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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 that do not respond adequately to initial bronchodilator therapy. It works by reducing airway inflammation.
## Primary Indications
Adjunctive treatment for moderate to severe acute asthma exacerbations.
## Adult Dosing
* **Dosing:** 100 mg IV every 6 to 8 hours.
* **Maximum:** No specific maximum dose is typically stated, but doses are usually guided by clinical response and the standard administration of 100 mg.
* **Continuous Infusion:** Some protocols may utilize a continuous infusion of 200 mg over 24 hours.
## Pediatric Dosing
* **Dosing:** 1 mg/kg IV every 6 hours.
* **Maximum per dose:** 80 mg.
* **Infants <1 month:** Dosing may vary; consult specific pediatric guidelines.
## Dose Adjustments
* **Renal Impairment:** No specific dose adjustment is typically required for renal impairment.
* **Hepatic Impairment:** No specific dose adjustment is typically required for hepatic impairment.
## Contraindications
* Known hypersensitivity to hydrocortisone or other corticosteroids.
* Systemic fungal infections.
## Adverse Effects
Common adverse effects may include hyperglycemia, fluid and electrolyte disturbances (e.g., sodium retention, potassium loss), increased susceptibility to infection, mood changes, and insomnia. Rapid IV administration can cause cardiovascular effects like hypotension.
## Key Drug Interactions
* **Potassium-depleting drugs (e.g., diuretics, amphotericin B):** Increased risk of hypokalemia.
* **CYP3A4 inhibitors (e.g., ketoconazole, ritonavir):** May increase hydrocortisone levels.
* **Live vaccines:** Increased risk of adverse reactions.
## Monitoring
* **Clinical response:** Improvement in respiratory rate, work of breathing, and oxygen saturation.
* **Electrolytes:** Especially potassium and glucose, particularly with prolonged use or in susceptible patients.
* **Signs of infection.**
## Clinical Pearls
* IV hydrocortisone is typically initiated when patients do not show adequate improvement with inhaled bronchodilators.
* It takes several hours for the anti-inflammatory effects to become apparent, so it should not delay aggressive bronchodilator therapy.
* Conversion to oral corticosteroids can occur once clinical improvement is achieved and the patient can tolerate oral medications.
* Protocols for IV hydrocortisone dosing in acute asthma can vary between institutions.
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**Disclaimer:** This information is intended for healthcare professionals. Always verify the most current prescribing information and institutional protocols before administering any medication.
