hydrocortisone (Rx)

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


Dosage Forms & Strengths


  • 5mg
  • 10mg
  • 20mg

powder for injection

  • 100mg
  • 250mg
  • 500mg
  • 1g


20-240 mg PO qDay

100-500 mg/dose IV/IM q2hr, q4hr, or q6hr

Status Asthmaticus

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

Acute Adrenal Crisis (Off-label)

100 mg IV bolus, then 200 mg over 24hr by continuous infusion or divided q6hr; then 100 mg over 24 hr the following day

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

Dosage Forms and Strengths


  • 5mg
  • 10mg
  • 20mg

powder for injection

  • 100mg
  • 250mg
  • 500mg
  • 1g


<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:

  • 20-240 mg PO qDay
  • 100-500 mg/dose IV/IM q2hr, q4hr, or q6hr

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 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/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


  • 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


Interaction Checker

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            Adverse Effects

            Frequency Not Defined


            Adrenal suppression


            Bladder dysfunction



            Cushing syndrome

            Delayed wound healing



            Diabetes mellitus


            Fat embolism



            Hypokalemic alkalosis

            Increased appetite




            Myocardial rupture (post myocardial infarction)



            Pseudotumor cerebri (on withdrawal)







            Postmarketing Reports

            Epidural lipomatosis

            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 (IM administration only)

            Intrathecal administration (injection)

            Use in premature infants (formulations containing benzyl alcohol only)

            Documented hypersensitivity

            Systemic fungal infections

            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, myasthenia gravis, peptic ulcer disease, ulcerative colitis, psychotic tendencies, renal insufficiency, pregnancy, diabetes mellitus, congestive heart failure, thromboembolic disorders, GI disorders

            Use caution in head injury; increased mortality reported in patients receiving high-dose corticosteroids; not for use as part of head injury management

            Thromboembolic disorders and myopathy may occur

            High dose corticosteroids associated with increased bone loss and osteoporotic fractures; use caution

            May cause hypercorticism or suppression of hypothalamic-pituitary-adrenal (HPA) axis in patients receiving high doses for prolonged periods and in young children, which may lead to adrenal crisis; use caution when transferring patients from corticosteroids to inhaled products (may precipitate withdrawal symptoms); fatalities resulting from adrenal insufficiency in asthmatic patients during and after transfer from systemic corticosteroids to aerosol steroids, reported

            Anaphylactoid reactions reported in patients receiving corticosteroids

            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

            Seizure reported with adrenal crisis; use with caution in patients with history of seizures

            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; may need dosage adjustments when changes in thyroid status occur; metabolic clearance of corticosteroids may occur in patients with hyperthyroidsm; it may decrease in hypothoroid patients

            Myopathy reported with high dose corticosteroids; mostly in patients with neuromuscular transmission disorders; likely to affect ocular and/or respiratory muscles; monitor creatinine kinase

            Kaposi sarcoma occurrence associated with prolonged corticosteroid treatment; consider discontinuing therapy if it occurs

            Dermal and/or subdermal skin atrophy may occur at site of injection may occur

            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

            Prolonged use of corticosteroids may increase incidence of secondary infection; rule out latent or active amebiasis in any patient with recent travel to tropical climates or unexplained diarrhea prior to initiating corticosteroid therapy; 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

            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.



            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%

            Duration: Short-acting


            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)



            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




            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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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.