(hye droe kor' ti sone)
P / L : Caution - pregnancy & lactation (breast feeding)
|Indication & Dosage||Oral route
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.
As 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.
As 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.
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.
Soft tissue inflammation
Adult: As Na phosphate or Na succinate esters: 100-200 mg as local inj.
Adult: As acetate: 5-50 mg depending on size of affected joint.
Adult: Apply a 0.1-2.5% cream/ointment/lotion onto affected area.
|Administration||Should be taken on an empty stomach. Do not take w/ or immediately after a meal.
|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 Drug 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.
|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.
Please consult detailed Drug Interactions before prescribing.
|Food Interaction||Interferes with calcium absorption.|
|Pregnancy Category (US FDA)||Category C: Either studies in animals have revealed adverse effects on the foetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the foetus.
|Storage||All formulations: Store at 15-30°C.|
|Pharmacology||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.
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).
|ATC Classification||S01CB03 - hydrocortisone; Belongs to the class of corticosteroids/antiinfectives/mydriatics combinations. Used in the treatment of eye diseases.
S01BA02 - hydrocortisone; Belongs to the class of corticosteroids. Used in the treatment of inflammation of the eye.
D07AA02 - hydrocortisone; Belongs to the class of weak (group I) corticosteroids. Used in the treatment of dermatological diseases.
A07EA02 - hydrocortisone; Belongs to the class of corticosteroids acting locally. Used in the treatment of intestinal inflammation.
C05AA01 - hydrocortisone; Belongs to the class of products containing corticosteroids for topical use. Used in the treatment of hemorrhoids.
H02AB09 - hydrocortisone; Belongs to the class of glucocorticoids. Used in systemic corticosteroid preparations.
S02BA01 - hydrocortisone; Belongs to the class of corticosteroids used in the treatment of inflammation of the ear.
A01AC03 - hydrocortisone; Belongs to the class of local corticosteroid preparations. Used in the treatment of diseases of the mouth.
D07XA01 - hydrocortisone; Belongs to the class of weak (group I) corticosteroids in other combinations. Used in the treatment of dermatological diseases.
|Brand Name||Manufacturer/Marketer||Composition||Dosage Form||Pack Size & Price|
|ANACORT||Techno Drugs||Hydrocortisone sodium succinate 100mg/2ml||IV/IM Injection||5's: 225.00 MRP|
|CORTAID||Novo Healthcare and Pharma Ltd.||Hydrocortisone sodium succinate 100mg/2ml||IV/IM Injection||2ml vial: 50.00 MRP|
|CORTEF||Aristopharma Ltd.||Hydrocortisone sodium succinate 100mg/2ml||IV/IM Injection||2ml vial: 50.00 MRP|
|CORTIDER||Eskayef Bangladesh Ltd||Hydrocortisone 1% Cream||Cream||10mg MRP: 28.00|
|CORTIMET||Medimet Pharmaceuticals Ltd||Hydrocortisone acetate BP 1% Cream||Cream||10gm: 28.00 MRP|
|CORTINEX||Ziska Pharmaceuticals Ltd.||Hydrocortisone sodium succinate 100mg/2ml||IV/IM Injection||2ml vial: 50.00 MRP|
|COTSON||Opsonin Pharma Limited||Hydrocortisone USP 10mg||Tablet||100's: 250.00 MRP|
|COTSON Injection||Opsonin Pharma Limited||Hydrocortisone sodium succinate 100mg/2ml||IV/IM Injection||2ml vial: 50.00 MRP|
|G-HYDROCORTISONE||Gonoshasthaya Pharmaceuticals Ltd||Hydrocortisone sodium succinate 100mg/2ml||IV/IM Injection||5's: 201.25 MRP|
|GENACORT||General Pharmaceuticals Ltd||Hydrocortisone acetate BP 1%||Ointment||5gm: 15.06 MRP|
|HISON||ACI Ltd.||Hydrocortisone sodium succinate 100mg/2ml||IV/IM Injection||2ml vial: 60.19 MRP|
|HYCORT||Chemist Laboratories Ltd.||Hydrocortisone sodium succinate 100mg/2ml||IV/IM Injection||2ml vial: 50.00 MRP|
|HYDROCORT||Alco Pharma Ltd||Hydrocortisone acetate BP 1% Cream||Cream||10gm: 28.00 MRP|
|HYDROCORTISONE-Rotex||Rotex/City Overseas||Hydrocortisone sodium succinate 100mg/2ml||IV/IM Injection||2ml vial: 56.00 TP|
|Intasone||Incepta Pharmaceuticals Limited||Hydrocortisone 1% Cream||Cream||10gm x1's:MRP 30 Tk|
|Intasone Injection||Incepta Pharmaceuticals Limited||Hydrocortisone sodium succinate USP equivalent to Hydrocortisone 100mg||Injection||1x1's:MRP 50 Tk|
|UNICORT||Gaco Pharmaceutical Ltd.||Hydrocortisone acetate BP 1% Cream||Cream||5gm: 19.00 MRP|
|ZOCORT||ACI Ltd.||Hydrocortisone acetate BP 1% Cream||Cream||15gm: 38.14 MRP|
Why is this medication prescribed?
Hydrocortisone, a corticosteroid, is similar to a natural hormone produced by your adrenal glands. It is often used to replace this chemical when your body does not make enough of it. It relieves inflammation (swelling, heat, redness, and pain) and is used to treat certain forms of arthritis; skin, blood, kidney, eye, thyroid, and intestinal disorders (e.g., colitis); severe allergies; and asthma. Hydrocortisone is also used to treat certain types of cancer.
Hydrocortisone injection is used to relieve inflammation. The drug will be injected into a large muscle (such as your buttock or hip), into your vein, or added to an intravenous fluid that will drip through a needle or catheter placed in your vein.
Topical Hydrocortisone in low-strength preparations (0.5% or 1%) are used for the temporary relief of
(1) minor skin irritations, itching, and rashes caused by eczema, insect bites, poison ivy, poison oak, poison sumac, soaps, detergents, cosmetics and jewelry;
(2) itchy anal and rectal areas and
(3) itching and irritation of the scalp.
It is also used to relieve the discomfort of mouth sores.
Topical Hydrocortisone may be also prescribed to relieve the itching, redness, dryness, crusting, scaling, inflammation, and discomfort of various skin conditions; the inflammation of ulcerative colitis or proctitis; or the swelling and discomfort of hemorrhoids and other rectal problems.
This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.
How should this medicine be used?
Hydrocortisone comes as a tablet and suspension to be taken by mouth. Your doctor will prescribe a dosing schedule that is best for you. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take hydrocortisone exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
Do not stop taking hydrocortisone without talking to your doctor. Stopping the drug abruptly can cause loss of appetite, an upset stomach, vomiting, drowsiness, confusion, headache, fever, joint and muscle pain, peeling skin, and weight loss. If you take large doses for a long time, your doctor probably will decrease your dose gradually to allow your body to adjust before stopping the drug completely. Watch for these side effects if you are gradually decreasing your dose and after you stop taking the tablets or oral liquid, even if you switch to an inhalation. If these problems occur, call your doctor immediately. You may need to increase your dose of oral hydrocortisone temporarily or start taking it again.
What special precautions should I follow?
Before taking hydrocortisone,
- tell your doctor if you are allergic to hydrocortisone, aspirin, tartrazine (a yellow dye in some processed foods and drugs), or any other drugs.
- tell your doctor what prescription and nonprescription medications you are taking, especially anticoagulants ('blood thinners') such as warfarin, arthritis medication, aspirin, cyclosporine (Neoral, Sandimmune), digoxin, diuretics ('water pills'), estrogen, ketoconazole (Nizoral), oral contraceptives, phenobarbital, phenytoin, rifampin, theophylline, and vitamins.
- if you have a fungal infection (other than on your skin), do not take hydrocortisone without talking to your doctor.
- tell your doctor if you have or have ever had liver, kidney, intestinal, or heart disease; diabetes; an underactive thyroid gland; high blood pressure; mental illness; myasthenia gravis; osteoporosis; herpes eye infection; seizures; tuberculosis (TB); or ulcers.
- tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking hydrocortisone, call your doctor.
- if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking hydrocortisone.
- if you have a history of ulcers or take large doses of aspirin or other arthritis medication, limit your consumption of alcoholic beverages while taking this drug. Hydrocortisone makes your stomach and intestines more susceptible to the irritating effects of alcohol, aspirin, and certain arthritis medications. This effect increases your risk of ulcers.
What special dietary instructions should I follow?
Your doctor may instruct you to follow a low-sodium, low-salt, potassium-rich, or high-protein diet. Follow these directions.
Hydrocortisone may cause an upset stomach. Take hydrocortisone with food or milk.
What should I do if I forget a dose?
When you start to take hydrocortisone, ask your doctor what to do if you forget a dose. Write down these instructions so that you can refer to them later.
If you take hydrocortisone once a day, take the missed dose as soon as you remember it. If you do not remember a missed dose until it is time for the next dose, skip the missed dose completely and take only the regularly scheduled dose.
If you take more than one dose a day, take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.
What side effects can this medication cause?
Hydrocortisone may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
increased hair growth
irregular or absent menstrual periods
If you experience any of the following symptoms, call your doctor immediately:
swollen face, lower legs, or ankles
cold or infection that lasts a long time
- black or tarry stool
What should I know about storage and disposal of this medication?
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.
In case of emergency/overdose
In case of overdose, consult your doctor. If the victim has collapsed or is not breathing, consult local medical emergency services.
What other information should I know?
Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your response to hydrocortisone. Checkups are especially important for children because hydrocortisone can slow bone growth.
If your condition worsens, call your doctor. Your dose may need to be adjusted.
Carry an identification card that indicates that you may need to take supplementary doses (write down the full dose you took before gradually decreasing it) of hydrocortisone during periods of stress (injuries, infections, and severe asthma attacks). Ask your pharmacist or doctor how to obtain this card. List your name, medical problems, drugs and dosages, and doctor's name and telephone number on the card.
This drug makes you more susceptible to illnesses. If you are exposed to chicken pox, measles, or tuberculosis (TB) while using hydrocortisone, call your doctor. Do not have a vaccination, other immunization, or any skin test while you are taking hydrocortisone unless your doctor tells you that you may.
Report any injuries or signs of infection (fever, sore throat, pain during urination, and muscle aches) that occur during treatment.
Your doctor may instruct you to weigh yourself every day. Report any unusual weight gain.
If your sputum (the matter you cough up during an asthma attack) thickens or changes color from clear white to yellow, green, or gray, call your doctor; these changes may be signs of an infection.
If you have diabetes, hydrocortisone may increase your blood sugar level. If you monitor your blood sugar (glucose) at home, test your blood or urine more frequently than usual. Call your doctor if your blood sugar is high or if sugar is present in your urine; your dose of diabetes medication and your diet may need to be changed.
Do not let anyone else take your medication.
It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.
Ref: U.S. National Library of Medicine.
This information is provided for reference only and not a replacement for and should only be used in conjunction with full consultation with a registered medical practitioner. It may not contain all the available information you require and cannot substitute professional medical care, nor does it take into account all individual circumstances. Although great effort has been made to ensure content accuracy, mph-bd 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.