II. Indications
- Acute Adrenal Insufficiency
- Refractory Septic Shock adjunct
- Acute, new onset Ulcerative Colitis or Regional Enteritis
- Autoimmune Hemolytic Anemia
- Immune Thrombocytopenic Purpura
- Leukemia and Lymphoma (not before diagnosis)
- Acute Systemic Lupus Erythematosus or Rheumatoid Arthritis
III. Mechanism
- See Systemic Corticosteroid
- Preferred replacement in Adrenal Insufficiency (both Glucocorticoid and mineralcorticoid activity)
- Hydrocortisone is identical chemically to the Cortisol synthesized by the Adrenal Gland
- Short-acting Corticosteroid
- Weak mineralcorticoid activity
IV. Medications
- Systemic
- Hydrocortisone Tablets: 5 mg, 10 mg, 20 mg
- Hydrocortisone Injection (Solu-Cortef)
- Non-Systemic
V. Dosing: General anti-inflammatory dosing
- Adult
- Parenteral: 100 to 150 mg IV/IM every 2 to 6 hours prn
- Oral: 20 to 240 mg/day orally in divided dosing
- Child (not standardized in general outside of specific indications)
- Oral or IV: 0.5 to 8 mg/kg/day divided every 6 to 8 hours
VI. Dosing: Adrenal Insufficiency
- See Acute Adrenal Insufficiency
- Adults
- Primary: 15 to 25 mg/day orally every 8 to 12 hours (give at least 50% of the dose in the AM)
- Acute Crisis: 100 mg IV every 8 hours (or Dexamethasone 4 mg IV)
- Children
- Primary: 8 mg/m2 divided every 8 to 12 hours
- Acute Crisis
- Calculated
- Weight: 1 to 2 mg/kg IV every 8 hours
- BSA: 50 to 100 mg/m2 IV load then 50 to 100 mg/m2/day divided every 6 hours
- Age
- Newborns: 12.5 mg IV
- Infants and young children: 25 mg IV
- School Aged Children: 50 mg IV
- Teens (same as adult dosing): 100 mg IV
- Calculated
VII. Dosing: Stress Dose Steroid
- See Stress Dose Steroid
- See Perioperative Corticosteroid
- Indication: Acute severe illness (critically ill such as Septic Shock)
- Serum Cortisol <15 to 34 mcg/dl
- Cortisol <9 after Corticotropin Stimulation Test
- Hydrocortisone
- Adults: 50 mg IV or IM q6 hours (or 3x the chronic dose)
- Children: 1 to 2 mg/kg IV every 8 hours
- Consider adding fludricortisone 50 mcg daily for 7 days (for additional mineralcorticoid activity)
- Taper stress dosing over 10-14 days
VIII. Pharmacokinetics
- Low potency and low anti-inflammatory activity
- Has Mineralocorticoid activity
- High mineralcorticoid activity (effect on Sodium and water retention)
- Short Half-Life (8-12 hours)
IX. Adverse Effects
X. Safety
- Unknown safety in pregnancy
- Avoid in Lactation
XI. Resources
- Hydrocortisone Tablet (DailyMed)
- Hydrocortisone Injection (DailyMed)
XII. References
- LoVecchio (2022) Crit Dec Emerg Med 36(11): 32
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Related Studies
| hydrocortisone (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| HYDROCORTISONE 0.5% CREAM | Generic OTC | $0.05 per gram |
| HYDROCORTISONE 1% CREAM | Generic | $0.10 per gram |
| HYDROCORTISONE 1% OINTMENT | Generic | $0.15 per gram |
| HYDROCORTISONE 10 MG TABLET | Generic | $0.29 each |
| HYDROCORTISONE 100 MG/60 ML | Generic | $0.16 per ml |
| HYDROCORTISONE 2.5% CREAM | Generic | $0.11 per gram |
| HYDROCORTISONE 2.5% LOTION | Generic | $0.19 per ml |
| HYDROCORTISONE 2.5% OINTMENT | Generic | $0.10 per gram |
| HYDROCORTISONE 20 MG TABLET | Generic | $0.38 each |
| HYDROCORTISONE 5 MG TABLET | Generic | $0.17 each |
| HYDROCORTISONE BUTY 0.1% CREAM | Generic | $2.04 per gram |
| HYDROCORTISONE VAL 0.2% CREAM | Generic | $0.60 per gram |
| HYDROCORTISONE VAL 0.2% OINTMT | Generic | $3.20 per gram |
| HYDROCORTISONE-ALOE 1% CREAM | Generic OTC | $0.06 per gram |
| solu-cortef (on 1/1/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| SOLU-CORTEF 100 MG ACT-O-VIAL | $17.70 each | |
| SOLU-CORTEF 100 MG VIAL | $13.12 each | |