Hydrocort

# hydrocort ## Overview - **Classification**: Corticosteroid (Glucocorticoid) - **Mechanism**: Binds to intracellular glucocorticoid receptors, modulating gene expression to produce anti-inflammatory, immunosuppressive, and metabolic effects. ## Primary Indications 1. **Adrenal Insufficiency** - Replacement therapy for primary or secondary adrenal hypofunction. 2. **Anti-inflammatory/Immunosuppressive** - Management of severe allergic reactions, asthma exacerbations, rheumatic disorders, and other inflammatory conditions. 3. **Septic Shock** - Adjunctive therapy in refractory shock, especially with suspected adrenal insufficiency. ## Adult Dosing ### Standard Dosing **Adrenal Insufficiency (Physiologic Replacement)** - **Dose**: **15-30 mg** - **Frequency**: Daily, typically divided into **2/3 morning, 1/3 late afternoon** - **Route**: Oral - **Duration**: Lifelong **Acute Severe Allergic Reactions / Asthma Exacerbation** - **Dose**: **100-500 mg** - **Frequency**: Every **6-8 hours** - **Route**: Intravenous (IV) - **Duration**: Until stable, then switch to oral taper **Septic Shock (Refractory)** - **Dose**: **50 mg** - **Frequency**: Every **6 hours** or **200 mg/day continuous IV infusion** - **Route**: Intravenous (IV) - **Duration**: Until vasopressors discontinued for 24-48 hours ### Dose Adjustments - **Renal Impairment**: No specific dose adjustment generally needed. - **Hepatic Impairment**: May require dose reduction in severe hepatic impairment; monitor for increased effects. - **Elderly Patients**: Use lowest effective dose; increased risk of adverse effects (e.g., osteoporosis, hyperglycemia). ## Pediatric Dosing ### Neonates (0-28 days) **Adrenal Insufficiency (Replacement)** - **Dose**: **0.5-0.8 mg/kg/day** - **Frequency**: Divided into **3 doses daily** - **Maximum**: Usually **20 mg/day** (varies) - **Special Notes**: Monitor closely for growth, blood pressure, electrolytes. ### Infants (1-12 months) **Adrenal Insufficiency (Replacement)** - **Dose**: **0.5-0.8 mg/kg/day** - **Frequency**: Divided into **2-3 doses daily** - **Maximum**: Usually **20 mg/day** - **Acute Inflammatory/Allergic (e.g., Status Asthmaticus)** - **Dose**: **5-7 mg/kg** (loading), then **5-7 mg/kg/day** - **Frequency**: Loading dose once, maintenance divided **every 6 hours** - **Maximum**: **250 mg/dose** ### Children (1-12 years) **Adrenal Insufficiency (Replacement)** - **Dose**: **0.25-0.5 mg/kg/day** - **Frequency**: Divided into **2-3 doses daily** - **Maximum**: **30 mg/day** - **Acute Inflammatory/Allergic (e.g., Status Asthmaticus)** - **Dose**: **5-7 mg/kg** (loading), then **5-7 mg/kg/day** - **Frequency**: Loading dose once, maintenance divided **every 6 hours** - **Maximum**: **250 mg/dose** or **adult dose equivalent** for acute conditions. ### Adolescents (13-18 years) - **Dose**: Generally follow **adult dosing guidelines** based on indication. - **Maximum**: **Adult dose** for specific indications. - **Special Notes**: Consider potential impact on bone density with long-term use. ## Safety Information ### Contraindications - **Absolute**: Systemic fungal infections (unless used to control drug reactions). - **Absolute**: Hypersensitivity to hydrocortisone or components. - **Relative**: Live or live attenuated vaccines when receiving immunosuppressive doses. ### Common Adverse Effects - **Very Common (>10%)**: Fluid retention, hyperglycemia, increased appetite, mood changes (irritability, euphoria). - **Common (1-10%)**: Hypertension, GI upset, muscle weakness, impaired wound healing, insomnia. - **Serious but Rare**: Adrenal suppression (with chronic use), osteoporosis, avascular necrosis, peptic ulcer, cataracts, glaucoma. ### Key Drug Interactions - **CYP3A4 Inducers (e.g., Phenytoin, Rifampin)**: May decrease hydrocortisone levels; consider dose increase. - **CYP3A4 Inhibitors (e.g., Ketoconazole, Ritonavir)**: May increase hydrocortisone levels; consider dose reduction. - **NSAIDs**: Increased risk of GI ulceration/bleeding; use caution. - **Diuretics (Thiazide, Loop)**: Increased risk of hypokalemia; monitor potassium. - **Live Vaccines**: Risk of severe infection; avoid concurrent use with immunosuppressive doses. ## Monitoring & Follow-up - **Before Treatment**: Baseline weight, BP, electrolytes, glucose. - **During Treatment**: - **Acute**: BP, glucose, electrolytes (especially K+), fluid balance. - **Chronic**: BP, weight, glucose (HbA1c if diabetic), electrolytes, bone mineral density (DEXA scan for long-term use), growth in children. - **Clinical Signs**: Watch for signs of infection, GI bleeding, Cushing's syndrome, adrenal insufficiency (upon withdrawal). ## Clinical Pearls - 💡 **Stress Dosing**: Patients on chronic glucocorticoids need increased doses during times of physical stress (surgery, severe illness) to prevent adrenal crisis. - 💡 **Tapering**: Do not abruptly discontinue chronic hydrocortisone; taper slowly to allow adrenal glands to recover. - 💡 **Timing**: For replacement therapy, take hydrocortisone in divided doses that mimic natural cortisol secretion (e.g., 2/3 in AM, 1/3 in PM). - 💡 **Administration**: Take with food or milk to minimize GI upset. > **⚠️ Important**: This information is for educational purposes only. Always consult current prescribing information, local guidelines, and clinical judgment before prescribing.