Hydrocortisone

Aka: Hydrocortisone, Cortef, Solu-Cortef

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II. Indications

  1. Acute Adrenal Insufficiency
  2. Refractory Septic Shock adjunct
  3. Acute, new onset Ulcerative Colitis or Regional Enteritis
  4. Autoimmune Hemolytic Anemia
  5. Immune Thrombocytopenic Purpura
  6. Leukemia and Lymphoma (not before diagnosis)
  7. Acute Systemic Lupus Erythematosus or Rheumatoid Arthritis

III. Mechanism

  1. See Systemic Corticosteroid
  2. Preferred replacement in Adrenal Insufficiency (both Glucocorticoid and mineralcorticoid activity)
  3. Hydrocortisone is identical chemically to the Cortisol synthesized by the Adrenal Gland
  4. Short-acting Corticosteroid
  5. Weak mineralcorticoid activity

IV. Medications

  1. Systemic
    1. Hydrocortisone Tablets: 5 mg, 10 mg, 20 mg
    2. Hydrocortisone Injection (Solu-Cortef)
  2. Non-Systemic
    1. Hydrocortisone Topical (Topical Corticosteroids)
      1. Hydrocortisone butyrate
      2. Hydrocortisone valerate
      3. Hydrocortisone Cream
    2. Hydrocortisone for Inflammatory Bowel Disease
      1. Hydrocortisone Rectal Foam
      2. Hydrocortisone Enema

V. Dosing: General anti-inflammatory dosing

  1. Adult
    1. Parenteral: 100 to 150 mg IV/IM every 2 to 6 hours prn
    2. Oral: 20 to 240 mg/day orally in divided dosing
  2. Child (not standardized in general outside of specific indications)
    1. Oral or IV: 0.5 to 8 mg/kg/day divided every 6 to 8 hours

VI. Dosing: Adrenal Insufficiency

  1. See Acute Adrenal Insufficiency
  2. Adults
    1. Primary: 15 to 25 mg/day orally every 8 to 12 hours (give at least 50% of the dose in the AM)
    2. Acute Crisis: 100 mg IV every 8 hours (or Dexamethasone 4 mg IV)
  3. Children
    1. Primary: 8 mg/m2 divided every 8 to 12 hours
    2. Acute Crisis
      1. Calculated
        1. Weight: 1 to 2 mg/kg IV every 8 hours
        2. BSA: 50 to 100 mg/m2 IV load then 50 to 100 mg/m2/day divided every 6 hours
      2. Age
        1. Newborns: 12.5 mg IV
        2. Infants and young children: 25 mg IV
        3. School Aged Children: 50 mg IV
        4. Teens (same as adult dosing): 100 mg IV

VII. Dosing: Stress Dose Steroid

  1. See Stress Dose Steroid
  2. See Perioperative Corticosteroid
  3. Indication: Acute severe illness (critically ill such as Septic Shock)
    1. Serum Cortisol <15 to 34 mcg/dl
    2. Cortisol <9 after Corticotropin Stimulation Test
  4. Hydrocortisone
    1. Adults: 50 mg IV or IM q6 hours (or 3x the chronic dose)
    2. Children: 1 to 2 mg/kg IV every 8 hours
  5. Consider adding fludricortisone 50 mcg daily for 7 days (for additional mineralcorticoid activity)
  6. Taper stress dosing over 10-14 days

VIII. Pharmacokinetics

  1. Low potency and low anti-inflammatory activity
  2. Has Mineralocorticoid activity
  3. High mineralcorticoid activity (effect on Sodium and water retention)
  4. Short Half-Life (8-12 hours)

IX. Adverse Effects

  1. See Systemic Corticosteroid

X. Safety

  1. Unknown safety in pregnancy
  2. Avoid in Lactation

XI. Resources

  1. Hydrocortisone Tablet (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=9fe627ad-4aba-4bd1-8590-6cc2d61674ba
  2. Hydrocortisone Injection (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=f5bb0854-a477-4e59-914b-eeeaef92a596

XII. References

  1. LoVecchio (2022) Crit Dec Emerg Med 36(11): 32

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Related Studies

Cost: Medications

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
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information. GoodRx is another tool for finding lower drug prices.

Ontology: Hydrocortisone (C0020268)

Definition (MSHCZE) Nejdůležitější glukokortikoid vylučuje NADLEDVINOVÁ KŮRA. Jeho syntetický analog se užívá ve formě injekce nebo lokálně při léčbě zánětů, alergií, kolagenóz, astmatu, adrenokortikální nedostatečnosti, šoku a někdy při nádorových onemocněních.
Definition (NCI) A synthetic or semisynthetic analog of natural hydrocortisone hormone produced by the adrenal glands with primary glucocorticoid and minor mineralocorticoid effects. As a glucocorticoid receptor agonist, hydrocortisone promotes protein catabolism, gluconeogenesis, capillary wall stability, renal excretion of calcium, and suppresses immune and inflammatory responses. (NCI04)
Definition (NCI_NCI-GLOSS) A hormone made by the adrenal cortex (the outer layer of the adrenal gland). It helps the body use glucose (a sugar), protein, and fats. Cortisol made in the laboratory is called hydrocortisone. It is used to treat many conditions, including inflammation, allergies, and some cancers. Cortisol is a type of glucocorticoid hormone.
Definition (NCI_NCI-GLOSS) A drug used to relieve the symptoms of certain hormone shortages and to suppress an immune response.
Definition (MSH) The main glucocorticoid secreted by the ADRENAL CORTEX. Its synthetic counterpart is used, either as an injection or topically, in the treatment of inflammation, allergy, collagen diseases, asthma, adrenocortical deficiency, shock, and some neoplastic conditions.
Definition (CSP) main glucocorticoid secreted by the adrenal cortex; its synthetic counterpart is used, either as an injection or topically, in the treatment of inflammation, allergy, collagen diseases, asthma, adrenocortical deficiency, shock, and some neoplastic conditions.
Definition (PDQ) A synthetic or semisynthetic analog of natural hydrocortisone hormone produced by the adrenal glands with primary glucocorticoid and minor mineralocorticoid effects. As a glucocorticoid receptor agonist, hydrocortisone promotes protein catabolism, gluconeogenesis, capillary wall stability, renal excretion of calcium, and suppresses immune and inflammatory responses. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=39274&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=39274&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C555" NCI Thesaurus)
Concepts Pharmacologic Substance (T121) , Steroid (T110) , Hormone (T125)
MSH D006854
SnomedCT 396458002, 56423005, 16602005
LNC LP97871-5, LP70288-3, LP14161-1, MTHU001562, MTHU035101
English Compound F, Cortisol, Hydrocortisone, Pregn-4-ene-3,20-dione, 11,17,21-trihydroxy-, (11beta)-, Dihydrocortisone, (11beta)-11,17,21-Trihydroxypregn-4-ene-3,20-dione, hydrocortisone, Domolene, Therapeutic Hydrocortisone, hydrocortisone (medication), HYDROCORTISONE, Hydrocortisone [Chemical/Ingredient], cortisols, 17-hydroxycorticosterone, hydrocortisones, Cortisol (substance), Compound F preparation, Cortisol preparation, Cortisol product, HC - Hydrocortisone, Hydrocortisone preparation, Hydrocortisone product, Hydrocortisone (substance), Hydrocortisone preparation (product), cortisol, HC, Hydrocortisone preparation (substance)
Swedish Hydrokortison
Spanish cortisol, preparado con hidrocortisona (producto), hidrocortisona (producto), preparado con hidrocortisona, cortisol (sustancia), hidrocortisona (sustancia), hidrocortisona, preparado de hidrocortisona (producto), preparado de hidrocortisona (sustancia), preparado de hidrocortisona, Cortisol, Hidrocortisona
Czech hydrokortison, kortisol, kortizol, hydrokortizon
Finnish Kortisoli
Russian KORTIZOL, GIDROKORTIZON, ГИДРОКОРТИЗОН, КОРТИЗОЛ
Japanese コルチソール, ヒドロコルチゾン, コルチソル, 17-ヒドロキシコルチコステロン, ハイドロコルチゾン, コートリル, コルチゾール
Italian Cortisolo, Idrocortisone
Croatian HIDROKORTIZON
Polish Hydrokortyzon, Kortyzol
Norwegian Kortisol, Hydrokortison
French Cortisol, Hydrocortisone
German Cortisol, Hydrocortison, Kortisol
Portuguese Cortisol, Hidrocortisona
Derived from the NIH UMLS (Unified Medical Language System)

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