hydrocortisone (AHydrocort, Alphosyl, Aquacort, Cortef, Cortenema, SoluCortef)
Classes: Corticosteroids
Dosing and uses of AHydrocort, Alphosyl (hydrocortisone)
Adult dosage forms and strengths
tablet
- 5mg
- 10mg
- 20mg
powder for injection
- 100mg
- 250mg
- 500mg
- 1g
Inflammation
15-240 mg PO/IM/IV q12hr
Status Asthmaticus
1-2 mg/kg IV q6hr initially for 24 hours; maintenance: 0.5-1 mg/kg q6hr
Acute Adrenal Insufficiency
100 mg IV bolus, then 300 mg/day IV divided q8hr or administered by continuous infusion for 48 hours
When patient is stabilized: 50 mg PO q8hr for 6 doses, then tapered to 30-50 mg/day PO in divided doses
Chronic Adrenal Insufficiency
15-25 mg/day PO divided q8-12hr
Dosage considerations
Usual PO dosing range: 10-320 mg/day divided q6-8hr
Usual IV/IM dosing range (sodium succinate): 100-500 mg PRN initially; may be repeated q2hr, q4hr, or q6hr PRn
Pediatric dosage forms and strengths
tablet
- 5mg
- 10mg
- 20mg
powder for injection
- 100mg
- 250mg
- 500mg
- 1g
Inflammation
<12 years: 2.5-10 mg/kg/day PO divided q6-8hr or 1-5 mg/kg/day IM/IV divided q12-24hr
&ge:12 years: 15-240 mg PO/IM/IV/SC q12hr
Status Asthmaticus
1-2 mg/kg IV q6hr for 24 hr; not to exceed 250 mg
IV Maintenance: 2 mg/kg/day IV divided q6hr
PO Maintenance: 0.5-1 mg/kg IV q6hr
Physiologic Replacement
8-10 mg/m²/day PO/IV/IM divided q8hr
Acute Adrenal Crisis (Off-label)
>1 month-1 year
- 25 mg IV bolus, then 50 mg/m²/day by continuous IV drip or divided q6-8hr
- Alternative: 1-2 mg/kg IV bolus, then 25-150 mg/kg/day IV divided q6-8 hr
1-12 years
- 50-100 mg rapid IV bolus, then 50 mg/m²/day by continuous IV drip or divided q6-8hr
- Alternative: 1-2 mg/kg IV bolus, then 150-250 mg/day divided q6-8hr
Congenital Adrenal Hyperplasia (Orphan)
Chronocort, modified release capsules
Sponsor
- Diurnal LTD; Cardiff Medicentre; Cardiff CF14 4UJ, UK
Adrenal Insufficiency (Orphan)
Hydrocortisone oral granules (Infacort)
Orphan designation for treatment of pediatric adrenal insufficiency for ages birth through 16 yr
Sponsor
- Diurnal Limited; Cardiff Medicentre, Cardiff CF14 4UJ; United Kingdom
AHydrocort, Alphosyl (hydrocortisone) adverse (side) effects
Frequency not defined
Acne
Adrenal suppression
Arthralgia
Bladder dysfunction
Cardiomegaly
Cataract
Cushing syndrome
Delayed wound healing
Delirium
Depression
Diabetes mellitus
Epistaxis
Fat embolism
Hirsutism
Hyperglycemia
Hypokalemic alkalosis
Increased appetite
Indigestion
Insomnia
Malaise
Myocardial rupture (post myocardial infarction)
Myopathy
Osteoporosis
Pseudotumor cerebri (on withdrawal)
Psychosis
Syncope
Tachycardia
Thromboembolism
Vasculitis
Vertigo
Postmarketing Reports
Epidural lipomatosis
Central serous chorioretinopathy
Leukocytosis
Secondary thrombocytopenia in adults
Idiopathic thrombocytopenic purpura in adults
Erythroblastopenia (RBC anemia)
Congenital (erythroid) hypoplastic anemia
Warnings
Contraindications
Untreated serious infections (except tuberculous meningitis or septic shock)
Idiopathic thrombocytopenic purpura
Intrathecal administration (injection)
Documented hypersensitivity
Administration of live or live, attenuated vaccines is contraindicated in patients receiving immunosuppressive doses of corticosteroids
Cautions
Use with caution in cirrhosis, ocular herpes simplex, hypertension, diverticulitis, hypothyroidism, myasthenia gravis, peptic ulcer disease, osteoporosis, ulcerative colitis, psychotic tendencies, renal insufficiency, pregnancy, diabetes mellitus, congestive heart failure, thromboembolic disorders, GI disorders
Thromboembolic disorders and myopathy may occur
Delayed wound healing is possible
Patients receiving corticosteroids should avoid chickenpox or measles-infected persons if unvaccinated
Latent tuberculosis may be reactivated (patients with positive tuberculin test should be monitored)
Some suggestion (not fully substantiated) of slightly increased cleft palate risk if corticosteroids are used in pregnancy
Prolonged corticosteroid use may result in elevated intraocular pressure, glaucoma, or cataracts
Killed or inactivated vaccines may be administered; however, the response to such vaccines cannot be predicted
Pheochromocytoma crisis, which can be fatal, reported after administration of systemic corticosteroids; in patients with suspected pheochromocytoma, consider risk of pheochromocytoma crisis prior to administering corticosteroids
There is enhanced effect of corticosteroids on patients with hypothyroidism and in those with cirrhosis
Corticosteroids should be used cautiously in patients with ocular herpes simplex because of possible corneal perforation
In patients on corticosteroid therapy subjected to unusual stress, increased dosage of rapidly acting corticosteroids before, during, and after stressful situations is indicated
Corticosteroids may mask some signs of infection, and new infections may appear during their use; with increasing doses of corticosteroids, rate of occurrence of infectious complications increases; there may be decreased resistance and inability to localize infection when corticosteroids are used
Immunization procedures may be undertaken in patients who are receiving corticosteroids as replacement therapy in physiologic doses (eg, for Addison’s disease)
Epidural injection
- Serious neurologic events, some resulting in death, have been reported with epidural injection
- Specific events reported include, but are not limited to, spinal cord infarction, paraplegia, quadriplegia, cortical blindness, and stroke
- These serious neurologic events have been reported with and without use of fluoroscopy
- Safety and effectiveness of epidural administration of corticosteroids have not been established, and corticosteroids are not approved for this use
Pregnancy and lactation
Pregnancy category: C
Lactation: Drug enters breast milk; use with caution
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of AHydrocort, Alphosyl (hydrocortisone)
Mechanism of action
Glucocorticoid; elicits mild mineralocorticoid activity and moderate anti-inflammatory effects; controls or prevents inflammation by controlling rate of protein synthesis, suppressing migration of polymorphonuclear leukocytes (PMNs) and fibroblasts, and reversing capillary permeability
Absorption
Bioavailability: PO, 96%
Duration: Short-acting
Distribution
Protein bound: 90%
Vd: 34 L
Metabolism
Metabolized in tissues and liver
Metabolites: Glucuronide and sulfates (inactive)
Elimination
Half-life: Plasma, 1-2 hr; biologic, 8-12 hr
Excretion: Urine (mainly), feces (minimally)
Administration
IV Incompatibilities
Sodium phosphate
- Syringe: Doxapram
- Y-site: Sargramostim
Sodium succinate
- Additive: Amobarbital(?), ampicillin(?), bleomycin, colistimethate, cytarabine(?), dimenhydrinate (may be compatible at low concentrations of both), ephedrine, heparin in D5W, hydralazine, kanamycin(?), metaraminol, nafcillin, pentobarbital, phenobarbital, prochlorperazine, promethazine
- Syringe: Doxapram
- Y-site: Ciprofloxacin, diazepam, idarubicin, methylprednisolone(?), midazolam, phenytoin, promethazine(?; may be diluent-dependent), sargramostim
IV Compatibilities
Sodium phosphate
- Additive: Amikacin, amphotericin B, amphotericin-heparin, bleomycin, metaraminol, mitoxantrone, verapamil
- Syringe: Metoclopramide
- Y-site: Allopurinol, amifostine, aztreonam, cefepime, cladribine, clarithromycin, docetaxel, etoposide phosphate, famotidine, filgrastim, fluconazole, fludarabine, gemcitabine, granisetron, melphalan, ondansetron, paclitaxel, piperacillin-tazobactam, teniposide, thiotepa, vinorelbine
Sodium succinate
- Solution: dextrose-Ringer, dextrose-lactated Ringer, dextrose-saline, D5W, D10W, fructose 10%, Ringer, lactated Ringer, NS, 0.5NS, sodium lactate 1/6M
- Additive: Amikacin, aminophylline, amphotericin B, calcium chloride, calcium gluconate, chloramphenicol, clindamycin, corticotropin, daunorubicin, diphenhydramine, dopamine, erythromycin, floxacillin, furosemide, heparin in NS, lidocaine, magnesium sulfate, mephentermine, metronidazole, mitomycin, mitoxantrone, netilmicin, norepinephrine, penicillin G potassium/sodium, piperacillin, polymyxin B, potassium chloride, procaine, theophylline, thiopental, vancomycin, verapamil, vitamins B and C
- Syringe: Diatrizoate, iohexol, iopamidol, ioxaglate, iothalamate. thiopental
- Y-site (partial list): Acyclovir, allopurinol, amifostine, aminophylline, amphotericin B cholesteryl sulfate, ampicillin, argatroban, atracurium, atropine, aztreonam, betamethasone, bivalirudin, calcium gluconate, cefepime, chlordiazepoxide, cisatracurium, cladribine, cytarabine, dexamethasone sodium phosphate, digoxin, diltiazem, diphenhydramine, dopamine, esmolol, conjugated estrogens, fentanyl, fluorouracil, hydralazine, heparin, inamrinone, linezolid, morphine sulfate, magnesium sulfate, ondansetron, propofol, propranolol, scopolamine, succinylcholine, tacrolimus, vecuronium
IV Preparation
Sodium phosphate
- Intermittent infusion: Dilute in dextrose injections or NS
Sodium succinate
- 100-mg vial: Reconstitute in ≤2 mL SWI/BWI
- Act-O-Vial: Follow instructions (final concentration, 50-125 mg/mL)
- Infusion: Dilute in D5W, NS, or D5/NS to 0.1-1 mg/mL
IV Administration
Sodium succinate
- IV push: Over 0.5-10 min
- Intermittent infusion: Over 30 minutes