Hydrocortisone(hye droe kor’ ti zone)
Hydrocortisone Acetate
Dermatologic cream, ointment: Cortaid with Aloe, Cortef Cream (CAN), Cortef Feminine Itch, Cortoderm (CAN), Gynecort Female Creme, Lanacort-5, Lanacort-10, Maximum Strength Caldecort, Maximum Strength Cortaid, Tucks, U-Cort
Hydrocortisone Butyrate
Dermatologic ointment and cream: Locoid
Hydrocortisone Probutate
Pandel
Hydrocortisone Sodium Succinate
IV, IM injection: A-Hydrocort, Solu-Cortef
Hydrocortisone Valerate
Dermatologic cream, ointment, lotion: Westcort
PREGNANCY CATEGORY C
Drug Classes
Adrenocortical steroid
Corticosteroid (short-acting)
Glucocorticoid
Hormone
Therapeutic Actions
Enters target cells and binds to cytoplasmic receptors; initiates many complex reactions that are responsible for its anti-inflammatory, immunosuppressive (glucocorticoid), and salt-retaining (mineralocorticoid) actions. Some actions may be undesirable, depending on drug use.
Indications
Replacement therapy in adrenal cortical insufficiency
Allergic states—severe or incapacitating allergic conditions
Hypercalcemia associated with cancer
Short-term inflammatory and allergic disorders, such as rheumatoid arthritis, collagen diseases (SLE), dermatologic diseases (pemphigus), status asthmaticus, and autoimmune disorders
Hematologic disorders—thrombocytopenic purpura, erythroblastopenia
Trichinosis with neurologic or myocardial involvement
Ulcerative colitis, acute exacerbations of MS, and palliation in some leukemias and lymphomas
Intra-articular or soft-tissue administration: Arthritis, psoriatic plaques
Retention enema: For ulcerative colitis, proctitis
Topical preparations: Minor skin irritation and rashes due to seborrheic dermatitis and psoriasis
Dermatologic preparations: To relieve inflammatory and pruritic manifestations of dermatoses that are steroid responsive
Anorectal cream, suppositories: To relieve discomfort of hemorrhoids and perianal itching or irritation
Ophthalmic
Ophthalmic diseases: Acute and chronic severe allergic or inflammatory conditions including herpes zoster ophthalmicus, iritis, iridocyclitis, chorioretinitis, uveitis and choroiditis, optic neuritis, sympathetic ophthalmia, allergic conjunctivitis, keratitis, allergic corneal marginal ulcers, anterior segment inflammation
Contraindications and Cautions
Systemic administration
Contraindicated with allergy to any component of the drug, fungal infections, amebiasis, hepatitis B, vaccinia, or varicella, and antibiotic-resistant infections, immunosuppression.
Use cautiously with kidney disease (risk for edema); liver disease, cirrhosis, hypothyroidism; ulcerative colitis with impending perforation; diverticulitis; recent GI surgery; active or latent peptic ulcer; inflammatory bowel disease (risks exacerbations or bowel perforation); hypertension, heart failure; thromboembolic tendencies, thrombophlebitis, osteoporosis, convulsive disorders, metastatic carcinoma, diabetes mellitus; TB; lactation.
Retention enemas, intrarectal foam
Contraindicated with systemic fungal infections, recent intestinal surgery, extensive fistulas.
Use cautiously with pregnancy.
Topical dermatologic administration
Contraindicated with fungal, tubercular, herpes simplex skin infections; vaccinia, varicella; ear application when eardrum is perforated.
Use cautiously with pregnancy, lactation.
Available Forms
Tablets—5, 10, 20 mg; injection—25, 50 mg/mL, 100, 250, 500, 1,000 mg/vial; topical lotion—0.25%, 0.5%, 1%, 2%, 2.5%; topical liquid—1%; topical oil—1%; topical solution—1%; topical spray—1%; cream—0.2%, 0.5%, 1%, 2.5%; ointment—0.5%, 1%, 2.5%; topical gel—1%, 2%; stick, roll-on—1%; pump spray—1%
Dosages
Adults
Individualize dosage, based on severity and response. Give daily dose before 9 AM to minimize adrenal suppression. If long-term therapy is needed, alternate-day therapy should be considered. After long-term therapy, withdraw drug slowly to avoid adrenal insufficiency. For maintenance therapy, reduce initial dose in small increments at intervals until lowest clinically satisfactory dose is reached.
IM, IV (hydrocortisone sodium succinate)
100–500 mg IM or IV initially and every 2, 4, or 6 hr, based on condition and response.
Pediatric patients
Individualize dosage based on severity and response rather than on formulas that correct adult doses for age or weight. Carefully observe growth and development in infants and children on prolonged therapy.
Adults and pediatric patients
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