U-CORT
Clinical safety rating: caution
Comprehensive clinical and safety monograph for U-CORT (U-CORT).
U-CORT (hydrocortisone) is a corticosteroid that binds to the glucocorticoid receptor, leading to modulation of gene expression and subsequent anti-inflammatory, immunosuppressive, and metabolic effects. It inhibits phospholipase A2, reducing prostaglandin and leukotriene synthesis, and suppresses cytokine production and immune cell migration.
| Metabolism | Hydrocortisone is primarily metabolized in the liver via 11β-hydroxysteroid dehydrogenase and 5α/5β-reductase, with CYP450 enzymes (e.g., CYP3A4) playing a minor role. Metabolites are excreted renally. |
| Excretion | Primarily hepatic metabolism; inactive metabolites excreted renally (60-70%) and biliary/fecal (20-30%). |
| Half-life | Terminal half-life approximately 1.6-2.2 hours; clinically used as short-acting topical corticosteroid. |
| Protein binding | Approximately 85-90% bound, primarily to corticosteroid-binding globulin (CBG) and albumin. |
| Volume of Distribution | Vd ~0.5 L/kg, indicating distribution into total body water, with minimal sequestering in deep compartments. |
| Bioavailability | Topical: <5% systemic bioavailability through intact skin; increased with occlusion or damaged skin. |
| Onset of Action | Topical: 2-4 hours for vasoconstriction; full anti-inflammatory effect within 1-2 days of continuous use. |
| Duration of Action | Duration of vasoconstriction 8-12 hours after single application; therapeutic effect persists with daily dosing. |
| Molecular Weight | 362.46 |
U-CORT (hydrocortisone) 100 mg intravenous bolus, followed by 100 mg intravenous every 8 hours for 48 hours, then taper as clinically indicated.
| Dosage form | CREAM |
| Renal impairment | No dose adjustment required for renal impairment. |
| Liver impairment | Child-Pugh Class A: No adjustment. Child-Pugh Class B: Reduce dose by 50%. Child-Pugh Class C: Reduce dose by 75%. |
| Pediatric use | 1-2 mg/kg intravenous bolus, then 0.5-1 mg/kg intravenously every 6 hours; maximum 100 mg per dose. |
| Geriatric use | Use lowest effective dose; monitor for hyperglycemia, hypertension, and osteoporosis. No specific dose adjustment required based on age alone. |
| 1st trimester | U-CORT (hydrocortisone) is generally avoided in the first trimester unless essential, as corticosteroids have been associated with a small increased risk of oral clefts. Use only if potential benefit outweighs risk. |
| 2nd trimester | Use with caution. Monitor for fetal growth restriction and maternal glucose intolerance. Short-term use may be acceptable for maternal conditions. |
| 3rd trimester | May be used but monitor for adrenal suppression in the neonate if used chronically or in high doses. Avoid use near term if possible. |
Clinical note
Comprehensive clinical and safety monograph for U-CORT (U-CORT).
| Placental transfer | Hydrocortisone crosses the placenta; however, it is extensively metabolized by placental 11β-hydroxysteroid dehydrogenase type 2, limiting fetal exposure. Degree of transfer is low to moderate depending on dose and duration. |
| Breastfeeding | Hydrocortisone passes into breast milk in small amounts. Maternal doses up to 20 mg daily are considered compatible with breastfeeding. Higher doses may suppress infant adrenal function; monitor infant for signs of adrenal suppression. |
■ FDA Black Box Warning
There is no FDA black box warning specific to hydrocortisone. However, systemic corticosteroids are associated with increased risk of serious infections, adrenal suppression, and Cushing's syndrome with prolonged use.
| Serious Effects |
Systemic fungal infectionsStatus asthmaticusHypersensitivity to hydrocortisone or any componentAdministration of live or live attenuated vaccines (due to immunosuppression)
| Precautions | May cause adrenal suppression, immunosuppression, osteoporosis, glaucoma, cataracts, hypertension, hyperglycemia, and growth retardation in children. Avoid abrupt discontinuation after prolonged use. Use with caution in infections, peptic ulcer disease, and hypothyroidism. |
| Food/Dietary | Avoid grapefruit and grapefruit juice as they may increase hydrocortisone levels. Limit sodium and high-sugar foods to manage fluid retention and blood glucose. Take with food to reduce GI irritation. |
Loading safety data…
| Lactation Rating | L2 (Safer) |
| Teratogenic Risk | U-CORT (hydrocortisone) is a corticosteroid. First trimester: Increased risk of cleft palate (odds ratio ~3.4) with systemic use; topical use minimal systemic absorption considered low risk. Second/third trimester: Chronic use associated with fetal growth restriction, adrenal suppression, and preterm birth. Avoid high doses near term. |
| Fetal Monitoring | Maternal: Blood pressure, blood glucose, electrolytes, signs of infection. Fetal: Serial ultrasounds for growth restriction in prolonged use; monitor for fetal adrenal suppression if near term. |
| Fertility Effects | Hydrocortisone may inhibit ovulation at high doses due to suppression of LH; can delay conception. Unlikely to cause permanent fertility impairment. |
| Clinical Pearls | U-CORT (hydrocortisone) is a corticosteroid used for anti-inflammatory and immunosuppressive effects. Administer with food to reduce GI irritation. Avoid abrupt discontinuation; taper dose. Monitor for adrenal suppression, hyperglycemia, and electrolyte imbalances. Use lowest effective dose for shortest duration. |
| Patient Advice | Take with food or milk to prevent stomach upset. · Do not stop taking this medication suddenly; follow your doctor's tapering schedule. · Report any signs of infection (fever, sore throat), unusual weight gain, or mood changes. · Avoid live vaccines while on this medication. · Carry a medical alert card indicating you are on corticosteroids. |