BETA-HC
Clinical safety rating: caution
Comprehensive clinical and safety monograph for BETA-HC (BETA-HC).
BETA-HC (hydrocortisone) is a corticosteroid that binds to the glucocorticoid receptor, leading to modulation of gene expression and suppression of inflammatory mediators such as prostaglandins and leukotrienes. It also inhibits phospholipase A2 and reduces cytokine production.
| Metabolism | Primarily hepatic via CYP3A4; also metabolized by 11β-hydroxysteroid dehydrogenase. |
| Excretion | Renal (approximately 75% as metabolites, <5% unchanged); fecal (approximately 15%) |
| Half-life | 1.5 hours (beta phase); clinical context: anti-inflammatory effects persist longer than serum levels due to receptor binding and gene transcription |
| Protein binding | 90-95% bound to corticosteroid-binding globulin (CBG) and albumin |
| Volume of Distribution | 1.0 L/kg (0.8-1.3 L/kg); indicates extensive tissue distribution |
| Bioavailability | Oral: 60-70% (due to first-pass metabolism); Topical: approximately 1-2% depending on skin condition and formulation |
| Onset of Action | Oral: 1-2 hours; Topical: 2-3 days for full effect; Intravenous: rapid (within minutes for anti-inflammatory action) |
| Duration of Action | Oral: 18-36 hours; Topical: 12-24 hours after single application; clinical notes: duration varies with dose, severity, and individual response |
1-2 tablets (200-400 mg) orally every 6-8 hours as needed for pain; not to exceed 6 tablets (1200 mg) per day.
| Dosage form | LOTION |
| Renal impairment | GFR 30-50 mL/min: Administer 50% of normal dose every 8-12 hours. GFR <30 mL/min: Avoid use due to accumulation of active metabolite. |
| Liver impairment | Child-Pugh Class A: No adjustment. Child-Pugh Class B: Reduce dose by 50% and extend interval to every 8-12 hours. Child-Pugh Class C: Contraindicated. |
| Pediatric use | Children 6-12 years: 5-10 mg/kg orally every 6-8 hours; maximum 40 mg/kg/day. Children >12 years: Same as adult dosing. |
| Geriatric use | Initiate at half the lowest adult dose (100 mg) every 8-12 hours; maximum 600 mg/day due to increased risk of renal and CNS adverse effects. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for BETA-HC (BETA-HC).
| Breastfeeding | Entered into breast milk in low concentrations. M/P ratio unknown. Not expected to cause adverse effects in nursing infants at therapeutic maternal doses. Consider risk-benefit in prolonged high-dose therapy. |
| Teratogenic Risk | FDA Pregnancy Category C. Beta-methasone crosses the placenta. First trimester: associated with cleft palate in animal studies, risk in humans not established. Second/third trimester: chronic use may cause fetal growth restriction, hypothalamic-pituitary-adrenal suppression, and electrolyte disturbances in the newborn. |
■ FDA Black Box Warning
No FDA black box warning.
| Serious Effects |
Hypersensitivity to hydrocortisone or any component; systemic fungal infections; administration of live or live-attenuated vaccines in patients receiving immunosuppressive doses.
| Precautions | May cause immunosuppression, masking of infections; adrenal suppression with prolonged use; increased risk of osteoporosis, glaucoma, and cataracts; caution in patients with diabetes, hypertension, or heart failure; growth suppression in children. |
| Food/Dietary | Avoid grapefruit and grapefruit juice as they may increase hydrocortisone levels. Excessive licorice consumption may potentiate mineralocorticoid effects (hypokalemia, hypertension). Maintain a low-sodium, high-potassium diet if fluid retention occurs. Alcohol may increase gastric irritation; limit intake. |
Loading safety data…
| Fetal Monitoring |
| Monitor fetal growth via ultrasound if prolonged use. Assess newborn for signs of adrenal suppression if maternal therapy continued until delivery. Monitor maternal blood pressure, blood glucose, and electrolytes. |
| Fertility Effects | No known adverse effects on fertility in humans. Animal studies show no impairment at clinical doses. |
| Clinical Pearls | Beta-HC (hydrocortisone) is a short-acting glucocorticoid with mineralocorticoid activity. For adrenal insufficiency, give stress-dose coverage (e.g., 100 mg IV q8h) during major surgery or critical illness. Taper doses to avoid adrenal crisis. Monitor serum potassium and glucose; may cause hypokalemia and hyperglycemia. Use local injection for bursitis with caution to avoid tendon rupture. |
| Patient Advice | Do not stop taking this medication abruptly; taper doses as directed. · Report signs of infection (fever, sore throat) or unusual weight gain. · May cause mood changes, insomnia, or increased appetite. · Avoid live vaccines while on high-dose therapy. · Carry a steroid alert card and emergency supply for adrenal insufficiency. |