Hydrocortisone Tablets

1. Introduction

Hydrocortisone tablets are a systemic corticosteroid used to replace or supplement cortisol in conditions of adrenal insufficiency or to treat inflammation in various autoimmune and allergic disorders. Hydrocortisone mimics natural cortisol, a hormone essential for stress response, metabolism, and immune regulation.

2. Indications

  • Approved Indications:
    • Primary adrenal insufficiency (e.g., Addison’s disease).
    • Secondary adrenal insufficiency (e.g., pituitary insufficiency).
    • Congenital adrenal hyperplasia.
    • Acute adrenal crisis (as part of emergency treatment).
    • Severe allergic reactions (e.g., anaphylaxis, angioedema).
    • Inflammatory and autoimmune diseases (e.g., rheumatoid arthritis, systemic lupus erythematosus).

3. Dosage

  • Adults:
    • Adrenal Insufficiency: 15–30 mg daily, divided into 2–3 doses (e.g., 10 mg in the morning, 5 mg at noon, 5 mg in the afternoon).
    • Inflammatory/Autoimmune Disorders: 20–240 mg daily in divided doses, depending on the severity of the condition.
  • Children:
    • Adrenal Insufficiency: 8–12 mg/m²/day, divided into 2–3 doses.
  • Elderly:
    • Use the lowest effective dose to reduce the risk of side effects, with careful monitoring.
  • Stress Dosing:
    • During illness or surgery, the dose may need to be doubled or tripled as directed by a healthcare provider.

4. Administration

  • Take orally with food to reduce gastrointestinal discomfort.
  • Doses should be spaced throughout the day to mimic the body’s natural cortisol rhythm, with the largest dose in the morning.

5. Forms Available

  • Tablets: 5 mg, 10 mg, 20 mg.

6. Side Effects

6.1. Common Side Effects

  • Weight gain.
  • Mood changes (e.g., irritability, insomnia).
  • Increased appetite.
  • Mild gastrointestinal upset.

6.2. Less Common Side Effects

  • Hypertension.
  • Hyperglycaemia.
  • Skin thinning or bruising.

6.3. Rare but Serious Side Effects

  • Adrenal suppression (with prolonged use).
  • Osteoporosis.
  • Immunosuppression (increased infection risk).
  • Cushing’s syndrome (from chronic high doses).

7. Warnings

  • Adrenal Suppression: Prolonged use can suppress natural cortisol production. Gradual tapering is necessary when discontinuing.
  • Infections: Increased risk of infections due to immunosuppressive effects.
  • Growth Suppression: Long-term use in children can affect growth.

8. Precautions

  • Use cautiously in patients with:
    • Diabetes (may worsen glucose control).
    • Hypertension or cardiovascular disease.
    • Osteoporosis.
    • Active infections, especially fungal or tuberculosis.

9. Interactions

  • Drug-Drug Interactions:
    • NSAIDs: Increased risk of gastrointestinal bleeding.
    • Anticoagulants: May increase or decrease their effects.
    • CYP3A4 inhibitors (e.g., ketoconazole): May increase hydrocortisone levels.
    • Diuretics: Increased risk of hypokalaemia.
  • Drug-Food Interactions:
    • No significant interactions, but taking with food helps reduce gastrointestinal irritation.

10. Monitoring Parameters

  • Blood pressure and blood sugar levels.
  • Signs of infection or gastrointestinal discomfort.
  • Bone density in long-term use (to assess risk of osteoporosis).
  • Electrolyte levels (e.g., potassium).

11. Use in Children

  • Safe when doses are carefully adjusted for weight or body surface area. Long-term use requires monitoring for growth suppression.

12. Use in Pregnancy

  • Category C: May be used if the potential benefits outweigh the risks. Hydrocortisone is preferred among corticosteroids due to minimal foetal risk.

13. Use in Elderly

  • Safe but monitor closely for side effects like hypertension, osteoporosis, and hyperglycaemia.

14. Use in Kidney Disease

  • No dose adjustment is required, as hydrocortisone is not renally excreted.

15. Use in Liver Disease

  • Use cautiously in severe liver impairment, as hydrocortisone metabolism occurs in the liver.

16. Patient Counselling Points

  • Take hydrocortisone tablets as prescribed, usually in the morning and early afternoon to mimic natural cortisol levels.
  • Do not stop taking hydrocortisone abruptly, especially after long-term use; follow your doctor’s tapering instructions.
  • Inform your doctor of any unusual symptoms, such as persistent fatigue, fever, or signs of infection.
  • Carry a medical alert card or bracelet indicating you are on corticosteroid therapy.
  • During illness or stress (e.g., surgery), you may need higher doses—consult your doctor immediately.
  • Maintain a balanced diet rich in calcium and vitamin D to reduce the risk of osteoporosis.

17. Table of Brand Names, Manufacturers, and Prices

Brand NameManufacturerPrice (USD)
CortefPfizer$20–40 (30 tablets, 10 mg)
Generic HydrocortisoneVarious manufacturers$5–20 (30 tablets, 10 mg)

18. FAQs (15 Questions)

  1. What are hydrocortisone tablets used for?
    They are used to treat adrenal insufficiency, inflammation, and severe allergic reactions.
  2. How do hydrocortisone tablets work?
    They mimic cortisol, reducing inflammation and regulating stress responses.
  3. How should hydrocortisone tablets be taken?
    Take them with food, spaced throughout the day, with the largest dose in the morning.
  4. Can hydrocortisone tablets cause weight gain?
    Yes, weight gain is a common side effect, especially with prolonged use.
  5. What are the long-term risks of hydrocortisone use?
    Long-term use can lead to adrenal suppression, osteoporosis, and Cushing’s syndrome.
  6. Can hydrocortisone tablets be stopped suddenly?
    No, they must be tapered gradually to prevent adrenal insufficiency.
  7. Are hydrocortisone tablets safe during pregnancy?
    Yes, they may be used if necessary, but only under medical supervision.
  8. Can children take hydrocortisone tablets?
    Yes, but doses must be carefully adjusted, and growth must be monitored during long-term use.
  9. Can hydrocortisone tablets be used for stress dosing?
    Yes, doses are often increased during stress or illness for patients with adrenal insufficiency.
  10. What should I do if I miss a dose?
    Take it as soon as you remember, but skip it if it’s close to the next dose. Do not double up.
  11. Does hydrocortisone interact with other medications?
    Yes, it interacts with NSAIDs, diuretics, and CYP3A4 inhibitors, among others.
  12. Can I drink alcohol while taking hydrocortisone tablets?
    Alcohol should be avoided, as it may worsen gastrointestinal irritation and other side effects.
  13. How long does hydrocortisone take to work?
    It typically starts working within hours, depending on the condition being treated.
  14. Can hydrocortisone tablets cause mood changes?
    Yes, mood changes like irritability, insomnia, or anxiety are possible.
  15. How should hydrocortisone tablets be stored?
    Store at room temperature, away from heat and moisture.