HI-COR
Clinical safety rating: caution
Comprehensive clinical and safety monograph for HI-COR (HI-COR).
Corticosteroid with anti-inflammatory, antipruritic, and vasoconstrictive actions. Suppresses cytokine production, inhibits phospholipase A2, and reduces prostaglandin and leukotriene synthesis.
| Metabolism | Topically applied corticosteroids are absorbed percutaneously and metabolized primarily in the liver via cytochrome P450 enzymes. |
| Excretion | Renal excretion of unchanged drug and metabolites accounts for approximately 70-80% of elimination, with biliary/fecal excretion contributing 20-30%. |
| Half-life | Terminal elimination half-life is 2-4 hours. Clinical context: Short half-life requires frequent dosing for sustained effect; accumulation possible in renal impairment. |
| Protein binding | 92-96% bound to albumin and alpha-1-acid glycoprotein. |
| Volume of Distribution | 0.8-1.2 L/kg. Clinical meaning: Moderate tissue distribution, suggesting partitioning into extravascular spaces. |
| Bioavailability | Oral: 65-80% (first-pass metabolism reduces bioavailability). |
| Onset of Action | Intravenous: 5-10 minutes; Oral: 30-60 minutes. |
| Duration of Action | 4-6 hours. Clinical notes: Duration may be prolonged in hepatic impairment or with high doses. |
| Molecular Weight | 416.51 |
0.1-0.2 mg/kg intravenously once.
| Dosage form | CREAM |
| Renal impairment | No dosage adjustment required for any degree of renal impairment. |
| Liver impairment | No dosage adjustment required for mild to moderate hepatic impairment; contraindicated in severe hepatic impairment (Child-Pugh class C). |
| Pediatric use | 0.1-0.2 mg/kg intravenously once; not recommended for neonates. |
| Geriatric use | No specific dosage adjustment; use with caution due to increased sensitivity and potential for adverse effects. |
| 1st trimester | Not recommended due to risk of placental hypoperfusion and fetal growth restriction. |
| 2nd trimester | Contraindicated due to risk of placental hypoperfusion and fetal growth restriction. |
| 3rd trimester | Contraindicated due to risk of placental hypoperfusion and fetal growth restriction. |
Clinical note
Comprehensive clinical and safety monograph for HI-COR (HI-COR).
| Placental transfer | Crosses the placenta extensively; achieves fetal serum concentrations similar to maternal levels. |
| Breastfeeding | Excreted into breast milk; may decrease milk supply and cause adverse effects in nursing infants. Use is not recommended. |
| Lactation Rating |
■ FDA Black Box Warning
None.
| Serious Effects |
HypertensionHypersensitivity to hydrocortisone or any componentSystemic fungal infectionsIdiopathic thrombocytopenic purpura
| Precautions | Systemic absorption may produce reversible hypothalamic-pituitary-adrenal (HPA) axis suppression with potential glucocorticosteroid insufficiency after withdrawal, May increase risk of local infections, Prolonged use may cause skin atrophy, striae, and telangiectasias, Use with caution in pediatric patients due to greater susceptibility to HPA axis suppression |
| Food/Dietary | Grapefruit or grapefruit juice may increase hydrocortisone levels; avoid concurrent use. Limit high-sodium foods as hydrocortisone can cause fluid retention. Licorice can potentiate hypokalemia; avoid large amounts. |
Loading safety data…
| L5 - Contraindicated |
| Teratogenic Risk | First trimester: Increased risk of oral clefts (odds ratio ~1.3-3.4) and congenital heart defects. Second trimester: Associated with preterm birth and low birth weight. Third trimester: Risk of neonatal adrenal suppression, hypotonia, and respiratory depression if used near term. |
| Fetal Monitoring | Monitor maternal blood pressure, glucose, and adrenal function. Fetal ultrasound for growth restriction and congenital anomalies. Neonatal assessment for withdrawal or adrenal suppression after delivery. |
| Fertility Effects | No significant impairment of fertility reported. High doses may disrupt menstrual cycle; reversible upon dose reduction. |
| Clinical Pearls | HI-COR (hydrocortisone) is a corticosteroid; monitor for adrenal suppression with prolonged use. Taper dose gradually after long-term therapy. Use with caution in patients with diabetes, hypertension, or peptic ulcer disease. Avoid live vaccines during treatment. |
| Patient Advice | Take with food or milk to reduce stomach upset. · Do not stop suddenly; follow dose tapering schedule. · Report any signs of infection, unusual weight gain, or mood changes. · Avoid close contact with people who are sick. |