hydrocortisone

corticosteroid· Brands: Cortef, Solu-Cortef, Cortaid, Dermacort, CortrilIMIVPOTOP

Mechanism of action

Hydrocortisone is a corticosteroid that binds to the glucocorticoid receptor, modulating gene transcription to produce anti-inflammatory, immunosuppressive, and antiproliferative effects. It inhibits phospholipase A2, thereby reducing arachidonic acid release and the formation of prostaglandins and leukotrienes. It also has significant effects on carbohydrate, protein, and lipid metabolism, promoting gluconeogenesis and lipolysis.

Pharmacokinetics

Metabolism occurs in the liver via CYP3A4, and the plasma half-life is approximately 1.5 to 2 hours, although the biological duration of action is 8 to 12 hours.

Indications & dosing

Adrenal insufficiency (replacement therapy)

Largest dose in the morning to mimic circadian rhythm.

adult · PO: 5–10 mg 2-3 times daily · Largest dose in the morning to mimic circadian rhythm.

Acute severe allergic reaction or anaphylaxis

Adjunct to adrenaline; repeat after 6 hours if needed.

adult · IV: 100–200 mg Once · Adjunct to adrenaline; repeat after 6 hours if needed.

Acute asthma exacerbation

Use if unable to take oral corticosteroids.

adult · IV: 100 mg Every 6 hours · Use if unable to take oral corticosteroids.

Severe ulcerative colitis, acute flare

Continue until clinical response, then switch to oral.

adult · IV: 100 mg Every 8 hours · Continue until clinical response, then switch to oral.

Contraindications & precautions

Systemic fungal infection · Corticosteroids may exacerbate systemic fungal infections.
Known hypersensitivity to hydrocortisone · May cause anaphylaxis or allergic reactions.
Live vaccines during immunosuppressive doses · Risk of vaccine-associated disease; defer until immune function recovers.
Peptic ulcer disease · May increase the risk of gastrointestinal ulceration or bleeding.
Use the lowest effective dose for the shortest duration of treatment.
Monitor for signs of adrenal insufficiency during and after prolonged therapy; taper the dose gradually.
Take with food to reduce gastrointestinal irritation.
Monitor blood glucose levels in patients with diabetes mellitus.
Avoid live vaccines during immunosuppressive therapy.

Adverse effects

Increased appetite and weight gain
Insomnia and mood changesserious
Hyperglycaemiaserious
Increased susceptibility to infectionsserious
Osteoporosisserious
Adrenal suppressionserious

Renal & hepatic adjustment

Hepatic impairment (mild): No dose adjustment required.
Hepatic impairment (moderate): Use with caution; consider a reduced dose due to impaired hepatic metabolism.
Hepatic impairment (severe): Reduce the dose and monitor for signs of corticosteroid excess.

Monitoring, pregnancy & toxicity

Blood pressure · Regularly, especially during long-term therapy.
Blood glucose · Regularly, especially in patients with diabetes mellitus.
Serum electrolytes · Periodically, particularly with high-dose treatment.
Signs of infection · Throughout therapy, as corticosteroids may mask symptoms.
Bone density · In patients receiving long-term systemic therapy.
Growth in children · During prolonged treatment.
Pregnancy: Hydrocortisone is the corticosteroid of choice in pregnancy; it is inactivated by placental enzymes. Use the lowest effective dose when clinically indicated.
Toxicity: Large acute ingestion may cause hyperglycaemia, fluid retention, and gastritis. · Supportive care; monitor blood glucose and serum electrolytes.
Toxicity: Chronic high-dose therapy can lead to Cushing's syndrome and adrenal suppression. · Taper the dose gradually; monitor for signs of adrenal crisis.

Clinical notes

Hydrocortisone is used for adrenal insufficiency, inflammatory and allergic conditions, and dermatological disorders. Topical preparations are used for eczema and dermatitis. Prolonged systemic use can cause adrenal suppression, hyperglycaemia, hypertension, osteoporosis, and increased susceptibility to infection. Withdrawal of corticosteroid therapy should be gradual. Avoid systemic use in systemic fungal infections unless specific antifungal therapy is given. Caution in diabetes, hypertension, and peptic ulcer disease.

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BNF; local formulary