Drug Guide

Generic Name

Hydrocortisone

Brand Names Hydrocortone, Cortef, Cortril, Cort-dome, Cortenema, Colocort, Texacort, Cetacort, Hc #1, Hc #4, Nutracort, Eldecort, Hytone, Hc (hydrocortisone), Hi-cor, Ala-cort, Proctocort, Dermacort, Epicort, Ala-scalp, Aeroseb-hc, Hydro-rx, Acticort, H-cort, Flexicort, Nogenic Hc, Synacort, Glycort, Balneol-hc, Hydrocortisone In Absorbase, Penecort, Anusol Hc, Stie-cort, Beta-hc, Alkindi Sprinkle

Classification

Therapeutic: Anti-inflammatory, Immunosuppressant

Pharmacological: Glucocorticoid

FDA Approved Indications

Adrenal insufficiency
Allergic reactions
Dermatologic conditions
Inflammatory bowel disease (e.g., Colocort, Cortenema)
Asthma and COPD (inhalational forms)
Other autoimmune disorders

Mechanism of Action

Hydrocortisone mimics endogenous cortisol, binding to glucocorticoid receptors, leading to decreased inflammation, immune responses, and metabolic effects.

Dosage and Administration

Adult: Varies widely based on indication; for example, oral for adrenal insufficiency: 20-240 mg/day in divided doses.

Pediatric: Dosing varies; typically weight-based, prescribed by a physician.

Geriatric: Adjust dose based on response and comorbidities; monitor for side effects.

Renal Impairment: Use with caution; dose adjustments may be necessary.

Hepatic Impairment: Use cautiously; monitor for increased effects.

Pharmacokinetics

Absorption: Well-absorbed orally and from topical applications.

Distribution: Widely distributed, crosses the placenta, into breast milk.

Metabolism: Primarily hepatic via CYP3A4 enzyme.

Excretion: Renal excretion of metabolites.

Half Life: Approximately 1.5 to 2 hours.

Contraindications

Systemic fungal infections
Hypersensitivity to hydrocortisone

Precautions

Active or latent infections
Diabetes mellitus
Osteoporosis
Psychiatric effects
Use with caution in pediatric and elderly patients

Adverse Reactions - Common

Weight gain, fluid retention (Common)
Gastrointestinal upset (Common)
Elevated blood pressure (Common)

Adverse Reactions - Serious

Adrenal suppression (Serious with prolonged use)
Increased risk of infection (Serious)
Psychosis, mood changes (Serious)
Osteoporosis (Serious)

Drug-Drug Interactions

NSAIDs (risk of GI bleeding)
K+ losing diuretics
Antidiabetic drugs (affect blood glucose)

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor for signs of infection, blood glucose, electrolyte imbalance, weight, blood pressure.

Diagnoses:

Risk for infection
Imbalanced nutrition: less/more than body requirements

Implementation: Administer with food to minimize GI upset; adjust doses during illness; monitor labs.

Evaluation: Assess symptom control and monitor for adverse effects.

Patient/Family Teaching

Take medication exactly as prescribed.
Report signs of infection, hyperglycemia, unusual mood changes.
Do not stop abruptly to avoid adrenal crisis.

Special Considerations

Black Box Warnings:

Use with caution in pediatric patients; risk of adrenal suppression,

Genetic Factors: None specific.

Lab Test Interference: May increase serum glucose, decrease calcium levels, and affect adrenal function tests.

Overdose Management

Signs/Symptoms: Cushingoid features, hyperglycemia, hypertension, hypokalemia.

Treatment: Discontinue medication gradually; symptomatic treatment; monitor vitals and electrolytes.

Storage and Handling

Storage: Store at room temperature, away from light and moisture.

Stability: Stable until expiry date on label.