Hydrocortisone

Hydrocortisone (中文: 氫化可的松) is a steroid with anti-inflammatory and immunosuppressant effects. Indications include:

• Hypersensitivity reactions e.g. anaphylaxis and angioedema
• Asthma
• Inflammatory bowel disease
• Eczema, psoriasis and other inflammatory skin conditions
• Rheumatoid arthritis
• Treatment of choice for adrenocortical insufficiency

Hydrocortisone can be given by mouth, topically, or by injection.

Pronunciation

Hydrocortisone 20mg

Equivalent anti-inflammatory doses of steroids

Prednisolone 5 mg is equivalent to	Betamethasone 750 micrograms
	dexamethasone 750 micrograms
	hydrocortisone 20 mg
	methylprednisolone 4 mg
	triamcinolone 4 mg

Drug Names

Generic Name 藥名	HA Code 藥物代碼	Classification藥物分類
Hydrocortisone Tablet 20mg	HYDR06	P1S1S3

Mechanism of Action

Immunosuppression agent, Steroid replacement agent, Anti-inflammatory agent

Dosage

Hydrocortisone is used, usually with a more potent mineralocorticoid fludrocortisone, for replacement therapy in adrenocortical insufficiency.

By Oral	as replacement therapy, 20-30 mg daily (usually in 2 doses, the larger in the morning and the smaller in the early evening, to mimic the circadian rhythm of the body).
By intramuscular injection or slow intravenous injection	100-500 mg, 3-4 times in 24 hours or as required.

Child dose: as replacement therapy in adrenocortical insufficiency
By slow intravenous injection
Up to 1 year: 25 mg
1-5 years: 50 mg
6-12 years: 100 mg

Side Effects

Short-term use

include nausea and feeling tired. More severe side effects include psychiatric problems including euphoria, nightmares, insomnia, irritability, confusion, suicidal thoughts and behavioral disturbances. This may occur in about 5% of people.

Long-term steroid use can lead to

Adrenal suppression
Steroid-induced diabetes
Osteoporosis, muscle wasting and weakness	which is a danger, particularly in the elderly, as it can result in osteoporotic fractures for example of the hip or vertebrae
Susceptibility to infection
Cushing’s syndrome	moon face, striae, and acne
Endocrine side effects	menstrual irregularities and amenorrhea, hirsutism, weight gain, hyperlipidemia
Neuropsychiatric side effects	aggravation of schizophrenia, aggravation of epilepsy, insomnia, irritability, mood changes
Dermatological effects	easy bruising, impaired wound healing, and thinning of skin
Ophthalmic effects	glaucoma, corneal or scleral thinning and exacerbation of ophthalmic viral or fungal disease

Side-effects can be minimized by using lowest effective dose for minimum period possible.

Pharmacokinetics

Hydrocortisone is readily absorbed from the gastrointestinal tract. Peak blood concentrations occur in about an hour. The plasma half-life is about 100 minutes.

It is more than 90% bound to plasma proteins.

Following intramuscular injection, the absorption of the water-soluble sodium phosphate and sodium succinate esters is rapid. Absorption of hydrocortisone acetate after intra-articular or soft-tissue injection is slower. Hydrocortisone is absorbed through the skin.

Hydrocortisone is metabolized in the liver and is excreted in the urine.

Hydrocortisone crosses the placenta and may distributed in small amounts into breast milk.

Drug Management

Monitoring

• Elderly (close supervision required particularly on long-term treatment)
• Frequent monitoring required if history of tuberculosis (or X-ray changes)
• Blood sugar level, blood pressure, mood change,
• Monitoring of the fluid intake and output, and daily weight records may give early warning of fluid retention.
• Sodium intake may need to be reduced and calcium and potassium supplements may be necessary.
• Back pain may signify osteoporosis
• Height should be monitored in children receiving prolonged therapy with inhaled or nasal steroid.

Drug interaction

Interactions do not generally apply to steroid used for topical action including inhalation, unless specified.

Drugs given with steroid	Potential adverse drug interactions
NSAIDs	Increased risk of gastro-intestinal bleeding
Rifampicin	Accelerate metabolism of steroid so reduce the effects of steroid
Antidiabetics	Steroid antagonize hypoglycaemic effect. Requirements of antidiabetics may be increased.
Antiepileptics: Carbamazepine Phenobarbitone phenytoin	Accelerate metabolism of steroid so reduce the effects of steroidd
Antifungals: amphotericin	Increased risk of hypokalaemia
Antivirals: ritonavir	Increase plasma concentration of steroid – increased risk of adrenal suppression
Digoxin	Increased risk of hypokalaemia
Diuretics: frusemide hydrochlorothiazide	antagonize diuretic effect, increased risk of hypokalaemia
Oral contraceptive (oestrogens)	Increase plasma concentration of steroid
Theophylline	Increased risk of hypokalaemia

Caution

• Children and adolescents (growth restriction possibly irreversible)
• Osteoporosis (post-menopausal women at special risk)
• Recent myocardial infarction, congestive heart failure
• Glaucoma (including family history)
• Ocular herpes simplex – risk of corneal perforation
• Psychiatric disorders (particularly if history of steroid-induced psychosis)
• Epilepsy
• Peptic ulcer
• Hypothyroidism
• Ulcerative colitis
• Diverticulitis
• Thromboembolic disorders
• Myasthenia gravis

Contraindication

• acute infections
• patients with active or doubtfully quiescent tuberculosis
• concurrent treatment live virus vaccines for at least 3 months afterwards

Hepatic impairment

When steroids are administered orally or parenterally, the plasma-drug concentration may be increased in patients with hepatic impairment. The patient should be monitored closely.

Renal impairment

Should be used with caution in patients with renal impairment.

Pregnancy

Hydrocortisone should only be used in pregnant women when benefits outweigh the risks.

• No convincing evidence that systemic steroids increase the incidence of congenital abnormalities such as cleft palate or lip.
• Prolonged use increases the risk of intra-uterine growth; but no evidence of intra-uterine growth restriction following short-term treatment.

Note

Prolonged use of steroid	Advice to patient
Immunosuppression Prolonged use can increase susceptibility to infection	Avoid contact with people who have chickenpox, shingles, or measles.
Adrenal suppression Steroid suppresses the endogenous secretion of corticotropin by the anterior pituitary, resulting the adrenal cortex becomes atrophied. If given for more than 3 weeks, treatment must not be stopped gradually.	Patient must mention the course of steroid when receiving treatment for intercurrent illnesses or trauma such as surgery.

FAQ

How should I take the tablet?

Follow all directions on your prescription label. Use prednisolone exactly as directed on the label. Steroids are associated with a risk of GI irritation. The tablet MUST be with or after food to help reduce side-effects.

What should I avoid while taking?

Avoid abruptly discontinue the medication. Should not be taken with NSAIDs.

What happen if I overdose?

Contact your primary care doctor. If emergency situation, call 999

What happen if I miss a dose?

Take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.