hydrocortisone injection (Solu-Cortef, A-Hydrocort)

  • Pharmacy Author:
    Omudhome Ogbru, PharmD

    Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.

  • Medical and Pharmacy Editor: Jay W. Marks, MD
    Jay W. Marks, MD

    Jay W. Marks, MD

    Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

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PRESCRIPTION: Yes

GENERIC AVAILABLE: Yes

PREPARATIONS: Powder for injection: 100, 250, 500, and 1000 mg

STORAGE: Unopened products should be stored at room temperature between 20 C to 25 C (68 F to 77 F).

DOSING: Hydrocortisone injection may be administered into a large muscle such as the buttock or hip, into a vein, or added to the intravenous (IV) fluid bag. Dosing varies and is based on the condition being treated. The intravenous or intramuscular injection dose range for adults is 100-500 mg given every 2, 4, or 6 hours as needed.

DRUG INTERACTIONS:

  • Combining corticosteroids with amphotericin B injection or potassium-depleting agents (for example, diuretics) can lead to low blood potassium.
  • Macrolide antibiotics (for example, erythromycin) may increase blood levels of corticosteroids by decreasing their elimination from the body.
  • Combining corticosteroids and warfarin (Coumadin) usually results in inhibition of response to warfarin.
  • Dosage adjustments of antidiabetic agents may be required because corticosteroids may increase blood glucose concentrations.
  • Barbiturates, phenytoin (Dilantin, Dilantin Infatabs, Phenytek, Phenytoin Infatabs), carbamazepine (Tegretol, Tegretol XR , Equetro, Carbatrol, Epitol, Teril), rifampin and other drugs that increase the activity of cytochrome P450 3A4, an enzyme in the liver, may enhance the breakdown of corticosteroids.
  • Conversely, ketoconazole (Nizoral, Extina, Xolegel, Kuric), erythromycin, troleandomycin, and other drugs that inhibit cytochrome P450 3A4 liver enzymes may increase blood levels of corticosteroids. Ketoconazole may significantly decrease the breakdown of certain corticosteroids by up to 60%, leading to an increased risk of corticosteroid side effects.
  • Combining aspirin or other nonsteroidal anti-inflammatory (NSAIDs) agents with corticosteroids increases the risk of gastrointestinal side effects.
  • Corticosteroids reduce the response to live or inactivated vaccines because they suppress the immune system. Corticosteroids may also help some organisms contained in live attenuated vaccines grow. Vaccination should be delayed until after corticosteroid therapy is completed.
  • Corticosteroids may also suppress reactions to skin tests.

PREGNANCY: Birth defects including cleft palate, still birth, and premature abortion have been reported in some patients taking corticosteroids. Therefore, hydrocortisone injection should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

NURSING MOTHERS: Hydrocortisone is excreted into human milk and should be used with caution in nursing mothers.

REFERENCE: FDA Prescribing Information

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