Cortef Side Effects
Generic Name: hydrocortisone
Medically reviewed by Drugs.com. Last updated on June 17, 2020.
Note: This document contains side effect information about hydrocortisone. Some of the dosage forms listed on this page may not apply to the brand name Cortef.
For the Consumer
Applies to hydrocortisone: oral tablet
Other dosage forms:
Side effects requiring immediate medical attention
Along with its needed effects, hydrocortisone (the active ingredient contained in Cortef) may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur while taking hydrocortisone:
- blurred vision
- burning, dry, or itching eyes
- decrease in the amount of urine
- discharge, excessive tearing
- dry mouth
- ear congestion
- fast, slow, pounding, or irregular heartbeat or pulse
- irregular heartbeats
- mental depression
- mood changes
- noisy, rattling breathing
- numbness or tingling in the arms or legs
- pounding in the ears
- redness, pain, swelling of eye, eyelid, or inner lining of the eyelid
- runny or stuffy nose
- sore throat
- swelling of the fingers, hands, feet, or lower legs
- trouble thinking, speaking, or walking
- trouble breathing
- trouble sleeping
- unusual tiredness or weakness
- weight gain
Incidence not known
- bloody, black, or tarry stools
- cough or hoarseness
- darkening of the skin
- decrease in height
- decreased vision
- eye pain
- eye tearing
- facial hair growth in females
- fever or chills
- flushed, dry skin
- fruit-like breath odor
- full or round face, neck, or trunk
- heartburn 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
- pain in the back, ribs, arms, or legs
- painful or difficult urination
- skin rash
- stomach pain or cramps
- trouble healing
- unexplained weight loss
- vision changes
- vomiting of material that looks like coffee grounds
Side effects not requiring immediate medical attention
Some side effects of hydrocortisone may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.
Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
- increased appetite
- large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
- puffiness or swelling of the eyelids or around the eyes, face, or lips
Incidence not known
- Abnormal fat deposits on the face, neck, and trunk
- 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 granule, oral suspension, oral tablet, rectal foam with applicator, rectal suspension
Corticosteroid side effects/complications are primarily dose and duration dependent; adverse effects are infrequent with physiologic or lower pharmacologic dosages. Short-term effects have included sodium retention-related weight gain and fluid accumulation, hyperglycemia/glucose intolerance, hypokalemia, and psychic disturbances. Long-term effects have included hypothalamus-pituitary-adrenal activity suppression, Cushingoid appearance, hirsutism, impotence, menstrual irregularities, peptic ulcer disease, cataracts and increased intraocular pressure/glaucoma, myopathy, osteoporosis, and vertebral compression fractures.[Ref]
Frequency not reported: Bradycardia, cardiac arrest, cardia arrhythmias, cardiac enlargement, circulatory collapse, fat embolism, hypertension, congestive heart failure, hypertrophic cardiomyopathy in premature infants, myocardial rupture following recent myocardial infarction, thrombophlebitis, vasculitis, syncope, tachycardia, thromboembolism, thrombophlebitis, vasculitis, necrotising angiitis[Ref]
An antagonism occurs between the parathyroids and hypercorticism. Latent hyperparathyroidism may be unmasked by administration of corticosteroids; hypoparathyroidism may be manifest by phosphate retention occurring in renal failure caused by adrenal insufficiency.[Ref]
Frequency not reported: Hypothalamus-pituitary-adrenal activity has been suppressed up to 12 months following long-term corticosteroid administration, Cushingoid appearance with chronic therapy, hirsutism, virilism, impotence, menstrual irregularities, hypertrichosis, moon face, latent hyperparathyroidism, hypoparathyroidism[Ref]
Frequency not reported: Gastrointestinal upset, nausea, vomiting, peptic ulcer disease, pancreatitis, ulcerative esophagitis, abdominal distention, gastrointestinal perforation and hemorrhage, esophageal candidiasis[Ref]
Rare (0.01% to 0.1%): Hypernatremia
Frequency not reported: Decreased glucose tolerance, hyperglycemia, hypokalemia, fluid retention, negative nitrogen balance due to protein catabolism, increased blood urea nitrogen concentration, sodium retention, hypokalemic alkalosis, increased appetite, weight gain, hypertriglyceridemia[Ref]
Frequency not reported: Steroid myopathy, muscle weakness, loss of muscle mass, osteoporosis, vertebral compression fractures, tendon rupture (particularly the Achilles tendon), aseptic necrosis of bone, growth suppression in pediatric patients, Charcot-like arthropathy, post-injection flare (intra-articular use), osteonecrosis[Ref]
Aseptic necrosis has been reported most often to affect the femoral head. 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]
Frequency not reported: Impairment in cell-mediated immunity, increased susceptibility to bacterial, viral, fungal and parasitic infections, immunosuppression, opportunistic infections from mild to fatal, reactivation of tuberculosis[Ref]
Increases in serum transaminases and alkaline phosphatase have been observed with corticosteroid therapy; these laboratory changes are generally small, not associated with clinical symptoms, and are reversible upon discontinuation.[Ref]
Frequency not reported: Reversible increases in serum transaminase and alkaline phosphatase concentrations, hepatomegaly[Ref]
Corticosteroid therapy has been associated with a total increase in WBC; with an increase in neutrophils and a decrease in monocytes, lymphocytes, and eosinophils.[Ref]
Frequency not reported: Increased ease in bruising, ecchymosis, petechiae, delayed wound healing, acne, thin fragile skin, facial erythema, increased sweating, suppress reaction to skin testing, allergic dermatitis, burning or tingling in the perineal area after IV injection, cutaneous and subcutaneous atrophy, edema, hyperpigmentation, hypopigmentation, erythema, sterile abscess, striae, thinning scalp hair, urticaria[Ref]
Frequency not reported: Increased intraocular pressure, glaucoma, posterior subcapsular cataracts, exophthalmos, central serous chorioretinopathy, corneal or scleral thinning, exacerbation of ophthalmic viral disease[Ref]
Frequency not reported: Psychoses, personality or behavioral changes, depression, emotional instability, euphoria, insomnia, mood swings, personality changes, psychic disorders, exacerbation of preexisting affect lability or psychotic behavior[Ref]
In adults, the incidence of severe psychic reactions has been estimated to be around 5% to 6%. Psychological effects have been reported on withdrawal of corticosteroids, although the incidence is unknown.[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 (the active ingredient contained in Cortef) 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.
Bronchospasm after intravenous hydrocortisone 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]
Rare (0.01% to 0.1%): Hypersensitivity reaction (enema)
Frequency not reported: Anaphylaxis, anaphylactoid reaction, angioedema[Ref]
Frequency not reported: Glycosuria, increased or decreased motility and number of spermatozoa
Frequency not reported: Convulsions, increased intracranial pressure with papilledema/pseudo-tumor cerebri (usually occurs after treatment), headache, neuritis, neuropathy, paresthesia, arachnoiditis, meningitis, paraparesis/paraplegia, sensory disturbances, epidural lipomatosis
Paresthesia, arachnoiditis, meningitis, paraparesis/paraplegia, and sensory disturbances have occurred after intrathecal administration. Intrathecal use is contraindicated and epidural administration is not recommended due to the occurrence of serious adverse events having been associated with these routes of administration.
Frequency not reported: Kaposi's sarcoma
1. "Product Information. Cortenema (hydrocortisone topical)." Solvay Pharmaceuticals Inc, Marietta, GA.
2. Cerner Multum, Inc. "Australian Product Information." O 0
3. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co, Inc, West Point, PA.
4. "Product Information. Cortef (hydrocortisone)." Pfizer U.S. Pharmaceuticals Group, New York, NY.
5. "Product Information. Solu-Cortef (hydrocortisone sodium succinate)." Pfizer U.S. Pharmaceuticals Group, New York, NY.
6. "Product Information. Cortifoam (hydrocortisone)." Meda Pharmaceuticals, Somerset, NJ.
7. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
8. Egashira K, Origuchi H, Sagara T, Kikuchi Y "Coronary artery spasm during hydrocortisone-induced allergic reactions." Am Heart J 113 (1987): 1516-7
9. Lauerma AI, Reitamo S, Maibach HI "Systemic hydrocortisone/cortisol induces allergic skin reactions in presensitized subjects." J Am Acad Dermatol 24 (1991): 182-5
10. 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
11. Peller JS, Bardana EJ Jr "Anaphylactoid reaction to corticosteroid: case report and review of the literature." Ann Allergy 54 (1985): 302-5
12. Kamm GL, Hagmeyer KO "Allergic-type reactions to corticosteroids." Ann Pharmacother 33 (1999): 451-60
13. 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
14. Mendelson LM, Meltzer EO, Hamburger RN "Anaphylaxis-like reactions to corticosteroid therapy." J Allergy Clin Immunol 54 (1974): 125-31
15. 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
16. Partridge MR, Gibson GJ "Adverse bronchial reactions to intravenous hydrocortisone in two aspirin-sensitive asthmatic patients." Br Med J 1 (1978): 1521-2
Frequently asked questions
- Is this drug the same as hydrocortisone?
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- How long does it take for neomycin, polymyxin b and hydrocortisone ear drops to work?
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Some side effects may not be reported. You may report them to the FDA.