hydrocortisone oral (Cortef)

Hydrocortisone is a naturally-occurring corticosteroid produced by the adrenal glands. Corticosteroids have potent anti-inflammatory properties and are used in a wide variety of inflammatory conditions such as:

• arthritis,
• colitis,
• asthma,
• bronchitis,
• certain skin rashes, and
• allergic or inflammatory conditions of the nose and eyes.

There are numerous preparations of corticosteroids including oral tablets, capsules, liquids, topical creams and gels, inhalers and eye drops, and injectable and intravenous solutions. Hydrocortisone that is prescribed in oral, tablet and liquid forms is addressed in this article.

Dosage requirements of corticosteroids vary among individuals and the diseases being treated. In general, the lowest possible effective dose is used. Corticosteroids given in multiple doses throughout the day are more effective but also more toxic than if the same total dose is given once daily or every other day. The FDA approved hydrocortisone in December 1952.

A-Hydrocort, Solu-CORTEE, Cortef

GENERIC AVAILABLE: Yes

Yes

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:

• fluid retention,
• weight gain,
• high blood pressure,
• potassium loss,
• headache,
• muscle weakness,
• puffiness of and hair growth on the face,
• thinning and easy bruising of the skin,
• glaucoma,
• cataracts,
• peptic ulceration,
• worsening of diabetes,
• irregular menses,
• growth retardation in children,
• convulsions, and
• psychic disturbances.

Psychic disturbances can include:

• depression,
• euphoria,
• insomnia,
• mood swings,
• personality changes, and
• 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.

Hydrocortisone impairs calcium absorption and new bone formation. Patients on prolonged treatment with hydrocortisone and other corticosteroids can develop osteoporosis and an increased risk of bone fractures. Supplemental calcium and vitamin D are encouraged to slow this process of bone thinning.

In rare individuals, destruction of large joints (aseptic necrosis) can occur while undergoing treatment with hydrocortisone or other corticosteroids. These patients experience severe pain in the joints involved, and can require joint replacements. The reason behind such destruction is not clear.

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.

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.

Hydrocortisone has not been adequately evaluated during pregnancy.

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

What preparations of hydrocortisone, oral are available?

Tablets: 5, 10 and 20 mg; Oral Suspension: 10 mg/5 ml.

How should I keep hydrocortisone, oral stored?

Hydrocortisone should be stored at room temperature at 20 C - 25 C (68 F - 77 F) in a sealed container.