Adult Dosing
Corticosteroid responsive conditions
- Initial dose: 100-500 mg IM/IV q2-6 hrs, depending upon the patient’s response and clinical condition; Max duration: 48-72 hrs
- After favorable response, reduce the initial dosage in small decrements at appropriate time intervals, until the lowest dosage that maintains an adequate clinical response is reached
- After long term therapy, drug should be withdrawn gradually
Acute exacerbations of multiple sclerosis
- 800 mg/day IM/IV x 1 wk, followed by 320 mg qod x 1 month
Pediatric Dosing
Corticosteroid responsive conditions
- Initial dose: 0.56-8 mg/kg/day IM/IV q6-8 hrs
[Outline]
- Hydrocortisone injection can cause dermal and subdermal atrophy, hence do not exceed recommended doses in injections and avoid injection into the deltoid muscle, as there is high incidence of subcutaneous atrophy
- Do not use high doses of systemic corticosteroids, including hydrocortisone in the treatment of traumatic brain injury
- Elevation of blood pressure, salt and water retention, and increased excretion of potassium have been reported with average to large doses of corticosteroids. Use cautiously in patients with congestive heart failure, hypertension, or renal insufficiency, restrict dietary salt and provide potassium supplement during therapy
- Left ventricular free wall rupture has occurred with corticosteroid use after a recent myocardial infarction, therefore use cautiously in these patients
- Hypothalamic-pituitary adrenal (HPA) axis suppression, Cushing’s syndrome, and hyperglycemia have been reported with chronic use of corticosteroids. Monitor patients for the occurrence of these conditions
- May cause drug-induced secondary adrenocortical insufficiency after discontinuation of therapy, remitted by reducing the dose. Give hormone therapy if any stress occurs during this period
- Mild to severe infection (viral, bacterial, fungal, protozoan or helminthic) is associated with the use of corticosteroids. With increasing doses of corticosteroids, the rate of occurrence of infectious complications increases and may also mask some signs of current infection
- Corticosteroids exacerbate systemic fungal infections, hence should not be used in the presence of such infections unless they are needed to control drug reactions
- Cardiac enlargement and congestive heart failure have been reported with concomitant use of amphotericin B and hydrocortisone
- Corticosteroid use may activate or exacerbate latent diseases or intercurrent infection like amoeba, candida, cryptococus, mycobacterium, nocardia, pneumocystis, toxoplasma. Hence use cautiously in patients with known or suspected infections
- Restrict the use of corticosteroids in cases of fulminating or disseminated tuberculosis, if indicated in patients with latent tuberculosis or tuberculin reactivity, closely monitor the patient as reactivation of the disease may occur
- Do not administer live or live, attenuated vaccines in patients receiving immunosuppressive doses of corticosteroids. Killed or inactivated vaccines may be administered
- Chicken pox and measles can have a more serious or even fatal course in pediatric and adult patients on corticosteroids, hence take particular care to avoid exposure in patients who have not had these diseases, if exposed to chicken pox, prophylaxis with varicella zoster immune globulin (VZIG) is indicated and if exposed to measles, prophylaxis with immunoglobulin (IG) may be indicated
- Corticosteroid use can produce posterior subcapsular cataracts, glaucoma with possible damage to the optic nerves, and may enhance the establishment of secondary ocular infections due to bacteria, fungi, or virus. Do not use in the treatment of optic neuritis or active ocular herpes simplex
- Corticosteroid use may increase the risk of a perforation, hence use cautiously in active or latent peptic ulcers, diverticulitis, fresh intestinal anastomoses, and nonspecific ulcerative colitis
- Corticosteroids decrease bone formation and increase bone resorption and inhibition of osteoblast function, this along with increase in protein catabolism, and reduced sex hormone production, may lead to inhibition of bone growth in pediatric patients and the development of osteoporosis at any age. Use cautiously in patients with increased risk of osteoporosis
- Acute myopathy involving ocular and respiratory muscles, and sometimes resulting in quadriparesis has been reported with high doses of corticosteroids, more often in patients with disorders of neuromuscular transmission (myasthenia gravis) or in patients receiving concomitant therapy with neuromuscular blocking drugs (pancuronium)
- Increase in intraocular pressure has been observed when steroid therapy is continued for more than 6 weeks. Monitor the IOP periodically during the therapy
Cautions: Use cautiously in
- Renal impairment
- Hepatic impairment
- Recent MI
- Congestive heart failure
- Hypertension
- Diabetes mellitus
- Risk of osteoporosis
- Peptic ulcer diseases
- Ulcerative colitis
- Diverticulitis
- Active infection
- Ocular herpes simplex
- Latent tuberculosis
- Suspected Strongyloides infestation
- Measles or varicella exposure
- Immunosuppression
- Hypothyroidism
- Recent intestinal anastomosis
- Myasthenia gravis
- Psychiatric disorder
Pregnancy Category:C
Breastfeeding: Hydrocortisone is a normal component of breastmilk that passes from the mother's bloodstream into milk. Exogenous administration of hydrocortisone in pharmacologic amounts has not been studied in breastmilk. Although it is unlikely that dangerous amounts of hydrocortisone would reach the infant, a better studied alternate corticosteroid might be preferred. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 14 March 2011). Corticosteroids are excreted in human milk and could suppress growth or cause other untoward effects. Because of the potential for serious adverse reactions in nursing infants from corticosteroids, manufacturer advises that a decision should be made whether to discontinue nursing, or discontinue the drug, taking into account the importance of the drug to the mother.
US Trade Name(s)
US Availability
A-hydrocort
- PWDR for INJ: 100 mg/vial
Solu Cortef (hydrocortisone sodium succinate)
- PWDR for INJ: 100 mg/vial
- PWDR for INJ: 250 mg/vial
- PWDR for INJ: 500 mg/vial
- PWDR for INJ: 1 g/vial
Canadian Trade Name(s)
Canadian Availability
hydrocortisone sodium succinate(generic)
- PWDR for INJ: 100 mg/vial
- PWDR for INJ: 250 mg/vial
- PWDR for INJ: 500 mg/vial
- PWDR for INJ: 1 g/vial
A-hydrocort, solu-cortef (hydrocortisone sodium succinate)
- PWDR for INJ: 100 mg/vial
- PWDR for INJ: 250 mg/vial
- PWDR for INJ: 500 mg/vial
- PWDR for INJ: 1 g/vial
UK Trade Name(s)
- Efcortesol
- Hydrocortistab
- Solu Cortef
UK Availability
Efcortesol (hydrocortisone)
- INJ: 13.39% w/v (1, 5 mL amp)
Hydrocortistab (hydrocortisone acetate)
Solu Cortef (hydrocortisone sodium succinate)
- PWDR for INJ: 100 mg/vial
Australian Trade Name(s)
Australian Availability
Solu Cortef (hydrocortisone sodium succinate)
- PWDR for INJ: 100 mg/vial
- PWDR for INJ: 250 mg/vial
- PWDR for INJ: 500 mg/vial
[Outline]
