Hydrocortisone

Pronunciation: HIGH-droe-CORE-tih-sone
Class: Corticosteroid, Glucocorticoid, Topical

Trade Names

Ala-Cort
- Cream 1%
- Lotion 1%

Ala-Scalp
- Lotion 2%

Anusol-HC
- Cream 2.5%

Anusol-HC-1
- Ointment 1%

Aquanil-HC
- Lotion 1%

Balneol for Her
- Lotion 0.25%

Beta-HC
- Lotion 1%

Cetacort
- Lotion 1%

Colocort
- Enema 100 mg hydrocortisone in 60 mL

Corta-Cap
- Spray 1%

Cortaid Intensive Therapy
- Cream 1%

Cortaid Maximum Strength
- Cream 1%
- Sticks 1%

Cortef
- Tablets 5 mg
- Tablets 10 mg
- Tablets 20 mg

Corticool Maximum Strength
- Gel 1%

Cortizone 5
- Ointment 0.5%

Cortizone 10
- Liquid 1%

Cortizone 10 Maximum Strength
- Cream 1%
- Ointment 1%

Cortizone 10 Quick Shot
- Spray 1%

Dermarest Dricort
- Cream 1%

Dermarest Eczema
- Lotion 1%

Dermtex-HC
- Cream 1%
- Spray 1%

Earsol-HC
- Solution 1%

Hemorrodil
- Ointment 1%

Hydrocortisone
- Ointment 2.5%

Hytone
- Cream 2.5%
- Lotion 1%

Instacort-5
- Cream 0.5%

Instacort-10
- Cream 1%

Instacort-10 Maximum Strength
- Ointment 1%

Keratol HC
- Cream 1%

Microcort
- Lotion 0.5%

Mycin Scalp
- Liquid 1%

NuCort
- Lotion 2%

Post Peel Balm
- Cream 1%

Preparation H Hydrocortisone
- Cream 1%

Proctocare-HC
- Cream 2.5%

Proctocort
- Cream 1%

Proctocream-HC
- Cream 2.5%

Proctosol-HC
- Cream 2.5%

Proctozone-HC
- Cream 2.5%

Recort Plus
- Cream 1%

Sarnol-HC Maximum Strength
- Lotion 1%

Scalacort DK
- Lotion 2%

Scalpcort
- Lotion 1%

Texacort
- Solution 2.5%

Therasoft Anti-Itch
- Ointment 1%

Tucks
- Ointment 1%

Claritin Skin Itch Relief (Canada)
Cortoderm (Canada)
Emo-Cort (Canada)
Hydrosone (Canada)
Prevex HC (Canada)
Sarna HC (Canada)
Hydrocortisone Acetate

Anu-Med-HC
- Suppositories 25 mg

Anucort-HC
- Suppositories 25 mg

Anusol-HC
- Suppositories 25 mg

Caldecort
- Cream 1%

Cortaid Maximum Strength
- Ointment 1%

Cortifoam
- Foam 10%

Hemorrhoidal-HC
- Cream 1%
- Suppositories 25 mg

Hemril-30
- Suppositories 30 mg

Hemril-HC Uniserts
- Suppositories 25 mg

Keratol-HC
- Cream 1%

Nuzon
- Gel 2%

Proctocort
- Suppositories 30 mg

Proctosert-HC
- Suppositories 30 mg

Proctosol-HC
- Suppositories 25 mg

Raskando
- Cream 0.5%

Rectasol-HC
- Suppositories 25 mg

U-Cort
- Cream 1%

Cortef Cream (Canada)
Hyderm (Canada)
Hydrocortisone Butyrate

Locoid
- Cream 0.1%
- Ointment 0.1%
- Solution 0.1%

Lociod Lipocream
- Cream 0.1%

Hydrocortisone Probutate

Pandel
- Cream 0.1%

Hydrocortisone Sodium Succinate

A-Hydrocort
- Injection 100 mg/vial
- Injection 500 mg/vial

Solu-Cortef
- Injection 100 mg/vial
- Injection 250 mg/vial
- Injection 500 mg/vial
- Injection 1,000 mg/vial

Hydrocortisone Valerate

Westcort
- Cream 0.2%
- Ointment 0.2%

Pharmacology

Short-acting glucocorticoid that depresses formation, release, and activity of endogenous mediators of inflammation including prostaglandins, kinins, histamine, liposomal enzymes, and complement system. Also modifies body's immune response.

Indications and Usage

Treatment of primary or secondary adrenal cortex insufficiency, rheumatic disorders, collagen diseases, dermatologic diseases, allergic states, allergic and inflammatory ophthalmic processes, respiratory diseases, hematologic disorders (idiopathic thrombocytopenic purpura), neoplastic diseases, edematous states (resulting from nephrotic syndrome), GI diseases (ulcerative colitis and sprue), multiple sclerosis, tuberculous meningitis, trichinosis with neurologic or myocardial involvement.

Intra-articular or soft tissue administration

Treatment of synovitis of osteoarthritis and symptoms of rheumatoid arthritis, bursitis, acute gouty arthritis, epicondylitis, acute nonspecific tenosynovitis, and post-traumatic osteoarthritis.

Intralesional administration

Treatment of keloids, lesions of lichen planus, psoriatic plaques, granuloma annulare, lichen simplex chronicus, discoid lupus erythematosus, necrobiosis lipoidica diabeticorum, alopecia areata, and cystic tumors of aponeurosis or tendon.

Topical administration

Treatment of inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses, management of refractory lesions of psoriasis, and other deep-seated dermatoses; hygienic cleansing of irritated perianal and external vaginal areas.

Rectal administration

Relief of discomfort associated with hemorrhoids, perianal itching, or irritation.

Contraindications

Systemic fungal infections; IM use in idiopathic thrombocytopenic purpura; administration of live virus vaccines in patients receiving immunosuppressive corticosteroid doses.

Dosage and Administration

Hydrocortisone Probutate
Adults and Children

Topical Apply thin film to affected area twice daily.

Hydrocortisone Butyrate
Adults and Children

Topical Apply sparingly to affected areas 2 to 4 times daily.

Hydrocortisone
Adults and Children

PO 20 to 240 mg/day.

Hydrocortisone Sodium Succinate
Adults and Children

IV / IM 100 to 500 mg every 2 to 6 h.

Hydrocortisone Acetate (Intralesional, Intra-Articular or Soft Tissue Injection Only)
Large Joints (Knee) and Bursae Adults and Children

25 to 37.5 mg.

Small Joints (Interphalangeal, Temporomandibular) Adults and Children

10 to 25 mg.

Tendon Sheaths Adults and Children

5 to 12.5 mg.

Soft Tissue Infiltration Adults and Children

25 to 75 mg.

Ganglia Adults and Children

12.5 to 25 mg.

Topical Adults and Children

Apply sparingly to affected areas 2 to 4 times daily.

Drug Interactions

Oral administration of hydrocortisone:

Anticholinesterases

May antagonize anticholinesterase effects in myasthenia gravis.

Anticoagulants, oral

May alter anticoagulant dose requirements.

Barbiturates

May decrease effect of hydrocortisone.

Cholestyramine

May decrease hydrocortisone levels.

Contraceptives (oral) estrogens

May decrease Cl of hydrocortisone.

Hydantoins, rifampin

May increase Cl and decrease therapeutic efficacy of hydrocortisone.

Salicylates

May reduce serum levels and efficacy of salicylates.

Troleandomycin

May increase effects of hydrocortisone.

Laboratory Test Interactions

May cause increased urine glucose and serum cholesterol, decreased serum levels of potassium, T ₃ and T ₄ , decreased uptake of Thyroid I ¹³¹ , false-negative nitroblue-tetrazolium test for bacterial infection, suppression of skin test reactions.

Adverse Reactions

Cardiovascular

Thromboembolism or fat embolism; thrombophlebitis; necrotizing angiitis; cardiac arrhythmias or ECG changes; syncopal episodes; hypertension; myocardial rupture; CHF.

CNS

Convulsions; increased intracranial pressure with papilledema (pseudotumor cerebri); vertigo; headache; neuritis; paresthesias; psychosis.

Dermatologic

Impaired wound healing; thin, fragile skin; petechiae and ecchymoses; erythema; lupus erythematosus-like lesions; subcutaneous fat atrophy; striae; hirsutism; acneiform eruptions; allergic dermatitis; urticaria; angioneurotic edema; perineal irritation; hyperpigmentation or hypopigmentation. Topical application may cause burning; irritation; erythema; dryness; folliculitis; hypertrichosis; pruritus; perioral dermatitis; allergic contact dermatitis; stinging, cracking and tightening of skin; secondary infections; skin atrophy; striae; miliaria; telangiectasia.

EENT

Posterior subcapsular cataracts; increased IOP; glaucoma; exophthalmos.

GI

Pancreatitis; abdominal distension; ulcerative esophagitis; nausea; vomiting; increased appetite and weight gain; peptic ulcer with perforation and hemorrhage; bowel perforation.

Genitourinary

Increased or decreased motility and number of spermatozoa.

Hematologic

Leukocytosis.

Metabolic

Sodium and fluid retention; hypokalemia; hypokalemic alkalosis; metabolic alkalosis; hypocalcemia.

Miscellaneous

Musculoskeletal effects (eg, weakness, myopathy, muscle mass loss, osteoporosis, spontaneous fractures); endocrine abnormalities (eg, menstrual irregularities, cushingoid state, growth suppression in children, sweating, decreased carbohydrate tolerance, hyperglycemia, glycosuria, increased insulin or sulfonylurea requirements in diabetics); anaphylactoid or hypersensitivity reactions; aggravation or masking of infections; malaise; fatigue; insomnia. Topical use may cause same adverse reactions seen with systemic use because of possibility of absorption.

Precautions

Pregnancy

Safety not established (systemic use); Category C (topical).

Lactation

Excreted in breast milk.

Children

Children may absorb proportionally larger amounts of topical corticosteroids and thus be more susceptible to systemic toxicity. Observe growth and development of infants and children on prolonged therapy.

Elderly

May require lower doses.

Renal Function

Use cautiously; monitor renal function.

Adrenal suppression

Prolonged (daily systemic) therapy (more than 7 days) may lead to hypothalamic-pituitary-adrenal suppression.

Fluid and electrolyte balance

May cause elevation of BP, salt and water retention, and increased excretion of potassium and calcium. Dietary salt restriction and potassium supplementation may be needed.

Hepatitis

May be harmful in chronic active hepatitis positive for hepatitis B surface antigen.

Infections

May mask signs of infection. May decrease host-defense mechanisms.

Ocular effects

Use caution in patients with ocular herpes simplex because of possible corneal perforation.

Peptic ulcer

May contribute to peptic ulceration, especially in large doses.

Repository injections

Do not inject subcutaneously; avoid injection into deltoid and repeated IM injection into the same site.

Stress

Increased dosage of rapidly acting corticosteroid may be needed before, during, and after stressful situations.

Withdrawal

Abrupt discontinuation may result in adrenal insufficiency. Discontinue gradually; increase supplementation during times of stress.

Overdosage

Symptoms

Acute toxicity and death are rare. Acute adrenal insufficiency (caused by withdrawal after long-term use): Fever, myalgia, arthralgia, malaise, anorexia, nausea, shedding of skin, orthostatic hypotension, dizziness, fainting, dyspnea, hypoglycemia Cushingoid symptoms (caused by chronic large doses): Moonface, central obesity, striae, hirsutism, acne, ecchymoses, hypertension, osteoporosis, myopathy, sexual dysfunction, diabetes, hyperlipidemia, peptic ulcer, increased susceptibility to infection, electrolyte and fluid imbalance.

Patient Information

• Advise patient to take oral medication with food to minimize GI upset.
• Warn patient not to stop taking drug abruptly.
• Caution diabetic patients that insulin or oral hypoglycemic agent needs may increase.
• Instruct elderly patient to have BP, blood glucose, and electrolytes monitored at least every 6 mo.
• Advise patient that sunglasses may reduce sensitivity to sunlight that occurs with optic administration.
• Caution against eye contact with topical agents.
• Instruct patient to wash or soak areas for topical administration prior to administration to increase absorption.
• Advise patient to apply topical agents sparingly, rubbing in lightly.
• Caution against covering topically treated areas unless specifically prescribed by health care provider.
• Advise against mixing topical agents with other products unless advised by health care provider.
• Instruct patient if topical dose is missed to apply as soon as remembered, but not to double doses.
• Teach patient using suppositories or other hemorrhoidal agents that appropriate diet, fluid intake, and adequate exercise are useful treatment adjuncts.
• Remind patient to wear medical identification (eg, card, bracelet) while taking this medication.
• Advise that temporary burning is common after administration of optic preparations.
• Caution patient that systemic reactions may occur with topical applications.

Copyright © 2009 Wolters Kluwer Health.