Head-to-head clinical analysis & difference comparison: details on mechanism of action, dosing, half-life, interactions, and maternal-fetal safety.
A-HYDROCORT vs ACTICORT
Clinician-reviewed, head-to-head comparison of mechanism, dosing, pharmacokinetics, and safety profiles.
Last clinically reviewed: July 2026 · OpiCalc Medical Review Team
Hydrocortisone is a corticosteroid hormone that binds to glucocorticoid receptors, modulating gene expression to suppress inflammation, inhibit immune response, and regulate metabolism.
Topical corticosteroid with anti-inflammatory, antipruritic, and vasoconstrictive actions. Suppresses cytokine production and inflammatory mediators via glucocorticoid receptor binding.
Adrenocortical insufficiency (primary and secondary),Congenital adrenal hyperplasia,Inflammatory conditions (e.g., rheumatoid arthritis, ulcerative colitis),Allergic reactions (severe),Asthma exacerbations,Dermatologic disorders (topical use),Ophthalmic inflammation (ophthalmic use)
Corticosteroid-responsive dermatoses (e.g., eczema, psoriasis, contact dermatitis),Off-label: atopic dermatitis, lichen planus, discoid lupus erythematosus
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.
5-60 mg orally once daily, or divided twice daily, depending on condition severity and response.
Terminal half-life: 1.5-2 hours (cortisol); clinical effect persists 8-12 hours due to glucocorticoid receptor binding
1.5-2.5 hours; prolonged in hepatic impairment (up to 10 hours) and renal impairment (up to 6 hours)
Primarily hepatic via CYP3A4 and other CYP450 enzymes, with reduction in the A-ring to inactive metabolites (e.g., tetrahydrocortisol).
Hepatic metabolism via CYP3A4; inactive metabolites excreted renally and biliary.
Renal (primarily as metabolites, <1% unchanged); biliary/fecal (<5%)
Renal (70% as unchanged drug and metabolites), biliary/fecal (30%)
90-95% bound to corticosteroid-binding globulin (CBG) and albumin
90% bound to albumin and corticosteroid-binding globulin
0.5-0.8 L/kg; represents distribution into total body water, higher in obesity
1.2-1.5 L/kg; indicates extensive tissue distribution
Oral: 96% (well absorbed); IM/IV: 100%; topical: minimal systemic absorption (<1% with intact skin)
Oral: 80-90%; IM: 100%
No specific adjustment required; monitor fluid/electrolytes in severe renal impairment.
No dose adjustment necessary for acute use; for chronic therapy in severe renal impairment (e GFR <30 m L/min/1.73 m2), consider dose reduction by 50% to minimize mineralocorticoid effects.
Dose reduction may be necessary in severe hepatic impairment; caution as metabolism is hepatic.
Child-Pugh A: no adjustment; Child-Pugh B: reduce dose by 50%; Child-Pugh C: avoid use or reduce dose by 75% due to reduced clearance.
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.
0.05-2 mg/kg/day orally divided every 6-8 hours, not to exceed 80 mg/day; adjust based on response and severity.
Use lowest effective dose; monitor for osteoporosis, hypertension, and glucose intolerance.
Initiate at lowest effective dose (e.g., 5 mg/day) and titrate slowly due to increased risk of osteoporosis, glucose intolerance, and immunosuppression; monitor for adverse effects.
None.
None
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
HPA axis suppression with prolonged use or large surface area,Local irritation and skin atrophy,Systemic absorption with occlusive dressings,Potential for rebound effects after discontinuation
Systemic fungal infections,Hypersensitivity to hydrocortisone or any component,Administration of live or live-attenuated vaccines (relative),Herpes simplex keratitis (topical ophthalmic use),Peptic ulcer disease (relative),Uncontrolled hypertension (relative)
Known hypersensitivity to components,Untreated bacterial/fungal infections,Viral skin infections (e.g., herpes simplex, varicella),Perioral dermatitis, rosacea
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.
No clinically significant food interactions. Alcohol may increase systemic absorption if tympanic membrane is perforated, but generally avoid alcohol-based ear drops if perforation suspected.
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.
First trimester: Increased risk of cleft palate and cardiac defects (OR 1.3-3.5). Second/third trimesters: Risk of fetal growth restriction, adrenal suppression, and oligohydramnios with chronic use. Avoid use unless maternal benefit outweighs risks.
Hydrocortisone is excreted into breast milk in low concentrations. M/P ratio approximately 0.4-1.0. Doses up to 20 mg/day are considered compatible with breastfeeding. Higher doses may suppress infant adrenal function; monitor infant for growth and adrenal suppression.
Prednisone enters breast milk at low levels (M/P ratio ~0.1-0.3). At maternal doses ≤20 mg/day, the infant dose is <10% of maternal weight-adjusted dose. Consider risk of adrenal suppression in infant with high-dose, long-term therapy. AAP rates as compatible with breastfeeding.
Due to increased clearance and protein binding changes, doses may need to be increased by 50-100% in the second and third trimesters. Monitor clinical response and adjust dose accordingly. Stress doses (e.g., 50-100 mg IV) should be given during labor and delivery.
No empirical dose adjustment required; however, pharmacokinetic changes (increased Vd, hepatic metabolism) may reduce efficacy. Doses may need to be increased by 20-30% in third trimester if disease activity increases. Taper to lowest effective dose.
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.
ACTICORT (hydrocortisone/neomycin/polymyxin B) is a topical combination used for inflammatory ear conditions. Avoid prolonged use (>10 days) to prevent sensitization and overgrowth of non-susceptible organisms. Tympanic membrane perforation is a contraindication due to ototoxicity risk. Use the otic solution not the ophthalmic suspension for ear infections.
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).
Instill drops while lying down with affected ear upward, then remain in position for 5 minutes.,Do not touch dropper to ear or any surface to avoid contamination.,Complete full course even if symptoms improve; do not use longer than prescribed.,Report worsening redness, swelling, or hearing loss immediately.,Avoid getting water in ear during treatment; use a cotton ball soaked in petroleum jelly to protect ear when showering.
No interactions on record
No interactions on record
Explore head-to-head clinical comparisons of other medications in the same therapeutic classes.
Common clinical questions about A-HYDROCORT vs ACTICORT, answered by our medical review team.
A-HYDROCORT is a Corticosteroid that works by Hydrocortisone is a corticosteroid hormone that binds to glucocorticoid receptors, modulating gene expression to suppress inflammation, inhibit immune response, and regulate metabolism.. ACTICORT is a Corticosteroid that works by Topical corticosteroid with anti-inflammatory, antipruritic, and vasoconstrictive actions. Suppresses cytokine production and inflammatory mediators via glucocorticoid receptor binding.. They differ in pharmacokinetic profiles, FDA-approved indications, and side effect profiles.
Potency comparisons between A-HYDROCORT and ACTICORT depend on the specific clinical indication. These are both Corticosteroid agents and are not directly interchangeable by dose. A physician or clinical pharmacist should guide any therapeutic switching decisions.
The standard adult dose of A-HYDROCORT is: 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.. The standard adult dose of ACTICORT is: 5-60 mg orally once daily, or divided twice daily, depending on condition severity and response.. Dosing should always be individualized based on indication, renal and hepatic function, age, and other patient factors.
No direct drug-drug interaction has been formally documented between A-HYDROCORT and ACTICORT in current clinical databases. However, individual patient risk factors including other medications, organ function, and comorbidities should always be evaluated by a qualified healthcare provider.
The maternal-fetal safety profiles differ. A-HYDROCORT is classified as Category C. 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. ACTICORT is classified as Category C. First trimester: Increased risk of cleft palate and cardiac defects (OR 1.3-3.5). Second/third trimesters: Risk of fetal growth restriction, adrenal suppression, and oligohydramnio. Always consult a maternal-fetal medicine specialist before taking either drug during pregnancy or lactation.