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Hydrocortisone

Class
Steroid hormones
Subclass
Glucocorticoids
Generic name
Hydrocortisone
Brand names
Cortef®
Common formulations
Tablet
Dosage and administration
Adults patients
Treatment
Loeffler's syndrome
•
20-240 mg PO daily
Adjunctive treatment
Adjunctive treatment for gouty arthritis • Acute
•
20-240 mg PO daily
Other off-label uses
•
Prevention of chemotherapy- and radiotherapy-induced nausea and vomiting
Indications for use
Labeled indications
Adults
•
Treatment of Loeffler's syndrome
•
Treatment of Stevens-Johnson syndrome
•
Treatment of acute rheumatic carditis
•
Treatment of adrenal insufficiency (secondary)
•
Treatment of allergic conjunctivitis
•
Treatment of allergic corneal marginal ulcer
•
Treatment of allergic rhinitis (seasonal or perennial)
•
Treatment of allergy in patients with drug hypersensitivity reaction
•
Treatment of aspiration pneumonitis
•
Treatment of asthma (bronchial asthma)
•
Treatment of atopic dermatitis
•
Treatment of autoimmune hemolytic anemia (acquired)
•
Treatment of berylliosis
•
Treatment of chorioretinitis
•
Treatment of congenital adrenal hyperplasia
•
Treatment of congenital hypoplastic anemia
•
Treatment of contact dermatitis
•
Treatment of dermatomyositis and polymyositis
•
Treatment of erythroblastopenia
•
Treatment of exfoliative dermatitis
•
Treatment of herpes zoster ophthalmicus
•
Treatment of hypercalcemia of malignancy
•
Treatment of idiopathic thrombocytopenic purpura
•
Treatment of iridocyclitis
•
Treatment of iritis (acute)
•
Treatment of iritis (chronic)
•
Treatment of keratitis
•
Treatment of mycosis fungoides
•
Treatment of neoplastic diseases in patients with leukemia
•
Treatment of neoplastic diseases in patients with lymphoma
•
Treatment of nephrotic syndrome (idiopathic)
•
Treatment of nephrotic syndrome in patients with SLE
•
Treatment of nonsuppurative thyroiditis
•
Treatment of optic neuritis
•
Treatment of posterior uveitis (diffuse posterior uveitis)
•
Treatment of regional enteritis
•
Treatment of sarcoidosis in patients with symptomatic sarcoidosis
•
Treatment of secondary thrombocytopenia
•
Treatment of serum sickness
•
Treatment of sympathetic ophthalmia
•
Treatment of SLE
•
Treatment of trichinosis (myocardial involvement, neurologic involvement)
•
Treatment of ulcerative colitis
•
Adjunctive treatment for acute bursitis (acute episode)
•
Adjunctive treatment for acute tenosynovitis (acute nonspecific tenosynovitis)
•
Adjunctive treatment for axial spondyloarthritis (acute flare)
•
Adjunctive treatment for dermatitis herpetiformis
•
Adjunctive treatment for gouty arthritis (acute)
•
Adjunctive treatment for LET (acute episode)
•
Adjunctive treatment for medial epicondylitis (acute episode)
•
Adjunctive treatment for post-traumatic osteoarthritis
•
Adjunctive treatment for psoriatic arthritis
•
Adjunctive treatment for rheumatoid arthritis
•
Adjunctive treatment for subacute bursitis
•
Adjunctive treatment for synovitis of osteoarthritis (acute exacerbation)
•
Adjunctive treatment for tuberculous meningitis
Off-label indications
Adults
•
Prevention of chemotherapy- and radiotherapy-induced nausea and vomiting
Safety risks
Contraindications
Hypersensitivity to hydrocortisone or its components
Systemic fungal infections
Warnings and precautions
Exacerbation of threadworm infestation
•
Use caution in patients with known or suspected Strongyloides (threadworm) infestation.
Fluid retention, increased BP
•
Use caution in patients taking high doses, especially those with hypertension, congestive HF, or renal insufficiency.
Gastrointestinal bleeding
•
Use caution in patients with a history of stomach ulcers.
Hyperglycemia
•
Use caution in patients with diabetes mellitus.
Increased intraocular pressure, cataract, optic atrophy, glaucoma, visual field defect
•
Maintain a high level of suspicion, as hydrocortisone has been found to be associated with these adverse reactions.
Kaposi sarcoma
•
Use caution in patients receiving corticosteroid therapy, most often for chronic conditions.
LV free wall rupture
•
Use extreme caution in patients with recent myocardial infarction.
Reactivation of amebiasis
•
Use caution in patients with latent amebiasis.
Reactivation of Mycobacterium tuberculosis infection
•
Use caution in patients with latent tuberculosis or tuberculin reactivity.
Recurrent infections, immunosuppression
•
Use extreme caution in patients taking the drug for prolonged period or high doses, with risk factors for developing infections with any pathogen, including viral, bacterial, fungal, protozoan, or helminth infection.
VZV infection, measles
•
Use caution in all patients especially non-immune patients taking corticosteroids, including hydrocortisone.
Specific populations
Renal impairment
eGFR 0-90 mL/min/1.73 m²
•
Use acceptable. No dose adjustment required.
Renal replacement therapy
Any modality
•
Use acceptable. No dose adjustment required.
Hepatic impairment
Any severity
•
Use with caution.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: A
•
Use only if benefits outweigh potential risks. Evidence of fetal harm in humans. Monitor neonates for signs of hypoadrenalism.
Breastfeeding
Use only if benefits outweigh potential risks.
Unknown drug levels in breastfed infants.
May potentially cause adverse effects in breastfed infants.
Some adverse effects on lactation reported.
Adverse reactions
Very common > 10%
•
Conjunctivitis, dental caries, pharyngitis, diarrhea, fever, vomiting
Common 1-10%
•
Gastrointestinal bleeding, ↑ blood glucose, peptic ulcer disease
Uncommon < 1%
•
Acneiform lesions, hepatitis, hypothalamic-pituitary-adrenal axis suppression, ↑ urine protein, osteoporosis, anxiety, emotional lability, insomnia
Unknown frequency
•
Acute pancreatitis, adrenocortical insufficiency, alopecia, anemia, angioedema, bone fracture, bradycardia, candidiasis, cardiac arrest, cardiomyopathy, cataract, cognitive impairment, Cushing's syndrome, ↓ serum calcium, ↓ serum potassium, delayed wound healing, delirium, diabetes mellitus, diaphoresis, EEG abnormalities, ecchymosis, exacerbation of arrhythmia, exophthalmos, fluid retention, gastritis, gastrointestinal perforation, glossitis, growth restriction, heart failure, hirsutism, hypertension, hypertrichosis, hypopigmented skin patches, hypotension, ↑ ICP, ↑ WBC count, ↑ intraocular pressure, ↑ liver enzymes, ↑ serum cholesterol, ↑ serum sodium, ↑ urine glucose, lethargy, maculopapular rash, metabolic alkalosis, miliaria, myocardial infarction, neuritis, optic neuritis, papilledema, peripheral neuropathy, petechiae, psychosis, pulmonary edema, abdominal pain, amnesia, angina pectoris, arthralgia, blurred vision, constipation, depression, euphoria, hallucinations, headache, hiccups, ↑ appetite, itching, loss of appetite, lupus-like symptoms, malaise, mania, memory impairment, menstrual irregularity, nausea, palpitations, paresthesia, perineal pain, syncope, vertigo, visual disturbances, weakness, weight gain, weight loss, seizure disorders, sinus tachycardia, skin erythema, stroke, thromboembolism, thrombosis, urticaria, vasculitis
Interactions
Drug(s)
Check Interactions
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