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 Name | Manufacturer | Price (USD) |
---|---|---|
Cortef (oral tablets) | Pfizer | $20–40 (30 tablets, 10 mg) |
Hydrocortisone Cream | Various 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)
- What is hydrocortisone used for?
Hydrocortisone is used to treat inflammation, adrenal insufficiency, eczema, and allergic reactions. - How does hydrocortisone work?
It reduces inflammation and suppresses the immune response. - How long can I use hydrocortisone cream?
Use for up to 7 days unless directed by a doctor. - Can hydrocortisone be used during pregnancy?
Yes, but only if prescribed. Topical use is generally safe. - What are the side effects of hydrocortisone?
Common side effects include skin thinning (topical) and nausea or mood changes (oral or injectable). - Can I use hydrocortisone on my face?
Use cautiously on the face and only under medical advice, as it may cause thinning or discolouration. - Can hydrocortisone cause weight gain?
Long-term systemic use may lead to weight gain due to fluid retention and fat redistribution. - 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. - Can children use hydrocortisone?
Yes, but use the lowest effective dose and monitor for side effects, especially with long-term use. - Can hydrocortisone cause infections?
Yes, it may increase the risk of infections due to its immunosuppressive effects. - How should hydrocortisone be stored?
Store at room temperature, away from moisture and heat. - Is hydrocortisone safe for eczema?
Yes, hydrocortisone cream is commonly used to treat mild to moderate eczema. - Can hydrocortisone be used for insect bites?
Yes, it helps reduce swelling and itching caused by insect bites. - How should I taper oral hydrocortisone?
Follow your doctor’s instructions for gradual dose reduction to prevent adrenal insufficiency. - Does hydrocortisone interact with other medications?
Yes, it interacts with NSAIDs, anticoagulants, and live vaccines.