Hysone

Hysone Dosage/Direction for Use

hydrocortisone

Manufacturer:

GPO

Distributor:

GPO
Full Prescribing Info
Dosage/Direction for Use
Dosage in adult: Maintenance dose: 20-30 mg/day divided to more closely mimic normal cortisol secretion. A morning dose is higher than the later doses i.e. twice daily regimens (20 mg in the morning and 10 mg in the evening) and three times daily (10 mg in the morning, 5 mg in the afternoon and 5 mg in the evening).
The daily dose of hydrocortisone should be doubled during periods of minor stress, and the dose needs to be increased to as much as 200 to 300 mg per day during periods of major stress, such as a surgical procedure.
Stress dose: Minor Febrile illness or stress: Increase hydrocortisone dose twofold to threefold for the few days of illness.
Contact physicians if illness worsens or persists for more than 3 days or if vomiting develops.
Moderate illness: Hydrocortisone 50 mg twice a day orally or intravenously. Taper rapidly to maintenance dose as patient recovers.
Severe illness, severe stresses or surgery: Increase hydrocortisone dose up to tenfold but the patients who cannot take oral medications or who experience a significant stress and potential instability should receive intravenous corticosteroid supplementation.
Switch therapy from IV to oral then taper rapidly to maintenance dose.
Dosage in Pregnancy (Category C): Women with primary adrenal insufficiency who become pregnant should be treated with standard replacement therapy. If nausea and vomiting in early pregnancy interfere with oral medication, injections may be necessary.
But daily doses of hydrocortisone are usually increased modestly (5 to 10 mg/day) in the last trimester.
During labor, patients should be well hydrated with a saline drip and receive hydrocortisone at 50 mg intramuscularly every 6 hours until delivery. Thereafter, doses can be rapidly tapered off to usual maintenance regimens.
Dosage in children: Neonate: Maintenance dose: 6-7 mg/m2 every 8 hours, adjusted according to response.
Children 1 month-18 years: Maintenance dose: 5-6.5 mg/m2 every 8 hours, adjusted according to response.
Stress dose: The degree to which doses should be increased varies between 2 and 10 times the maintenance rate depending on the severity of stress.
A common recommendation is to treat most stresses that require increased doses with hydrocortisone 30-50 mg/m2 per day (approximately tripling the daily dose) divided into 3 or 4 doses over the day.
The most severe stresses, such as major surgery or sepsis, are often treated more aggressively, with dose up to 100 mg/m2 per day divided every 6 hours intravenously.
Children who are unable to tolerate oral maintenance or stress doses during an illness require parenteral glucocorticoid administration.
Example of stress condition in Adrenal insufficiency: Minor: Inguinal hernia repair, Colonoscope, Mild febrile illness, Mild-moderate nausea/vomiting, Gastroenteritis.
Moderate: Open cholecystectomy, Hemicolectomy, Significant febrile illness, Pneumonia, Severe gastroenteritis.
Severe: Major cardiothoracic surgery, Whipple procedure, Liver resection, Pancreatitis.
Critically ill: Sepsis-induced hypotension or shock.
No extra supplementation is needed for most uncomplicated, outpatient dental procedures under local anesthesia.
Minor stresses i.e. immunization, uncomplicated viral illnesses and upper respiratory tract infections with sore throat, rhinorrhea and/ or low-grade fever and otitis media may not require use of a stress-dose hydrocortisone if the patient otherwise appears well.
IT SHOULD BE EMPHASIZED THAT DOSAGE REQUIREMENTS ARE VARIABLE AND MUST BE INDIVIDUALIZED ON THE BASIS OF THE DISEASE UNDER TREATMENT AND THE RESPONSE OF THE PATIENT.
If after long-term therapy the drug is to be stopped, it is recommended that it be withdrawn gradually, rather than abruptly.
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