CORTRIL
Clinical safety rating: caution
Comprehensive clinical and safety monograph for CORTRIL (CORTRIL).
Cortril (hydrocortisone) is a corticosteroid that binds to the glucocorticoid receptor, leading to inhibition of inflammatory mediators and suppression of immune response.
| Metabolism | Hepatic via CYP3A4 |
| Excretion | Renal (95% as free cortisol and metabolites, primarily tetrahydrocortisol and glucuronide conjugates). Biliary/fecal excretion is minimal (<5%). |
| Half-life | Terminal elimination half-life: 1.5–2.5 hours. Clinically, the biologic half-life (duration of ACTH suppression) is longer (8–12 hours). |
| Protein binding | 90–95% bound primarily to corticosteroid-binding globulin (CBG) and albumin. |
| Volume of Distribution | Vd: 0.3–0.4 L/kg (for free cortisol). Higher in obese patients. Reflects distribution into total body water. |
| Bioavailability | Oral: 25–40% (due to extensive first-pass metabolism). IM: 85–100%; IV: 100%; Topical: low systemic absorption (<5% on intact skin, higher on inflamed skin). |
| Onset of Action | Oral: 1–2 hours; IV: immediate; IM: 1–2 hours; Topical: hours to days. Oral peak effect at 2–4 hours. |
| Duration of Action | Duration of action: 6–8 hours for oral/IV (biologic half-life). Physiologic effects persist longer due to gene-mediated actions. Topical effects are sustained with regular application. |
Hydrocortisone (Cortril) for adrenal insufficiency: 20-30 mg orally daily divided into two or three doses. For acute conditions, IV or IM hydrocortisone sodium succinate 100 mg every 8 hours.
| Dosage form | TABLET |
| Renal impairment | No specific dose adjustment required in renal impairment. However, monitor for fluid retention and electrolyte disturbances. |
| Liver impairment | Severe hepatic impairment (Child-Pugh C): Reduce dose by 50%. Use with caution in moderate impairment (Child-Pugh B). |
| Pediatric use | Adrenal insufficiency: 0.5-1 mg/kg/day orally divided every 6-8 hours. Stress doses: 1-2 mg/kg IV every 6 hours. |
| Geriatric use | Start at lower end of dosing range (e.g., 10-20 mg daily oral). Monitor for osteoporosis, hyperglycemia, and immunosuppression closely. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for CORTRIL (CORTRIL).
| Breastfeeding | Prednisolone transfers into breast milk with M/P ratio 0.1-0.25; typical maternal doses <40 mg/day produce negligible infant exposure; however, monitoring for growth and adrenal suppression is advised. |
| Teratogenic Risk | First trimester: Cleft palate risk increased (OR 3.4) with systemic exposure >10 mg/day; second and third trimesters: Fetal adrenal suppression, intrauterine growth restriction, oligohydramnios with prolonged high doses. |
| Fetal Monitoring |
■ FDA Black Box Warning
None
| Serious Effects |
["Systemic fungal infections","Hypersensitivity to hydrocortisone","Administration of live vaccines"]
| Precautions | ["Immunosuppression and increased risk of infections","Adrenal suppression with prolonged use","Osteoporosis","Gastrointestinal perforation","Growth suppression in children","Cushing's syndrome","Psychiatric disturbances"] |
| Food/Dietary | Avoid grapefruit and grapefruit juice as they may increase hydrocortisone levels. Limit high-sodium foods to reduce edema. Maintain adequate calcium and vitamin D intake to prevent osteoporosis. Use with caution with alcohol due to increased GI irritation risk. |
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| Maternal: Blood pressure, blood glucose, weight, signs of infection; Fetal: Serial ultrasound for growth and amniotic fluid volume; Neonatal: Observe for adrenal suppression if high-dose used near term. |
| Fertility Effects | May reduce fertility via suppression of gonadotropins and menstrual irregularities; reversible upon dose reduction or discontinuation. |
| Clinical Pearls |
| Hydrocortisone (Cortril) is a short-acting glucocorticoid with mineralocorticoid activity. For stress dosing in adrenal insufficiency, double or triple the usual oral dose during minor illness; for major stress, switch to parenteral hydrocortisone 100 mg IV q8h. Monitor for hyperglycemia, hypokalemia, and osteoporosis with long-term use. Taper dose gradually to avoid adrenal crisis. Do not use intrathecally; contains benzyl alcohol in parenteral forms. |
| Patient Advice | Take with food to reduce gastric irritation. · Do not stop suddenly; follow dose-tapering plan. · Wear medical alert bracelet for adrenal insufficiency. · Report signs of infection, hyperglycemia (excessive thirst, urination), or mood changes. · Avoid live vaccines during therapy. |