Hydrocortisone

Hydrocortisone

Pronunciation: (HIGH-droe-CORE-tih-sone)
Class: Corticosteroid, Glucocorticoid, Topical Trade Names:
Ala-Cort
- Cream 1%
- Lotion 1%
Trade Names:
Ala-Scalp
- Lotion 2%
Trade Names:
Anusol-HC
- Cream 2.5%
Trade Names:
Anusol-HC-1
- Ointment 1%
Trade Names:
Aquanil-HC
- Lotion 1%
Trade Names:
Balneol for Her
- Lotion 0.25%
Trade Names:
Beta-HC
- Lotion 1%
Trade Names:
Cetacort
- Lotion 1%
Trade Names:
Colocort
- Enema 100 mg hydrocortisone in 60 mL
Trade Names:
Corta-Cap
- Spray 1%
Trade Names:
Cortaid Intensive Therapy
- Cream 1%
Trade Names:
Cortaid Maximum Strength
- Cream 1%
- Sticks 1%
Trade Names:
Cortef
- Tablets 5 mg
- Tablets 10 mg
- Tablets 20 mg
Trade Names:
Corticool Maximum Strength
- Gel 1%
Trade Names:
Cortizone 5
- Ointment 0.5%
Trade Names:
Cortizone 10
- Liquid 1%
Trade Names:
Cortizone 10 Maximum Strength
- Cream 1%
- Ointment 1%
Trade Names:
Cortizone 10 Quick Shot
- Spray 1%
Trade Names:
Dermarest Dricort
- Cream 1%
Trade Names:
Dermarest Eczema
- Lotion 1%
Trade Names:
Dermtex-HC
- Cream 1%
- Spray 1%
Trade Names:
Earsol-HC
- Solution 1%
Trade Names:
Hemorrodil
- Ointment 1%
Trade Names:
Hydrocortisone
- Ointment 2.5%
Trade Names:
Hytone
- Cream 2.5%
- Lotion 1%
Trade Names:
Instacort-5
- Cream 0.5%
Trade Names:
Instacort-10
- Cream 1%
Trade Names:
Instacort-10 Maximum Strength
- Ointment 1%
Trade Names:
Keratol HC
- Cream 1%
Trade Names:
Microcort
- Lotion 0.5%
Trade Names:
Mycin Scalp
- Liquid 1%
Trade Names:
NuCort
- Lotion 2%
Trade Names:
Post Peel Balm
- Cream 1%
Trade Names:
Preparation H Hydrocortisone
- Cream 1%
Trade Names:
Proctocare-HC
- Cream 2.5%
Trade Names:
Proctocort
- Cream 1%
Trade Names:
Proctocream-HC
- Cream 2.5%
Trade Names:
Proctosol-HC
- Cream 2.5%
Trade Names:
Proctozone-HC
- Cream 2.5%
Trade Names:
Recort Plus
- Cream 1%
Trade Names:
Sarnol-HC Maximum Strength
- Lotion 1%
Trade Names:
Scalacort DK
- Lotion 2%
Trade Names:
Scalpcort
- Lotion 1%
Trade Names:
Texacort
- Solution 2.5%
Trade Names:
Therasoft Anti-Itch
- Ointment 1%
Trade Names:
Tucks
- Ointment 1%
Claritin Skin Itch Relief (Canada)
Cortoderm (Canada)
Emo-Cort (Canada)
Hydrosone (Canada)
Prevex HC (Canada)
Sarna HC (Canada)
Hydrocortisone Acetate
Trade Names:
Anu-Med-HC
- Suppositories 25 mg
Trade Names:
Anucort-HC
- Suppositories 25 mg
Trade Names:
Anusol-HC
- Suppositories 25 mg
Trade Names:
Caldecort
- Cream 1%
Trade Names:
Cortaid Maximum Strength
- Ointment 1%
Trade Names:
Cortifoam
- Foam 10%
Trade Names:
Hemorrhoidal-HC
- Cream 1%
- Suppositories 25 mg
Trade Names:
Hemril-30
- Suppositories 30 mg
Trade Names:
Hemril-HC Uniserts
- Suppositories 25 mg
Trade Names:
Keratol-HC
- Cream 1%
Trade Names:
Nuzon
- Gel 2%
Trade Names:
Proctocort
- Suppositories 30 mg
Trade Names:
Proctosert-HC
- Suppositories 30 mg
Trade Names:
Proctosol-HC
- Suppositories 25 mg
Trade Names:
Raskando
- Cream 0.5%
Trade Names:
Rectasol-HC
- Suppositories 25 mg
Trade Names:
U-Cort
- Cream 1%
Cortef Cream (Canada)
Hyderm (Canada)
Hydrocortisone Butyrate
Trade Names:
Locoid
- Cream 0.1%
- Ointment 0.1%
- Solution 0.1%
Trade Names:
Lociod Lipocream
- Cream 0.1%
Hydrocortisone Probutate
Trade Names:
Pandel
- Cream 0.1%
Hydrocortisone Sodium Succinate
Trade Names:
A-Hydrocort
- Injection 100 mg/vial
- Injection 500 mg/vial
Trade Names:
Solu-Cortef
- Injection 100 mg/vial
- Injection 250 mg/vial
- Injection 500 mg/vial
- Injection 1,000 mg/vial
Hydrocortisone Valerate
Trade Names:
Westcort
- Cream 0.2%
- Ointment 0.2%

Pharmacology

Fast-acting glucocorticoid that depresses formation, release, and the activity of endogenous mediators of inflammation including prostaglandins, kinins, histamine, liposomal enzymes, and complement system. also modifies the body's immune response.
Listen
Read phonetically

Indications and Usage

Treatment of primary or secondary adrenal cortex insufficiency, rheumatic disorders, collagen diseases, dermatologic diseases, allergic states, allergic and inflammatory ophthalmic processes, respiratory diseases, hematologic disorders (idiopathic thrombocytopenic purpura), neoplastic diseases, edematous states (resulting from nephrotic syndrome), GI diseases (ulcerative colitis and sprue), multiple sclerosis, tuberculous meningitis, trichinosis with neurologic or myocardial involvement.
Intra-articular or soft tissue administration Treatment of synovitis of osteoarthritis andsymptoms of rheumatoid arthritis, bursitis, acute gouty arthritis, epicondylitis, acute nonspecific tenosynovitis, and post-traumatic osteoarthritis.
Intralesional administrationTreatment of keloids, lesions of lichen planus, psoriatic plaques, granuloma annulare, lichen simplex chronicus, discoid lupus erythematosus, necrobiosis lipoidica diabeticorum, alopeciaareata, and cystic tumors of aponeurosis or tendon.
Topical administration Treatment of inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses, management of refractory lesions of psoriasis, and other deep-seated dermatoses; hygienic cleansing of irritated perianal and external vaginal areas.
Rectal administration Relief of discomfort associated with hemorrhoids, perianal itching, or irritation.

Contraindications

Systemic fungal infections; IM use in idiopathic thrombocytopenic purpura; administration of live virus vaccines in patients receiving immunosuppressive corticosteroid doses.

Dosage and Administration

Hydrocortisone Probutate
Adults and Children Topical Apply thin film to affected area twice daily.
Hydrocortisone Butyrate
Adults and Children Topical Apply sparingly to affected areas 2 to 4 times daily.
Hydrocortisone
Adults and Children PO 20 to 240 mg/day.
Hydrocortisone Sodium Succinate
Adults and Children IV / IM 100 to 500 mg every 2 to 6 h.
Hydrocortisone Acetate (Intralesional, Intra-Articular or Soft Tissue Injection Only)
Large Joints (Knee) and BursaeAdults and Children 25 to 37.5 mg.
Small Joints (Interphalangeal, Temporomandibular) Adults and Children 10 to 25 mg.
Tendon Sheaths Adults and Children 5 to 12.5 mg.
Soft Tissue Infiltration Adults and Children 25 to 75 mg.
Ganglia Adults and Children 12.5 to 25 mg.
Topical Adults and Children Apply sparingly to affected areas 2 to 4 times daily.

Drug Interactions

Oral administration of hydrocortisone:
Anticholinesterases May antagonize anticholinesterase effects in myasthenia gravis.
Anticoagulants, oral May alter anticoagulant dose requirements.
Barbiturates May decrease effect of hydrocortisone.
Cholestyramine May decrease hydrocortisone levels.
Contraceptives (oral) estrogensMay decrease Cl of hydrocortisone.
Hydantoins, rifampin May increase Cl and decrease therapeutic efficacy of hydrocortisone.
Salicylates May reduce serum levels and efficacy of salicylates.
Troleandomycin May increase effects of hydrocortisone.

Laboratory Test Interactions

May cause increased urine glucose and serum cholesterol, decreased serum levels of potassium, T 3 and T 4 , decreased uptake of Thyroid I131 , false-negative nitroblue-tetrazolium test for bacterial infection, suppression of skin test reactions.

Adverse Reactions

Cardiovascular

Thromboembolism or fat embolism; thrombophlebitis; necrotizing angiitis; cardiac arrhythmias or ECG changes; syncopal episodes; hypertension; myocardial rupture; CHF.

CNS

Convulsions; increased intracranial pressure with papilledema (pseudotumor cerebri); vertigo; headache; neuritis; paresthesias; psychosis.

Dermatologic

Impaired wound healing; thin, fragile skin; petechiae and ecchymoses; erythema; lupus erythematosus-like lesions; subcutaneous fat atrophy; striae; hirsutism; acneiform eruptions; allergic dermatitis; urticaria; angioneurotic edema; perineal irritation; hyperpigmentation or hypopigmentation. Topical application may cause burning; irritation; erythema; dryness; folliculitis; hypertrichosis; pruritus; perioral dermatitis; allergic contact dermatitis; stinging, cracking and tightening of skin; secondary infections; skin atrophy; striae; miliaria; telangiectasia.

EENT

Posterior subcapsular cataracts; increased IOP; glaucoma; exophthalmos.

GI

Pancreatitis; abdominal distension; ulcerative esophagitis; nausea; vomiting; increased appetite and weight gain; peptic ulcer with perforation and hemorrhage; bowel perforation.

Genitourinary

Increased or decreased motility and number of spermatozoa.

Hematologic

Leukocytosis.

Metabolic

Sodium and fluid retention; hypokalemia; hypokalemic alkalosis; metabolic alkalosis; hypocalcemia.

Miscellaneous

Musculoskeletal effects (eg, weakness, myopathy, muscle mass loss, osteoporosis, spontaneous fractures); endocrine abnormalities (eg, menstrual irregularities, cushingoid state, growth suppression in children, sweating, decreased carbohydrate tolerance, hyperglycemia, glycosuria, increased insulin or sulfonylurea requirements in diabetics); anaphylactoid or hypersensitivity reactions; aggravation or masking of infections; malaise; fatigue; insomnia. Topical use may cause same adverse reactions seen with systemic use because of possibility of absorption.

Precautions
Pregnancy


Safety is not established (systemic use) Category C (topical).
Lactation

Excreted in breast milk.
Children

Children may absorb proportionally larger amounts of topical corticosteroids and thus be more susceptible to systemic toxicity. Observing the growth and development of infants and children on prolonged therapy.
Seniors

May require lower doses.
Renal function

Use with caution, monitor renal function.
adrenal suppression

Prolonged (daily systemic) treatment (more than 7 days) can lead to suppression of hypothalamic-pituitary-adrenal axis.
Electrolyte balance

May cause an increase in BP, salt and water retention and increased excretion of potassium and calcium. dietary salt restriction and potassium supplementation may be necessary.
Hepatitis

May be harmful in chronic active hepatitis positive for HBV surface antigen.
Infections

may mask signs of infection. May decrease host mechanisms of defense.
Ocular Effects

Use caution in patients with ocular herpes simplex because of possible corneal perforation.
peptic ulcer

Can contribute to peptic ulcer, especially in high doses.
Repository injections

Do not inject subcutaneously, avoiding injection into a deltoid IM injection and repeated in the same site.
Stress

Increasing the dose of rapidly acting corticosteroids may be necessary before, during and after stressful situations.
Withdrawal

Abrupt discontinuation may cause adrenal insufficiency. Phasing; supplementation increases during periods of stress.
Overdose
Symptoms

Acute toxicity and death are rare. Acute adrenal insufficiency (caused by the withdrawal after long-term use): fever, myalgia, arthralgia, malaise, anorexia, nausea, loss of skin, orthostatic hypotension, dizziness, fainting, dyspnea, cushingoid symptoms (hypoglycemia caused by chronic high doses): Moonface, central obesity, striae, hirsutism, acne, bruising, hypertension, osteoporosis, myopathy, sexual dysfunction, diabetes, hyperlipidemia, peptic ulcer ulcer, increased susceptibility to infection, electrolyte imbalance and water.
Patient Information

    * Advise patient to take oral medication with food to minimize gastrointestinal upset.
    * Warn patients not to abruptly stop taking the medication.
    * Please note that diabetics on insulin or oral hypoglycemic agent needs may increase.
    * Ask elderly patient to have BP, blood glucose, electrolytes and checked at least every six months.
    * Inform the patient that sunglasses can reduce the sensitivity to sunlight that occurs with administration perspective.
    * Note cons eye contact with topical agents.
    * Patient to wash or soak the area for topical administration prior to administration to enhance absorption.
    * Advise patient to apply topical agents sparingly, rubbing slightly.
    * Note cons covering areas treated with topical unless otherwise prescribed by the health care provider.
    * Is not recommended to mix with other topical products unless the health care provider.
    * Patient dose is missed if the current to be applied as soon as remembered, but not double the dose.
    * Teach patient using suppositories or other agents that hemorrhoids proper diet, fluid intake and adequate exercise is a useful addition to treatment.
    * Remind patient to wear medical identification (eg, card, bracelet) while taking this drug.
    * Temporary Adviser that burning is common after administration of preparations optics.
    * Caution patient that systemic reactions can occur with topical applications.
Read More:http://www.drugs.com/ppa/hydrocortisone.html