Hydrocortisone
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From Pharmacopedia
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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
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 users0
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[1]
Bioavailability
~96% (oral)[1]
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)[1].
References
edit- ↑ 1.0 1.1 1.2 FDA Prescribing Information, Cortef (hydrocortisone), Pfizer/Pharmacia, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/008697s045,008141s073lbl.pdf