HYDROCORTISONE IN ABSORBASE
Clinical safety rating: avoid
CYP3A4 inducers (eg phenytoin) may decrease efficacy and inhibitors may increase effects Can cause hyperglycemia and adrenal suppression with prolonged use.
Glucocorticoid receptor agonist that modulates gene expression, leading to anti-inflammatory, immunosuppressive, and vasoconstrictive effects.
| Metabolism | Primarily hepatic via CYP3A4, also local metabolism in skin; major metabolite is 6β-hydroxycortisol. |
| Excretion | Renal: primarily as 17-hydroxycorticosteroids and 17-ketosteroids; <5% unchanged. Biliary/fecal: minimal. Metabolites conjugated with glucuronide or sulfate. |
| Half-life | Terminal elimination half-life: 1-2 hours (plasma cortisol); biological half-life (duration of action) 8-12 hours due to intracellular receptor effects. |
| Protein binding | 90-95% bound to corticosteroid-binding globulin (CBG, transcortin) and albumin. CBG affinity high, albumin low capacity. |
| Volume of Distribution | 0.4-0.6 L/kg; distributes into total body water; crosses placenta and blood-brain barrier. |
| Bioavailability | Oral: 25-50% (first-pass metabolism); IM: 100% (assuming normal muscle perfusion); rectal: variable (low); topical: minimal systemic absorption (<1% with intact skin, higher with damaged skin or occlusion). |
| Onset of Action | IV: rapid (minutes); IM: 1-2 hours for adrenocortical insufficiency; oral: 1-2 hours; topical: 2-4 hours for anti-inflammatory effect. |
| Duration of Action | IV/IM/oral: 8-12 hours (adrenal suppression); topical: 4-6 hours for anti-inflammatory effect; duration extended by Absorbase base via enhanced penetration. |
| Molecular Weight | 362.46 |
Topical: Apply a thin layer to affected area 2-4 times daily.
| Dosage form | OINTMENT |
| Renal impairment | No dose adjustment required for topical use. |
| Liver impairment | No dose adjustment required for topical use. |
| Pediatric use | Apply sparingly to affected area 1-2 times daily for up to 7 days; avoid prolonged use. |
| Geriatric use | Use with caution; apply sparingly and avoid prolonged use due to increased risk of skin atrophy. |
| 1st trimester | Corticosteroids are associated with increased risk of cleft palate (1-2/1000 births) when used in first trimester. Use only if clearly needed. |
| 2nd trimester | May cause adrenal suppression in fetus with prolonged use. Use lowest effective dose. |
| 3rd trimester | Prolonged use may cause neonatal adrenal suppression. Taper if used near term. |
Clinical note
CYP3A4 inducers (eg phenytoin) may decrease efficacy and inhibitors may increase effects Can cause hyperglycemia and adrenal suppression with prolonged use.
| FDA category | Positive |
| Placental transfer | Crosses placenta; metabolized by placental 11β-HSD2 to inactive cortisone, but fetal exposure still occurs with high maternal doses. |
| Breastfeeding |
■ FDA Black Box Warning
None. Topical corticosteroids do not have FDA boxed warnings.
| Common Effects | adrenal insufficiency |
| Serious Effects |
Systemic fungal infectionHypersensitivity to hydrocortisone or vehicleAdministration of live or live-attenuated vaccines (with immunosuppressive doses)
| Precautions | May cause systemic absorption leading to HPA axis suppression, especially in children and with occlusive therapy, Local adverse reactions include skin atrophy, striae, telangiectasias, and secondary infections, May exacerbate or mask fungal or bacterial infections, Use caution in patients with impaired skin integrity or diabetes, Avoid use on face, axillae, or groin unless specifically indicated, Prolonged use may cause irreversible skin changes |
| Food/Dietary | None known for topical hydrocortisone. No dietary restrictions required. |
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| Hydrocortisone enters breast milk in small amounts. Topical application to nipples should be avoided. Oral or systemic use requires caution; monitor infant for growth and adrenal suppression. |
| Lactation Rating | L3: Moderately Safe |
| Teratogenic Risk | First trimester: Increased risk of orofacial clefts (odds ratio 1.3-3.3) with systemic exposure. Second/third trimesters: Associated with intrauterine growth restriction, preterm birth, and adrenal suppression in the neonate. Topical absorption via Absorbase vehicle is minimal but prolonged use over large areas may pose risk. |
| Fetal Monitoring | Maternal: Blood pressure, blood glucose, serum electrolytes, and signs of infection. Fetal: Serial ultrasound monitoring for growth (fundal height, estimated fetal weight) if prolonged systemic exposure. Neonatal: Assess for adrenal suppression (hypoglycemia, hypotension) in infants exposed to high doses in utero. |
| Fertility Effects | No direct impairment of fertility at physiologic doses. Supraphysiologic doses may disrupt hypothalamic-pituitary-ovarian axis, leading to ovulatory dysfunction or menstrual irregularities. |
| Clinical Pearls | Hydrocortisone in Absorbase is a low-potency topical corticosteroid (Class VII). Absorbase is a water-miscible base that enhances penetration. Use for mild to moderate dermatoses, especially on thin skin areas like face and intertriginous zones. Avoid prolonged use on face, groin, or axillae to prevent atrophy and striae. Limit use to 2 weeks for non-scaly conditions. Can be applied under occlusion for resistant plaques but increases systemic absorption. |
| Patient Advice | Apply a thin layer only to affected areas; do not use on broken skin or infections. · Do not cover with bandages or wraps unless directed by your doctor. · Do not use on face, underarms, or groin for more than 2 weeks without medical advice. · Avoid contact with eyes; rinse with water if accidental contact occurs. · Do not use for more than 2 weeks unless prescribed; prolonged use can cause skin thinning and stretch marks. · Inform your doctor if you are pregnant, breastfeeding, or have a skin infection. · Wash hands before and after application unless treating hands. · Do not share this medication with others. |