Hydrocortisone

Brands

DEA Class; Rx

Common Brand Names; Alkindi Sprinkle, Cortef, SoluCortef

  • Corticosteroids

hydrocortisone topical (Rx, OTC)

Brand and Other Names: Westcort, Locoid, Aquanil, Calmurid Cream, Cetacort, Claritin Skin Itch Relief, Coraz, CortaGel, Cortaid, Cortate, Cortisone-10 Poison Ivy Relief Pads, Cortisone-10 Quick Shot, Cortizone, Cortoderm, Dermacort, Dermazene Cream, DermiCort, Emo Cort, Hyderm, Hydrocort, HydroSKIN, HydroVal, Hytone, LactiCare, AlaCort, Locoid Lipocream, Massengill, Neosporin Eczema Essentials Anti-Itch Cream, Nutracort, Pediaderm HC, Penecort, Preparation H Anti-Itch Cream, Prevex HC, Proctocort, Proctocream, Sarna HC, Sarnol, Texacort, Timodine, Uniroid HC, AlaScalpt
  • Classes: Corticosteroids, Topical

hydrocortisone probutate topical (Rx)

Brand and Other Names: Pandel
  • Classes: Corticosteroids, Topical

hydrocortisone rectal (Rx)

Brand and Other Names: Anusol HC, Cortifoam, Anucort-HC, Peranex HC, Proctol, Proctomyxin, Proctosedyl, Proctosedyl Ointment, Xyralid RC, Cortenema
  • Classes: Corticosteroids, Gastrointestinal

Naturally occurring adrenal steroid hormone with glucocorticoid and mineralocorticoid activity
A preferred corticosteroid for adrenal insufficiency states; also used for a variety of inflammatory diseases systemically and rectally
Topical dosage forms are considered low-potency; used for mild to moderate corticosteroid responsive dermatoses

Indicated for use in nonspecific proctitis, postirradiation (factitial) proctitis, cryptitis, or for other non-specific inflammatory conditions of the anorectum.

For the treatment of primary adrenocortical insufficiency (e.g., Addison’s Disease, congenital adrenal hyperplasia or CAH) or secondary adrenocortical insufficiency.
For the relief of inflammation, pruritus ani, and swelling associated with hemorrhoids.
For the treatment of Crohn’s disease.
For the treatment of allergic disorders including anaphylaxis, anaphylactic shock, or anaphylactoid reactions, angioedema, acute noninfectious laryngeal edema, hypersensitivity reactions (drug or food allergy), transfusion-related reactions, urticaria, serum sickness.
For the systemic treatment of severe inflammatory dermatoses, like severe exfoliative dermatitis, erythema multiforme, Stevens-Johnson syndrome, or psoriasis unresponsive to topical treatment.
For the treatment of corticosteroid-responsive dermatologic disorders (e.g., alopecia areata, atopic dermatitis, bullous dermatitis herpetiformis, contact dermatitis including Rhus dermatitis due to poison ivy, poison oak, poison sumac, diaper dermatitis, discoid lupus erythematosus, eczema, exfoliative dermatitis, insect bites or stings, granuloma annulare, keloids, lichen striatus, lichen planus, lichen simplex, necrobiosis lipoidica diabeticorum, pemphigus, pityriasis rosea, polymorphous light eruption, pompholyx (dyshidrosis), pruritus, psoriasis, seborrheic dermatitis, xerosis).
For the short-term treatment of hypercalcemia associated with neoplastic disease.
For the management of nephrotic syndrome to induce diuresis or decrease proteinuria.
For the treatment of thyroiditis.
For asthma exacerbation.

Untreated serious infections (except tuberculous meningitis or septic shock)

Idiopathic thrombocytopenic purpura (IM administration only)

Intrathecal administration (injection)

Use in premature infants (formulations containing benzyl alcohol only)

Documented hypersensitivity

Systemic fungal infections

Administration of live or live, attenuated vaccines is contraindicated in patients receiving immunosuppressive doses of corticosteroids

Underlying infection

Hypersensitivity

Ophthalmic use

Treatment of diaper dermatitis

Fluid and electrolyte disturbances

  • Sodium retention
  • Fluid retention
  • Potassium loss
  • Hypokalemic alkalosis

Cardiovascular

  • Congestive heart failure in susceptible patients
  • Increased blood pressure

Musculoskeletal

  • Muscle weakness
  • Steroid myopathy
  • Loss of muscle mass
  • Osteoporosis
  • Tendon rupture, particularly of the Achilles tendon
  • Vertebral compression fractures
  • Aseptic necrosis of femoral and humeral heads
  • Pathologic fracture of long bones

Gastrointestinal

  • Peptic ulcer with possible perforation and hemorrhage
  • Pancreatitis
  • Abdominal distention
  • Ulcerative esophagitis
  • Increased ALT, AST, and alkaline phosphatase

Dermatologic

  • Impaired wound healing
  • Thin fragile skin
  • Petechiae and ecchymoses
  • Facial erythema
  • Increased sweating
  • May suppress reactions to skin tests

Neurological

  • Increased intracranial pressure with papilledema (pseudotumor cerebri) usually after treatment
  • Convulsions
  • Vertigo
  • Headache
  • Epidural lipomatosis
  • Behavioral and mood changes

Endocrine

  • Increased appetite and weight gain
  • Development of Cushingoid state
  • Suppression of growth in children
  • Secondary adrenocortical and pituitary unresponsiveness, particularly in times of stress, as in trauma, surgery or illness
  • Menstrual irregularities
  • Decreased carbohydrate tolerance
  • Manifestations of latent diabetes mellitus
  • Increased requirements for insulin or oral hypoglycemic agents in diabetics

Ophthalmic

  • Central serous chorioretinopathy
  • Posterior subcapsular cataracts
  • Increased intraocular pressure
  • Glaucoma
  • Exophthalmos

Metabolic

  • Negative nitrogen balance due to protein catabolism
  • Blood and lymphatic system disorders H4
  • Leukocytosis

Skin atrophy

Striae

Acneform lesions

Perioral dermatitis

Folliculitis

Itching

Pigmentation changes

HPA suppression (with higher potency used >2 wk)

Burning (2%)

Stinging (1%)

Paresthesia

Itching

Irritation

Dryness

Folliculitis

Hypertrichosis

Acneiform eruptions

Hypopigmentation

Perioral dermatitis

Allergic contact dermatitis

Secondary infections

Skin atrophy

Striae

Miliaria

Use with caution in cirrhosis, ocular herpes simplex, hypertension, diverticulitis, myasthenia gravis, peptic ulcer disease, ulcerative colitis, psychotic tendencies, renal insufficiency, pregnancy, diabetes mellitus, congestive heart failure, thromboembolic disorders, GI disorders

Use caution in head injury; increased mortality reported in patients receiving high-dose corticosteroids; not for use as part of head injury management

Thromboembolic disorders and myopathy may occur

High dose corticosteroids associated with increased bone loss and osteoporotic fractures; use caution

Anaphylactoid reactions reported in patients receiving corticosteroids

Delayed wound healing is possible

Patients receiving corticosteroids should avoid chickenpox or measles-infected persons if unvaccinated

Latent tuberculosis may be reactivated (patients with positive tuberculin test should be monitored)

Some suggestion (not fully substantiated) of slightly increased cleft palate risk if corticosteroids are used in pregnancy

Prolonged corticosteroid use may result in elevated intraocular pressure, glaucoma, or cataracts

Killed or inactivated vaccines may be administered; however, the response to such vaccines cannot be predicted

Pheochromocytoma crisis, which can be fatal, reported after administration of systemic corticosteroids; in patients with suspected pheochromocytoma, consider risk of pheochromocytoma crisis prior to administering corticosteroids

Chronic topical corticosteroid therapy may interfere with growth and development in children

Use lower potency in children; may absorb proportionally larger amounts after topical application and may cause systemic effects

Occlusive dressings, prolonged use, application to large surface areas, or application to denuded skin, may increase percutaneous absorption, which may result in Cushing syndrome, glycosuria, and hyperglycemia

Prolonged use may increase risk of Kaposi’s sarcoma

Pregnancy category: C

Lactation: Drug enters breast milk; use with caution

Corticosteroid dosage must be individualized and is highly variable depending on the nature and severity of the disease, route of administration, and patient response.

Hydrocortisone

tablet (Cortef, generic)

  • 5mg
  • 10mg
  • 20mg

powder for injection (SoluCortef)

  • 100mg/vial
  • 250mg/vial
  • 500mg/vial
  • 1g/vial

topical cream

  • 0.1%
  • 0.2%
  • 0.5%
  • 1%
  • 2.5%

topical lotion

  • 0.1%
  • 1%
  • 2%
  • 2.5%

topical gel

  • 1%
  • 10%

topical solution

  • 1%
  • 2.5%

topical ointment

  • 0.2%
  • 0.5%
  • 1%
  • 2.5%

topical cream

  • 0.1%

cream

  • 1%
  • 0.5%
  • 1%
  • 2%
  • 2.5%

enema

  • 100mg/60mL

foam

  • 10% (15g)

suppository

  • 25mg
  • 30mg
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