U-CORT

Clinical safety rating: caution

Comprehensive clinical and safety monograph for U-CORT (U-CORT).

How it works

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.

What the body does with it

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.

Classification & Brands

Dosing & administration

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.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for U-CORT (U-CORT).

Breastfeeding	Hydrocortisone: M/P ratio 0.2-0.5; excreted in breast milk in low amounts. Use caution with high doses; may suppress infant adrenal function. Endogenous hydrocortisone equivalent to physiologic replacement considered safe.
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.

Warnings & precautions

■ 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.

Side Effect Profile

Serious Effects

Absolute Contraindications

Systemic fungal infections, known hypersensitivity to hydrocortisone, live or attenuated virus vaccines (high doses), and idiopathic thrombocytopenic purpura (intramuscular use).

Clinical Precautions

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.

Clinical Tips & Counseling

Drug interactions

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U-CORT

Clinical safety rating: caution

Comprehensive clinical and safety monograph for U-CORT (U-CORT).

How it works

What the body does with it

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.

Classification & Brands

Dosing & administration

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.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for U-CORT (U-CORT).

Breastfeeding	Hydrocortisone: M/P ratio 0.2-0.5; excreted in breast milk in low amounts. Use caution with high doses; may suppress infant adrenal function. Endogenous hydrocortisone equivalent to physiologic replacement considered safe.
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.

Warnings & precautions

■ FDA Black Box Warning

Side Effect Profile

Serious Effects

Absolute Contraindications

Systemic fungal infections, known hypersensitivity to hydrocortisone, live or attenuated virus vaccines (high doses), and idiopathic thrombocytopenic purpura (intramuscular use).