Dosing & Uses
Dosage Forms & Strengths
powder for injection
15-240 mg PO/IM/IV q12hr
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
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
powder for injection
&ge:12 years: 15-240 mg PO/IM/IV/SC q12hr
IV Maintenance: 2 mg/kg/day IV divided q6hr
PO Maintenance: 0.5-1 mg/kg IV q6hr
Acute Adrenal Crisis (Off-label)
>1 month-1 year
- 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
- 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
- Diurnal Limited; Cardiff Medicentre, Cardiff CF14 4UJ; United Kingdom
Serious - Use Alternative
Significant - Monitor Closely
Frequency Not Defined
Delayed wound healing
Myocardial rupture (post myocardial infarction)
Pseudotumor cerebri (on withdrawal)
Central serous chorioretinopathy
Secondary thrombocytopenia in adults
Idiopathic thrombocytopenic purpura in adults
Erythroblastopenia (RBC anemia)
Congenital (erythroid) hypoplastic anemia
Untreated serious infections (except tuberculous meningitis or septic shock)
Idiopathic thrombocytopenic purpura
Intrathecal administration (injection)
Administration of live or live, attenuated vaccines is contraindicated in patients receiving immunosuppressive doses of corticosteroids
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)
- 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
Pregnancy & Lactation
Pregnancy category: C
Lactation: Drug enters breast milk; use with caution
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.
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
Bioavailability: PO, 96%
Protein bound: 90%
Vd: 34 L
Metabolized in tissues and liver
Metabolites: Glucuronide and sulfates (inactive)
Half-life: Plasma, 1-2 hr; biologic, 8-12 hr
Excretion: Urine (mainly), feces (minimally)
- Syringe: Doxapram
- Y-site: Sargramostim
- 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
- 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
- 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
- Intermittent infusion: Dilute in dextrose injections or NS
- 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 push: Over 0.5-10 min
- Intermittent infusion: Over 30 minutes
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|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.|
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