Hydrocortisone

Pronunciation

Hydrocortisone 20mg

Introduction

Hydrocortisone 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.

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

Mechanism of Action

Immunosuppression agent, Steroid replacement agent, Anti-inflammatory agent

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

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.