hydrocortisone (Rx)

Brand and Other Names:AHydrocort, Alphosyl, more...Aquacort, Cortef, Cortenema, SoluCortef
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet

  • 5mg
  • 10mg
  • 20mg

powder for injection

  • 100mg
  • 250mg
  • 500mg
  • 1g
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Inflammation

15-240 mg PO/IM/IV q12hr

Status Asthmaticus

1-2 mg/kg IV q6hr initially for 24 hours; maintenance: 0.5-1 mg/kg q6hr  

Acute Adrenal Insufficiency

100 mg IV bolus, then 300 mg/day IV divided q8hr or administered by continuous infusion for 48 hours

When patient is stabilized: 50 mg PO q8hr for 6 doses, then tapered to 30-50 mg/day PO in divided doses

Chronic Adrenal Insufficiency

15-25 mg/day PO divided q8-12hr

Dosage Considerations

Usual PO dosing range: 10-320 mg/day divided q6-8hr

Usual IV/IM dosing range (sodium succinate): 100-500 mg PRN initially; may be repeated q2hr, q4hr, or q6hr PRN

Dosing Forms and Strengths

tablet

  • 5mg
  • 10mg
  • 20mg

powder for injection

  • 100mg
  • 250mg
  • 500mg
  • 1g

Inflammation

<12 years: 2.5-10 mg/kg/day PO divided q6-8hr or 1-5 mg/kg/day IM/IV divided q12-24hr 

&ge:12 years: 15-240 mg PO/IM/IV/SC q12hr

Status Asthmaticus

1-2 mg/kg IV q6hr for 24 hr; not to exceed 250 mg 

IV Maintenance: 2 mg/kg/day IV divided q6hr

PO Maintenance: 0.5-1 mg/kg IV q6hr

Physiologic Replacement

8-10 mg/m²/day PO/IV/IM divided q8hr  

Acute Adrenal Crisis (Off-label)

>1 month-1 year

  • 25 mg IV bolus, then 50 mg/m²/day by continuous IV drip or divided q6-8hr 
  • Alternative: 1-2 mg/kg IV bolus, then 25-150 mg/kg/day IV divided q6-8 hr  

1-12 years

  • 50-100 mg rapid IV bolus, then 50 mg/m²/day by continuous IV drip or divided q6-8hr
  • Alternative: 1-2 mg/kg IV bolus, then 150-250 mg/day divided q6-8hr

Congenital Adrenal Hyperplasia (Orphan)

Chronocort, modified release capsules

Sponsor

  • Diurnal LTD; Cardiff Medicentre; Cardiff CF14 4UJ, UK

Adrenal Insufficiency (Orphan)

Hydrocortisone oral granules (Infacort)

Orphan designation for treatment of pediatric adrenal insufficiency for ages birth through 16 yr

Sponsor

  • Diurnal Limited; Cardiff Medicentre, Cardiff CF14 4UJ; United Kingdom
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Interactions

Interaction Checker

and hydrocortisone

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    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

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            Adverse Effects

            Frequency Not Defined

            Acne

            Adrenal suppression

            Arthralgia

            Bladder dysfunction

            Cardiomegaly

            Cataract

            Cushing syndrome

            Delayed wound healing

            Delirium

            Depression

            Diabetes mellitus

            Epistaxis

            Fat embolism

            Hirsutism

            Hyperglycemia

            Hypokalemic alkalosis

            Increased appetite

            Indigestion

            Insomnia

            Malaise

            Myocardial rupture (post myocardial infarction)

            Myopathy

            Osteoporosis

            Pseudotumor cerebri (on withdrawal)

            Psychosis

            Syncope

            Tachycardia

            Thromboembolism

            Vasculitis

            Vertigo

            Postmarketing Reports

            Epidural lipomatosis

            Central serous chorioretinopathy

            Leukocytosis

            Secondary thrombocytopenia in adults

            Idiopathic thrombocytopenic purpura in adults

            Erythroblastopenia (RBC anemia)

            Congenital (erythroid) hypoplastic anemia

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            Warnings

            Contraindications

            Untreated serious infections (except tuberculous meningitis or septic shock)

            Idiopathic thrombocytopenic purpura

            Intrathecal administration (injection)

            Documented hypersensitivity

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

            Cautions

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

            Thromboembolic disorders and myopathy may occur

            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

            There is enhanced effect of corticosteroids on patients with hypothyroidism and in those with cirrhosis

            Corticosteroids should be used cautiously in patients with ocular herpes simplex because of possible corneal perforation

            In patients on corticosteroid therapy subjected to unusual stress, increased dosage of rapidly acting corticosteroids before, during, and after stressful situations is indicated

            Corticosteroids may mask some signs of infection, and new infections may appear during their use; with increasing doses of corticosteroids, rate of occurrence of infectious complications increases; there may be decreased resistance and inability to localize infection when corticosteroids are used

            Immunization procedures may be undertaken in patients who are receiving corticosteroids as replacement therapy in physiologic doses (eg, for Addison’s disease)

            Epidural injection

            • Serious neurologic events, some resulting in death, have been reported with epidural injection
            • Specific events reported include, but are not limited to, spinal cord infarction, paraplegia, quadriplegia, cortical blindness, and stroke
            • These serious neurologic events have been reported with and without use of fluoroscopy
            • Safety and effectiveness of epidural administration of corticosteroids have not been established, and corticosteroids are not approved for this use
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            Pregnancy & Lactation

            Pregnancy category: C

            Lactation: Drug enters breast milk; use with caution

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Glucocorticoid; elicits mild mineralocorticoid activity and moderate anti-inflammatory effects; controls or prevents inflammation by controlling rate of protein synthesis, suppressing migration of polymorphonuclear leukocytes (PMNs) and fibroblasts, and reversing capillary permeability

            Absorption

            Bioavailability: PO, 96%

            Duration: Short-acting

            Distribution

            Protein bound: 90%

            Vd: 34 L

            Metabolism

            Metabolized in tissues and liver

            Metabolites: Glucuronide and sulfates (inactive)

            Elimination

            Half-life: Plasma, 1-2 hr; biologic, 8-12 hr

            Excretion: Urine (mainly), feces (minimally)

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            Administration

            IV Incompatibilities

            Sodium phosphate

            • Syringe: Doxapram
            • Y-site: Sargramostim

            Sodium succinate

            • Additive: Amobarbital(?), ampicillin(?), bleomycin, colistimethate, cytarabine(?), dimenhydrinate (may be compatible at low concentrations of both), ephedrine, heparin in D5W, hydralazine, kanamycin(?), metaraminol, nafcillin, pentobarbital, phenobarbital, prochlorperazine, promethazine
            • Syringe: Doxapram
            • Y-site: Ciprofloxacin, diazepam, idarubicin, methylprednisolone(?), midazolam, phenytoin, promethazine(?; may be diluent-dependent), sargramostim

            IV Compatibilities

            Sodium phosphate

            • Additive: Amikacin, amphotericin B, amphotericin-heparin, bleomycin, metaraminol, mitoxantrone, verapamil
            • Syringe: Metoclopramide
            • Y-site: Allopurinol, amifostine, aztreonam, cefepime, cladribine, clarithromycin, docetaxel, etoposide phosphate, famotidine, filgrastim, fluconazole, fludarabine, gemcitabine, granisetron, melphalan, ondansetron, paclitaxel, piperacillin-tazobactam, teniposide, thiotepa, vinorelbine

            Sodium succinate

            • Solution: dextrose-Ringer, dextrose-lactated Ringer, dextrose-saline, D5W, D10W, fructose 10%, Ringer, lactated Ringer, NS, 0.5NS, sodium lactate 1/6M
            • Additive: Amikacin, aminophylline, amphotericin B, calcium chloride, calcium gluconate, chloramphenicol, clindamycin, corticotropin, daunorubicin, diphenhydramine, dopamine, erythromycin, floxacillin, furosemide, heparin in NS, lidocaine, magnesium sulfate, mephentermine, metronidazole, mitomycin, mitoxantrone, netilmicin, norepinephrine, penicillin G potassium/sodium, piperacillin, polymyxin B, potassium chloride, procaine, theophylline, thiopental, vancomycin, verapamil, vitamins B and C
            • Syringe: Diatrizoate, iohexol, iopamidol, ioxaglate, iothalamate. thiopental
            • Y-site (partial list): Acyclovir, allopurinol, amifostine, aminophylline, amphotericin B cholesteryl sulfate, ampicillin, argatroban, atracurium, atropine, aztreonam, betamethasone, bivalirudin, calcium gluconate, cefepime, chlordiazepoxide, cisatracurium, cladribine, cytarabine, dexamethasone sodium phosphate, digoxin, diltiazem, diphenhydramine, dopamine, esmolol, conjugated estrogens, fentanyl, fluorouracil, hydralazine, heparin, inamrinone, linezolid, morphine sulfate, magnesium sulfate, ondansetron, propofol, propranolol, scopolamine, succinylcholine, tacrolimus, vecuronium

            IV Preparation

            Sodium phosphate

            • Intermittent infusion: Dilute in dextrose injections or NS

            Sodium succinate

            • 100-mg vial: Reconstitute in ≤2 mL SWI/BWI
            • Act-O-Vial: Follow instructions (final concentration, 50-125 mg/mL)
            • Infusion: Dilute in D5W, NS, or D5/NS to 0.1-1 mg/mL

            IV Administration

            Sodium succinate

            • IV push: Over 0.5-10 min
            • Intermittent infusion: Over 30 minutes
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            Images

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            Formulary

            FormularyPatient Discounts

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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