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Hydrocortisone

Pronunciation

Dosage Form: cream

Hydrocortisone CREAM USP, 1%

Rx only

For External Use Only

Not For Ophthalmic Use

Hydrocortisone Description

Hydrocortisone Cream USP, 1% contains Hydrocortisone [pregn-4-ene-3,20-dione, 11,17,21-trihydroxy-, (11ß)-], with the molecular formula C21H30O5 and molecular weight 362.47. Each gram contains 10 mg of Hydrocortisone in a base containing glyceryl monostearate, polyoxyl 40 stearate, glycerin, paraffin, stearyl alcohol, isopropyl palmitate, sorbitan monostearate, benzyl alcohol, potassium sorbate, lactic acid, and purified water.

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Hydrocortisone - Clinical Pharmacology

Topical corticosteroids share anti-inflammatory, anti-pruritic and vasoconstrictive actions. The mechanism of anti-inflammatory activity of the topical corticosteroids is unclear. Various laboratory methods, including vasoconstrictor assays, are used to compare and predict potencies and/or clinical efficacies of the topical corticosteroids. There is some evidence to suggest that a recognizable correlation exists between vasoconstrictor potency and therapeutic efficacy in man.

Pharmacokinetics: The extent of percutaneous absorption of topical corticosteroids is determined by many factors including the vehicle, the integrity of the epidermal barrier, and the use of occlusive dressings. Topical corticosteroids can be absorbed from normal intact skin. Inflammation and/or other disease processes in the skin increase percutaneous absorption. Occlusive dressings substantially increase the percutaneous absorption of topical corticosteroids. Thus, occlusive dressings may be a valuable therapeutic adjunct for treatment of resistant dermatoses. (See DOSAGE AND ADMINISTRATION). Once absorbed through the skin, topical corticosteroids are handled through pharmacokinetic pathways similar to systemically administered corticosteroids. Corticosteroids are bound to plasma proteins in varying degrees. Corticosteroids are metabolized primarily in the liver and then are excreted by the kidneys. Some of the topical corticosteroids and their metabolites are also excreted by the bile.

Indications and Usage for Hydrocortisone

Topical corticosteroids are indicated for the relief of the inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses.

Contraindications

Topical corticosteroids are contraindicated in those patients with a history of hypersensitivity to any of the components of the preparation.

Precautions

General: Systemic absorption of topical corticosteroids has produced reversible hypothalamic-pituitary-adrenal (HPA) axis suppression, manifestations of Cushing's syndrome, hyperglycemia, and glucosuria in some patients. Conditions which augment systemic absorption include the application of the more potent steroids, use over large surface areas, prolonged use, and the addition of occlusive dressings. Therefore, patients receiving a large dose of a potent topical steroid applied to a large surface area or under an occlusive dressing should be evaluated periodically for evidence of HPA axis suppression by using the urinary free cortisol and ACTH stimulation tests. If HPA axis suppression is noted, an attempt should be made to withdraw the drug, to reduce the frequency of application, or to substitute a less potent steroid. Recovery of HPA axis function is generally prompt and complete upon discontinuation of the drug. Infrequently, signs and symptoms of steroid withdrawal may occur, requiring supplemental systemic corticosteroids. Children may absorb proportionally larger amounts of topical corticosteroids and thus be more susceptible to systemic toxicity (See PRECAUTIONS-Pediatric Use). If irritation develops, topical corticosteroids should be discontinued and appropriate therapy instituted. In the presence of dermatological infections, the use of an appropriate antifungal or antibacterial agent should be instituted. If a favorable response does not occur promptly, the corticosteroid should be discontinued until the infection has been adequately controlled.

Information for the Patient: Patients using topical corticosteroids should receive the following information and instructions:

  1. This medication is to be used as directed by the physician. It is for external use only. Avoid contact with the eyes.
  2. Patients should be advised not to use this medication for any disorder other than for which it was prescribed.
  3. The treated skin area should not be bandaged or otherwise covered or wrapped as to be occlusive unless directed by the physician.
  4. Patients should report any signs of local adverse reactions especially under occlusive dressing.
  5. Parents of pediatric patients should be advised not to use tight-fitting diapers or plastic pants on a child being treated in the diaper area, as these garments may constitute occlusive dressings.

Laboratory Tests: The following tests may be helpful in evaluating the HPA axis suppression: Urinary free cortisol test; ACTH stimulation test.

Carcinogenesis, Mutagenesis, and Impairment of Fertility: Long-term animal studies have not been performed to evaluate the carcinogenic potential or the effect on fertility of topical corticosteroids. Studies to determine mutagenicity with prednisolone and Hydrocortisone have revealed negative results.

Pregnancy:Teratogenic effects- Pregnancy Category C. Corticosteroids are generally teratogenic in laboratory animals when administered systemically at relatively low dosage levels. The more potent corticosteroids have been shown to be teratogenic after dermal application in laboratory animals. There are no adequate and well-controlled studies in pregnant women on teratogenic effects from topically applied corticosteroids. Therefore, topical corticosteroids should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Drugs of this class should not be used extensively on pregnant patients, in large amounts, or for prolonged periods of time.

Nursing Mothers: It is not known whether topical administration of corticosteroids could result in sufficient systemic absorption to produce detectable quantities in breast milk. Systemically administered corticosteroids are secreted into breast milk in quantities not likely to have a deleterious effect on the infant. Nevertheless, caution should be exercised when topical corticosteroids are administered to a nursing woman.

Pediatric Use:Pediatric patients may demonstrate greater susceptibility to topical corticosteroid-induced HPA axis suppression and Cushing's syndrome than mature patients because of a larger skin surface area to body weight ratio. Hypothalamic-pituitary-adrenal (HPA) axis suppression, Cushing's syndrome, and intracranial hypertension have been reported in children receiving topical corticosteroids. Manifestations of adrenal suppression in children include linear growth retardation, delayed weight gain, low plasma cortisol levels, and absence of response to ACTH stimulation. Manifestations of intracranial hypertension include bulging fontanelles, headaches, and bilateral papilledema. Administration of topical corticosteroids to children should be limited to the least amount compatible with an effective therapeutic regimen. Chronic corticosteroid therapy may interfere with the growth and development of children.

Adverse Reactions

The following local adverse reactions are reported infrequently with topical corticosteroids, but may occur more frequently with the use of occlusive dressings. These reactions are listed in an approximate decreasing order of occurrence: burning, itching, irritation, dryness, folliculitis, hypertrichosis, acneiform eruptions, hypopigmentation, perioral dermatitis, allergic contact dermatitis, maceration of the skin, secondary infection, skin atrophy, striae and miliaria.

Overdosage

Topically applied corticosteroids can be absorbed in sufficient amounts to produce systemic effects (See PRECAUTIONS).

Hydrocortisone Dosage and Administration

Topical corticosteroids are generally applied to the affected area as a thin film two or three times a day depending on the severity of the condition. Occlusive dressings may be used for the management of psoriasis or recalcitrant conditions. If an infection develops, the use of occlusive dressings should be discontinued and appropriate antimicrobial therapy instituted.

How is Hydrocortisone Supplied

Hydrocortisone Cream USP, 1%, a white cream, is supplied as follows:

NDC 0168-0015-31 28.35 g (1 Oz) tubes
NDC 0168-0015-16 453.6 g (1 lb) jars

Store at controlled room temperature 15°-30°C (59°-86°F).

E. FOUGERA & CO.
A division of
Fougera
PHARMACEUTICALS INC.
Melville, New York 11747

I21531H/IF21504H
R11/11
#190

PACKAGE LABEL – PRINCIPAL DISPLAY PANEL – 28.35 G CONTAINER

NDC 0168-0015-31

FOUGERA®

Hydrocortisone

CREAM USP, 1%

FOR EXTERNAL USE ONLY

NOT FOR OPHTHALMIC USE

Rx only

CONTAINS: 10 mg of Hydrocortisone

per gram in a base containing glyceryl

monostearate, polyoxyl 40 stearate,

glycerin, paraffin, stearyl alcohol, isopropyl

palmitate, sorbitan monostearate, benzyl

alcohol, potassium sorbate, lactic acid

and purified water.

NET WT 28.35 g (1 Oz)

PACKAGE LABEL – PRINCIPAL DISPLAY PANEL – 28.35 G CARTON

NDC 0168-0015-31

Rx only

FOUGERA®

Hydrocortisone

CREAM USP, 1%

WARNING: Keep out of

reach of children.

For External Use Only

Not for Ophthalmic Use

NET WT 28.35 g (1 Oz)

Hydrocortisone 
Hydrocortisone cream
Product Information
Product Type HUMAN PRESCRIPTION DRUG LABEL Item Code (Source) NDC:0168-0015
Route of Administration TOPICAL DEA Schedule     
Active Ingredient/Active Moiety
Ingredient Name Basis of Strength Strength
Hydrocortisone (Hydrocortisone) Hydrocortisone 10 mg  in 1 g
Inactive Ingredients
Ingredient Name Strength
glyceryl monostearate  
polyoxyl 40 stearate  
glycerin  
paraffin  
stearyl alcohol  
isopropyl palmitate  
sorbitan monostearate  
benzyl alcohol  
potassium sorbate  
lactic acid  
water  
Packaging
# Item Code Package Description
1 NDC:0168-0015-31 1 TUBE (1 TUBE) in 1 CARTON
1 28.35 g in 1 TUBE
2 NDC:0168-0015-16 453.6 g in 1 JAR
Marketing Information
Marketing Category Application Number or Monograph Citation Marketing Start Date Marketing End Date
ANDA ANDA080693 04/30/1976
Labeler - E. FOUGERA & CO. A division of Fougera Pharmaceuticals Inc. (043838424)
Establishment
Name Address ID/FEI Operations
Fougera Pharmaceuticals Inc. 043838424 ANALYSIS
Establishment
Name Address ID/FEI Operations
Fougera Pharmaceuticals Inc. 174491316 MANUFACTURE
Revised: 01/2012
 
E. FOUGERA & CO. A division of Fougera Pharmaceuticals Inc.
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