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# IV Hydrocortisone for Acute Asthma ## Overview IV hydrocortisone is a corticosteroid used as an adjunct therapy in moderate to severe acute asthma exacerbations to reduce airway inflammation. It is not a bronchodilator and does not provide immediate relief. ## Primary Indications Adjunctive treatment for moderate to severe acute asthma exacerbations in patients who have not responded adequately to inhaled bronchodilators and systemic corticosteroids. ## Adult Dosing * **Loading Dose:** 100 mg IV every 6-8 hours as a continuous infusion or intermittent bolus. * **Duration:** Typically continued until the patient can tolerate oral prednisone or prednisolone. Note: Dosing may vary based on institutional protocols and patient response. ## Pediatric Dosing * **Loading Dose:** 1-2 mg/kg IV every 6-8 hours. * **Maximum Dose:** 100 mg per dose. * **Duration:** Similar to adults, transitioned to oral therapy when appropriate. Note: Dosing varies based on age and weight, and institutional protocols should be consulted. ## Dose Adjustments No specific dose adjustments are typically required for hepatic or renal impairment, but prolonged use requires caution. ## Contraindications Systemic fungal infections. Hypersensitivity to hydrocortisone or other components of the formulation. ## Adverse Effects Common: Hyperglycemia, insomnia, mood changes, increased appetite, fluid retention. Less Common: Hypertension, peptic ulceration, increased risk of infection, adrenal suppression (with prolonged use). ## Key Drug Interactions * **CYP3A4 Inducers (e.g., rifampin, phenytoin, phenobarbital):** May decrease hydrocortisone efficacy. * **Diuretics (non-potassium sparing):** Increased risk of hypokalemia. * **Antidiabetics:** May decrease efficacy, requiring dose adjustment. ## Monitoring * Blood glucose levels, especially in diabetic patients or those at risk. * Electrolytes (e.g., potassium). * Signs and symptoms of infection. * Clinical response to asthma therapy (spirometry, respiratory rate, oxygen saturation, work of breathing). * Signs of adrenal suppression if used long-term or with previous corticosteroid exposure. ## Clinical Pearls * Administer as soon as possible in moderate to severe exacerbations, though maximal benefit may take several hours. * It is most effective when given early in the course of the exacerbation. * Should be used in conjunction with inhaled bronchodilators and potentially other adjunctive therapies. * Transition to oral corticosteroids (e.g., prednisone, prednisolone) as soon as clinically possible due to IV hydrocortisone's short half-life and potential for more frequent dosing. --- **Disclaimer:** This information is intended for clinical use and is not a substitute for professional medical advice. Always verify current prescribing information with the manufacturer's product labeling and consult with healthcare professionals for patient-specific management.