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. |
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 | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for MICORT-HC (MICORT-HC).
| Breastfeeding | Hydrocortisone is excreted into human breast milk in low amounts (M/P ratio ~0.25). Topical use at recommended doses is considered compatible with breastfeeding; avoid application to nipple/areola. For systemic use, a single dose is likely safe; chronic high doses may theoretically suppress infant adrenal function. Monitor infant for growth and adrenal suppression. |
| 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. |
■ FDA Black Box Warning
None
| Serious Effects |
["Hypersensitivity to hydrocortisone or any component of the formulation","Untreated bacterial, fungal, viral, or parasitic skin infections","Perioral dermatitis","Rosacea","Acne vulgaris"]
| 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."] |
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| 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. |