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 Name | Manufacturer | Price (USD) |
---|---|---|
Cortef | Pfizer | $20–40 (30 tablets, 10 mg) |
Generic Hydrocortisone | Various manufacturers | $5–20 (30 tablets, 10 mg) |
18. FAQs (15 Questions)
- What are hydrocortisone tablets used for?
They are used to treat adrenal insufficiency, inflammation, and severe allergic reactions. - How do hydrocortisone tablets work?
They mimic cortisol, reducing inflammation and regulating stress responses. - How should hydrocortisone tablets be taken?
Take them with food, spaced throughout the day, with the largest dose in the morning. - Can hydrocortisone tablets cause weight gain?
Yes, weight gain is a common side effect, especially with prolonged use. - What are the long-term risks of hydrocortisone use?
Long-term use can lead to adrenal suppression, osteoporosis, and Cushing’s syndrome. - Can hydrocortisone tablets be stopped suddenly?
No, they must be tapered gradually to prevent adrenal insufficiency. - Are hydrocortisone tablets safe during pregnancy?
Yes, they may be used if necessary, but only under medical supervision. - Can children take hydrocortisone tablets?
Yes, but doses must be carefully adjusted, and growth must be monitored during long-term use. - Can hydrocortisone tablets be used for stress dosing?
Yes, doses are often increased during stress or illness for patients with adrenal insufficiency. - 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. - Does hydrocortisone interact with other medications?
Yes, it interacts with NSAIDs, diuretics, and CYP3A4 inhibitors, among others. - Can I drink alcohol while taking hydrocortisone tablets?
Alcohol should be avoided, as it may worsen gastrointestinal irritation and other side effects. - How long does hydrocortisone take to work?
It typically starts working within hours, depending on the condition being treated. - Can hydrocortisone tablets cause mood changes?
Yes, mood changes like irritability, insomnia, or anxiety are possible. - How should hydrocortisone tablets be stored?
Store at room temperature, away from heat and moisture.