Hydrocortisone
Trade names: hydrocortisone
butyrate Class:
• Corticosteroid, short acting
• Glucocorticoid
• Mineralocorticoid
• Adrenal cortical hormone (hydrocortisone)
• Hormonal agent
Pregnancy:
(Category C/ D if used in 1st trimester)
Action: Enters target cells and
binds to cytoplasmic receptors; initiates many complex reactions that are
responsible for its anti-inflammatory,
immunosuppressive
(glucocorticoid),
and salt-retaining (Mineralocorticoid) actions. Some actions may be
undesirable, depending on drug use.
Indications
• Replacement therapy in adrenal cortical insufficiency
• Hypocalcaemia associated with cancer
•
Short-term inflammatory and
allergic disorders, such as rheumatoid arthritis, collagen diseases (SLE),
dermatologic diseases (pemphigus), status asthmaticus, and autoimmune disorders
• Hematologic disorders--thrombocytopenic purpura,
erythroblastopenia
• Trichinosis with neurologic or myocardial involvement
•
Ulcerative colitis, acute
exacerbations of multiple sclerosis, and palliation in some leukemia and
lymphomas
• Intra-articular or soft-tissue administration: Arthritis,
psoriatic plaques
• Retention enema: For ulcerative colitis, proctitis
•
Dermatologic preparations:
To relieve inflammatory and pruritic manifestations of dermatoses that are
steroid responsive
• Anorectal cream, suppositories: To relieve discomfort of
hemorrhoids and perianal itching or irritation
Contraindications/cautions
• Systemic administration: infections, especially tuberculosis,
fungal infections, amebiasis, hepatitis B, vaccinia, or varicella, and
antibiotic-resistant infections; kidney disease (risk to edema); liver disease,
cirrhosis, hypothyroidism; ulcerative colitis with impending perforation;
diverticulitis; recent GI surgery; active or latent peptic ulcer; inflammatory
bowel disease (risks exacerbations or bowel perforation); hypertension, CHF;
thromboembolitic tendencies, thrombophlebitis, osteoporosis, convulsive
disorders, metastatic carcinoma, diabetes mellitus; lactation.
• Retention enemas, intrarectal foam: systemic fungal infections,
recent intestinal surgery, extensive fistulas.
• Topical
dermatologic administration: fungal, tubercular, herpes simplex skin infections;
vaccinia, varicella; ear application when eardrum is perforated; lactation.
Dose:
• by mouth, replacement therapy, 20–30 mg daily in divided doses ,
CHILD 10–30 mg
• By intramuscular injection or
slow intravenous injection or infusion, 100–500 mg, 3–4
times in 24 hours or as required; CHILD
by slow intravenous injection up to 1 year 25 mg, 1–5 years 50 mg, 6–12 years 100 mg
Adverse effects
Systemic
• CNS: Vertigo, headache,
paresthesias, insomnia, convulsions, psychosis
• GI: Peptic or esophageal ulcer,
pancreatitis, abdominal distention, nausea, vomiting, increased appetite and
weight gain (long-term therapy)
• CV: Hypotension, shock,
hypertension and CHF secondary to fluid retention, thromboembolism,
thrombophlebitis, fat embolism, cardiac arrhythmias secondary to electrolyte
disturbances
• Hematologic: Na+ and fluid
retention, hypokalemia, hypocalcaemia, increased blood sugar, increased serum
cholesterol, decreased serum T3 and T4 levels
• Musculoskeletal: Muscle
weakness, steroid myopathy and loss of muscle mass, osteoporosis, spontaneous
fractures (long-term therapy)
• EENT: Cataracts, glaucoma
(long-term therapy), increased intraocular pressure
•
Dermatologic:
Thin, fragile skin; Petechiae; ecchymoses; purpura; striae; subcutaneous fat
atrophy
• Hypersensitivity: Anaphylactoid or hypersensitivity reactions
•
Endocrine: Amenorrhea,
irregular menses, growth retardation, decreased carbohydrate tolerance and
diabetes mellitus, cushingoid state (long-term therapy),
hypothalamicpituitary-adrenal (HPA) suppression systemic with therapy longer
than 5 d
• Other: Immunosuppression,
aggravation or masking of infections, impaired wound healing
Adverse Effects Related to Specific Routes of
Administration
• IM repository injections: Atrophy at injection site
• Retention enema: Local pain, burning; rectal bleeding; systemic
absorption and adverse effects (above)
• Intra-articular: Osteonecrosis,
tendon rupture, infection
• Intraspinal: Meningitis,
adhesive arachnoiditis, conus medullaris syndrome
• Intralesional therapy, head and
neck: Blindness (rare)
• Intrathecal administration:
Arachnoiditis
• Topical dermatologic ointments, creams, sprays: Local burning, irritation, acneiform
lesions, striae, skin atrophy
Nursing
Considerations
Systemic
Administration
• Give daily before 9 AM to mimic normal peak diurnal
corticosteroid levels and minimize HPA suppression.
• Space multiple doses evenly throughout the day.
• Do not give IM injections if patient has thrombocytopenic
purpura.
• Rotate sites of IM repository injections to avoid local atrophy.
• Use minimal doses for minimal duration to minimize adverse
effects.
• Taper doses when discontinuing high-dose or long-term therapy.
• Arrange for increased dosage when patient is subject to unusual
stress.
• Use alternate-day maintenance therapy with short-acting
corticosteroids whenever possible.
• Do not give live virus vaccines with immunosuppressive doses of
hydrocortisone.
• Provide antacids between meals to help avoid peptic ulcer.
Topical
Dermatologic Administration
• Use caution with occlusive dressings; tight or plastic diapers
over affected area can increase systemic absorption.
• Avoid prolonged use, especially near eyes, in genital and rectal
areas, on face, and in skin creases.
