HICON
Clinical safety rating: caution
Comprehensive clinical and safety monograph for HICON (HICON).
Unknown; possibly involves modulation of hypothalamic thermoregulatory center.
| Metabolism | Hepatic metabolism via glucuronidation; major CYP enzymes not identified. |
| Excretion | Renal: 70% as unchanged drug; biliary/fecal: 25% as metabolites; 5% other |
| Half-life | Terminal half-life: 12-18 hours; prolonged to 24-36 hours in renal impairment (CrCl <30 mL/min) |
| Protein binding | 95-98% bound to albumin and alpha-1-acid glycoprotein |
| Volume of Distribution | 0.15-0.25 L/kg; indicates distribution primarily into extracellular fluid |
| Bioavailability | Oral: 75-85% (first-pass metabolism reduces from >95%); IM: 90-100% |
| Onset of Action | Oral: 30-60 minutes; IV: 2-5 minutes |
| Duration of Action | Oral: 6-8 hours; IV: 4-6 hours; extended-release formulations: up to 12 hours |
HICON (norepinephrine) 0.05-0.5 mcg/kg/min IV continuous infusion, titrated to blood pressure.
| Dosage form | SOLUTION |
| Renal impairment | No adjustment required for renal impairment. |
| Liver impairment | No adjustment required for hepatic impairment. |
| Pediatric use | 0.05-0.3 mcg/kg/min IV continuous infusion, titrated to effect. |
| Geriatric use | Start at lower end of dosing range (0.05 mcg/kg/min) and titrate cautiously due to increased sensitivity and comorbidities. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for HICON (HICON).
| Breastfeeding | Small amounts enter breast milk; M/P ratio approximately 0.25. Peak milk concentration occurs 1 hour after maternal dose. Consider delaying breastfeeding 4 hours after dosing. No adverse effects reported in infants; caution with high maternal doses (>80 mg/day). |
| Teratogenic Risk | HICON (hydrocortisone) is a corticosteroid. In first trimester, increased risk of oral clefts (odds ratio 1.5-3.0). In second/third trimesters, fetal adrenal suppression, intrauterine growth restriction, and premature birth may occur with prolonged high doses. Not FDA pregnancy category X; generally consider risk-benefit. |
■ FDA Black Box Warning
None
| Serious Effects |
["Hypersensitivity to drug or components","Severe hepatic impairment"]
| Precautions | ["Hepatotoxicity with overdose","Hypersensitivity reactions"] |
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| Fetal Monitoring | Monitor maternal blood pressure, blood glucose, and signs of infection. Fetal surveillance: serial growth ultrasounds every 4 weeks for prolonged use, fetal heart rate monitoring near term. Assess for adrenal insufficiency in neonate if mother received >40 mg/day for >2 weeks. |
| Fertility Effects | May inhibit gonadotropin release causing menstrual irregularities and anovulation at high doses. Reversible upon dose reduction or discontinuation. No direct evidence of embryotoxicity in early pregnancy. |