Hydrocortisone

Corticosteroid, Glucocorticoid (short-acting, with mineralocorticoid activity), Topical corticosteroid

Hydrocortisone (cortisol)

Cortef (oral), Solu-Cortef (IV), many topical brands (Cortizone, OTC); Plenadren, Alkindi (modified-release for adrenal insufficiency)

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Summary

Classes

Corticosteroid, Glucocorticoid (short-acting, with mineralocorticoid activity), Topical corticosteroid

Common uses

Adrenal insufficiency (primary, secondary, congenital)▲0▼, Adrenal crisis (IV)▲0▼, Mild inflammatory dermatoses (topical, OTC at 1%)▲0▼, Stress-dose coverage perioperatively in chronic steroid users▲0▼

Pharmacy

Starting dose

Physiologic replacement 15-25 mg/d divided (e.g., 10 mg AM, 5 mg noon, 5 mg afternoon); stress dose 50-100 mg IV q6-8h; adrenal crisis 100 mg IV then 50-100 mg q6h; topical 0.5-2.5% applied 2-4×/d

Preparations

5, 10, 20 mg oral tablets; 100, 250, 500, 1000 mg IV (Solu-Cortef); 0.5%, 1%, 2.5% topical creams/ointments; rectal foam and enemas

US FDA Max

Indication-specific

Pharmacology

Routes

Oral, IV, IM, topical, rectal

Onset

Hours

Duration

Biologic ~8-12 hours (short-acting)

Half-life

Plasma ~1-2 hours; biologic ~8-12 hours

Bioavailability

~96% (oral)

Pregnancy

Use when benefits outweigh; widely used at physiologic doses for adrenal insufficiency.^{[citation needed]}

Legal status

OTC (low-dose topicals) and Rx-only (other forms) in US

Purported mechanism

Hydrocortisone is bioidentical cortisol; at physiologic doses it provides glucocorticoid replacement in adrenal insufficiency, and at pharmacologic doses it produces broad anti-inflammatory and immunosuppressive effects via the glucocorticoid receptor.▲0▼ Unlike synthetic analogs like dexamethasone, hydrocortisone retains substantial mineralocorticoid activity, which is the source of the dose-dependent sodium retention and BP effects but also why it is the most physiologic single agent for primary adrenal insufficiency (when paired with fludrocortisone for additional mineralocorticoid coverage).