HYDROCORTISONE VALERATE
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.
Corticosteroid that binds to glucocorticoid receptors, modulating gene expression to induce anti-inflammatory, antipruritic, and vasoconstrictive effects.
| Metabolism | Hepatic metabolism via cytochrome P450 enzymes (primarily CYP3A4). |
| Excretion | Renal (approximately 80% as metabolites, <1% unchanged), fecal/biliary (approximately 20% as metabolites) |
| Half-life | Terminal elimination half-life is approximately 2-3 hours for the parent drug; 18-36 hours for the active metabolites (clinical context: duration of action is prolonged due to local tissue retention and metabolite activity) |
| Protein binding | Approximately 90-95% bound to albumin and corticosteroid-binding globulin (CBG) |
| Volume of Distribution | 0.2-0.4 L/kg (indicating distribution primarily in extracellular fluid and limited tissue penetration) |
| Bioavailability | Topical: minimal systemic absorption (<5% in intact skin; up to 10-30% in inflamed or damaged skin); Oral: not applicable; Intralesional: nearly 100% at injection site |
| Onset of Action | Topical: 2-4 hours; Intralesional: 1-2 hours; Intra-articular: 2-4 hours |
| Duration of Action | Topical: 12-24 hours; Intralesional: 3-7 days; Intra-articular: 1-3 weeks |
Apply a thin film to affected area twice daily. Topical use only.
| Dosage form | CREAM |
| 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 once or twice daily in children; limit treatment duration to avoid systemic absorption. |
| Geriatric use | Use with caution; apply sparingly and avoid prolonged use due to increased risk of skin atrophy and systemic absorption. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
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 |
| Breastfeeding | It is not known if hydrocortisone valerate is excreted in breast milk. Other corticosteroids are excreted in low amounts. The M/P ratio is unknown. Caution should be exercised; avoid application to breast area to prevent infant ingestion. |
| Teratogenic Risk |
■ FDA Black Box Warning
None.
| Common Effects | adrenal insufficiency |
| Serious Effects |
["Hypersensitivity to hydrocortisone or any component of the formulation.","Use on skin with active tuberculosis, varicella, or fungal infections."]
| Precautions | ["Systemic absorption may cause reversible hypothalamic-pituitary-adrenal (HPA) axis suppression, Cushing's syndrome, hyperglycemia, and glucosuria.","Prolonged use may produce atrophy of skin, striae, and telangiectasias.","Not for ophthalmic use.","May mask or exacerbate infections."] |
Loading safety data…
| Topical corticosteroids like hydrocortisone valerate are generally considered low risk for teratogenicity. However, systemic absorption may increase the risk of orofacial clefts in the first trimester with prolonged use of high potency corticosteroids. Use during pregnancy should be limited to low potency preparations for shortest duration; no specific fetal risks are established for hydrocortisone valerate. |
| Fetal Monitoring | Monitor for signs of maternal adrenal suppression (e.g., fatigue, hypotension) and fetal growth if used extensively. Observe infant for growth retardation or adrenal suppression if maternal use is prolonged or high dose. |
| Fertility Effects | No known effects on fertility in humans. Animal studies with corticosteroids have shown reduced fertility at high doses, but relevance to topical hydrocortisone valerate is minimal due to low systemic absorption. |