Hydrocortisone

Dosage of hydrocortisone is highly individualized based on the specific disease being treated and the patient's response.

• General Inflammatory Conditions: Initial dosages may range from 20 mg to 240 mg per day, administered in single or divided doses.
• Adrenal Insufficiency: Typically 20–30 mg daily, often split with a larger dose in the morning and a smaller dose in the late afternoon to mimic the body's natural circadian rhythm of cortisol.

Hydrocortisone is approved for use in children, but dosing is usually calculated based on body surface area or weight rather than age alone.

• Standard Pediatric Range: 0.5 to 8 mg/kg/day divided every 8 to 12 hours.
• Growth Monitoring: Chronic use in children can inhibit skeletal growth; therefore, pediatric patients must be monitored closely by a pediatrician.

Renal Impairment

Specific dose adjustments are not typically required for renal impairment, but patients should be monitored for fluid retention and electrolyte imbalances.

Hepatic Impairment

Since hydrocortisone is metabolized by the liver, patients with severe hepatic disease (e.g., cirrhosis) may experience increased drug levels. Dose reductions may be necessary to avoid toxicity.

Elderly Patients

Lower starting doses are often recommended for elderly patients due to a higher frequency of decreased hepatic or cardiac function and concomitant diseases or other drug therapies.

• Administration: Oral tablets should be taken with food or milk to minimize gastrointestinal irritation.
• Timing: If taking a single daily dose, it is often best taken in the morning (around 8:00 AM) to align with natural hormone cycles.
• Storage: Store at room temperature (20°C to 25°C / 68°F to 77°F) away from moisture and light.

If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and resume your regular schedule. Do not double the dose to catch up.

Acute overdose with hydrocortisone rarely causes life-threatening symptoms. However, chronic overdose can lead to Cushingoid features (moon face, weight gain). In case of a massive acute ingestion, contact a poison control center or emergency services immediately.

> Important: Follow your healthcare provider's dosing instructions exactly. Do not adjust your dose or stop taking this medication without medical guidance, as sudden discontinuation can lead to a life-threatening adrenal crisis.

Most patients taking systemic hydrocortisone will experience some side effects, particularly with higher doses. These may include:

• Increased Appetite: A significant increase in hunger often leading to weight gain.
• Insomnia: Difficulty falling or staying asleep due to the drug's stimulating effects.
• Mood Swings: Feelings of irritability, nervousness, or mild euphoria.
• Gastrointestinal Upset: Indigestion or mild stomach pain.

• Fluid Retention: Swelling in the ankles or feet (edema).
• Hypertension: Increased blood pressure.
• Hyperglycemia: Elevated blood sugar levels, which may require monitoring in diabetic patients.
• Thinning Skin: Increased bruising or slower wound healing.

• Cataracts or Glaucoma: Increased intraocular pressure with prolonged use.
• Muscle Weakness: Known as steroid myopathy, affecting the proximal muscles.
• Osteoporosis: Loss of bone density, increasing the risk of fractures.

> Warning: Stop taking Hydrocortisone and call your doctor immediately if you experience any of these.

• Anaphylaxis: Signs of a severe allergic reaction including hives, difficulty breathing, or swelling of the face and throat.
• Psychosis: Severe mood changes, hallucinations, or suicidal thoughts.
• Vision Changes: Sudden blurred vision or eye pain.
• Signs of Infection: Fever, chills, or persistent sore throat (steroids can mask infection symptoms).
• Adrenal Insufficiency: Severe fatigue, dizziness, or fainting when stopping the drug too quickly.

Prolonged use of hydrocortisone can lead to Cushing's Syndrome, characterized by a rounded "moon face," a fatty hump between the shoulders ("buffalo hump"), and central obesity. It can also cause permanent suppression of the Hypothalamic-Pituitary-Adrenal (HPA) axis, meaning the body stops producing its own cortisol.

There are currently no FDA black box warnings for hydrocortisone. However, the FDA mandates warnings regarding the risk of secondary infections and the necessity of tapering the dose after long-term use.

Report any unusual symptoms to your healthcare provider to ensure your treatment remains safe and effective.

Hydrocortisone is a potent medication that affects multiple organ systems. It should be used for the shortest duration possible at the lowest effective dose. Patients should carry a medical alert card or wear a bracelet indicating they are on corticosteroid therapy in case of emergencies.

No FDA black box warnings for Hydrocortisone.

• Infection Risk: Hydrocortisone suppresses the immune system, making you more susceptible to infections. It may also mask the signs of an existing infection. Avoid contact with people who have chickenpox or measles, as these can be fatal in patients on steroids.
• HPA Axis Suppression: Long-term use can suppress the body's natural ability to produce cortisol. During periods of stress (surgery, severe trauma, or infection), patients may require supplemental "stress doses" of steroids.
• Cardiovascular/Renal Effects: Hydrocortisone can cause sodium retention and potassium loss, leading to high blood pressure and heart failure in susceptible individuals.
• Ophthalmic Effects: Prolonged use may produce posterior subcapsular cataracts or glaucoma with possible damage to the optic nerves.

Healthcare providers will typically monitor the following during long-term therapy:

• Blood Pressure: Regular checks for hypertension.
• Blood Glucose: Especially in patients with diabetes or pre-diabetes.
• Bone Density: Periodic DEXA scans to screen for osteoporosis.
• Electrolytes: Monitoring serum potassium and sodium levels.
• Growth: In pediatric patients.

Hydrocortisone does not usually affect the ability to drive; however, some patients experience dizziness or mood changes. Ensure you know how you react to the medication before operating heavy machinery.

Alcohol should be used with caution. Both alcohol and hydrocortisone can irritate the stomach lining, increasing the risk of peptic ulcers or gastrointestinal bleeding.

Never stop taking hydrocortisone abruptly if you have been taking it for more than a few weeks. Your doctor will provide a tapering schedule to gradually reduce the dose, allowing your adrenal glands to resume natural hormone production.

> Important: Discuss all your medical conditions, especially history of tuberculosis, herpes simplex, or peptic ulcers, with your healthcare provider before starting Hydrocortisone.

• Live Vaccines: Administration of live or live-attenuated vaccines (e.g., MMR, Varicella) is contraindicated in patients receiving immunosuppressive doses of hydrocortisone. The diminished immune response may lead to the development of the disease from the vaccine.

• NSAIDs (e.g., Ibuprofen, Aspirin): Concurrent use increases the risk of gastrointestinal ulceration and bleeding.
• Warfarin and Anticoagulants: Hydrocortisone may alter the body's response to blood thinners; frequent monitoring of the INR is required.
• Antidiabetic Agents: Corticosteroids can increase blood glucose levels, necessitating adjustments in insulin or oral hypoglycemic dosages.

• CYP3A4 Inducers (e.g., Rifampin, Phenytoin, Carbamazepine): These drugs may increase the metabolism of hydrocortisone, potentially reducing its effectiveness.
• CYP3A4 Inhibitors (e.g., Ketoconazole, Erythromycin): These may decrease the clearance of hydrocortisone, increasing the risk of side effects.
• Diuretics (e.g., Furosemide): Increased risk of hypokalemia (low potassium) when used together.

• Sodium/Salt: High salt intake can worsen the fluid retention and high blood pressure caused by hydrocortisone. A low-sodium diet is often recommended.
• Grapefruit Juice: May increase the plasma concentration of hydrocortisone by inhibiting CYP3A4 metabolism in the gut.

• St. John's Wort: May decrease the effectiveness of hydrocortisone by inducing metabolic enzymes.
• Licorice Root: Contains glycyrrhizic acid, which can increase the half-life of hydrocortisone and lead to increased side effects like edema and hypertension.

Hydrocortisone may produce false-negative results in the nitroblue tetrazolium test for systemic bacterial infection and may suppress skin test reactions (e.g., allergy tests or TB tests).

> Important: Tell your doctor about ALL medications, supplements, and herbal products you are taking, including over-the-counter creams or vitamins.

• Systemic Fungal Infections: Hydrocortisone can worsen these infections and should not be used unless specific anti-fungal therapy is also administered.
• Known Hypersensitivity: Patients with a documented allergy to hydrocortisone or any component of the formulation must avoid use.
• Cerebral Malaria: Clinical trials have shown that steroids are not beneficial and may be harmful in this condition.

Healthcare providers will perform a careful risk-benefit analysis in patients with:

• Peptic Ulcer Disease: Risk of perforation or hemorrhage.
• Diverticulitis: Increased risk of bowel perforation.
• Hypertension or Heart Failure: Risk of fluid overload.
• Osteoporosis: Risk of worsening bone loss.
• Psychosis: Steroids may exacerbate mental health conditions.

Patients allergic to other corticosteroids (such as prednisone or dexamethasone) may also be allergic to hydrocortisone. Always inform your provider of any previous reactions to steroid medications.

> Important: Your healthcare provider will evaluate your complete medical history, including any dormant infections like tuberculosis, before prescribing Hydrocortisone.

Hydrocortisone is generally classified as Pregnancy Category C. While human data is limited, animal studies have shown an increased incidence of cleft palate when corticosteroids are administered during pregnancy. It should only be used if the potential benefit justifies the potential risk to the fetus. Infants born to mothers who received substantial doses of steroids during pregnancy should be carefully observed for signs of hypoadrenalism.

Hydrocortisone is excreted in human milk. While low doses are unlikely to harm the infant, high systemic doses could potentially suppress growth or interfere with endogenous corticosteroid production in the nursing child. Consult your doctor regarding the timing of doses to minimize infant exposure.

Hydrocortisone is FDA-approved for pediatric use in conditions like congenital adrenal hyperplasia and severe asthma. However, long-term use can cause growth suppression. Pediatricians must monitor height and weight frequently. Alternating-day therapy may be considered to minimize these effects.

Elderly patients are at a higher risk for side effects such as osteoporosis, hypertension, and diabetes. Healthcare providers typically start at the lowest end of the dosing range. There is also an increased risk of skin thinning and bruising in this population.

No specific dose adjustment is required based on GFR; however, the mineralocorticoid effects (sodium retention) may be more dangerous in patients with pre-existing kidney disease.

In patients with liver cirrhosis, the metabolism of hydrocortisone is slowed, leading to an increased clinical effect. Dose adjustments are often necessary to prevent Cushingoid side effects.

> Important: Special populations require individualized medical assessment and more frequent monitoring by a specialist.

Hydrocortisone is a short-acting corticosteroid. It diffuses across cell membranes and binds with high affinity to specific cytoplasmic receptors. This complex enters the nucleus, binds to DNA, and modifies gene expression. It inhibits the production of inflammatory mediators like prostaglandins and leukotrienes by inducing lipocortins, which inhibit phospholipase A2. Additionally, it suppresses the immune system by reducing the activity and volume of the lymphatic system.

Hydrocortisone has a 1:1 ratio of glucocorticoid to mineralocorticoid potency. This means it is effective at reducing inflammation but also has a significant effect on water and electrolyte balance compared to synthetic analogs like dexamethasone. The onset of action for oral hydrocortisone is roughly 1-2 hours, while intravenous forms act more rapidly.

| Parameter | Value |

|---|---|

| Bioavailability | >90% (Oral) |

| Protein Binding | 90% (CBG and Albumin) |

| Half-life | 1.5 - 2 hours |

| Tmax | 1 - 2 hours |

| Metabolism | Hepatic (primarily CYP3A4) |

| Excretion | Renal (90% as metabolites) |

• Molecular Formula: C21H30O5
• Molecular Weight: 362.46 g/mol
• Solubility: Sparingly soluble in water; soluble in alcohol and chloroform.
• Description: A white to practically white, odorless, crystalline powder.

Hydrocortisone is the prototype of the Glucocorticoid class. It is the standard against which the potency of all other synthetic corticosteroids is measured.