Hydrocortisone
Mechanism :
Hydrocortisone is an anti-inflammatory adrenocortical steroid. It is a short acting glucocorticoid with mineralocorticoid activities. It has a very rapid action
Indication :
- Anaphylaxis
- Acute asthma
- Adrenocortical insufficiency
- Tendonitis
- Small joint arthritis for local infiltration.
- Juvenile idiopathic arthritis
- Inflammation
- Replacement therapy
Contraindications :
Hypersensitivity to drug/class/component
Systemic fungal infection; Neonates or premature infants (benzyl alcohol-containing INJ forms); Avoid abrupt withdrawal (high dose or long-term use).
Caution if TB infection Caution if ocular HSV, Strongyloidiasis infection, measles or varicella exposure, immunosuppressed or active infection, HTN, CHF, diabetes mellitus, osteoporosis, hypothyroidism, PUD, ulcerative colitis, diverticulitis, recent intestinal anastomosis, seizure disorder, myasthenia gravis, psychiatric disorder, hepatic or renal impairment, anaphylaxis history.
Dosing :
Anaphylaxis and acute asthma:
1-2 mg/kg administered intravenously every six hours for the first 24 hours; maximum dose is 250 mg. Maintenance dose is 2 mg/kg/day given intravenously as 4 divided doses every 24 hours or 0.5-1 mg/kg given orally every 6 hourly.
Chronic adrenal insufficiency:
8-10 mg/m²/day PO divided tid. Doses upto 12 mg/m²/day may be required.
Replacement therapy:
4-5 mg/m²/dose PO 3 times daily with higher dose of 5-6 mg/m² in congenital adrenal hyperplasia.
Inflammation:
For <12 years:
2.5-10 mg/kg/day given as 3-4 divided oral doses or 1-5 mg/kg/day either intramuscularly or intravenously once or twice a day.
Adverse Effect :
Most adverse effects are caused by the mineralocorticoid activity and include congestive heart failure, hypertension, hypokalemia, cardiac enlargement, edema, and hypocalcemic alkalosis.
Musculoskeletal: Loss of muscle mass, muscle weakness, osteoporosis, pathologic fracture of long bones, aseptic necrosis of femoral and humeral heads, vertebral compression fractures, steroid myopathy, and spontaneous fractures.
Gastrointestinal: Ulcerative esophagitis, abdominal distention, pancreatitis, and peptic ulcer with possible perforation and hemorrhage.
Dermatologic: Impaired wound healing, hyperpigmentation of the skin and nails, thin fragile skin, bruising, subcutaneous fat atrophy, purpura, facial erythema, increased sweating, hirsutism, striae, petechiae and ecchymosis, reactions to skin tests may be suppressed.
Neurological: Features of raised intracranial pressure such as headache, papilledema, vertigo, and severe mental disturbances and convulsions.
Endocrine: Development of the cushingoid state, secondary adrenocortical and pituitary unresponsiveness, decreased carbohydrate tolerance, manifestations of latent diabetes mellitus, menstrual irregularities, suppression of growth in children, and increased requirements for insulin or oral hypoglycemic agents in diabetics.
Ophthalmic: Increased intraocular pressure, posterior subcapsular cataracts, exophthalmos and glaucoma.
Metabolic: Negative nitrogen balance due to protein catabolism, glycosuria, and hyperglycemia.
Interaction :
Amphotericin B or Potassium-Depleting Diuretics: Hypokalemia. Check serum potassium levels at frequent intervals and use potassium supplements if necessary.
Digitalis Glycosides: Enhanced possibility of arrhythmias or digitalis toxicity associated with hypokalemia.
Oral Anticoagulants: Decreased prothrombin time response. Monitor prothrombin levels and adjust anticoagulant dosage accordingly.
Antidiabetic Drugs: Diminished antidiabetic effect. Monitor for symptoms of hyperglycemia.
Aspirin: increased ulcerogenic effect, decreased pharmacologic effect of aspirin.
Barbiturates, Phenytoin, or Rifampin: Increased metabolic clearance of fludrocortisone acetate because of the induction of hepatic enzymes.
Anabolic Steroids such as Oxymetholone, Methandrostenolone, Norethandrolone: Enhanced tendency toward edema.
Vaccines: Neurological complications and lack of antibody response.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
| 20-50 | Dose as in normal renal function |
| 10-20 | Dose as in normal renal function |
| <10 | Dose as in normal renal function |
Dose in Patients undergoing Renal Replacement Therapies
| CAPD | Unlikely to be dialysed. Dose as in normal renal function |
| HD | Unlikely to be dialysed. Dose as in normal renal function |
| HDF/High flux | Unlikely to be dialysed. Dose as in normal renal function |
| CAV/VVHD | Unlikely to be dialysed. Dose as in normal renal function |
Hepatic Dose :
No dosage adjustments are recommended.