A-HYDROCORT
Clinical safety rating: caution
A-HYDROCORT (hydrocortisone) is a corticosteroid used for its anti-inflammatory, immunosuppressive, and anti-allergic properties. It is indicated for conditions such as adrenal insufficiency, inflammatory disorders, and allergic reactions.
Hydrocortisone is a corticosteroid hormone that binds to glucocorticoid receptors, modulating gene expression to suppress inflammation, inhibit immune response, and regulate metabolism.
| Metabolism | Primarily hepatic via CYP3A4 and other CYP450 enzymes, with reduction in the A-ring to inactive metabolites (e.g., tetrahydrocortisol). |
| Excretion | Renal (primarily as metabolites, <1% unchanged); biliary/fecal (<5%) |
| Half-life | Terminal half-life: 1.5-2 hours (cortisol); clinical effect persists 8-12 hours due to glucocorticoid receptor binding |
| Protein binding | 90-95% bound to corticosteroid-binding globulin (CBG) and albumin |
| Volume of Distribution | 0.5-0.8 L/kg; represents distribution into total body water, higher in obesity |
| Bioavailability | Oral: 96% (well absorbed); IM/IV: 100%; topical: minimal systemic absorption (<1% with intact skin) |
| Onset of Action | IV/IM: rapid (1-2 hours for anti-inflammatory effect); oral: 2-4 hours; topical: variable (hours to days) |
| Duration of Action | Duration: 8-12 hours after single dose; clinical anti-inflammatory effect may last 24-36 hours with high doses |
| Molecular Weight | 362.46 |
Adrenal insufficiency: oral 20-30 mg/day in divided doses; inflammatory conditions: 5-60 mg/day oral; IV/IM: hydrocortisone sodium succinate 50-100 mg every 4-6 hours.
| Dosage form | INJECTABLE |
| Renal impairment | No specific adjustment required; monitor fluid/electrolytes in severe renal impairment. |
| Liver impairment | Dose reduction may be necessary in severe hepatic impairment; caution as metabolism is hepatic. |
| Pediatric use | Doses are weight-based; for adrenal insufficiency: 0.5-0.75 mg/kg/day in divided doses; for anti-inflammatory: 0.5-10 mg/kg/day. |
| Geriatric use | Use lowest effective dose; monitor for osteoporosis, hypertension, and glucose intolerance. |
| 1st trimester | Hydrocortisone is a corticosteroid. Studies suggest an increased risk of cleft palate with first-trimester use, though absolute risk is low. Use only if clearly needed. |
| 2nd trimester | May be used if benefits outweigh risks, but monitor for fetal growth restriction and adrenal suppression. |
| 3rd trimester | Prolonged use may cause fetal adrenal suppression and growth restriction. Use with caution; taper if used near term. |
Clinical note
Hydrocortisone is safe in pregnancy only if clearly needed; consider benefits vs. risks as it crosses the placenta.
| Placental transfer | Hydrocortisone crosses the placenta. Metabolism by placental 11β-HSD2 limits fetal exposure, but high doses can overcome this barrier. |
| Breastfeeding | Hydrocortisone is excreted into breast milk in small amounts. Doses up to 20 mg daily are considered compatible; high doses may require monitoring of infant adrenal function. |
■ FDA Black Box Warning
None.
| Common Effects | Insomnia, Increased appetite, Fluid retention, Hypertension, Hyperglycemia, Mood changes, Osteoporosis, Thin skin |
| Serious Effects | Adrenal crisis, avascular necrosis, severe infections, pancreatitis, psychosis, thromboembolism. |
Systemic fungal infectionsKnown hypersensitivity to hydrocortisone
| Precautions | Immunosuppression and increased infection risk, Adrenal suppression with prolonged use, Cushing's syndrome with chronic use, Osteoporosis with long-term use, GI perforation risk in inflammatory bowel disease, Growth suppression in children, Fetal harm (category C), Ocular effects (cataracts, glaucoma), Fluid and electrolyte disturbances |
| Food/Dietary | No specific food interactions. However, high-sodium foods may exacerbate fluid retention; a low-sodium diet is recommended if edema occurs. Grapefruit juice does not significantly affect hydrocortisone. Avoid alcohol due to additive gastric irritation. |
Loading safety data…
| Lactation Rating | L2 (Safer) |
| Teratogenic Risk | Hydrocortisone is a corticosteroid. Use during first trimester is associated with increased risk of oral clefts (odds ratio 1.5-3.0). Second and third trimester use may cause fetal adrenal suppression, growth restriction, and premature birth. Risk of premature rupture of membranes and intrauterine growth restriction increases with prolonged use. |
| Fetal Monitoring | Monitor maternal blood pressure, blood glucose, and signs of infection. Monitor fetal growth via ultrasound every 4-6 weeks if used chronically. Assess for adrenal suppression in newborn (e.g., hypoglycemia, hypotension) if maternal dose >20 mg/day near term. |
| Fertility Effects | Hydrocortisone may impair fertility by altering gonadotropin secretion and menstrual cycle. High doses can cause amenorrhea and anovulation. Improvement in fertility may occur in certain autoimmune conditions. |
| Clinical Pearls | For acute adrenal insufficiency, give IV bolus of 100 mg hydrocortisone followed by 100 mg every 8 hours. Taper to oral replacement over days. In septic shock, stress-dose hydrocortisone (200 mg/day) may be used if vasopressor-dependent. Monitor for hyperglycemia, hypokalemia, and immunosuppression. Abrupt discontinuation can cause adrenal crisis. |
| Patient Advice | Take exactly as prescribed; do not stop suddenly without doctor's guidance. · Carry a medical alert card or bracelet indicating you take hydrocortisone. · Report signs of adrenal crisis: severe weakness, dizziness, nausea, vomiting, abdominal pain. · During illness or stress (e.g., surgery, infection), dose may need temporary increase; contact your doctor. · Avoid live vaccines during therapy. · Monitor for weight gain, swelling, mood changes, or high blood sugar symptoms (increased thirst, urination). |