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# IV Hydrocortisone for Acute Asthma
## Overview
Hydrocortisone is a short-acting systemic corticosteroid often used as an alternative to methylprednisolone in acute asthma exacerbations when oral administration is not feasible. It has both glucocorticoid and mineralocorticoid activity.
## Primary Indications
Treatment of acute, severe asthma exacerbations in patients unable to tolerate oral corticosteroids.
## Adult Dosing
* **Standard dose:** 100 mg IV every 6 to 8 hours.
* **Total daily dose range:** 300–400 mg/day (divided every 6–8 hours).
## Pediatric Dosing
* **Standard dose:** 2–4 mg/kg/dose IV every 6 hours.
* **Maximum single dose:** 100 mg.
* *Note: Always verify doses against institutional protocols, as local preferences for methylprednisolone (1 mg/kg) vs. hydrocortisone vary.*
## Dose Adjustments
* **Hepatic impairment:** May require dose reduction or longer intervals due to decreased metabolism.
* **Renal impairment:** No standard dosage adjustment; monitor for electrolyte disturbances.
* **Severe infection/stress:** Higher doses may be required; consult clinical guidelines.
## Contraindications
* Hypersensitivity to hydrocortisone or any component of the formulation.
* Systemic fungal infections.
* Avoid live or attenuated vaccines during high-dose therapy.
## Adverse Effects
* **Common:** Hyperglycemia, hypertension, fluid retention, hypokalemia, and insomnia.
* **Serious:** Psychosis, peptic ulcer disease, masking of infection, adrenal suppression (with prolonged use), and secondary osteoporosis.
## Key Drug Interactions
* **CYP3A4 Inducers (e.g., phenytoin, rifampin):** May decrease hydrocortisone efficacy.
* **CYP3A4 Inhibitors (e.g., ketoconazole, clarithromycin):** May increase hydrocortisone levels.
* **NSAIDs:** Increased risk of gastrointestinal ulceration/bleeding.
* **Diuretics:** Increased risk of hypokalemia.
## Monitoring
* **Clinical:** Respiratory rate, oxygen saturation, and lung auscultation.
* **Laboratory:** Serum glucose (diabetics), potassium, and blood pressure.
* **Physical:** Monitor for signs of GI bleeding or secondary infections.
## Clinical Pearls
* **Preference:** Methylprednisolone is often preferred over hydrocortisone for asthma due to the lack of significant mineralocorticoid activity, though both are acceptable.
* **Transition:** Transition to oral prednisone/prednisolone as soon as the patient can tolerate oral intake. Total course duration for acute asthma is typically 3–7 days.
* **Adrenal Function:** A short course for acute asthma (e.g., < 1 week) generally does not require a formal taper, though clinical status should dictate the plan.
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*Disclaimer: This information is for educational purposes and does not constitute medical advice. Always verify current institutional protocols, drug labeling, and prescribing information before administration.*
