Hydrocortisone

Hydrocortisone is approved by the U.S. Food and Drug Administration as a prescription steroid medication that is indicated to treat inflammation, status asthmaticus, acute and chronic adrenal insufficiency, and as a physiologic replacement in pediatric use.

In topical (applied to the skin) form, such as creams, lotions, and ointments, hydrocortisone is used as a treatment for redness, swelling, itching, and discomfort of various skin problems and conditions, as well as inflammatory conditions and rashes. Topical hydrocortisone cream is most often used as the treatment for these purposes. Some forms of hydrocortisone are available with or without a prescription.

Hydrocortisone is often compared to similar steroid drug treatments such as prednisone. Prednisone is a prescription oral corticosteroid drug that is often used for managing, reducing, or eliminating symptoms associated with your body's immune system responses (such as allergies and eczema).

Hydrocortisone is available under the following different brand names: Hydrocort, Alphosyl, Aquacort, Cortef, Cortenema, and Solu-Cortef.

Side effects associated with the use of Hydrocortisone, include the following:

• Acne
• Adrenal suppression
• Bladder dysfunction
• Cataract
• Cushing syndrome
• Delayed wound healing
• Delirium
• Depression
• Diabetes mellitus
• Enlarged heart
• Fast heart rate
• Fat embolism
• Feeling unwell (malaise)
• High blood sugar (hyperglycemia)
• High pressure around the brain (on withdrawal)
• Hypokalemic alkalosis
• Increased appetite
• Indigestion
• Insomnia
• Joint pain
• Lightheadedness and fainting
• Male-pattern hair growth in females
• Myocardial rupture (post-heart attack)
• Muscle disease
• Nosebleed
• Osteoporosis
• Psychosis
• Spinning sensation (vertigo)
• Thromboembolism
• Vasculitis

Postmarketing side effects of hydrocortisone reported include:

• Epidural lipomatosis
• Central serous chorioretinopathy
• Leukocytosis
• Secondary thrombocytopenia in adults
• Idiopathic thrombocytopenic purpura in adults
• Erythroblastopenia (RBC anemia)
• Congenital (erythroid) hypoplastic anemia

Seek medical care or call 911 at once if you have the following serious side effects:

• Severe headache, confusion, slurred speech, arm or leg weakness, trouble walking, loss of coordination, feeling unsteady, very stiff muscles, high fever, profuse sweating, or tremors;
• Serious eye symptoms such as sudden vision loss, blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights;
• Serious heart symptoms include fast, irregular, or pounding heartbeats; fluttering in the chest; shortness of breath; sudden dizziness, lightheartedness, or passing out.

This document does not contain all possible side effects and other serious side effects may occur. Check with your physician for additional information about other types of side effects.

Dosages of Hydrocortisone:

Adult and Pediatric Dosage Forms and Strengths

Tablet

• 5 mg
• 10 mg
• 20 mg

Powder for injection

• 100 mg
• 250 mg
• 500 mg
• 1 g

Dosage Considerations – Should be Given as Follows:

Inflammation

• Adult: 15-240 mg oral/intramuscular/intravenous (PO/IM/IV) every 12 hours
• Children under 12 years: 2.5-10 mg/kg/day orally divided every 6-8 hours or 1-5 mg/kg/day IM/IV divided every 12-24 hours
• Children 12 years and older: 15-240 mg oral/intramuscular/intravenous/subcutaneous (PO/IM/IV/SC) every 12 hours

Status Asthmaticus

• Adult: 1-2 mg/kg intravenously (IV) every 6 hours initially for 24 hours; maintenance: 0.5-1 mg/kg every 6 hours
• Pediatric
• 1-2 mg/kg IV every 6 hours for 24 hours; not to exceed 250 mg
• IV Maintenance: 2 mg/kg/day IV divided every 6 hours
• Oral Maintenance: 0.5-1 mg/kg every 6 hours

Acute Adrenal Insufficiency

• 100 mg intravenous (IV) bolus, then 300 mg/day IV divided every 8 hours or administered by continuous infusion for 48 hours
• When a patient is stabilized: 50 mg orally every 8 hours for 6 doses, then tapered to 30-50 mg/day orally in divided doses

Chronic Adrenal Insufficiency

• 15-25 mg/day orally divided every 8-12 hours

Physiologic Replacement, Pediatric

• 8-10 mg/m²/day oral/intramuscular/intravenous (PO/IM/IV) divided every 8 hours

Acute Adrenal Crisis Treatment (Off-label)

• Children age 1 month-1 year
  • 25 mg intravenous (IV) bolus, then 50 mg/m²/day by continuous IV drip or divided every 6-8 hours
  • Alternative: 1-2 mg/kg IV bolus, then 25-150 mg/kg/day IV divided every 6-8 hours
• Children 1-12 years
  • 50-100 mg rapid intravenous (IV) bolus, then 50 mg/m²/day by continuous IV drip or divided every 6-8 hours
  • Alternative: 1-2 mg/kg IV bolus, then 150-250 mg/day divided every 6-8 hours

Dosage Considerations

• Usual oral dosing range: 10-320 mg/day divided every 6-8 hours
• Usual intravenous/intramuscular (IV/IM) dosing range (sodium succinate): 100-500 mg as needed initially; may be repeated every 2 hours, every 4 hours, or every 6 hours as needed

If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first.

• Severe Interactions of hydrocortisone include:
  • mifepristone
• Hydrocortisone has serious interactions with at least 75 different drugs.
• Hydrocortisone has moderate interactions with at least 240 different drugs.
• Hydrocortisone has mild interactions with at least 128 different drugs.

This information does not contain all possible interactions or adverse effects. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share this information with your doctor, medical professional, and/or pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns, or for more information about this medicine.

Warnings

• This medication contains hydrocortisone. Do not take Hydrocort, Alphosyl, Aquacort, Cortef, Cortenema, or SoluCortef if you are allergic to hydrocortisone or any ingredients contained in this drug
• Keep this and all prescription drugs out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately

Contraindications

• Untreated serious infections (except tuberculous meningitis or septic shock)
• Idiopathic thrombocytopenic purpura
• Intrathecal administration (injection)
• Documented hypersensitivity
• Administration of live or live, attenuated vaccines is contraindicated in patients receiving immunosuppressive doses of the drug

Effects of Drug Abuse

• No information provided

Short-Term Effects

• See "What Are Side Effects Associated with Using Hydrocortisone?"

Long-Term Effects

• See "What Are Side Effects Associated with Using Hydrocortisone?"

Cautions

• Use with caution in cirrhosis, ocular herpes simplex, hypertension, diverticulitis, hypothyroidism, myasthenia gravis, peptic ulcer disease, osteoporosis, ulcerative colitis, psychotic tendencies, renal insufficiency, pregnancy, diabetes mellitus, congestive heart failure, thromboembolic disorders, GI disorders
• Thromboembolic disorders and myopathy may occur
• Delayed wound healing is possible
• Patients receiving this medication should avoid chickenpox or measles-infected persons if unvaccinated
• Latent tuberculosis may be reactivated (patients with positive tuberculin test should be monitored)
• Some suggestions (not fully substantiated) of slightly increased cleft palate risk if these drugs are used in pregnancy
• Prolonged use of this medication may result in elevated intraocular pressure, glaucoma, or cataracts
• Killed or inactivated vaccines may be administered; however, the response to such vaccines cannot be predicted
• Pheochromocytoma crisis, which can be fatal, is reported after administration of systemic corticosteroids; in patients with suspected pheochromocytoma, consider the risk of pheochromocytoma crisis before administration
• There is an enhanced effect of this medication on patients with hypothyroidism and in those with cirrhosis
• This medication should be used cautiously in patients with ocular herpes simplex because of possible corneal perforation
• In patients on therapy subjected to unusual stress, an increased dosage of rapidly acting corticosteroids before, during, and after stressful situations is indicated
• This drug may mask some signs of infection, and new infections may appear during their use; with increasing doses, the rate of occurrence of infectious complications increases; there may be decreased resistance and inability to localize infection
• Immunization procedures may be undertaken in patients who are receiving this prescription as replacement therapy in physiologic doses (e.g., for Addison's disease)
• Epidural injection:
  • Serious neurologic events, some resulting in death, have been reported with epidural injection
  • Specific events reported include, but are not limited to, spinal cord infarction, paraplegia, quadriplegia, cortical blindness, and stroke
  • These serious neurologic events have been reported with and without the use of fluoroscopy
  • The safety and effectiveness of epidural administration of corticosteroids have not been established, and corticosteroids are not approved for this use

Pregnancy and Lactation

• Use hydrocortisone with caution during pregnancy if the benefits outweigh the risks
• Animal studies show risk and human studies are not available, or neither animal nor human studies were done
• There is some suggestion (not fully substantiated) of slightly increased cleft palate risk if corticosteroids are used in pregnancy
• Hydrocortisone enters breast milk; use with caution if breastfeeding