Cortef Side Effects

Generic Name: hydrocortisone

Note: This page contains information about the side effects of hydrocortisone. Some of the dosage forms included on this document may not apply to the brand name Cortef.

Not all side effects for Cortef may be reported. You should always consult a doctor or healthcare professional for medical advice. Side effects can be reported to the FDA here.

For the Consumer

Applies to hydrocortisone: oral suspension, oral tablet

In addition to its needed effects, some unwanted effects may be caused by hydrocortisone (the active ingredient contained in Cortef). In the event that any of these side effects do occur, they may require medical attention.

You should check with your doctor immediately if any of these side effects occur when taking hydrocortisone:

More common
  • Aggression
  • agitation
  • anxiety
  • blurred vision
  • decrease in the amount of urine
  • dizziness
  • fast, slow, pounding, or irregular heartbeat or pulse
  • headache
  • irritability
  • mental depression
  • mood changes
  • nervousness
  • noisy, rattling breathing
  • numbness or tingling in the arms or legs
  • pounding in the ears
  • shortness of breath
  • swelling of the fingers, hands, feet, or lower legs
  • trouble thinking, speaking, or walking
  • troubled breathing at rest
  • weight gain
Incidence not known
  • Abdominal cramping and/or burning (severe)
  • abdominal pain
  • backache
  • bloody, black, or tarry stools
  • cough or hoarseness
  • darkening of skin
  • decrease in height
  • decreased vision
  • diarrhea
  • dry mouth
  • eye pain
  • eye tearing
  • facial hair growth in females
  • fainting
  • fatigue
  • fever or chills
  • flushed, dry skin
  • fractures
  • fruit-like breath odor
  • full or round face, neck, or trunk
  • heartburn and/or indigestion (severe and continuous)
  • increased hunger
  • increased thirst
  • increased urination
  • loss of appetite
  • loss of sexual desire or ability
  • lower back or side pain
  • menstrual irregularities
  • muscle pain or tenderness
  • muscle wasting or weakness
  • nausea
  • pain in back, ribs, arms, or legs
  • painful or difficult urination
  • skin rash
  • sleeplessness
  • sweating
  • trouble healing
  • trouble sleeping
  • unexplained weight loss
  • unusual tiredness or weakness
  • vision changes
  • vomiting
  • vomiting of material that looks like coffee grounds

Some of the side effects that can occur with hydrocortisone may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:

More common
  • Increased appetite
Incidence not known
  • Abnormal fat deposits on the face, neck, and trunk
  • acne
  • dry scalp
  • lightening of normal skin color
  • red face
  • reddish purple lines on the arms, face, legs, trunk, or groin
  • swelling of the stomach area
  • thinning of the scalp hair

For Healthcare Professionals

Applies to hydrocortisone: compounding powder, injectable powder for injection, injectable solution, injectable suspension, oral suspension, oral tablet, rectal foam with applicator, rectal suspension

General

Corticosteroid complications are primarily dose and duration of therapy dependent. Adverse effects have occurred less frequently at physiologic or lower pharmacologic dosages.

Adverse effects associated with duration of corticosteroid therapy include those occurring during short-term therapy (up to three weeks) or those occurring during long-term therapy (greater than three weeks).

Short-term effects have included sodium retention-related weight gain and fluid accumulation, hyperglycemia and glucose intolerance, hypokalemia, gastrointestinal upset and ulceration, reversible depression of the hypothalamus-pituitary-adrenal axis, and mood changes including mild euphoria and insomnia, nervousness, restlessness, mania, catatonia, depression, delusions, hallucinations, and violent behavior.

Long-term effects have included hypothalamus-pituitary-adrenal activity suppression, Cushingoid appearance, hirsutism or virilism, impotence, menstrual irregularities, peptic ulcer disease, cataracts and increased intraocular pressure/glaucoma, myopathy, osteoporosis, and vertebral compression fractures.[Ref]

Cardiovascular

Cardiovascular effects such as hypertension and congestive heart failure due to long-term fluid retention as well as direct vascular effects have occurred during corticosteroid therapy.[Ref]

Endocrine

Corticosteroid therapy may induce glucose intolerance by reducing the utilization of glucose in tissues and increasing hepatic glucose output. Diabetes mellitus requiring diet modifications and hypoglycemic agents has developed in some patients.

Adrenal suppression can persist for up to twelve months after long-term corticosteroid therapy. Giving corticosteroids once a day or once every other day may reduce adrenal suppression. After corticosteroid therapy has been tapered, supplemental corticosteroid therapy during times of physical stress may be required.[Ref]

Endocrine effects such as decreased glucose tolerance and hyperglycemia resulting in diabetes-like symptoms have occurred. Hypothalamus-pituitary-adrenal activity has been suppressed up to 12 months following long-term corticosteroid administration. Cushingoid appearance commonly has occurred with chronic therapy. Hirsutism or virilism, impotence, and menstrual irregularities may occur.[Ref]

Gastrointestinal

Gastrointestinal effects of corticosteroid therapy have included gastrointestinal upset, nausea, vomiting, and peptic ulcer disease. Pancreatitis, ulcerative esophagitis, gastrointestinal perforation and hemorrhage have also been reported.[Ref]

Gastrointestinal effects most commonly occurring during corticosteroid therapy have included nausea, vomiting, dyspepsia, and anorexia. Peptic ulcer disease has been associated with long-term corticosteroid therapy, but is relatively uncommon. Routine prophylactic therapy is not warranted in all individuals. Aluminum/magnesium-containing antacids generally have been used to manage GI complaints without significant drug interactions.[Ref]

Metabolic

Metabolic adverse effects including hypernatremia (rare), hypokalemia, fluid retention, negative nitrogen balance and increased blood urea nitrogen concentration have occurred during corticosteroid therapy. Glucocorticoids have been reported to decrease the secretion of thyrotropin (TSH).[Ref]

Musculoskeletal

Musculoskeletal effects of corticosteroid therapy including myopathy, osteoporosis, vertebral compression fractures, tendon rupture (particularly the Achilles tendon), and aseptic necrosis of bone have been reported. Aseptic necrosis has been reported most often to affect the femoral head.[Ref]

Corticosteroid myopathy has presented as weakness and wasting of the proximal limb and girdle muscles and generally has been reversible following cessation of therapy.

Corticosteroids inhibit intestinal absorption and increase urinary excretion of calcium leading to bone resorption and bone loss. Postmenopausal females are at risk of loss of bone density. Sixteen percent of elderly patients treated with corticosteroids for 5 years may experience vertebral compression fractures.[Ref]

Immunologic

Immunologic effects of corticosteroid therapy have included impairment in cell-mediated immunity and increased susceptibility to bacterial, viral, fungal and parasitic infections. Immune response to skin tests may be suppressed.[Ref]

Hepatic

Hepatic effects such as reversible increases in serum transaminase and alkaline phosphatase concentrations have occurred during corticosteroid therapy.[Ref]

Hematologic

Hematologic effects have included thrombocytopenia, lymphopenia, and platelet alterations resulting in thrombolic events.[Ref]

Dermatologic

Dermatologic effects occurring during corticosteroid therapy have included increased ease in bruising, ecchymosis, petechiae striae, delayed wound healing, and acne.[Ref]

Ocular

Ocular changes with corticosteroid therapy have included increased intraocular pressure, glaucoma, and posterior subcapsular cataracts.[Ref]

Psychiatric

Psychiatric effects including psychoses, personality or behavioral changes, and pseudotumor cerebri have occurred/been exacerbated during corticosteroid therapy.[Ref]

Hypersensitivity

Bronchospasm after intravenous hydrocortisone (the active ingredient contained in Cortef) has been reported in some patients with aspirin-sensitive respiratory disease. A challenge study with oral aspirin followed with 100 mg hydrocortisone (IV) resulted in respiratory reactions to aspirin in 45 of 53 patients. These 45 patients then received a hydrocortisone challenge. No naso-ocular, dermal, or respiratory reactions were noted in 44 of 45 patients administered hydrocortisone. One aspirin-sensitive patient experienced bronchospasm and naso-ocular reactions to hydrocortisone and naso-ocular with minimal bronchospasm with methylprednisolone. Following aspirin desensitization and while on maintenance aspirin therapy, this patient again reacted with similar symptoms to hydrocortisone.[Ref]

Case reports of hypersensitivity reactions to corticosteroids have been relatively uncommon. Side effects have included bronchospasm, shock, urticaria, and angioedema. Cross-reactivity between aspirin and hydrocortisone in patients with aspirin-sensitive respiratory disease has been suggested as the mechanism in patients with asthma, however data are controversial. Anaphylaxis has been most frequently associated with rapid injection or infusion of a high dose of corticosteroid. Reactions may be mediated by an immune or nonimmune mechanism.[Ref]

Other

Pseudorheumatism or glucocorticoid-withdrawal syndrome not related to adrenal insufficiency has occurred on withdrawal of corticosteroids. Patients experienced anorexia, nausea, vomiting, lethargy, headache, fever, arthralgias, myalgias, and postural hypotension. Symptoms resolved when corticosteroid therapy was reinstated.[Ref]

References

1. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co, Inc, West Point, PA.

2. Egashira K, Origuchi H, Sagara T, Kikuchi Y "Coronary artery spasm during hydrocortisone-induced allergic reactions." Am Heart J 113 (1987): 1516-7

3. Swartz SL, Dluhy RG "Corticosteroids: clinical pharmacology and therapeutic use." Drugs 16 (1978): 238-55

4. Burrows AW "Reversible hypothyroidism after steroid replacement for Addison's disease." Postgrad Med J 57 (1981): 368-70

5. Feek CM, Ratcliffe JG, Seth J, Gray CE, Toft AD, Irvine WJ "Patterns of plasma cortisol and ACTH concentrations in patients with Addison's disease treated with conventional corticosteroi replacement." Clin Endocrinol (Oxf) 14 (1981): 451-8

6. Bohrer H, Schmidt H, Bach A, Bottiger BW, Motsch J "Masking of the symptoms of esophageal and bowel perforation by combination treatment of sepsis with polyvalent immunoglobulins and low-dose hydrocortisone." Hepatogastroenterology 43 (1996): 515-8

7. Leung AC, Orange G, Henderson IS "Intraperitoneal hydrocortisone in eosinophilic peritonitis associated with continuous ambulatory peritoneal dialysis." Br Med J (Clin Res Ed) 286 (1983): 766

8. Novak E, Gilbertson TJ, Seckman CE, Stewart RD, DiSanto AR, Stubbs SS "Anorectal pruritus after intravenous hydrocortisone sodium succinate and sodium phosphate." Clin Pharmacol Ther 20 (1976): 109-12

9. Surks MI, Sievert R "Drugs and thyroid function." N Engl J Med 333 (1995): 1688-94

10. Ramsahoye BH, Davies SV, el-Gaylani N, Sandeman D, Scanlon MF "The mineralocorticoid effects of high dose hydrocortisone." BMJ 310 (1995): 656-7

11. Powell JR "Steroid and hypokalemic myopathy after corticosteroids for ulcerative colitis. Systemic and tropical application." Am J Gastroenterol 52 (1969): 425-32

12. Conesa D, Rello J, Valles J, Mariscal D, Ferreres JC "Invasive aspergillosis: a life-threatening complication of short-term steroid treatment." Ann Pharmacother 29 (1995): 1235-7

13. Borges AA, Krasnow SH, Wadleigh RG, Cohen MH "Nocardiosis after corticosteroid therapy for malignant thymoma." Cancer 71 (1993): 1746-50

14. Rakela J, Mosley JW, Edwards VM, Govindarajan S, Alpert E "A double-blinded, randomized trial of hydrocortisone in acute hepatic failure. The Acute Hepatic Failure Study Group." Dig Dis Sci 36 (1991): 1223-8

15. Lauerma AI, Reitamo S, Maibach HI "Systemic hydrocortisone/cortisol induces allergic skin reactions in presensitized subjects." J Am Acad Dermatol 24 (1991): 182-5

16. Dajani BM, Sliman NA, Shubair KS, Hamzeh YS "Bronchospasm caused by intravenous hydrocortisone sodium succinate (Solu-Cortef) in aspirin-sensitive asthmatics." J Allergy Clin Immunol 68 (1981): 201-4

17. Fulcher DA, Katelaris CH "Anaphylactoid reaction to intravenous hydrocortisone sodium succinate: a case report and literature review [see comments." Med J Aust 154 (1991): 210-4

18. Peller JS, Bardana EJ Jr "Anaphylactoid reaction to corticosteroid: case report and review of the literature." Ann Allergy 54 (1985): 302-5

19. Mendelson LM, Meltzer EO, Hamburger RN "Anaphylaxis-like reactions to corticosteroid therapy." J Allergy Clin Immunol 54 (1974): 125-31

20. Kamm GL, Hagmeyer KO "Allergic-type reactions to corticosteroids." Ann Pharmacother 33 (1999): 451-60

21. Feigenbaum BA, Stevenson DD, Simon RA "Hydrocortisone sodium succinate does not cross-react with aspirin in aspirin-sensitive patients with asthma." J Allergy Clin Immunol 96 (1995): 545-8

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