Hydrocortisone

1. Introduction

Hydrocortisone is a corticosteroid with anti-inflammatory, immunosuppressive, and vasoconstrictive properties. It is used in a variety of formulations (topical, oral, injectable, and rectal) to treat conditions ranging from skin inflammation to adrenal insufficiency.

2. Indications

  • Approved Indications:
    • Topical: Eczema, dermatitis, insect bites, psoriasis (mild cases).
    • Oral: Adrenal insufficiency (Addison’s disease), congenital adrenal hyperplasia, severe allergic reactions.
    • Injectable: Severe asthma, anaphylaxis, septic shock, adrenal crisis.
    • Rectal: Ulcerative colitis, proctitis.
  • Off-Label Uses:
    • Autoimmune diseases (e.g., lupus, rheumatoid arthritis).
    • Chemotherapy-induced nausea (as part of combination therapy).

3. Dosage

  • Topical Use:
    • Adults and children: Apply a thin layer to the affected area 1–2 times daily for up to 7 days.
    • Do not use on broken or infected skin unless directed by a healthcare provider.
  • Oral Use:
    • Adults: 20–30 mg/day in divided doses for adrenal insufficiency.
    • Children: 8–12 mg/m²/day divided into 2–3 doses.
  • Injectable Use:
    • Acute adrenal crisis: 100 mg IV, followed by 50–100 mg every 6–8 hours.
    • Anaphylaxis: 200 mg IV, followed by maintenance doses as needed.
  • Rectal Use:
    • Ulcerative colitis/proctitis: 1 suppository (10 mg) 2–3 times daily or 1 enema (100 mg) at bedtime.

4. Administration

  • Topical: Apply sparingly to affected areas. Avoid sensitive areas (e.g., eyes, face) unless directed.
  • Oral: Take with food to reduce gastrointestinal upset.
  • Injectable: Administer under medical supervision in a hospital or clinic.
  • Rectal: Follow instructions for suppository or enema use.

5. Forms Available

  • Topical: Cream, ointment, lotion (0.5%, 1%, 2.5%).
  • Oral: Tablets (5 mg, 10 mg, 20 mg).
  • Injectable: 100 mg/mL, 250 mg/mL.
  • Rectal: Suppositories (10 mg), enemas (100 mg).

6. Side Effects

6.1. Common Side Effects

  • Topical: Skin thinning, dryness, mild irritation.
  • Oral: Nausea, mood changes, weight gain.
  • Injectable: Headache, fluid retention, blood sugar elevation.

6.2. Less Common Side Effects

  • Skin discolouration.
  • Hyperglycaemia (oral or injectable).

6.3. Rare but Serious Side Effects

  • Adrenal suppression (prolonged use).
  • Infection risk (due to immunosuppression).
  • Cushing’s syndrome (long-term high-dose use).

7. Warnings

  • Adrenal Suppression: Prolonged systemic use may suppress the hypothalamic-pituitary-adrenal (HPA) axis, leading to adrenal insufficiency.
  • Infections: Increased risk of infections, including fungal and viral infections.
  • Growth Suppression: Long-term use in children may impair growth.

8. Precautions

  • Use cautiously in patients with:
    • Diabetes (may worsen blood sugar control).
    • Hypertension (can increase blood pressure).
    • Osteoporosis (long-term use may exacerbate bone loss).
  • Avoid abrupt discontinuation after long-term use; taper the dose gradually.

9. Interactions

  • Drug-Drug Interactions:
    • NSAIDs: Increased risk of gastrointestinal bleeding.
    • Anticoagulants: May reduce anticoagulant efficacy or increase bleeding risk.
    • Live vaccines: Avoid use due to immunosuppressive effects.
  • Drug-Food Interactions:
    • Take oral hydrocortisone with food to minimise stomach irritation.

10. Monitoring Parameters

  • For systemic use: Blood pressure, blood glucose, weight, and signs of infection.
  • For topical use: Skin condition improvement and signs of irritation or thinning.

11. Use in Children

  • Topical: Use sparingly and for the shortest duration possible to avoid systemic absorption.
  • Oral and injectable: Dose adjustments based on weight or body surface area. Monitor growth in long-term use.

12. Use in Pregnancy

  • Category C: Use only if benefits outweigh the risks. Minimal systemic absorption with topical use reduces risk. Systemic use should be reserved for specific conditions.

13. Use in Elderly

  • Safe but monitor for side effects such as osteoporosis, hypertension, and glucose intolerance.

14. Use in Kidney Disease

  • No dose adjustment required for topical or systemic use, as hydrocortisone is primarily metabolised in the liver.

15. Use in Liver Disease

  • Use cautiously in severe hepatic impairment, as metabolism may be affected.

16. Patient Counselling Points

  • Topical: Apply a thin layer only to the affected area. Avoid overuse to prevent skin thinning.
  • Oral: Take with food to reduce stomach upset. Do not stop abruptly if used for more than a few weeks; follow your doctor’s tapering instructions.
  • Injectable: Ensure regular monitoring for side effects if receiving repeated injections.
  • Inform your doctor of any unusual symptoms, such as persistent infections or signs of adrenal suppression (e.g., fatigue, weakness).
  • For long-term use, discuss bone health and calcium/vitamin D supplementation with your doctor.

17. Table of Brand Names, Manufacturers, and Prices

Brand NameManufacturerPrice (USD)
Cortef (oral tablets)Pfizer$20–40 (30 tablets, 10 mg)
Hydrocortisone CreamVarious manufacturers$5–15 (30 g, 1%)
Solu-Cortef (injection)Pfizer$25–50 (100 mg vial)
Anucort-HC (suppository)ANI Pharmaceuticals$30–60 (12 suppositories, 10 mg)

18. FAQs (15 Questions)

  1. What is hydrocortisone used for?
    Hydrocortisone is used to treat inflammation, adrenal insufficiency, eczema, and allergic reactions.
  2. How does hydrocortisone work?
    It reduces inflammation and suppresses the immune response.
  3. How long can I use hydrocortisone cream?
    Use for up to 7 days unless directed by a doctor.
  4. Can hydrocortisone be used during pregnancy?
    Yes, but only if prescribed. Topical use is generally safe.
  5. What are the side effects of hydrocortisone?
    Common side effects include skin thinning (topical) and nausea or mood changes (oral or injectable).
  6. Can I use hydrocortisone on my face?
    Use cautiously on the face and only under medical advice, as it may cause thinning or discolouration.
  7. Can hydrocortisone cause weight gain?
    Long-term systemic use may lead to weight gain due to fluid retention and fat redistribution.
  8. What should I do if I miss a dose of oral hydrocortisone?
    Take it as soon as you remember, but skip it if it’s close to the next dose. Do not double up.
  9. Can children use hydrocortisone?
    Yes, but use the lowest effective dose and monitor for side effects, especially with long-term use.
  10. Can hydrocortisone cause infections?
    Yes, it may increase the risk of infections due to its immunosuppressive effects.
  11. How should hydrocortisone be stored?
    Store at room temperature, away from moisture and heat.
  12. Is hydrocortisone safe for eczema?
    Yes, hydrocortisone cream is commonly used to treat mild to moderate eczema.
  13. Can hydrocortisone be used for insect bites?
    Yes, it helps reduce swelling and itching caused by insect bites.
  14. How should I taper oral hydrocortisone?
    Follow your doctor’s instructions for gradual dose reduction to prevent adrenal insufficiency.
  15. Does hydrocortisone interact with other medications?
    Yes, it interacts with NSAIDs, anticoagulants, and live vaccines.