MICORT-HC
Clinical safety rating: caution
Comprehensive clinical and safety monograph for MICORT-HC (MICORT-HC).
Topical corticosteroid that binds to glucocorticoid receptors, modulating gene expression to inhibit phospholipase A2, reduce prostaglandin and leukotriene synthesis, and suppress cytokine release, thereby exerting anti-inflammatory, antipruritic, and vasoconstrictive effects.
| Metabolism | Metabolized primarily in the liver via reduction, hydrolysis, and conjugation; minor renal excretion of metabolites. |
| Excretion | Renal (approximately 70% as inactive metabolites, <5% unchanged); fecal (approximately 30%) |
| Half-life | Terminal elimination half-life is 1.5-2.5 hours; clinical duration of action is longer due to genomic effects lasting 8-12 hours. |
| Protein binding | Approximately 80-90%, primarily to corticosteroid-binding globulin (CBG) and albumin. |
| Volume of Distribution | 0.3-0.6 L/kg; indicates distribution into total body water with some tissue penetration. |
| Bioavailability | Oral: ~80-90% (first-pass metabolism minimal); Topical: <1% systemically absorbed; IM: 100%. |
| Onset of Action | Oral: rapid, within 1-2 hours; Topical: onset within 1-2 days for anti-inflammatory effect; IM: onset within 2-4 hours. |
| Duration of Action | Oral: 12-36 hours (based on dose and genomic effects); Topical: anti-inflammatory effect lasts 2-3 days after single application; IM: 1-3 days. |
| Molecular Weight | 360.44 |
Topical: Apply a thin film to affected area 2-4 times daily. Rectal: Insert one suppository (25 mg) rectally twice daily (morning and evening) for 2-3 weeks, then taper as needed.
| Dosage form | CREAM |
| Renal impairment | No dosage adjustment necessary for topical or rectal use due to minimal systemic absorption. |
| Liver impairment | No dosage adjustment necessary for topical or rectal use due to minimal systemic absorption. |
| Pediatric use | Topical: Apply sparingly to affected area 1-2 times daily for no longer than 2 weeks. Use lowest potency formulation. Avoid occlusive dressings. Not recommended in children under 2 years due to increased systemic absorption. |
| Geriatric use | Use with caution due to increased risk of skin atrophy and systemic effects from prolonged use. Apply lowest effective dose for shortest duration. Avoid occlusive dressings. |
| 1st trimester | Avoid first-trimester use; potential for cleft palate and intrauterine growth restriction. |
| 2nd trimester | Use if clearly needed; monitor for fetal growth, low birth weight, and adrenal suppression. |
| 3rd trimester | Use with caution; risk of neonatal adrenal suppression, hypoglycemia, and premature closure of ductus arteriosus. |
Clinical note
Comprehensive clinical and safety monograph for MICORT-HC (MICORT-HC).
| Placental transfer | Crosses placenta; metabolized to active metabolite prednisolone. Fetal serum levels are approximately 20-50% of maternal levels. |
| Breastfeeding | Excreted into breast milk in low amounts; with maternal doses up to 80 mg/day, no adverse effects reported in infants. Use lowest effective dose for shortest duration. |
■ FDA Black Box Warning
None
| Serious Effects |
Systemic fungal infectionsKnown hypersensitivity to hydrocortisone or any component
| Precautions | Prolonged use may cause local skin atrophy, striae, telangiectasias, and secondary infections., Systemic absorption can lead to reversible hypothalamic-pituitary-adrenal (HPA) axis suppression, especially with high potency, large surface area, or occlusive dressings., Use caution in pediatric patients due to increased risk of systemic effects., Avoid use on face, groin, axillae, or intertriginous areas unless specifically indicated., Not for ophthalmic use., May mask signs of infection; discontinue if infection develops and treat appropriately. |
| Food/Dietary | No known food or dietary restrictions. Topical application has minimal systemic absorption, so dietary interactions are negligible. However, avoid grapefruit or other CYP3A4 modulators if on high-dose or occlusive therapy, though unlikely. |
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| Lactation Rating |
| L2 - Safer |
| Teratogenic Risk | First trimester: Retrospective studies suggest a small increased risk of oral clefts (odds ratio ~1.3). Second/third trimesters: Risk of fetal adrenal suppression, intrauterine growth restriction, and preterm birth with chronic high-dose therapy. Topical use at recommended doses is considered low risk due to minimal systemic absorption. |
| Fetal Monitoring | For chronic systemic use: Monitor maternal blood pressure, blood glucose, signs of infection. Monitor fetal growth via serial ultrasound (every 4-6 weeks) due to risk of intrauterine growth restriction. Consider fetal non-stress test or biophysical profile if high-dose therapy in third trimester. Adrenal function testing of neonate if maternal use in late pregnancy. |
| Fertility Effects | No known direct adverse effects on fertility. Hypercortisolism (e.g., Cushing's syndrome) from high-dose systemic use may cause menstrual irregularities and anovulation, potentially impairing fertility. Topical use is not associated with fertility impairment. |
| Clinical Pearls | MICORT-HC (hydrocortisone acetate) is a low-potency topical corticosteroid. Use sparingly on thin skin areas (e.g., face, groin) to avoid atrophy. Do not use on infected lesions without concurrent antimicrobial therapy. Limit duration to 2 weeks for moderate conditions to reduce systemic absorption risk. Monitor for adrenal suppression if used over large areas or under occlusion. |
| Patient Advice | Apply a thin layer to the affected area only, avoiding healthy skin. · Do not use on face, underarms, or groin unless directed by your provider. · Wash hands after application unless treating hands. · Avoid bandaging or covering the area unless instructed, as occlusion increases absorption. · Do not use for more than 2 weeks without re-evaluation. · Report any signs of skin thinning, infection, or worsening rash. |