Yes

Corticosteroid, Oral; Corticosteroid, Parenteral; Corticosteroid, Rectal; Corticosteroid, Topical

Dental: Treatment of a variety of oral diseases of allergic, inflammatory or autoimmune origin

Medical: Management of adrenocortical insufficiency; relief of inflammation of corticosteroid-responsive dermatoses (low and medium potency topical corticosteroid); adjunctive treatment of ulcerative colitis

C

Serious infections, except septic shock or tuberculous meningitis; known hypersensitivity to hydrocortisone; viral, fungal, or tubercular skin lesions

Use with caution in patients with hyperthyroidism, cirrhosis, nonspecific ulcerative colitis, hypertension, osteoporosis, thromboembolic tendencies, CHF, convulsive disorders, myasthenia gravis, thrombophlebitis, peptic ulcer, diabetes

Acute adrenal insufficiency may occur with abrupt withdrawal after long-term therapy or with stress; young pediatric patients may be more susceptible to adrenal axis suppression from topical therapy

Because of the risk of adverse effects, systemic corticosteroids should be used cautiously in the elderly, in the smallest possible dose, and for the shortest possible time

>10%:

Central nervous system: Insomnia, nervousness

Gastrointestinal: Increased appetite, indigestion

1% to 10%:

Dermatologic: Hirsutism

Endocrine & metabolic: Diabetes mellitus

Neuromuscular & skeletal: Arthralgia

Ocular: Cataracts

Respiratory: Epistaxis

<1%: Hypertension, edema, euphoria, headache, delirium, hallucinations, seizures, mood swings, acne, dermatitis, skin atrophy, bruising, hyperpigmentation, hypokalemia, hyperglycemia, Cushing's syndrome, sodium and water retention, bone growth suppression, amenorrhea, peptic ulcer, abdominal distention, ulcerative esophagitis, pancreatitis, muscle wasting, hypersensitivity reactions, immunosuppression

Symptoms of overdose include cushingoid appearance (systemic), muscle weakness (systemic), osteoporosis (systemic) all with long-term use only. When consumed in excessive quantities for prolonged periods, systemic hypercorticism and adrenal suppression may occur. In those cases, discontinuation and withdrawal of the corticosteroid should be done judiciously.

CYP2D6 and 3A3/4 enzyme substrate

Insulin decreases hypoglycemic effect

Phenytoin, phenobarbital, ephedrine, and rifampin increase metabolism of hydrocortisone and decrease steroid blood level

Increased toxicity:

Oral anticoagulants change prothrombin time; potassium-depleting diuretics increase risk of hypokalemia

Cardiac glucosides increase risk of arrhythmias or digitalis toxicity secondary to hypokalemia

Hydrocortisone sodium phosphate and hydrocortisone sodium succinate are clear, light yellow solutions which are heat labile

After initial reconstitution, hydrocortisone sodium succinate solutions are stable for 3 days at room temperature and refrigeration if protected from light

Stability of parenteral admixture (Solu-Cortef®) at room temperature (25°C) and at refrigeration temperature (4°C) is concentration dependent

Minimum volume: Concentration should not exceed 1 mg/mL

Stability of concentration less than or equal to 1 mg/mL: 24 hours

Stability of concentration >1 mg/mL to <25 mg/mL: Unpredictable, 4-6 hours

Stability of concentration greater than or equal to 25 mg/mL: 3 days

Standard diluent (Solu-Cortef®): 50 mg/50 mL D₅W; 100 mg/100 mL D₅W

Comments: Should be administered in a 0.1-1 mg/mL concentration due to stability problems

Decreases inflammation by suppression of migration of polymorphonuclear leukocytes and reversal of increased capillary permeability

Absorption: Rapid by all routes, except rectally

Metabolism: In the liver

Half-life, biologic: 8-12 hours

Elimination: Renally, mainly as 17-hydroxysteroids and 17-ketosteroids

Hydrocortisone acetate salt has a slow onset but long duration of action when compared with more soluble preparations

Hydrocortisone sodium phosphate salt is a water soluble salt with a rapid onset but short duration of action

Hydrocortisone sodium succinate salt is a water soluble salt with is rapidly active

Dose should be based on severity of disease and patient response

Infants and young Children: Succinate: 1-2 mg/kg/dose bolus, then 25-150 mg/day in divided doses every 6-8 hours

Older Children: Succinate: 1-2 mg/kg bolus then 150-250 mg/day in divided doses every 6-8 hours

Adults: Succinate: 100 mg I.V. bolus, then 300 mg/day in divided doses every 8 hours or as a continuous infusion for 48 hours; once patient is stable change to oral, 50 mg every 8 hours for 6 doses, then taper to 30-50 mg/day in divided doses

Chronic adrenal corticoid insufficiency: Adults: Oral: 20-30 mg/day

Anti-inflammatory or immunosuppressive:

Infants and Children:

Oral: 2.5-10 mg/kg/day or 75-300 mg/m²/day every 6-8 hours

I.M., I.V.: Succinate: 1-5 mg/kg/day or 30-150 mg/m²/day divided every 12-24 hours

Adolescents and Adults: Oral, I.M., I.V.: Succinate: 15-240 mg every 12 hours

Congenital adrenal hyperplasia: Oral: Initial: 30-36 mg/m²/day with 1/3 of dose every morning and 2/3 every evening or 1/4 every morning and mid-day and 1/2 every evening; maintenance: 20-25 mg/m²/day in divided doses

Physiologic replacement: Children:

Oral: 0.5-0.75 mg/kg/day or 20-25 mg/m²/day every 8 hours

I.M.: Succinate: 0.25-0.35 mg/kg/day or 12-15 mg/m²/day once daily

Shock: I.M., I.V.: Succinate:

Children: Initial: 50 mg/kg, then repeated in 4 hours and/or every 24 hours as needed

Adolescents and Adults: 500 mg to 2 g every 2-6 hours

Status asthmaticus: Children and Adults: I.V.: Succinate: 1-2 mg/kg/dose every 6 hours for 24 hours, then maintenance of 0.5-1 mg/kg every 6 hours

Rheumatic diseases:

Adults: Intralesional, intra-articular, soft tissue injection: Acetate:

Large joints: 25 mg (up to 37.5 mg)

Small joints: 10-25 mg

Tendon sheaths: 5-12.5 mg

Soft tissue infiltration: 25-50 mg (up to 75 mg)

Bursae: 25-37.5 mg

Ganglia: 12.5-25 mg

Dermatosis: Children >2 years and Adults: Topical: Apply to affected area 3-4 times/day (Buteprate: Apply once or twice daily). Therapy should be discontinued when control is achieved; if no improvement is seen, reassessment of diagnosis may be necessary.

Ulcerative colitis: Adults: Rectal: 10-100 mg 1-2 times/day for 2-3 weeks

Systemic use of corticosteroids may require a diet with increased potassium, vitamins A, B₆, C, D, folate, calcium, zinc, phosphorus, and decreased sodium.

Blood pressure, weight, serum glucose, and electrolytes

Therapeutic: AM: 5-25 mg/dL (SI: 138-690 nmol/L), PM: 2-9 mg/dL (SI: 55-248 nmol/L) depending on test, assay

Insomnia and nervousness are common; rare reports of delirium, euphoria, hallucinations, and mood swings

Barbiturates may increase the metabolism of hydrocortisone; lithium has been used to treat mood swings associated with hydrocortisone

No information available to require special precautions

No effects or complications reported

Systemic: Take as directed; do not increase doses and do not stop abruptly without consulting prescribed. Dosage of systemic hydrocortisone is usually tapered off gradually. Take oral dose with food to reduce GI upset. Hydrocortisone may cause immunosuppression and mask symptoms of infection; avoid exposure to contagion and notify prescriber of any signs of infection (eg, fever, chills, sore throat, injury) and notify dentist or surgeon (if necessary) that you are taking this medication. You may experience increased appetite, indigestion, or increased nervousness. Report any sudden weight gain (>5 lb/week), swelling of extremities or difficulty breathing, abdominal pain, severe vomiting, black or tarry stools, fatigue, anorexia, weakness, or unusual mood swings. Pregnancy precautions: Inform prescriber if you are or intend to be pregnant. Consult prescriber if breast-feeding.

Topical: Before applying, wash area gently and thoroughly. Apply gel, cream, or ointment in thin film to cleansed area and rub in gently until medication vanishes. Avoid exposing affected area to sunlight; you will be more sensitive and severe sunburn may occur. Consult prescriber if breast-feeding.

Rectal: Insert suppository gently as high as possible with gloved finger while lying down. Avoid injury with long or sharp fingernails. Remain in resting position for 10 minutes after insertion.

Apply sparingly; I.V. bolus: Dilute to 50 mg/mL and administered over 3-5 minutes; I.V. intermittent infusion: Dilute to 1 mg/mL and administered over 20-30 minutes

Hydrocortisone acetate:

Aerosol, rectal: 10% (20 g)

Cream, topical: 0.5% (15 g, 22.5 g, 30 g); 1% (15 g, 30 g, 120 g)

Ointment, topical: 0.5% (15 g, 30 g); 1% (15 g, 21 g, 30 g)

Injection, suspension: 25 mg/mL (5 mL, 10 mL); 50 mg/mL (5 mL, 10 mL)

Suppositories, rectal: 10 mg, 25 mg

Hydrocortisone base:

Aerosol, topical: 0.5% (45 g, 58 g); 1% (45 mL)

Cream, rectal: 1% (30 g); 2.5% (30 g)

Cream, topical: 0.2%; 0.5% (15 g, 30 g, 60 g, 120 g, 454 g); 1% (15 g, 20 g, 30 g, 60 g, 90 g, 120 g, 240 g, 454 g); 2.5% (15 g, 20 g, 30 g, 60 g, 120 g, 240 g, 454 g)

Gel, topical: 0.5% (15 g, 30 g); 1% (15 g, 30 g)

Lotion, topical: 0.25% (120 mL); 0.5% (30 mL, 60 mL, 120 mL); 1% (60 mL, 118 mL, 120 mL); 2% (30 mL) ; 2.5% (60 mL, 120 mL)

Ointment, rectal: 1% (30 g)

Ointment, topical: 0.2%; 0.5% (30 g) ; 1% (15 g, 20 g, 28 g, 30 g, 60 g, 120 g, 240 g, 454 g); 2.5% (20 g, 30 g)

Paste: 0.5% (5 g)

Solution, topical: 1% (45 mL, 75 mL, 120 mL)

Suspension, rectal: 100 mg/60 mL (7s)

Tablet, oral: 5 mg, 10 mg, 20 mg

Hydrocortisone buteprate: Cream: 1% (15 g, 45 g)

Hydrocortisone butyrate:

Cream: 0.1% (15 g, 45 g)

Ointment, topical: 0.1% (15 g, 45 g)

Solution, topical: 0.1% (20 mL, 50 mL)

Hydrocortisone cypionate:

Suspension, oral: 10 mg/5 mL (120 mL)

Hydrocortisone sodium phosphate:

Injection, I.M./I.V./S.C.: 50 mg/mL (2 mL, 10 mL)

Hydrocortisone sodium succinate:

Injection, IM/I.V.: 100 mg, 250 mg, 500 mg, 1000 mg

Hydrocortisone valerate:

Cream, topical: 0.2% (15 g, 45 g, 60 g)

Ointment, topical: 0.2% (15 g, 45 g, 60 g, 120 g)