hydrocortisone (topical)

Contraindicated in:

Hypersensitivity or known intolerance to glucocorticoid or components of vehicles (ointment or cream base, preservative, alcohol);
Untreated bacterial or viral infections.

Use Cautiously in:

Hepatic impairment;
Diabetes mellitus, cataracts, glaucoma, or tuberculosis (use of large amounts of high-potency agents may worsen condition);
Patients with pre-existing skin atrophy;
OB: Chronic high-dose usage may result in adrenal suppression in mother, growth suppression in children; children may be more susceptible to adrenal and growth suppression.

Adv. Reactions/Side Effects ⬆ ⬇

Derm: allergic contact dermatitis, atrophy, burning, dryness, edema, folliculitis, hypersensitivity reactions, hypertrichosis, hypopigmentation, irritation, maceration, miliaria, perioral dermatitis, secondary infection, striae

Misc: adrenal suppression (use of occlusive dressings, long-term therapy)

Interactions ⬆ ⬇

Drug-drug:

None significant.

Availability ⬆ ⬇

(Generic available)

Cream: 0.5%Rx, OTC; 1%Rx, OTC; 2.5%
Gel: 0.5%Rx, OTC; 1%Rx, OTC
Ointment: 0.5%Rx, OTC; 1%Rx, OTC
Lotion: 0.25%; 0.5%Rx, OTC; 1%Rx, OTC; 2%; 2.5%
Solution: 1%
Spray: 0.5%Rx, OTC; 1%Rx, OTC
Rectal cream: 1%
Rectal aerosol: 10%
In combination with: acetic acid, antifungals, anti-infectives, antihistamines, urea, and benzoyl peroxide in various otic and topical preparations; acyclovir (Xerese). See Appendix [not included in this PDA edition].

Route/Dosage ⬆ ⬇

(Adults and Children ): Apply to affected area(s) 1–4 times daily (depends on product, preparation, and condition being treated).
Rect (Adults ): Aerosol foam: 90 mg 1–2 times/day for 2–3 wk; then adjusted.

US Brand Names ⬆ ⬇

Ala-Cort, Ala-Scalp, Anusol HC, CaldeCORT Anti-Itch, Carmol HC, Cortaid, Corticaine, Cortifoam, Cortizone, Lanacort 9-1-1, Locoid, Nutracort, Synacort, Texacort

Action ⬆ ⬇

Suppress normal immune response and inflammation.

Therapeutic effects:

Suppression of dermatologic inflammation and immune processes.

Classifications ⬆ ⬇

Therapeutic Classification: corticosteroids

Pharmacologic Classification: corticosteroids

Pharmacokinetics ⬆ ⬇

Absorption: Minimal. Prolonged use on large surface areas, application of large amounts, or use of occlusive dressings may ↑ systemic absorption.

Distribution: Remain primarily at site of action.

Metabolism/Excretion: Usually metabolized in skin; some have been modified to resist local metabolism and have a prolonged local effect.

Half-Life: 1.5–2 hr (plasma), 8–12 hr (tissue).

Canadian Brand Names ⬆ ⬇

Barriere-HC, Cortate, Cortoderm, Emo-Cort, Hyderm, Hydroval, Prevex HC, Sarna HC, Topiderm HC, Uremol HC

Time/Action Profile ⬆ ⬇

(response depends on condition being treated)

ROUTE	ONSET	PEAK	DURATION
Topical	mins–hrs	hrs–days	hrs–days

Patient/Family Teaching ⬆ ⬇

Educate patient on reason for hydrocortisone and side effects. Instruct them to take medication as directed. Instruct patient on correct technique of medication administration. Emphasize importance of avoiding the face, underarms, or groin areas unless directed by a health care provider. Avoid contact with the eyes. If a dose is missed, it should be applied as soon as remembered unless almost time for next dose. Advise patient to read Patient Information before starting and with each Rx refill in case of changes.
Caution patient to use only as directed. Avoid using cosmetics, bandages, dressings, or other skin products over the treated area unless directed by health care professional.
Advise parents of pediatric patients not to apply tight-fitting diapers or plastic pants on a child treated in the diaper area; these garments work like an occlusive dressing and may cause more of the drug to be absorbed.
Advise patient to consult health care professional before using medicine for conditions other than indicated.
Instruct patient to inform health care professional if symptoms of underlying disease return or worsen or if symptoms of infection develop.
Rep: May cause adrenal suppression if long-term use or large application site. Advise patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding. Use lowest potency possible if used on breast and remove thoroughly before breastfeeding.

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Indications ⬇

Contraind./Precautions ⬆ ⬇