasculitis; delirium, depression, emotional instability, euphoria, hallucinations, headache, insomnia, increased intracranial pressure, malaise, mood swings, nervousness, neuritis, neuropathy, personality changes, pseudotumor cerebri, psychic disorders, psychoses, seizure, vertigo; acne, allergic dermatitis, alopecia, bruising, burning/tingling, dry scaly skin, edema, erythema, hirsutism, hyper-/hypopigmentation, impaired wound healing, petechiae, rash, skin atrophy, impaired skin test reaction, sterile abscess, striae, urticaria; adrenal suppression, alkalosis, amenorrhea, increased carbohydrate intolerance, Cushing's syndrome, DM, glucose intolerance, growth suppression, hyperglycemia, hyperlipidemia, hypokalemia, hypokalemic alkalosis, menstrual irregularities, negative nitrogen balance, pituitary-adrenal axis suppression, K loss, protein catabolism, Na & water retention, increased/decreased sperm motility, increased/decreased spermatogenesis; abdominal distention, increased appetite, indigestion, nausea, pancreatitis, peptic ulcer, GI perforation, ulcerative esophagitis, vomiting, wt gain; leukocytosis (transient); hepatomegaly, increased transaminases; thrombophlebitis; arthralgia, necrosis (femoral and humoral heads), Charcot-like arthropathy, fractures, muscle mass loss, muscle weakness, myopathy, osteoporosis, tendon rupture, vertebral compression fractures; cataracts, exophthalmoses, glaucoma, increased IOP; abnormal fat deposits, anaphylaxis, avascular necrosis, diaphoresis, hiccups, hypersensitivity reactions, infection, secondary malignancy.
Drug Interactions
Decreased corticosteroid effect w/ barbiturates. Decreased AUC w/ cholestyramine. t½ & conc may be increased & clearance decreased w/ OCs. Decreased clearance w/ estrogens. Increased clearance w/ hydantoins & rifampin. Decreased clearance & increased AUC w/ ketoconazole. Effects may be antagonized w/ anticholinesterases. May oppose actions of anticoagulants. May enhance toxicity of cyclosporine. May enhance digitalis toxicity w/ digitalis glycosides. Decreased INH serum conc. May potentiate, counteract w/ nondepolarizing muscle relaxants. May reduce serum levels & effectiveness of salicylates. May inhibit growth-promoting effect of somatrem. Alterations in the pharmacologic activity may occur w/ theophylline. Metabolism may be inhibited w/ erythromycin.
MIMS Class
Corticosteroid Hormones
ATC Classification
H02AB09 - hydrocortisone ; Belongs to the class of glucocorticoids. Used in systemic corticosteroid preparations.
Hysone tab 10 mg
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