hydrocortisone oral, Hydrocortone, Cortef (cont.)

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Hydrocortisone also is used as a replacement for the naturally occurring hormone in patients whose adrenal glands are unable to produce sufficient amounts of corticosteroids.

DOSING: Hydrocortisone should be taken with food. The recommended dosage range is 10 mg to 300 mg per day depending on the disease administered in 3 to 4 divided doses.

DRUG INTERACTIONS: By interfering with the patient's immune response, hydrocortisone can impede the effectiveness of vaccinations. Hydrocortisone also can interfere with the tuberculin skin test and cause false negative results in patients with tuberculosis infection.

Rifampin and phenytoin (Dilantin, Dilantin-125) may increase the elimination of hydrocortisone from the body, reducing its effectiveness. Troleandomycin and ketoconazole may reduce the elimination of hydrocortisone, possibly leading to increased side effects.

PREGNANCY: Hydrocortisone has not been adequately evaluated during pregnancy.

NURSING MOTHERS: HHydrocortisone can appear in breast milk, and can have adverse effects on the baby. Therefore, mothers taking hydrocortisone should discontinue nursing.

SIDE EFFECTS: Hydrocortisone side effects depend on the dose, the duration and the frequency of administration. Short courses of hydrocortisone usually are well tolerated with few and mild side effects. Long term, high doses of hydrocortisone usually will produce predictable, and potentially serious side effects. Whenever possible, the lowest effective doses of hydrocortisone should be used for the shortest possible length of time to minimize side effects. Alternate day dosing also can help reduce side effects.

Side effects of hydrocortisone and other corticosteroids range from mild to serious. Side effects include:

Psychic disturbances can include depression, euphoria, insomnia, mood swings, personality changes, and even psychotic behavior.

Hydrocortisone and other corticosteroids can mask signs of infection and impair the body's natural immune response to infection. Patients on corticosteroids are more susceptible to infections, and can develop more serious infections than healthy individuals. For instance, chickenpox and measles viruses can produce serious and even fatal illnesses in patients on high doses of hydrocortisone. Live virus vaccines, such as the small pox vaccine, should be avoided in patients taking high doses of hydrocortisone, since even vaccine viruses may cause disease in these patients.

Some infectious organisms, such as tuberculosis (TB) and malaria, can remain dormant in a patient for years. Hydrocortisone and other corticosteroids can reactivate dormant infections in these patients and cause serious illness. Patients with dormant TB may require anti-TB medications while undergoing prolonged corticosteroid treatment. Prolonged use of hydrocortisone can depress the ability of body's adrenal glands to produce corticosteroids.

Abruptly stopping hydrocortisone in these individuals can cause symptoms of corticosteroid insufficiency, with accompanying nausea, vomiting, and even shock. Therefore, withdrawal of hydrocortisone is usually accomplished by gradual tapering. Gradually tapering hydrocortisone not only minimizes the symptoms of corticosteroid insufficiency, it also reduces the risk of an abrupt flare of the disease under treatment. The insufficient adrenal gland function may not recover fully for many months after stopping hydrocortisone. These patients need additional hydrocortisone treatment during periods of stress, such as surgery, to avoid symptoms of corticosteroid insufficiency and shock, while the adrenal gland is not responding by producing its own corticosteroid.



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