Does Solu-Cortef (hydrocortisone) cause side effects?

Solu-Cortef (hydrocortisone) injection is a corticosteroid used to treat inflammation due to a number of diseases and conditions that cause inflammation like rheumatoid arthritis, ulcerative colitis, serious skin conditions, allergies, and asthma

The medicine in Solu-Cortef is similar to cortisol, a natural hormone produced by our adrenal glands. Corticosteroids have potent anti-inflammatory actions and also suppress the immune response.

Common side effects of Solu-Cortef include

Serious side effects of Solu-Cortef include increased susceptibility to infections, depressed ability of body's adrenal glands to produce corticosteroids (with long-term use), osteoporosis and an increased risk of bone fractures, and rarely, destruction of large joints (aseptic necrosis).

Drug interactions of Solu-Cortef include

Solu-Cortef can impede the effectiveness of vaccinations

Solu-Cortef also can interfere with the tuberculin skin test and cause false negative results in patients with tuberculosis infection. 

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

Solu-Cortef is excreted into breast milk and should be used with caution in nursing mothers. Consult your doctor before breastfeeding

What are the important side effects of Solu-Cortef (hydrocortisone)?

Side effects of corticosteroids include:

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.

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 smallpox 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 is gradually tapered.

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. More aggressive treatment may be necessary if osteoporosis occurs.

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.

Solu-Cortef (hydrocortisone) side effects list for healthcare professionals

The following adverse reactions have been reported with SOLU-CORTEF or other corticosteroids:

What drugs interact with Solu-Cortef (hydrocortisone)?

  • Aminoglutethimide: Aminoglutethimide may lead to a loss of corticosteroid-induced adrenal suppression.
  • Amphotericin B injection and potassium-depleting agents: When corticosteroids are administered concomitantly with potassium-depleting agents (e.g., amphotericin B, diuretics), patients should be observed closely for development of hypokalemia. There have been cases reported in which concomitant use of amphotericin B and hydrocortisone was followed by cardiac enlargement and congestive heart failure.
  • Antibiotics: Macrolide antibiotics have been reported to cause a significant decrease in corticosteroid clearance (see DRUG INTERACTIONS, Hepatic Enzyme Inhibitors).
  • Anticholinesterases: Concomitant use of anticholinesterase agents and corticosteroids may produce severe weakness in patients with myasthenia gravis. If possible, anticholinesterase agents should be withdrawn at least 24 hours before initiating corticosteroid therapy.
  • Anticoagulants, oral: Coadministration of corticosteroids and warfarin usually results in inhibition of response to warfarin, although there have been some conflicting reports. Therefore, coagulation indices should be monitored frequently to maintain the desired anticoagulant effect.
  • Antidiabetics: Because corticosteroids may increase blood glucose concentrations, dosage adjustments of antidiabetic agents may be required.
  • Antitubercular drugs: Serum concentrations of isoniazid may be decreased. Cholestyramine: Cholestyramine may increase the clearance of corticosteroids.
  • Cyclosporine: Increased activity of both cyclosporine and corticosteroids may occur when the two are used concurrently. Convulsions have been reported with this concurrent use.
  • Digitalis glycosides: Patients on digitalis glycosides may be at increased risk of arrhythmias due to hypokalemia.
  • Estrogens, including oral contraceptives: Estrogens may decrease the hepatic metabolism of certain corticosteroids, thereby increasing their effect.
  • Hepatic Enzyme Inducers (e.g., barbiturates, phenytoin, carbamazepine, rifampin): Drugs that induce cytochrome P450 3A4 enzyme activity may enhance the metabolism of corticosteroids and require that the dosage of the corticosteroid be increased.
  • Hepatic Enzyme Inhibitors (e.g., ketoconazole, macrolide antibiotics such as erythromycin and troleandomycin): Drugs that inhibit cytochrome P450 3A4 have the potential to result in increased plasma concentrations of corticosteroids.
  • Ketoconazole: Ketoconazole has been reported to significantly decrease the metabolism of certain corticosteroids by up to 60%, leading to an increased risk of corticosteroid side effects.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs): Concomitant use of aspirin (or other nonsteroidal anti-inflammatory agents) and corticosteroids increases the risk of gastrointestinal side effects. Aspirin should be used cautiously in conjunction with corticosteroids in hypoprothrombinemia. The clearance of salicylates may be increased with concurrent use of corticosteroids.
  • Skin tests: Corticosteroids may suppress reactions to skin tests.
  • Vaccines: Patients on prolonged corticosteroid therapy may exhibit a diminished response to toxoids and live or inactivated vaccines due to inhibition of antibody response. Corticosteroids may also potentiate the replication of some organisms contained in live attenuated vaccines. Routine administration of vaccines or toxoids should be deferred until corticosteroid therapy is discontinued if possible.

Summary

Solu-Cortef (hydrocortisone) injection is a corticosteroid used to treat inflammation due to a number of diseases and conditions that cause inflammation like rheumatoid arthritis, ulcerative colitis, serious skin conditions, allergies, and asthma. Common side effects of Solu-Cortef include headache, nausea, vomiting, dizziness, difficulty falling asleep or staying asleep, restlessness, depression, anxiety, increased sweating, increased hair growth, moon face, acne, thinning of the skin, easy bruising or bleeding, and others. Birth defects including cleft palate, stillbirth, and premature abortion have been reported in some patients taking corticosteroids. Solu-Cortef is excreted into breast milk and should be used with caution in nursing mothers.

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Medically Reviewed on 11/6/2020
References
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Professional side effects and drug interactions sections courtesy of the U.S. Food and Drug Administration.