Hydrocortisone is a naturally occuring corticosteroid used princially for its antiinfalmmatory and immunosuppressive actions or as a hormone replacement therapy. Hydrocortisone is used to reduce swelling and inflammation. Hydrocortisone is used in a variety of disorders including allergic conditions, respiratory conditions, blood disorders, digestive problems, eyes, skin, and rheumatic disorders etc.
Hydrocortisone also known as Hydrocortisona, Hydrocortisona, Hydrocortisona, Hydrocortisona. Hydrocortisone Valerate, Hydrocortisone Valerate are the derivatives of Hydrocortisone. It is of Natural origin and belongs to Steroid. It belongs to Glucocorticoid agonist pharmacological group on the basis of mechanism of action and also classified in Adrenal Cortical Steroids pharmacological group.The Molecular Weight of Hydrocortisone is 362.50. Its pKa is 13.81.
Oral absorption of Hydrocortisone is found to be 100% . Volume of distribution is found to be 0.4-0.7 l/kg and plasma protien binding is >90%. Presystemic metabolism is noted to be 37% ±37 and metabolism is reported extensively via liver. Renal Excretion accounts for major and plasma half life is 6-120 min.
Hydrocortisone is primarily indicated in conditions like
Adrenal insufficiency, Anaphylactic reactions, Apthous ulcers, Atopic eczema, Collagen disease, Congenital adrenal hyperplasia, Contact allergic dermatitis, Discoid eczema, Flexural psoriasis, Graft rejection, Hypercalcaemia, Infantile eczema, Inflammation, Irritant dermatitis, Itching, Joint inflammation, Perineal trauma, Seborrheic dermatitis, Shock, Soft tissue inflammation, Status asthmaticus, Ulcerative protocolitis, and can also be given in adjunctive therapy as an alternative drug of choice in Anaphylactic shock, Insect bites, Otitis externa, Sunburn, Ulcerative colitis.
Hydrocortisone is known to interact with other drugs, the details of drug interactions is as follows:
Drug Details Severity Onset Management Aminoglutethimide Aminoglutethimide accelerates the metabolism of hydrocortisone (reduced effects). Amobarbital Amlodipine accelerates the metabolism of Hydrocortisone (reduced effects). Amphotericin B Increased risk of hypokalemia when Amphotericin given with corticosteroids (e.g hydrocortisone). ADVICE: Avoid concomitant use unless corticosteroids needed to control the reactions. Major Ascorbic Acid Aspirin hydrocortisone increase the bioavailability of aspirin Bismuth Subsalicylates Carbamazepine Carbamazepine accelerates metabolism of Corticosteroids (reduced effect). Cholestyramine Colestipol (HCl) Dicumarol Frusemide or Furosemide Gentamicin coadministration may potentiate gentamicin nephrotoxicity Indacaterol concomitant therapy may increase risk of hypokalemia monitor closely Ipilimumab Corticosteroids interfere with the pharmacodynamic activity and efficacy of ipilimumab Corticosteroids (e.g hydrocortisone) or other immunosuppressant should be avoided before starting ipilimumab. However, these can be used after starting ipilimumab to treat immune related adverse reactions. Lofexidine Theoretical potential for HYDROCORTISONE reducing the HYPOTENSIVE effect of LOFEXIDINE HYDROCHLORIDE. Moderate Mephenytoin Methohexitone (Na) Metyrosine Theoretical potential for HYDROCORTISONE reducing the HYPOTENSIVE effect of METIROSINE. Moderate Natamycin Concurrent use may increase the toxicity, therefore concomitant use is contraindicated.
Neostigmine Oxandrolone The concomitant administration of oxandrolone and adrenal cortical steroids may increase the edema in patients with edema. The mechanism and clinical significance are unknown. Closer monitoring may be appropriate, especially in patients with conditions that may be aggravated by fluid retention. Minor Pentobarbitone (Na) Phenobarbitone Phenytoin (Na) Primidone Promethazine (HCl) Quinidine Rhubarb Potassium deficiency can be increased by concurrent use. Rifampicin Rotavirus vaccine The administration of live, attenuated virus or bacterial vaccines during immunosuppressant or intense antineoplastic therapy may be associated with a risk of disseminated infection due to enhanced replication of vaccine virus or bacteria in the presence of diminished immune competence. Patients may be immunosuppressed if they have recently received Hydrocortisone. Moderate In general, live virus or bacterial vaccines should not be used in patients receiving Hydrocortisone. Tacrine (HCl) Tice-BCG Hydrocortisone may increase the risk of serious, life-threatening infections when given concurrently with Tice-BCG.
These interactions are sometimes beneficial and sometimes may pose threats to life. Always consult your physician for the change of dose regimen or an alternative drug of choice that may strictly be required.
Interference in Pathology
Increases Cortisol metabolites in urine
The severe or irreversible adverse effects of Hydrocortisone, which give rise to further complications include Convulsions, Gi bleeding, Telangiectasia, Striae, Glaucoma, Cataract, Pancreatitis, Hypersensitivity reactions, Osteoporosis, Psychosis, Increased intracranial pressure, Growth retardation, Glucose intolerance, Epidermal thinning, Vertebral fractures, Avascular necrosis, Papilloedema, Opthalmic fungal or viral disease, Dendritic corneal ulcers, Thromboembolic disorder, Long bone fractures, Hypokalemic alkalosis, Reduced visual function, Tendon rupture, Intestinal perforation, Opportunistic infections, Addisonian crises, Adrenal atrophy, Increased IOP (intraocular pressure), Subcutaneous atrophy.
Hydrocortisone produces potentially life-threatening effects which include Anaphylactoid reactions, Addisonian crises, CHF, Opportunistic infections, Acute pancreatitis, GI hemorrhage. which are responsible for the discontinuation of Hydrocortisone therapy.
The signs and symptoms that are produced after the acute overdosage of Hydrocortisone include hypomagnesaemia, Hyperkalemia, Adrenal suppression.
The symptomatic adverse reactions produced by Hydrocortisone are more or less tolerable and if they become severe, they can be treated symptomatically, these include Insomnia, Irritation, Allergic reactions, Itching, Burning, Depression, Weight gain, Acne, Euphoria, Menstrual irregularity, Perioral dermatitis, Cushingoid facies, Mood swings, Dryness, Local hypopigmentation, Stinging.
Click on the appropriate strength of the dosage form to view its available brands.
Single Ingredient Inj: 100 mg, 200 mg, 250 mg, 500 mg, Eye Drops: 1 %w/v, Oint: 1 %w/w, Cream: 1 %w/w, 2 %w/w, 2.5 %w/w, Multi ingredient
Eye Drops: 1 %w/v, 0.5 %w/v, Ear Drops: 1 %w/v, Eye Oint: 10 mg/g, 0.5 %w/w, E and E Drops: 1 %w/v, Oint: 1 %w/w, 0.5 %w/w, 0.25 %w/w, Cream: 1 %w/w, 150 mg, 4 %w/w, 0.04 %w/w, Lotion: 1 %w/v, 2.5 %w/v, Vag Cream: 1 %w/w,
Hydrocortisone's dosage details are as follows:
100 to 500 mg 300 (300) 8 hourly IV 1 % 1 (1) As recommended. Ophthalmic As Required
0.1 to 2 % 1 (1.05) 8 hourly Topical As Required
Paedriatic Dosage ( 20 Kg. )
5 mg/kg 5 (5) 6 hourly Intra Muscular - 5 mg/kg 5 (5) 6 hourly Intra Venous -
1 % 1 (1) As recommended. Opthalmic As Required
Neonatal Dosage ( 3 Kg. )
6.25 mg/kg 6.2 (6.25) 6 hourly Intramuscular
6.25 mg/kg 6.2 (6.25) 6 hourly Intravenous
High Risk Groups
Drug should not be given to Paediatrics, Pregnant Mothers, Cardiac / Hypertensive Patients, patients suffering from Liver Malfunction, Geriatrics, and Neonates.
If prescribing authority justifies the benefits of the drug against the possible damages he/she should reevaluate them and consult the reference material and previous studies.
Warning / Precautions
Hydrocortisone should be used with caution in patients with active tuberculosis infection of respiratory tract or in untreated fungal, bacterial or systemic viral infections. Corticosteroids should only be used systemically with great caution in the presence of congestive heart failure (CHF), recent myocardial infraction (MI), hypertension, diabetes mellitus, epilepsy, glaucoma, hypothyroidism, liver failure, osteoporosis, peptic ulceration or renal impairment. Children may be at increase risk of some adverse effects, corticosteroid causes growth retardation and prolonged use is rarely justified. Passive immunization is recommended to non-immune patients who do come in contact with chickenpox or measles. Live vaccine should not be given to patients receiving high dose systemic corticosteroid therapy nor for atleast 3 months afterwards, killed vaccine or toxoids may be given, although the response may be attenuated. During prolong treatment with corticosteroids, patients should be examined regularly, sodium intake may need to be reduced and calcium and potassium supplement may be necessary. Patient should carry cards given full details of their corticosteroid therapy. Avoid use during pregnancy. Use nasal steroids with caution until healing has occurred. Donot take Hydrocortisone if you are allergic to it. Donot exceed recommended dose. Avoid getting this medication in your eyes. Caution is required in children.
Inj, Oral Susp, Dental Paste, Cream, Oint
Store Below 40°C. Do not Freeze. Protect from Sunlight.
Store at room temperature, Below 15°C or in refrigerator. Do not Freeze. Protect from Sunlight and Moisture.
Store at room temperature.
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