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. |
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 | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for H-CORT (H-CORT).
| Breastfeeding | Excreted in breast milk (M/P ratio ~0.25). Systemic doses >20 mg/day prednisone equivalent may suppress infant adrenal function. High doses for prolonged periods: avoid breastfeeding or pump and discard. Topical hydrocortisone: compatible with breastfeeding if applied to small areas; avoid nipples. |
| 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. |
■ FDA Black Box Warning
No FDA boxed warning.
| Serious Effects |
["Systemic fungal infections","Hypersensitivity to hydrocortisone","Administration of live vaccines (relative)","Herpes simplex keratitis (relative)"]
| 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"] |
Loading safety data…
| 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. |