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Hydrocortisone

Overview

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.

Category:

Primary Characterstics

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.

Pharmacokinetics

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 41.5% ±32.5 and metabolism is reported extensively via liver. Renal Excretion accounts for major and plasma half life is 1.5 hr.

Indications

Contraindications

Hydrocortisone is contraindicated in conditions like Ulcers,Systemic infections,Hypersensitivity.

Drug Interactions

Hydrocortisone is known to interact with other drugs, the details of drug interactions is as follows:

DrugDetailsSeverityOnsetManagement
AminoglutethimideAminoglutethimide accelerates the metabolism of hydrocortisone (reduced effects).
AmobarbitalAmlodipine accelerates the metabolism of Hydrocortisone (reduced effects).
Amphotericin BIncreased 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
Aspirinhydrocortisone increase the bioavailability of aspirin
CarbamazepineCarbamazepine accelerates metabolism of Corticosteroids (reduced effect).
Frusemide or Furosemide
Gentamicincoadministration may potentiate gentamicin nephrotoxicity
IpilimumabCorticosteroids interfere with the pharmacodynamic activity and efficacy of ipilimumabCorticosteroids (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.
LofexidineTheoretical potential for HYDROCORTISONE reducing the HYPOTENSIVE effect of LOFEXIDINE HYDROCHLORIDE. Moderate
MetyrosineTheoretical potential for HYDROCORTISONE reducing the HYPOTENSIVE effect of METIROSINE. Moderate
NatamycinConcurrent use may increase the toxicity, therefore concomitant use is contraindicated.
OxandroloneThe 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
Phenobarbitone
Phenytoin (Na)
Primidone
Promethazine (HCl)
RhubarbPotassium deficiency can be increased by concurrent use.
Rifampicin
Rotavirus vaccineThe 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.ModerateIn general, live virus or bacterial vaccines should not be used in patients receiving Hydrocortisone.
Tice-BCGHydrocortisone 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

Side Effects

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.

Available Brands

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, 1 % w/w, 1 %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, 1 %w/w, 2.5 %w/v,
Vag Cream: 1 %w/w,

Dosage

Hydrocortisone's dosage details are as follows:
Dose Single Dose Frequency Route Instructions

Adult Dosage

100 to 500 mg300 (300)8 hourlyIV
1 %1 (1)As recommended.OphthalmicAs Required
0.1 to 2 %1 (1.05)8 hourlyTopicalAs Required

Paedriatic Dosage ( 20 Kg. )

5 mg/kg5 (5)6 hourlyIntra Muscular-
5 mg/kg5 (5)6 hourlyIntra Venous-
1 %1 (1)As recommended.OpthalmicAs Required

Neonatal Dosage ( 3 Kg. )

6.25 mg/kg6.2 (6.25)6 hourlyIntramuscular
6.25 mg/kg6.2 (6.25)6 hourlyIntravenous

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.

Storage Conditions

Inj, Oral Susp, Dental Paste, Cream, Oint

Store Below 40°C. Do not Freeze. Protect from Sunlight.

Suppositories

Store at room temperature, Below 15°C or in refrigerator. Do not Freeze. Protect from Sunlight and Moisture.

Tab

Store at room temperature.

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