Hydrocortisone

• Adrenal Insufficiency
• Primary (Addison’s disease) and secondary adrenal insufficiency for hormone replacement therapy.
• Inflammatory and Autoimmune Disorders
• Rheumatoid arthritis, systemic lupus erythematosus, polymyalgia rheumatica
• Severe allergic reactions, asthma exacerbations, chronic obstructive pulmonary disease (COPD)
• Dermatologic Disorders
• Eczema, psoriasis, contact dermatitis, atopic dermatitis
• Gastrointestinal Disorders
• Inflammatory bowel disease (ulcerative colitis, Crohn’s disease)
• Off-label / clinically accepted uses
• Shock due to adrenal insufficiency or severe sepsis
• Management of certain hematologic, endocrine, and ophthalmic conditions

Administered orally, intravenously, intramuscularly, rectally, or topically depending on indication.

• Adrenal Insufficiency
• Adults: 15–30 mg/day orally, divided doses (2–3 times daily)
• Pediatrics: 8–12 mg/m²/day orally, divided doses
• Acute Adrenal Crisis
• IV: 100 mg hydrocortisone every 6–8 hours until stabilized, then taper
• Inflammatory Disorders
• Adults: 20–240 mg/day orally, adjusted per disease severity
• Topical
• Apply thin layer 1–4 times daily depending on lesion severity
• Special Populations
• Renal or hepatic impairment: Adjust dose cautiously
• Elderly: Start at lower doses and titrate to clinical response

Hydrocortisone is a glucocorticoid hormone that binds to cytoplasmic glucocorticoid receptors, forming a receptor-steroid complex. This complex translocates to the nucleus, where it modulates gene transcription, leading to the production of anti-inflammatory proteins and suppression of pro-inflammatory cytokines. It reduces immune cell infiltration, vascular permeability, and mediator release, thereby diminishing inflammation, allergic reactions, and immune responses. Hydrocortisone also exerts mineralocorticoid activity, promoting sodium and water retention and potassium excretion, contributing to blood pressure maintenance.

• Absorption: Well absorbed orally; bioavailability ~96%
• Distribution: Widely distributed; 90–95% protein bound (mainly to corticosteroid-binding globulin)
• Metabolism: Hepatic metabolism via reduction and conjugation
• Excretion: Urine (mainly as inactive metabolites), minor fecal excretion
• Onset: Oral 1–2 hours; IV immediate
• Half-life: Plasma half-life 1.5–2 hours; biological effect up to 8–12 hours

• Pregnancy: Category C; may be used if benefits outweigh risks. Risk of fetal growth restriction or adrenal suppression in prolonged high-dose therapy.
• Lactation: Excreted in small amounts in breast milk; generally considered compatible with short-term or low-dose therapy. Monitor infant for adrenal suppression if maternal high-dose therapy is required.

• Primary therapeutic class: Corticosteroid
• Subclass: Glucocorticoid with mineralocorticoid activity

• Known hypersensitivity to hydrocortisone or excipients
• Systemic fungal infections
• Active untreated infections
• Live vaccines (during systemic therapy)

• High-risk patients: Diabetes, hypertension, osteoporosis, peptic ulcer disease, psychiatric disorders
• Adrenal suppression: Taper gradually to prevent adrenal crisis
• Immunosuppression: Increased risk of infections; monitor for signs of sepsis
• Electrolyte disturbances: Monitor sodium and potassium
• Ophthalmic therapy: Risk of glaucoma and cataracts with prolonged use

• Common
• Fluid retention, weight gain, hypertension
• Mood changes, insomnia, increased appetite
• Skin thinning or easy bruising (topical)
• Metabolic
• Hyperglycemia, hyperlipidemia
• Musculoskeletal
• Osteoporosis, muscle weakness
• Gastrointestinal
• Peptic ulcer, dyspepsia
• Rare / serious
• Adrenal suppression, Cushingoid appearance, severe infections, psychiatric disturbances

• NSAIDs: Increased risk of gastrointestinal bleeding
• Diuretics: Enhanced risk of hypokalemia
• Anticoagulants: May alter warfarin effects
• Antidiabetic drugs: May reduce glucose-lowering efficacy
• Live vaccines: Reduced immune response and risk of infection
• Minimal CYP450 interactions; monitor concurrent medications affecting liver metabolism

• Long-term glucocorticoid therapy should use lowest effective dose to minimize adverse effects
• Stress dosing recommended during surgery, infection, or trauma in adrenal insufficiency
• Updated guidelines emphasize monitoring for osteoporosis, hyperglycemia, and infection risk

• Store at 20°C to 25°C (room temperature)
• Protect from light and moisture
• Keep in tight, well-closed container
• Do not freeze; discard if solution or tablet shows discoloration or degradation