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# IV Hydrocortisone for Acute Asthma
## Overview
Intravenous (IV) hydrocortisone is a corticosteroid used as an adjunct in the management of moderate to severe acute asthma exacerbations to reduce airway inflammation.
## Primary Indications
Adjunctive treatment for moderate to severe acute asthma exacerbations in patients who have not responded adequately to initial bronchodilator therapy.
## Adult Dosing
* **Initial Dose:** 100 mg IV every 6 to 8 hours.
* **Continuous Infusion:** In some protocols, an infusion of 200 mg over 24 hours may be used.
* **Alternative:** Some guidelines suggest doses based on lean body weight, such as 3 mg/kg every 6 hours, with a maximum of 100 mg per dose.
* Dosing frequency and duration depend on clinical response and local protocols.
## Pediatric Dosing
* **1 month to 12 years:** 1 mg/kg/dose IV every 6 to 8 hours. Maximum dose: 100 mg/dose.
* **12 to 18 years:** 100 mg IV every 6 to 8 hours.
* Dosing frequency and duration depend on clinical response and local protocols.
## Dose Adjustments
No specific dose adjustments are typically required for hepatic or renal impairment, but caution is advised.
## Contraindications
* Known hypersensitivity to hydrocortisone or other components of the formulation.
* Systemic fungal infections.
## Adverse Effects
Common adverse effects include hyperglycemia, fluid retention, electrolyte imbalances (hypokalemia), mood changes, insomnia, and increased susceptibility to infection. Long-term use can lead to more severe effects like Cushingoid features, osteoporosis, and adrenal suppression.
## Key Drug Interactions
* **CYP3A4 inducers (e.g., rifampin, phenytoin):** May decrease hydrocortisone effectiveness.
* **CYP3A4 inhibitors (e.g., ketoconazole):** May increase hydrocortisone levels.
* **Diuretics:** Increased risk of hypokalemia.
* **Vaccines:** Live vaccines should be avoided.
## Monitoring
* Blood glucose levels.
* Electrolytes (especially potassium).
* Clinical response (respiratory rate, wheezing, oxygen saturation, subjective dyspnea).
* Signs of infection.
## Clinical Pearls
* IV hydrocortisone is generally considered less potent than IV methylprednisolone for acute asthma.
* Onset of action is typically delayed (4-6 hours or longer). It is not a rescue medication.
* Once the patient is improving, IV hydrocortisone should be transitioned to oral corticosteroids for a short-term course to prevent adrenal suppression. Tapering may not be necessary for short courses (e.g., <7 days).
* Ensure adequate hydration and electrolyte balance.
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*This information is intended for healthcare professionals. It is essential to consult the most current prescribing information and relevant clinical guidelines for definitive guidance. Dosing may vary based on institutional protocols and individual patient factors.*
