Hydrocortisone

Drug Information: Hydrocortisone

Hydrocortisone is a corticosteroid medication used to treat a variety of conditions, including adrenal insufficiency, allergic reactions, and inflammatory diseases. It mimics the effects of cortisol, a natural hormone produced by the adrenal glands, and helps regulate inflammation, immune responses, and metabolism. It can be administered topically, orally, intravenously, or intramuscularly, depending on the condition being treated and its severity.

Category

Hormones – Other endocrine medications

Mechanism of Action

Hydrocortisone, as a corticosteroid, exerts its effects by binding to intracellular glucocorticoid receptors. These receptors are present in most body tissues. Upon binding, the hydrocortisone-receptor complex translocates to the nucleus, where it interacts with DNA and alters gene transcription. This results in both increased production of certain proteins (transactivation) and decreased production of others (transrepression).

Specifically, hydrocortisone reduces inflammation by inhibiting the production of inflammatory mediators such as prostaglandins and leukotrienes. It also suppresses the migration of neutrophils and monocytes to the site of inflammation. Furthermore, it affects carbohydrate, protein, and fat metabolism, promoting gluconeogenesis (glucose production) and increasing glycogen storage. Hydrocortisone also has mineralocorticoid activity, affecting sodium and water balance in the body, although this effect is weaker than that of aldosterone.

Clinical Uses

Hydrocortisone is primarily used to treat adrenal insufficiency, including Addison’s disease, where the adrenal glands do not produce enough cortisol. It’s also used to manage inflammatory conditions such as arthritis, allergic reactions (e.g., severe allergic reactions, skin allergies), asthma, and certain autoimmune diseases (e.g., lupus, rheumatoid arthritis). Topical hydrocortisone is used for skin conditions like eczema, dermatitis, and psoriasis. In emergency situations, it can be used to treat severe allergic reactions (anaphylaxis) and shock.

Dosage

Adult Dosage:
* Oral: Typically 15-240 mg per day, depending on the condition and severity. For adrenal insufficiency, a common starting dose is 15-30 mg daily, divided into two or three doses.
* IV/IM: Dosage varies depending on the severity of the condition. A typical dose may range from 100-500 mg initially, followed by maintenance doses.
* Topical: Apply a thin layer to the affected area 1-4 times daily.

Pediatric Dosage:
* Oral: Dosage is usually weight-based (e.g., 0.5-0.8 mg/kg/day in divided doses).
* IV/IM: Dosage is weight-based and depends on the condition being treated.
* Topical: Same as adult, apply a thin layer to the affected area 1-4 times daily. Use with caution in children due to increased absorption.

Route of Administration: Oral, Intravenous (IV), Intramuscular (IM), Topical.

Indications

* Adrenal Insufficiency (Addison’s Disease)
* Allergic Reactions (Severe allergic reactions, skin allergies)
* Inflammatory Conditions (Arthritis, asthma, colitis, others)
* Skin Conditions (Eczema, dermatitis, psoriasis)
* Autoimmune Diseases (Lupus, rheumatoid arthritis)
* Shock

Contraindications

* Systemic fungal infections
* Hypersensitivity to hydrocortisone or any component of the formulation
* Live or live attenuated vaccines (concurrent use, especially with high doses)
* Caution in patients with diabetes, hypertension, osteoporosis, peptic ulcer disease, glaucoma, or cataracts

FAQ

Q: What is hydrocortisone used for?
A: Hydrocortisone is used to treat various conditions, including adrenal insufficiency, allergic reactions, inflammatory conditions, and skin disorders.

Q: How does hydrocortisone work?
A: It works by reducing inflammation and suppressing the immune system, mimicking the effects of cortisol, a natural hormone.

Q: What are the common side effects of hydrocortisone?
A: Common side effects include increased appetite, weight gain, fluid retention, mood changes, and increased risk of infection. Long-term use can lead to more serious side effects like osteoporosis and high blood pressure.

Q: Can I stop taking hydrocortisone suddenly?
A: No, you should not stop taking hydrocortisone suddenly, especially if you have been taking it for a long time. Your doctor will gradually reduce the dose to allow your body to produce its own cortisol again.

Q: Is hydrocortisone safe to use during pregnancy?
A: Hydrocortisone should be used during pregnancy only if the potential benefits outweigh the risks to the fetus. Talk to your doctor before using it during pregnancy.

Q: Does hydrocortisone interact with other medications?
A: Yes, hydrocortisone can interact with various medications, including blood thinners, diuretics, and certain antibiotics. Inform your doctor about all the medications you are taking.

Q: How should I store hydrocortisone?
A: Store hydrocortisone at room temperature, away from moisture and heat. Keep it out of reach of children.

Q: Can hydrocortisone cause weight gain?
A: Yes, hydrocortisone can cause weight gain, especially with long-term use. This is due to increased appetite and fluid retention.