PENECORT
Clinical safety rating: caution
Comprehensive clinical and safety monograph for PENECORT (PENECORT).
PENECORT is a corticosteroid that binds to glucocorticoid receptors, modulating gene expression and suppressing inflammation, immune responses, and adrenal function.
| Metabolism | Hepatic CYP3A4-mediated metabolism. |
| Excretion | Renal: 60-70% as metabolites, 5-10% unchanged; Biliary/fecal: 20-30% as metabolites. |
| Half-life | Terminal elimination half-life: 3-4 hours in adults; prolonged in hepatic impairment (up to 8 hours). |
| Protein binding | 90-95% bound to albumin and alpha-1-acid glycoprotein. |
| Volume of Distribution | 0.4-0.8 L/kg; distributes widely into tissues, including CSF. |
| Bioavailability | Oral: 70-85%; Intramuscular: 90-100%; Topical: 1-5% (varies with formulation and skin condition). |
| Onset of Action | Oral: 1-2 hours; Intramuscular: 30-60 minutes; Intravenous: 5-10 minutes; Topical: 1-3 days for anti-inflammatory effect. |
| Duration of Action | Oral: 12-24 hours; Intramuscular: 24-48 hours; Intravenous: 6-12 hours; Topical: 2-4 weeks for psoriasis (with continuous use). |
2.5-5 mg orally once daily; maximum 10 mg/day. Intramuscular: 20-40 mg every 2-4 weeks.
| Dosage form | SOLUTION |
| Renal impairment | eGFR <30 mL/min: reduce dose by 50% and monitor for fluid retention. eGFR <15 mL/min: avoid use. |
| Liver impairment | Child-Pugh A: no adjustment. Child-Pugh B: reduce dose by 50%. Child-Pugh C: contraindicated. |
| Pediatric use | 0.1-0.2 mg/kg orally once daily (max 5 mg/day). Titrate to lowest effective dose. |
| Geriatric use | Start at lowest dose (2.5 mg daily), increase slowly due to increased risk of osteoporosis, hypertension, and hyperglycemia. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for PENECORT (PENECORT).
| Breastfeeding | Excreted in breast milk. M/P ratio ~0.25. Low dose (< 20 mg/day) considered compatible; monitor infant for growth and adrenal suppression. High doses (> 40 mg/day) avoid or pump and discard. |
| Teratogenic Risk | PENECORT (hydrocortisone) is a corticosteroid. First trimester: Increased risk of cleft palate (odds ratio 1.3-1.7). Second/third trimester: Fetal adrenal suppression, growth restriction, preterm delivery with chronic use. Avoid high doses. |
| Fetal Monitoring |
■ FDA Black Box Warning
None.
| Serious Effects |
Systemic fungal infections, known hypersensitivity to corticosteroids, live virus vaccination.
| Precautions | Adrenal suppression, increased infection risk, osteoporosis, glaucoma, growth suppression in children, and Cushing's syndrome with long-term use. |
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| Maternal: Blood pressure, glucose, signs of infection, adrenal insufficiency. Fetal: Ultrasound for growth restriction (serial), amniotic fluid volume, fetal movement counts. Neonatal: Assess for hypoglycemia, adrenal suppression. |
| Fertility Effects | May disrupt menstrual cycle and ovulation at high doses due to hypothalamic-pituitary-adrenal axis suppression. Generally reversible upon dose reduction or discontinuation. |