H-CORT
Clinical safety rating: caution
Comprehensive clinical and safety monograph for H-CORT (H-CORT).
H-CORT (hydrocortisone) is a corticosteroid with glucocorticoid and mineralocorticoid activity. It binds to the glucocorticoid receptor, leading to anti-inflammatory and immunosuppressive effects by inhibiting phospholipase A2, reducing prostaglandin and leukotriene synthesis, and suppressing cytokine production.
| Metabolism | Hepatic metabolism primarily via CYP3A4; also reduced by 11-beta-hydroxysteroid dehydrogenases. |
| Excretion | Renal: ~80% as metabolites, ~5% unchanged; biliary/fecal: ~15% |
| Half-life | Terminal elimination half-life: 1.5-2 hours. Clinical context: Short half-life requires q4-6h dosing; duration may be prolonged in hepatic impairment. |
| Protein binding | ~90% bound to corticosteroid-binding globulin (CBG) and albumin |
| Volume of Distribution | 0.4-0.5 L/kg. Clinical meaning: Moderate distribution, primarily in extracellular fluid; low Vd indicates poor tissue penetration. |
| Bioavailability | Oral: ~80% (high, rapid absorption); Intramuscular: ~100% |
| Onset of Action | Intravenous: 5-15 minutes; Intramuscular: 30-60 minutes; Oral: 1-2 hours |
| Duration of Action | Single dose: 12-24 hours (glucocorticoid effect). Clinical notes: Duration longer than half-life due to receptor-mediated effects; taper to avoid adrenal suppression. |
| Molecular Weight | 362.46 |
Intravenous: 100-250 mg as a single dose or up to 1 gram daily for acute conditions. Oral: 20-30 mg daily in divided doses. Maintenance: 5-20 mg daily.
| Dosage form | POWDER |
| Renal impairment | No specific GFR-based dose adjustment required; however, monitor fluid and electrolyte balance in severe renal impairment. |
| Liver impairment | No specific Child-Pugh based dose adjustment; use caution in severe hepatic impairment due to reduced clearance. |
| Pediatric use | Intravenous: 0.5-2 mg/kg/day in divided doses every 6-12 hours. Oral: 0.5-2 mg/kg/day in divided doses every 6-8 hours. Maximum: 60 mg/day. |
| Geriatric use | Start at lower end of dosing range (e.g., 10-15 mg/day oral) due to increased risk of osteoporosis, hyperglycemia, and infections. Monitor closely. |
| 1st trimester | Use only if clearly needed; limited data suggest some risk of oral clefts at high doses. Weigh benefits vs risks. |
| 2nd trimester | Use with caution; may cause fetal adrenal suppression or growth retardation with prolonged use. |
| 3rd trimester | Avoid prolonged use; may cause neonatal adrenal suppression and hypoglycemia. Short courses may be acceptable. |
Clinical note
Comprehensive clinical and safety monograph for H-CORT (H-CORT).
| Placental transfer | Corticosteroids, including H-CORT, cross the placenta with variable extent; prednisolone (active form) less efficiently than dexamethasone. Placental enzyme 11β-HSD2 partially metabolizes cortisol to inactive cortisone, reducing fetal exposure. |
| Breastfeeding | Minimal systemic absorption; generally considered compatible with breastfeeding when used at typical doses. However, use lowest effective dose for shortest duration to minimize exposure. |
■ FDA Black Box Warning
No FDA boxed warning.
| Serious Effects |
Systemic fungal infectionsHypersensitivity to corticosteroids or any componentLive or attenuated virus vaccines (concurrent use)Idiopathic thrombocytopenic purpura (for high-dose systemic use)
| Precautions | Immunosuppression and increased infection risk, Adrenal suppression with prolonged use, Cushing's syndrome with high doses, Osteoporosis with chronic use, Gastrointestinal perforation risk in certain conditions, Growth suppression in children, Exacerbation of diabetes mellitus and hypertension |
| Food/Dietary | Avoid grapefruit juice as it can increase hydrocortisone levels. Limit high-sodium foods to manage fluid retention. Maintain adequate potassium intake (bananas, oranges) if on high doses. |
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| Lactation Rating | L2 (Safer) |
| Teratogenic Risk | First trimester: Crosses placenta; associated with increased risk of oral clefts (odds ratio 1.3-3.3) with systemic use, dose-dependent. Second/third trimesters: Chronic exposure may cause fetal adrenal suppression, intrauterine growth restriction, and preterm birth; risk of adrenal insufficiency in neonate. Topical use: Minimal systemic absorption, low risk unless applied to large areas or under occlusion. |
| Fetal Monitoring | Monitor maternal blood pressure, blood glucose (steroid-induced hyperglycemia), and signs of infection. Fetal monitoring: serial ultrasound for growth restriction if chronic high-dose use. Neonatal monitoring for adrenal insufficiency (e.g., hypoglycemia, hypotonia) if maternal dose equivalent to >20 mg/day prednisone during third trimester. |
| Fertility Effects | No direct impairment of fertility in males or females. Chronic high doses may suppress HPA axis and alter menstrual cycles via glucocorticoid excess. Reversible upon dose reduction. |
| Clinical Pearls | H-CORT (hydrocortisone) is a corticosteroid for inflammatory and immunosuppressive effects. For acute adrenal insufficiency, administer IV/IM with stress-dose coverage. In topical use, avoid occlusion on large areas to reduce systemic absorption. Monitor for hyperglycemia, hypertension, and immunosuppression. Taper to avoid adrenal crisis. |
| Patient Advice | Take exactly as prescribed; do not abruptly stop without medical guidance. · Report signs of infection, weight gain, swelling, or mood changes. · Avoid live vaccines while on therapy. · Use caution with NSAIDs due to increased GI risk. |