Hydrocortisone (Cortisol)

(HIGH-droe-CORE-tih-sone)

  Action:
Short-acting glucocorticoid that depresses formation, release, and activity of endogenous mediators of inflammation including prostaglandins, kinins, histamine, liposomal enzymes, and complement system. Also modifies body's immune response.

  Indications:
Treatment of primary or secondary adrenal cortex insufficiency, rheumatic disorders, collagen diseases, dermatologic diseases, allergic states, allergic and inflammatory ophthalmic processes, respiratory diseases, hematologic disorders (idiopathic thrombocytopenic purpura), neoplastic diseases, edematous states (resulting from nephrotic syndrome), GI diseases (ulcerative colitis and sprue), multiple sclerosis, tuberculous meningitis, trichinosis with neurologic or myocardial involvement.

Intra-articular or soft tissue administration: Treatment of synovitis of osteoarthritis and symptoms of rheumatoid arthritis, bursitis, acute gouty arthritis, epicondylitis, acute nonspecific tenosynovitis, and post-traumatic osteoarthritis.

Intralesional administration: Treatment of keloids, lesions of lichen planus, psoriatic plaques, granuloma annulare, lichen simplex chronicus, discoid lupus erythematosus, necrobiosis lipoidica diabeticorum, alopecia areata, and cystic tumors of aponeurosis or tendon.

Topical administration: Treatment of inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses, management of refractory lesions of psoriasis, and other deep-seated dermatoses.

Rectal administration: Relief of discomfort associated with hemorrhoids, perianal itching, or irritation.

  Contraindications:
Systemic fungal infections; IM use in idiopathic thrombocytopenic purpura; administration of live virus vaccines in patients receiving immunosuppressive corticosteroid doses.

  Route/Dosage:

Hydrocortisone Buteprate

Adults and Children:
Topical Apply thin film to affected area bid.

Hydrocortisone Butyrate

Adults and Children:
Topical Apply sparingly to affected areas bid to qid.

Hydrocortisone and Hydrocortisone Cypionate

Adults and Children:
PO 20 to 240 mg/day.

Hydrocortisone Sodium Phosphate

Adults and Children:
IV/IM/SC 15 to 240 mg/day.

Hydrocortisone Sodium Succinate

Adults and Children:
IV/IM 100 to 500 mg q 2 to 6 hr.

Hydrocortisone Acetate (Intralesional, Intra-Articular or Soft Tissue Injection Only)

Large Joints (Knee) and Bursae: Adults and Children: 25 to 37.5 mg.

Small Joints (Interphalangeal, Temporomandibular) Adults and Children: 10 to 25 mg.

Tendon Sheaths Adults and Children: 5 to 12.5 mg.

Soft Tissue Infiltration Adults and Children: 25 to 75 mg.

Ganglia Adults and Children: 12.5 to 25 mg.

Topical Adults and Children: Apply sparingly to affected areas bid to qid.

  Interactions:
Oral administration of hydrocortisone:

Anticholinesterases: May antagonize anticholinesterase effects in myasthenia gravis.

Anticoagulants, oral: May alter anticoagulant dose requirements.

Barbiturates: May decrease effect of hydrocortisone.

Cholestyramine: May decrease hydrocortisone levels.

Contraceptives (oral) estrogens: May decrease clearance of hydrocortisone.

Hydantoins, rifampin: May increase clearance and decrease therapeutic efficacy of hydrocortisone.

Salicylates: May reduce serum levels and efficacy of salicylates.

Troleandomycin: May increase effects of hydrocortisone.

  Lab Test Interferences:
May cause increased urine glucose and serum cholesterol, decreased serum levels of potassium, T₃ and T₄, decreased uptake of Thyroid ¹³¹I, false-negative nitroblue-tetrazolium test for bacterial infection, suppression of skin test reactions.

  Adverse Reactions:

CV:

Thromboembolism or fat embolism; thrombophlebitis; necrotizing angitis; cardiac arrhythmias or ECG changes; syncopal episodes; hypertension; myocardial rupture; CHF.

CNS:

Convulsions; increased intracranial pressure with papilledema (pseudotumor cerebri); vertigo; headache; neuritis; paresthesias; psychosis.

DERM:

Impaired wound healing; thin, fragile skin; petechiae and ecchymoses; erythema; lupus erythematosus-like lesions; subcutaneous fat atrophy; striae; hirsutism; acneiform eruptions; allergic dermatitis; urticaria; angioneurotic edema; perineal irritation; hyperpigmentation or hypopigmentation. Topical application may cause burning; irritation; erythema; dryness; folliculitis; hypertrichosis; pruritus; perioral dermatitis; allergic contact dermatitis; stinging, cracking and tightening of skin; secondary infections; skin atrophy; striae; miliaria; telangiectasia.

EENT:

Posterior subcapsular cataracts; increased IOP; glaucoma; exophthalmos.

GI:

Pancreatitis; abdominal distension; ulcerative esophagitis; nausea; vomiting; increased appetite and weight gain; peptic ulcer with perforation and hemorrhage; bowel perforation.

GU:

Increased or decreased motility and number of spermatozoa.

HEMA:

Leukocytosis.

META:

Sodium and fluid retention; hypokalemia; hypokalemic alkalosis; metabolic alkalosis; hypocalcemia.

OTHER:

Musculoskeletal effects (eg, weakness, myopathy, muscle mass loss, osteoporosis, spontaneous fractures); endocrine abnormalities (eg, menstrual irregularities, cushingoid state, growth suppression in children, sweating, decreased carbohydrate tolerance, hyperglycemia, glycosuria, increased insulin or sulfonylurea requirements in diabetics); anaphylactoid or hypersensitivity reactions; aggravation or masking of infections; malaise; fatigue; insomnia. Topical use may cause same adverse reactions seen with systemic use because of possibility of absorption.

  Precautions:

Pregnancy: Safety not established (systemic use); Category C (topical).

Lactation: Excreted in breast milk.

Children: Children may absorb proportionally larger amounts of topical corticosteroids and thus be more susceptible to systemic toxicity. Observe growth and development of infants and children on prolonged therapy.

Elderly: May require lower doses.

Adrenal suppression: Prolonged (daily systemic) therapy (> 7 days) may lead to hypothalamic-pituitary-adrenal suppression.

Fluid and electrolyte balance: May cause elevation of BP, salt and water retention, and increased excretion of potassium and calcium. Dietary salt restriction and potassium supplementation may be needed.

Hepatitis: May be harmful in chronic active hepatitis positive for hepatitis B surface antigen.

Infections: May mask signs of infection. May decrease host-defense mechanisms.

Ocular effects: Use caution in patients with ocular herpes simplex because of possible corneal perforation.

Peptic ulcer: May contribute to peptic ulceration, especially in large doses.

Renal impairment: Use cautiously; monitor renal function.

Repository injections: Do not inject SC; avoid injection into deltoid and repeated IM injection into the same site.

Stress: Increased dosage of rapidly acting corticosteroid may be needed before, during, and after stressful situations.

Withdrawal: Abrupt discontinuation may result in adrenal insufficiency. Discontinue gradually; increase supplementation during times of stress.

  Administration/Storage:

• Give medication with food.
• With large doses, administer antacids between meals.
• For intra-articular injection, local anesthetic may be administered prior to or mixed in same syringe and used immediately. Discard unused portions of mixture.
• Shake optic solutions well prior to use.
• Apply topical doses sparingly.
• Topical absorption enhanced by heat, hydration, inflamed, denuded or thin skin surfaces, or occlusive dressings.
• Avoid mixing topical preparations with other agents.
• Avoid abrupt discontinuation of systemic preparations used for > 7 days.

  Assessment/Interventions:

• Obtain patient history, including drug history and any known allergies. Note recent use of steroids.
• Monitor for covert infections.
• Monitor BP and body weight.
• Monitor routine laboratory studies including serum K ⁺ and Na⁺.
• Monitor blood glucose.
• Monitor I&O for increased edema.
• Monitor growth and development in infants and children on prolonged therapy.
• Observe for signs of potassium depletion.
• Observe for signs of GI irritation.
• If local irritation occurs with topical use, discontinue and notify health care provider.
• Following dosage reduction or therapy withdrawal, monitor for signs of adrenal insufficiency, including fatigue, anorexia, nausea, vomiting, diarrhea, weight loss, weakness, dizziness, or low blood sugar.
• Notify health care provider of weight gain, swelling, muscle weakness, black tarry stools, hematemesis, facial puffiness, menstrual irregularities, prolonged sore throat, fever, cold, or signs of infection.

  Patient/Family Education:

• Advise patient to take oral medication with food to minimize GI upset.
• Warn patient not to stop taking drug abruptly.
• Caution diabetic patients that insulin or oral hypoglycemic agent needs may increase.
• Instruct elderly patient to have BP, blood glucose, and electrolytes monitored q 6 mo.
• Advise patient that sunglasses may reduce sensitivity to sunlight that occurs with optic administration.
• Caution against eye contact with topical agents.
• Instruct patient to wash or soak areas for topical administration prior to administration to increase absorption.
• Advise patient to apply topical agents sparingly, rubbing in lightly.
• Caution against covering topically treated areas unless specifically prescribed by health care provider.
• Advise against mixing topical agents with other products unless advised by health care provider.
• Instruct patient if topical dose is missed to apply as soon as remembered, but not to double doses.
• Teach patient using suppositories or other hemorrhoidal agents that appropriate diet, fluid intake, and adequate exercise are useful treatment adjuncts.
• Remind patient to wear Medi-Alert identification while taking this medication.
• Advise that temporary burning is common after administration of optic preparations.
• Caution patient that systemic reactions may occur with topical applications.

AtoZ Drug Facts · Copyright©2000 by Facts and Comparisons