Hydrocortisone

Also known as: Hydrocortisona, Anti-inflammatory hormone, Cortisol, Hydrocortisone (Topical)

Drug #365

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.

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Primary Characteristics

Hydrocortisone is also known as Hydrocortisona, Anti-inflammatory hormone, Cortisol, Hydrocortisone (Topical), Hydrocortisone Valerate, Hydrocortisone sodium succinate.

It is of Natural origin and belongs to Steroid.

It belongs to Glucocorticoid agonist pharmacological group on the basis of mechanism of action. It is also classified under Adrenal Cortical Steroids .

Molecular Weight: 362.5 · pK_a: 13.81 · Solubility in Water: 1 in 3500 · Solubility in Alcohol: 1 in 40 · Non-proprietary name: Hydrocortisone.

Pharmacokinetics

Absorption: Hydrocortisone has an oral bioavailability is 100%, pre-systemic (first-pass) metabolism accounts for 37% (±37%).

Distribution: Hydrocortisone has a volume of distribution is 0.4-0.7 l/kg. plasma protein binding is >90%.

Elimination: it is metabolised via extensively via liver, plasma half-life is 6-120 min, renal excretion is major.

Indications

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.

Hydrocortisone is also indicated for secondary conditions like Anaphylactic shock, Insect bites, Otitis externa, Sunburn, Ulcerative colitis.

Contraindications

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

Dosage

Hydrocortisone's dosage details are as follows:

Dose	Single Dose	Frequency	Route	Instructions
Adult Dosage
100 mg	100 mg	Every 8h	IV
1 %	1 %	—	Ophthalmic	As Required
1.5 %	1.5 %	Every 8h	Topical	As Required
Paediatric Dosage (20kg)
5 mg/kg	5 mg/kg	Every 6h	Intra Muscular	-
5 mg/kg	5 mg/kg	Every 6h	Intra Venous	-
1 %	1 %	—	Opthalmic	As Required
Neonatal Dosage (3kg)
6.25 mg/kg	6.25 mg/kg	Every 6h	Intramuscular
6.25 mg/kg	6.25 mg/kg	Every 6h	Intravenous

Drug Interactions

Unknown7 interactions

20 interactions

Major1 interaction

Minor1 interaction

Moderate3 interactions

Always consult your physician for the change of dose regimen or an alternative drug of choice that may strictly be required.

Side Effects

Hydrocortisone in overdosage may give rise to further complications which include Glaucoma , Growth retardation , Epidermal thinning , Papilloedema , Thromboembolic disorder , Hypersensitivity reactions , Long bone fractures , Gi bleeding , Cataract, Psychosis , Striae , Pancreatitis , Glucose intolerance , Reduced visual function, Tendon rupture, Intestinal perforation, Opportunistic infections, Increased IOP (intraocular pressure), Convulsions , Vertebral fractures , Addisonian crises, Adrenal atrophy, Telangiectasia, Increased intracranial pressure , Avascular necrosis , Osteoporosis , Opthalmic fungal or viral disease , Dendritic corneal ulcers , Hypokalemic alkalosis, Subcutaneous atrophy.

Hydrocortisone produces potentially life-threatening effects which include Anaphylactoid reactions , Addisonian crises, CHF , Opportunistic infections, Acute pancreatitis, GI hemorrhage. Careful monitoring is needed with proper medical management.

The signs and symptoms that are produced after acute overdosage of Hydrocortisone are hypomagnesaemia, Adrenal suppression, Hyperkalemia.

Hydrocortisone is known to cause more or less tolerable side effects which are usually transient. These include Acne, Allergic reactions, Burning, Cushingoid facies, Depression, Dryness , Euphoria, Insomnia, Irritation, Itching, Local hypopigmentation, Menstrual irregularity, Mood swings, Perioral dermatitis, Stinging, Weight gain.

Warnings / 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.

Interference in Pathology

Hydrocortisone may interfere in the diagnosis of Increases Cortisol metabolites in urine .

Available Brands

Click on a strength to view available brands.

Single Ingredient

Cream

1 %w/w 2 %w/w 2.5 %w/w

Eye Drops

1 %w/v

Inj

100 mg 200 mg 250 mg 500 mg

Oint

1 %w/w

Multi-Ingredient Combinations

Cream

0.04 %w/w 1 %w/w 4 %w/w

E and E Drops

Ear Drops

Eye Drops

Eye Drops

Eye Oint

0.5 %w/w 1 %w/v 10 mg/g

Lotion

1 %w/v 2.5 %w/v

Oint

0.25 %w/w 0.5 %w/w 1 %w/w

Vag Cream

1 %w/w

Storage Conditions

Hydrocortisone should be stored Inj, Oral Susp, Dental Paste, Cream, Oint. Suppositories. Tab.

Drug Classification

1.13.3.1 — Corticosteroids plain
2.17.4 — Anti-inflammtory drugs
3.18.1 — Corticosteroids, systemic
4.21.2.1 — Corticosteroids
5.28 — Otic drugs

Manufacturers

Manufacturers of Hydrocortisone in Pakistan: