MAGNACORT
Clinical safety rating: caution
Comprehensive clinical and safety monograph for MAGNACORT (MAGNACORT).
Corticosteroid receptor agonist; modulates gene transcription to produce anti-inflammatory and immunosuppressive effects.
| Metabolism | Primarily hepatic via CYP3A4; also metabolized by reductases and sulfatases. |
| Excretion | Renal (80% as unchanged drug and metabolites, primarily via glomerular filtration and tubular secretion); biliary/fecal (15%) |
| Half-life | 3.5 ± 0.8 hours (terminal); prolonged in renal impairment (up to 12 hours in ESRD) and hepatic disease; requires dose adjustment in CrCl <30 mL/min |
| Protein binding | 92% primarily to albumin (low-affinity binding also to alpha-1-acid glycoprotein); reduced binding in hypoalbuminemia (e.g., burns, nephrotic syndrome) |
| Volume of Distribution | 0.25–0.35 L/kg (~20 L in adults); indicates moderate extravascular distribution, consistent with water-soluble corticosteroid |
| Bioavailability | Oral: 75–90% (high, complete absorption; food delays rate but not extent); IM: 100% (absolute); rectal: ~50% (low due to first-pass metabolism) |
| Onset of Action | Oral: 30–60 minutes; IV: 5–15 minutes; IM: 10–30 minutes |
| Duration of Action | Oral/IV: 8–12 hours for single dose, with clinical effect correlating to plasma levels; anti-inflammatory effects persist up to 24 hours |
| Molecular Weight | 420.52 |
5 mg orally once daily for 7 days, then 5 mg orally every other day for 7 days. Alternatively, 1 mg/kg intravenously every 12 hours for 14 days.
| Dosage form | OINTMENT |
| Renal impairment | GFR ≥60 mL/min: No adjustment. GFR 30-59: Reduce dose by 25%. GFR 15-29: Reduce dose by 50%. GFR <15: Use alternative therapy. |
| Liver impairment | Child-Pugh A: No adjustment. Child-Pugh B: Reduce dose by 50%. Child-Pugh C: Contraindicated. |
| Pediatric use | Weight-based: 0.5 mg/kg orally twice daily for 7 days, then 0.5 mg/kg orally once daily for 7 days. Maximum 100 mg per dose. |
| Geriatric use | Initial dose 2.5 mg orally once daily for 7 days, then 2.5 mg every other day for 7 days. Monitor renal function and electrolytes. |
| 1st trimester | MAGNACORT is a synthetic corticosteroid with pregnancy category C. In the first trimester, there is an increased risk of oral clefts; use only if potential benefit justifies risk to the fetus. |
| 2nd trimester | May cause fetal adrenal suppression; prolonged or repeated use should be avoided. Use lowest effective dose for shortest duration. |
| 3rd trimester | Use in third trimester may cause neonatal adrenal suppression; monitor neonate for hypoadrenalism if used near term. |
Clinical note
Comprehensive clinical and safety monograph for MAGNACORT (MAGNACORT).
| Placental transfer | MAGNACORT readily crosses the placenta; approximately 25% of maternal plasma concentration reaches fetal circulation. The drug is metabolized by placental 11β-HSD2 to a less active form, but significant exposure occurs. |
| Breastfeeding | Corticosteroids distribute into breast milk in low amounts; with high maternal doses, monitor infant for adrenal suppression, growth retardation, and electrolyte disturbances. Consider using lower doses and short-term therapy. |
■ FDA Black Box Warning
None.
| Serious Effects |
Systemic fungal infectionsKnown hypersensitivity to MAGNACORT or any componentsAdministration of live or live-attenuated vaccines during immunosuppressive dosesIdiopathic thrombocytopenic purpura (intramuscular route)
| Precautions | Adrenal suppression; increased susceptibility to infections; masking of infection; Cushing's syndrome; osteoporosis; gastrointestinal perforation; increased intraocular pressure; growth suppression in children; psychiatric disturbances; fluid and electrolyte disturbances; use with NSAIDs increases GI risk. |
| Food/Dietary | Avoid grapefruit and grapefruit juice as they may increase exposure. High-sodium foods may exacerbate fluid retention; consider a low-sodium diet. Potassium supplements may be needed if hypokalemia develops. |
Loading safety data…
| Lactation Rating | L3 (Moderately Safe) |
| Teratogenic Risk | Category C: First trimester increased risk of cleft palate (OR 3.35), second/third trimester fetal adrenal suppression, IUGR, oligohydramnios. Risk increases with dose and duration. |
| Fetal Monitoring | Maternal: Blood pressure, glucose tolerance, signs of infection. Fetal: Ultrasound for growth restriction (every 4 weeks after 24 weeks), amniotic fluid index, fetal heart rate monitoring. |
| Fertility Effects | May suppress hypothalamic-pituitary-adrenal axis, potentially inhibiting ovulation. Reversible upon dose reduction or discontinuation. |
| Clinical Pearls | MAGNACORT (hydrocortisone) is a short-acting glucocorticoid with high mineralocorticoid activity. For acute adrenal insufficiency, give IV bolus 100 mg, then 50 mg q6h. Taper slowly to avoid adrenal crisis. In septic shock, use stress-dose steroids only if refractory to fluids and vasopressors. Monitor for hyperglycemia, hypokalemia, and immunosuppression. |
| Patient Advice | Do not stop taking this medication abruptly; gradual dose reduction is required. · Report signs of adrenal insufficiency: fatigue, weakness, dizziness, nausea. · Avoid live vaccines while on therapy. · Carry a medical alert card stating you are on steroids. · Monitor blood sugar if diabetic; appetite may increase. |