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hydrocortisone

Pronunciation

Generic Name: hydrocortisone (oral) (hye droe KOR ti sone)
Brand Name: Cortef, Hydrocortone

What is hydrocortisone?

Hydrocortisone is in a class of drugs called steroids. Hydrocortisone prevents the release of substances in the body that cause inflammation.

Hydrocortisone is used to treat many different conditions such as allergic disorders, skin conditions, ulcerative colitis, arthritis, lupus, psoriasis, or breathing disorders.

Hydrocortisone may also be used for other purposes not listed in this medication guide.

What is the most important information I should know about hydrocortisone?

You should not use this medication if you are allergic to hydrocortisone, or if you have a fungal infection anywhere in your body.

Before taking hydrocortisone, tell your doctor about all of your medical conditions, and about all other medicines you are using. There are many other diseases that can be affected by steroid use, and many other medicines that can interact with steroids.

Your steroid medication needs may change if you have any unusual stress such as a serious illness, fever or infection, or if you have surgery or a medical emergency. Tell your doctor about any such situation that affects you during treatment.

Steroid medication can weaken your immune system, making it easier for you to get an infection or worsening an infection you already have or have recently had. Tell your doctor about any illness or infection you have had within the past several weeks.

Avoid being near people who are sick or have infections. Call your doctor for preventive treatment if you are exposed to chicken pox or measles. These conditions can be serious or even fatal in people who are using steroid medication.

Do not receive a "live" vaccine while you are taking hydrocortisone. Vaccines may not work as well while you are taking a steroid.

Do not stop using hydrocortisone suddenly, or you could have unpleasant withdrawal symptoms. Talk to your doctor about how to avoid withdrawal symptoms when stopping the medication.

Carry an ID card or wear a medical alert bracelet stating that you are taking a steroid, in case of emergency.

What should I discuss with my healthcare provider before taking hydrocortisone?

You should not use this medication if you are allergic to hydrocortisone, or if you have a fungal infection anywhere in your body.

Steroid medication can weaken your immune system, making it easier for you to get an infection. Steroids can also worsen an infection you already have, or reactivate an infection you recently had. Before taking this medication, tell your doctor about any illness or infection you have had within the past several weeks.

If you have any of these other conditions, you may need a dose adjustment or special tests to safely take hydrocortisone:

  • liver disease (such as cirrhosis);

  • kidney disease;

  • a thyroid disorder;

  • diabetes;

  • a history of malaria;

  • tuberculosis;

  • osteoporosis;

  • a muscle disorder such as myasthenia gravis;

  • glaucoma or cataracts;

  • herpes infection of the eyes;

  • stomach ulcers, ulcerative colitis, or diverticulitis;

  • depression or mental illness;

  • congestive heart failure; or

  • high blood pressure

FDA pregnancy category C. It is not known whether hydrocortisone is harmful to an unborn baby. Before taking this medication, tell your doctor if you are pregnant or plan to become pregnant during treatment.

Hydrocortisone can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

Steroids can affect growth in children. Talk with your doctor if you think your child is not growing at a normal rate while using this medication.

How should I take hydrocortisone?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.

Your doctor may occasionally change your dose to make sure you get the best results from this medication.

Your steroid medication needs may change if you have unusual stress such as a serious illness, fever or infection, or if you have surgery or a medical emergency. Tell your doctor about any such situation that affects you.

This medication can cause you to have unusual results with certain medical tests. Tell any doctor who treats you that you are using hydrocortisone.

Do not stop using hydrocortisone suddenly, or you could have unpleasant withdrawal symptoms. Talk to your doctor about how to avoid withdrawal symptoms when stopping the medication.

Carry an ID card or wear a medical alert bracelet stating that you are taking a steroid, in case of emergency. Any doctor, dentist, or emergency medical care provider who treats you should know that you are taking steroid medication.

Store hydrocortisone at room temperature away from moisture and heat.

What happens if I miss a dose?

If you miss a dose or forget to take your medicine, contact your doctor or pharmacist for instructions.

What happens if I overdose?

Seek emergency medical attention if you think you have received too much of this medicine.

A single large dose of hydrocortisone is not expected to produce life-threatening symptoms. However, high doses taken over a long period of time may cause weight gain, roundness of the face, increased facial hair growth, bruising, swelling, and muscle pain or weakness.

What should I avoid while taking hydrocortisone?

Avoid being near people who are sick or have infections. Call your doctor for preventive treatment if you are exposed to chicken pox or measles. These conditions can be serious or even fatal in people who are using steroid medication.

Do not receive a "live" vaccine while you are being treated with hydrocortisone. Vaccines may not work as well while you are taking a steroid.

Avoid drinking alcohol while you are taking hydrocortisone.

Hydrocortisone side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have any of these serious side effects:

  • problems with your vision;

  • swelling, rapid weight gain, feeling short of breath;

  • severe depression, unusual thoughts or behavior, seizure (convulsions);

  • bloody or tarry stools, coughing up blood;

  • pancreatitis (severe pain in your upper stomach spreading to your back, nausea and vomiting, fast heart rate);

  • low potassium (confusion, uneven heart rate, extreme thirst, increased urination, leg discomfort, muscle weakness or limp feeling); or

  • dangerously high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, confusion, chest pain, shortness of breath, uneven heartbeats, seizure).

Less serious side effects may include:

  • sleep problems (insomnia), mood changes;

  • acne, dry skin, thinning skin, bruising or discoloration;

  • slow wound healing;

  • increased sweating;

  • headache, dizziness, spinning sensation;

  • nausea, stomach pain, bloating; or

  • changes in the shape or location of body fat (especially in your arms, legs, face, neck, breasts, and waist).

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Hydrocortisone dosing information

Usual Adult Dose for Adrenocortical Insufficiency:

Acute Adrenal Crisis:
100 mg IV followed by IV infusion of 200 mg over 24 hours OR 50 mg IV every 6 hours; then 100 mg IV the following day

Management of Primary Adrenal Insufficiency (PAI):
15 mg to 25 mg orally in 2 or 3 divided doses per day
-Highest dose should be given in the morning, then 2 hours after lunch (2-dose/day regimen) or at lunch and afternoon (3-dose/day regimen)

Prevention of Acute Adrenal Crisis:
Adjust dose according to severity of illness or magnitude of stressor

Comments:
-Fluid status should be managed according to protocols.
-Glucocorticoid replacement therapy should be adjusted based on clinical response.
-Most patients with PAI will require mineralocorticoid supplementation.
-Surgery and other stress inducing situations will require supplemental doses.

Suggested supplemental doses:
-Illness with fever: Double (fever greater than 100.4F [38C]) or triple (fever greater than 102.2F [39C]) oral hydrocortisone doses until recovery (usually 2 to 3 days); increase consumption of electrolyte-containing fluids as tolerated
-Not tolerating oral medication due to gastroenteritis or trauma: 100 mg IM
-Minor to moderate surgical stress: 25 to 75 mg per 24 hours for 1 to 2 days
-Major surgery with anesthesia, trauma, delivery, or ICU care: 100 mg IV followed by 200 mg IV infusion over 24 hours (or 50 mg IV/IM every 6 hours for 24 hours)

Use: For the treatment of adrenocortical insufficiency

Usual Adult Dose for Anti-inflammatory:

Dosing should be individualized on the basis of disease and patient response

Oral:
-Initial dose: 20 mg to 240 mg orally per day
Parenteral:
-Initial dose: 100 mg to 500 mg IV or IM per day in divided doses every 2, 4, or 6 hours

Maintenance dose: After a favorable initial response, dose should be decreased in small amounts to the lowest dose that maintains an adequate clinical response; if a positive response is not achieved after a reasonable period of time, alternative therapy should be sought.

Comments:
-Lower doses, including doses lower than recommended doses, may suffice in less severe disease; doses in excess of recommended doses may be required in severe disease; in life-threatening situations, doses exceeding multiples of the oral dose may be justified.
-Patients should be closely monitored for signs requiring dose adjustments; if therapy is to be stopped after more than a few days, it should be gradually withdrawn.

Uses: For use as a potent anti-inflammatory agent in managing disorders, diseases, and conditions affecting many organ systems including endocrine, dermatologic, ophthalmic, nervous. gastrointestinal, respiratory, musculoskeletal, and hematologic.

Usual Adult Dose for Sepsis:

200 mg per day by continuous IV infusion

Recommendations from the International Guidelines for Management of Severe Sepsis and Septic Shock 2016:
-IV hydrocortisone should not be used if adequate fluid resuscitation and vasopressor therapy are able to restore hemodynamic stability
-Steroids should not be used in septic patients to prevent septic shock as there is a lack of evidence to support this
-Continuous infusion is recommended over repetitive bolus injections as repetitive boluses have been shown to significantly increase blood glucose
-Taper hydrocortisone treatment when vasopressors no longer required

Use: For the treatment of septic shock when adequate fluid resuscitation and vasopressor therapy are not able to restore hemodynamic stability.

Usual Adult Dose for Asthma:

100 mg IV every 8 hours during surgical period; dose should be rapidly reduced within 24 hours after surgery

Comments:
-Asthma control should be assessed prior to surgery and if lung function is not well controlled, medications to improve lung function should be provided.
-For patients receiving oral corticosteroids in the 6 months prior to surgery, and for selected patients on high dose inhaled corticosteroids (ICS), IV hydrocortisone may be necessary to reduce risk for complications during and after surgery.
-Stress doses of corticosteroids may be considered for select patients with prior high-dose ICS use as clinically important adrenal suppression has been reported in these patients.

Use: To reduce risks of complications during and after surgery in patients with asthma.

Usual Adult Dose for Ulcerative Colitis:

100 mg rectally (retention enema) nightly for 21 days or until both clinical and protological remission occurs
-Difficult cases may require 2 or 3 months of treatment

Comments:
-Clinical symptoms should subside within 3 to 5 days; improvement in appearance of the mucosa (as viewed by sigmoidoscopic exam) may lag behind; discontinue use if no improvement observed within 2 to 3 weeks.
-Some patients may require 2 to 3 months of therapy; if therapy lasts more than 21 days, do not stop abruptly
-Therapy has shown to benefit distal forms of ulcerative colitis including ulcerative proctitis, ulcerative proctosigmoiditis, and left-sided ulcerative colitis; it has been useful in some cases involving the transverse and ascending colons.

Use: As adjunctive therapy in the treatment of ulcerative colitis, especially distal forms.

Usual Adult Dose for Ulcerative Proctitis:

1 applicatorful rectally once or twice daily for 2 to 3 weeks, then every second day thereafter

Comments:
-Satisfactory response generally occurs within 5 to 7 days with a marked decreased in symptoms; symptomatic improvement should be verified with sigmoidoscopy to best judge dose adjustment, duration of therapy, and rate of improvement.
-Therapy should be individualized and the proper maintenance dose determined by decreasing the initial dose in small decrements at appropriate time intervals until the lowest effective dose is reached.
-After long-term therapy, this drug should be gradually withdrawn.

Use: As adjunctive therapy in the topical treatment of ulcerative proctitis of the distal portion of the rectum in patients who cannot retain hydrocortisone or other corticosteroid enemas.

Usual Adult Dose for Multiple Sclerosis:

Acute exacerbation: 800 mg oral/IV/IM once a day for 1 week followed by 320 mg oral/IV/IM every other day for 1 month

Comments:
-Short-term high-dose corticosteroids are an accepted standard of care for treating relapses of multiple sclerosis; chronic daily corticosteroids are not recommended.
-IV methylprednisolone, oral prednisone and prednisolone are the corticosteroids most studied and cited in clinical guidelines; while this drug has been used, efficacy studies and comparative data are lacking.

Use: For the treatment of acute exacerbations of multiple sclerosis.

Usual Pediatric Dose for Adrenocortical Insufficiency:

Acute Adrenal Crisis:
Infants: 2 to 3 mg/kg IV or intraosseous (IO) over 3 to 5 minutes, followed by 1 to 5 mg/kg IV/IO every 6 hours
Children: 2 to 3 mg/kg IV or IO over 3 to 5 minutes, followed by 12.5 mg/m2 IV/IO every 6 hours OR 50 to 100 mg/m2 IV bolus followed by 50 to 100 mg/m2 IV in divided doses every 6 hours
Maximum dose: 100 mg

Management of Primary Adrenal Insufficiency (PAI):
8 mg/m2 orally in 3 or 4 divided doses per day
-Highest dose should be administered in morning

Prevention of Acute Adrenal Crisis:
Adjust dose according to severity of illness or magnitude of stressor

Comments:
-It is important not to under dose during an adrenal crisis.
-Glucocorticoid replacement therapy should be adjusted based on clinical response including growth velocity, body weight, blood pressure, and energy levels.
-Most patients with PAI will require mineralocorticoid supplementation; infants will require up to 12 months of sodium chloride supplements.
-Surgery and other stress inducing situations will require supplemental doses.

Suggested supplemental doses:
-Illness with fever: Double (fever greater than 100.4F [38C]) or triple (fever greater than 102.2F [39C]) oral hydrocortisone doses until recovery (usually 2 to 3 days); increase consumption of electrolyte-containing fluids as tolerated
-Not tolerating oral medication due to gastroenteritis or trauma: 50 mg/m2 IM or estimate (e.g., infants: 25 mg; school-age: 50 mg; adolescents 100 mg)
-Minor to moderate surgical stress: 50 mg/m2 IM or double or triple oral replacement dose
-Major surgery with anesthesia, trauma, delivery, or ICU care: 50 mg/m2 IM followed by 50 to 100 mg/m2 IM in divided doses every 6 hours; rapidly taper and switch to oral regimen as soon as clinical state allows

Use: For the treatment of adrenocortical insufficiency

Usual Pediatric Dose for Anti-inflammatory:

Dosing should be individualized on the basis of disease and patient response

-Initial dose: 0.56 to 8 mg/kg/day oral or IV in 3 or 4 divided doses (20 to 240 mg/m2/day)

Maintenance dose: After a favorable initial response, dose should be decreased in small amounts to the lowest dose that maintains an adequate clinical response; if a positive response is not achieved after a reasonable period of time, alternative therapy should be sought.

Comments:
-Lower doses, including doses lower than recommended doses, may suffice in less severe disease; doses in excess of recommended doses may be required in severe disease; in life-threatening situations, doses exceeding multiples of the oral dose may be justified.
-Patients should be closely monitored for signs requiring dose adjustments; if therapy is to be stopped after more than a few days, it should be gradually withdrawn.

Uses: For use as a potent anti-inflammatory agent in managing disorders, diseases, and conditions affecting many organ systems including endocrine, dermatologic, ophthalmic, nervous, gastrointestinal, respiratory, musculoskeletal, and hematologic.

What other drugs will affect hydrocortisone?

There are many other medicines that can interact with steroids. Below is only a partial list of these medicines:

  • aspirin (taken on a daily basis or at high doses);

  • a diuretic (water pill);

  • a blood thinner such as warfarin (Coumadin);

  • cyclosporine (Gengraf, Neoral, Sandimmune);

  • insulin or diabetes medications you take by mouth;

  • ketoconazole (Nizoral);

  • rifampin (Rifadin, Rifater, Rifamate, Rimactane); or

  • seizure medications such as phenytoin (Dilantin) or phenobarbital (Luminal, Solfoton).

This list is not complete and there may be other drugs that can interact with hydrocortisone. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

  • Your pharmacist can provide more information about hydrocortisone.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 5.06.

Date modified: April 03, 2017
Last reviewed: December 15, 2010

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