20/4/2016 Hydrocortisone(systemic):Druginformation

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Hydrocortisone(systemic):Druginformation

Copyright19782016Lexicomp,Inc.Allrightsreserved.

(Foradditionalinformationsee"Hydrocortisone(systemic):Patientdruginformation"andsee"Hydrocortisone
(systemic):Pediatricdruginformation")

ForabbreviationsandsymbolsthatmaybeusedinLexicomp(showtable)

BrandNames:US AHydrocortCortefSoluCORTEF
BrandNames:Canada CortefSoluCortef
PharmacologicCategory Corticosteroid,Systemic
Dosing:Adult Doseshouldbebasedonseverityofdiseaseandpatientresponse.
Adrenalinsufficiency(acute)(offlabeldosing):IM,IV:100mgIVbolus,then5075mgevery6hoursfor24
hours then slowly taper over the next 72 hours administering every 46 hours during taper.Alternatively,
afterthebolusdose,mayadministerasacontinuousinfusionatarateof10mg/hourforthefirst24hours
followedbyagradualreductionindoseoverthenext72hours.Oncepatientisstable,maychangetoan
oralmaintenanceregimen.Note:Patientswithprimaryadrenalinsufficiencymayrequiremineralocorticoid
supplementation(eg,fludrocortisone)whenshiftingtoanoralmaintenanceregimen(Gardner,2011).

Adrenal insufficiency (chronic), physiologic replacement (offlabel dosing): Oral: 1525 mg/day in 23
divideddoses.Note:Studiessuggestadministeringonehalftotwothirdsofthedailydoseinthemorning
in order to mimic the physiological cortisol secretion pattern. If the twicedaily regimen is utilized, the
seconddoseshouldbeadministered68hoursfollowingthefirstdose(Arlt,2003).

Antiinflammatoryorimmunosuppressive:Oral,IM,IV:15240mgevery12hours

Congenitaladrenalhyperplasia(offlabeldosing):Oral:1525mg/dayin23divideddoses(Speiser,2010)

Statusasthmaticus:IV:12mg/kg/doseevery6hoursfor24hours,thenmaintenanceof0.51mg/kgevery6
hours

Stressdosing(surgery)inpatientsknowntobeadrenallysuppressedoronchronicsystemicsteroids:
IV:

Minorstress(ie,inguinalherniorrhaphy):25mg/dayfor1day

Moderatestress(ie,jointreplacement,cholecystectomy):5075mg/day(25mgevery812hours)for12
days

Major stress (pancreatoduodenectomy, esophagogastrectomy, cardiac surgery): 100150 mg/day (50 mg

every812hours)for23days

Septicshock(offlabeluse):IV:50 mg every 6 hours (Annane, 2002 COIITSS Study Investigators, 2010).

Practiceguidelinessuggestadministering200mgdailyasacontinuousinfusionover24hourstoprevent
adverse effects (eg, hyperglycemia) (Dellinger, 2013 WeberCarstens, 2007) however, the impact of
continuousinfusiononpatientoutcomeshasnotbeenformallyevaluated.Taperslowly(overseveraldays)
when vasopressors are no longer required do not stop abruptly. Note: Hydrocortisone should be used
alone(ie,withoutfludrocortisone)(Dellinger,2013).

Thyroidstorm(offlabeluse):IV:300mgloadingdose,followedby100mgevery8hours(Bahn,2011)

Dosing:Pediatric
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(Foradditionalinformationsee"Hydrocortisone(systemic):Pediatricdruginformation")

Doseshouldbebasedonseverityofdiseaseandpatientresponse.

Antiinflammatoryorimmunosuppressive:

InfantsandChildren:

Oral:2.510mg/kg/dayor75300mg/m2/dayevery68hours

IM,IV:15mg/kg/dayor30150mg/m2/daydividedevery1224hours

Adolescents:Oral,IM,IV:15240mgevery12hours

Congenitaladrenalhyperplasia(offlabeldosing):Oral:Note: Doses must be individualized by monitoring

growth,boneage,andhormonallevels.

Children:1015mg/m2/dayin3divideddoseshigherinitialdosesmayberequiredtoachieveinitialtarget
hormoneserumconcentrationsininfancy(Speiser,2010)

Adolescents:Refertoadultdosing.

Physiologicreplacement:Children:Oral:810mg/m2/daydividedevery8hoursupto12mg/m2/dayinsome
patients(Ahmet,2011Gupta,2008Maguire,2007)

Status asthmaticus: Children: IV: 12 mg/kg/dose every 6 hours for 24 hours, then maintenance of 0.51
mg/kgevery6hours.

Septicshock(offlabeluse):Children:IV:Initial:12mg/kg/day(intermittentorascontinuousinfusion)may
titrate up to 50 mg/kg/day for shock reversal (Brierley, 2009) alternative dosing suggests 50 mg/m2/day
(Dellinger, 2008). Note: Use recommended only in fluid refractory, catecholamineresistant shock, and
suspectedorprovenabsolute(classic)adrenalinsufficiency.

Dosing:Geriatric Refertoadultdosing.
Dosing:RenalImpairment Therearenodosageadjustmentsprovidedinthemanufacturerslabeling
usewithcaution.

Dosing:HepaticImpairment Therearenodosageadjustmentsprovidedinthemanufacturers
labeling.

DosageForms:US Excipientinformationpresentedwhenavailable(limited,particularlyforgenerics)
consultspecificproductlabeling.

SolutionReconstituted,Injection,assodiumsuccinate[strengthexpressedasbase]:

AHydrocort:100mg(1ea)

SoluCORTEF:100mg(1ea)

SolutionReconstituted,Injection,assodiumsuccinate[strengthexpressedasbase,preservativefree]:

SoluCORTEF:100mg(1ea)250mg(1ea)500mg(1ea)1000mg(1ea)

Tablet,Oral,asbase:

Cortef:5mg,10mg,20mg[scored]

Generic:5mg,10mg,20mg

GenericEquivalentAvailable:US Maybeproductdependent
Administration

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Oral:AdministerwithfoodormilktodecreaseGIupset.

Parenteral: Hydrocortisone sodium succinate may be administered by IM or IV routes. Dermal and/or

subdermal skin depression may occur at the site of injection. Avoid injection into deltoid muscle (high
incidenceofsubcutaneousatrophy).

IVbolus:Administerover30secondsorover10minutesfordoses500mg

IVintermittentinfusion:Administerover2030minutes

Compatibility
Hydrocortisone sodium succinate: Stable in dextran 6% in dextrose, dextran 6% in NS, D5LR, D51/4NS,
D51/2NS,D5NS,D5W,D10W,D20W,LR,1/2NS,NS,fatemulsion10%.

Ysiteadministration:

Compatible: Acetaminophen, acyclovir, allopurinol, amifostine, aminophylline, amphotericin B

cholesteryl sulfate complex, ampicillin, amsacrine, anidulafungin, argatroban, atracurium,
atropine, aztreonam, betamethasone sodium phosphate, bivalirudin, calcium gluconate,
caspofungin, cefepime, chlorpromazine, cisatracurium, cladribine, cyanocobalamin, cytarabine,
dexamethasone sodium phosphate, dexmedetomidine, digoxin, diphenhydramine, docetaxel,
dopamine, doripenem, doxorubicin liposome, droperidol, droperidol and fentanyl, edrophonium,
enalaprilat, epinephrine, esmolol, estrogens (conjugated), ethacrynate sodium, etoposide
phosphate, famotidine, fenoldopam, fentanyl, filgrastim, fludarabine, fluorouracil, foscarnet,
furosemide,galliumnitrate,gemcitabine,goldsodiumthiosulfate,granisetron,heparin,hetastarch
in lactate electrolyte injection (Hextend), hydralazine, inamrinone, insulin (regular),
isoproterenol, kanamycin, lidocaine, linezolid, lorazepam, magnesium sulfate, melphalan,
meperidine, methylergonovine, minocycline, morphine, neostigmine, nicardipine, norepinephrine,
ondansetron, oxacillin, oxaliplatin, oxytocin, paclitaxel, pancuronium, penicillin G potassium,
pentazocine, phytonadione, piperacillin/tazobactam, procainamide, prochlorperazine edisylate,
propofol, propranolol, pyridostigmine, remifentanil, scopolamine, sodium bicarbonate,
succinylcholine, tacrolimus, telavancin, teniposide, theophylline, thiotepa, trimethobenzamide,
vecuronium,vinorelbine.

Incompatible: Ciprofloxacin, diazepam, idarubicin, midazolam, phenytoin, sargramostim. Variable

(consult detailed reference): Antithymocyte globulin (rabbit), diltiazem, methylprednisolone
sodiumsuccinate,promethazine.

Compatibilityinsyringe:

Compatible: Dimenhydrinate, iohexol, iopamidol, iothalamate meglumine 60%, ioxaglate meglumine

39.3%andioxaglatesodium19.6%,methotrexate.

Incompatible: Doxapram, oxytocin, pantoprazole. Variable (consult detailed reference):

Cytarabine,magnesiumsulfate,thiopental.

Use Primarilyasanantiinflammatoryorimmunosuppressantagentinthetreatmentofavarietyofdiseases
includingthoseofdermatologic,endocrine,GI,hematologic,allergic,inflammatory,neoplastic,neurologic,
ophthalmic,renal,respiratory,andautoimmuneorigin.

Use:OffLabel
InhospitalcardiacarrestSepticshockThyroidstorm

MedicationSafetyIssues

Soundalike/lookalikeissues:
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Hydrocortisonemaybeconfusedwithhydrocodone,hydroxychloroquine,hydrochlorothiazide

CortefmaybeconfusedwithCoreg,Lortab

HCT (occasional abbreviation for hydrocortisone) is an errorprone abbreviation (mistaken as

hydrochlorothiazide)

SoluCORTEFmaybeconfusedwithSoluMEDROL

AdverseReactionsSignificant Frequencynotdefined.
Cardiovascular:Arrhythmias, bradycardia, cardiac arrest, cardiomegaly, circulatory collapse, congestive heart
failure, edema, fat embolism, hypertension, hypertrophic cardiomyopathy (premature infants), myocardial
rupture(postMI),syncope,tachycardia,thromboembolism,vasculitis

Central nervous system: Delirium, depression, emotional instability, euphoria, hallucinations, headache,
insomnia, intracranial pressure increased, malaise, mood swings, nervousness, neuritis, neuropathy,
personalitychanges,pseudotumorcerebri,psychicdisorders,psychoses,seizure,vertigo

Dermatologic:Acne, allergic dermatitis, alopecia, bruising, burning/tingling, dry scaly skin, edema, erythema,
hirsutism, hyper/hypopigmentation, impaired wound healing, petechiae, rash, skin atrophy, skin test
reactionimpaired,sterileabscess,striae,urticaria

Endocrine & metabolic: Adrenal suppression, alkalosis, amenorrhea, carbohydrate intolerance increased,
Cushing's syndrome, diabetes mellitus, glucose intolerance, growth suppression, hyperglycemia,
hyperlipidemia, hypokalemia, hypokalemic alkalosis, menstrual irregularities, negative nitrogen balance,
pituitaryadrenalaxissuppression,potassiumloss,proteincatabolism,sodiumandwaterretention,sperm
motilityincreased/decreased,spermatogenesisincreased/decreased

Gastrointestinal: Abdominal distention, appetite increased, bowel dysfunction (intrathecal administration),

indigestion,nausea,pancreatitis,pepticulcer,gastrointestinalperforation,ulcerativeesophagitis,vomiting,
weightgain

Genitourinary:Bladderdysfunction(intrathecaladministration)

Hematologic:Leukocytosis(transient)

Hepatic:Hepatomegaly,transaminasesincreased

Local:Atrophy(atinjectionsite),postinjectionflare(intraarticularuse),thrombophlebitis

Neuromuscular & skeletal: Arthralgia, necrosis (femoral and humoral heads), Charcotlike arthropathy,
fractures, muscle mass loss, muscle weakness, myopathy, osteoporosis, tendon rupture, vertebral
compressionfractures

Ocular:Cataracts,exophthalmoses,glaucoma,intraocularpressureincreased

Miscellaneous:Abnormalfatdeposits,anaphylaxis,avascularnecrosis,diaphoresis,hiccups,hypersensitivity
reactions,infection,secondarymalignancy

Contraindications Hypersensitivitytohydrocortisoneoranycomponentoftheformulationsystemic
fungalinfectionsseriousinfections,exceptsepticshockortuberculousmeningitisviral,fungal,ortubercular
skinlesionsIMadministrationcontraindicatedinidiopathicthrombocytopeniapurpuraintrathecal
administrationofinjection

Warnings/Precautions
Concernsrelatedtoadverseeffects:

Adrenal suppression: May cause hypercorticism or suppression of hypothalamicpituitaryadrenal (HPA)

axis, particularly in younger children or in patients receiving high doses for prolonged periods. HPA

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axissuppressionmayleadtoadrenalcrisis.Withdrawalanddiscontinuationofacorticosteroidshould
bedoneslowlyandcarefully.Particularcareisrequiredwhenpatientsaretransferredfromsystemic
corticosteroids to inhaled products due to possible adrenal insufficiency or withdrawal from steroids,
includinganincreaseinallergicsymptoms.Adultpatientsreceiving>20mgperdayofprednisone(or
equivalent) may be most susceptible. Fatalities have occurred due to adrenal insufficiency in
asthmaticpatientsduringandaftertransferfromsystemiccorticosteroidstoaerosolsteroidsaerosol
steroids do not provide the systemic steroid needed to treat patients having trauma, surgery, or
infections.

Anaphylactoid reactions: Rare cases of anaphylactoid reactions have been observed in patients
receivingcorticosteroids.

Dermal changes:Avoid injection or leakage into the dermis dermal and/or subdermal skin depression
mayoccuratthesiteofinjection.Avoiddeltoidmuscleinjectionsubcutaneousatrophymayoccur.

Immunosuppression: Prolonged use of corticosteroids may increase the incidence of secondary

infection,maskacuteinfection(includingfungalinfections),prolongorexacerbateviralinfections,or
limitresponsetovaccines.Exposuretochickenpoxshouldbeavoidedcorticosteroidsshouldnotbe
used to treat ocular herpes simplex. Corticosteroids should not be used for cerebral malaria, fungal
infections, or viral hepatitis. Close observation is required in patients with latent tuberculosis and/or
TB reactivity restrict use in active TB (only fulminating or disseminated TB in conjunction with
antituberculosis treatment).Amebiasis should be ruled out in any patient with recent travel to tropic
climatesorunexplaineddiarrheapriortoinitiationofcorticosteroids.

Kaposisarcoma:Prolongedtreatmentwithcorticosteroidshasbeenassociatedwiththedevelopmentof
Kaposisarcoma(casereports)ifnoted,discontinuationoftherapyshouldbeconsidered.

Myopathy:Acute myopathy has been reported with high dose corticosteroids, usually in patients with
neuromuscular transmission disorders may involve ocular and/or respiratory muscles monitor
creatinekinaserecoverymaybedelayed.

Psychiatricdisturbances:Corticosteroidusemaycausepsychiatricdisturbances,includingdepression,
euphoria, insomnia, mood swings, and personality changes. Preexisting psychiatric conditions may
beexacerbatedbycorticosteroiduse.

Diseaserelatedconcerns:

Cardiovascular disease: Use with caution in patients with HF and/or hypertension use has been
associatedwithfluidretention,electrolytedisturbances,andhypertension.

Diabetes: Use with caution in patients with diabetes mellitus may alter glucose production/regulation
leadingtohyperglycemia.

Gastrointestinal disease: Use with caution in patients with GI diseases (diverticulitis, intestinal
anastomoses, peptic ulcer, ulcerative colitis) due to perforation risk. Avoid ethanol may enhance
gastricmucosalirritation.

Head injury: Increased mortality was observed in patients receiving highdose IV methylprednisolone
highdosecorticosteroidsshouldnotbeusedforthemanagementofheadinjury.

Hepaticimpairment:Usewithcautioninpatientswithhepaticimpairment,includingcirrhosislongterm
usehasbeenassociatedwithfluidretention.

Myastheniagravis:Usewithcautioninpatientswithmyastheniagravisexacerbationofsymptomshas
occurredespeciallyduringinitialtreatmentwithcorticosteroids.

Myocardialinfarct(MI):UsewithcautionfollowingacuteMIcorticosteroidshavebeenassociatedwith
myocardialrupture.

Ocular disease: Use with caution in patients with cataracts and/or glaucoma increased intraocular
pressure, openangle glaucoma, and cataracts have occurred with prolonged use. Oral steroid
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treatment is not recommended for the treatment of acute optic neuritis may increase frequency of
newepisodesanddoesnotaffectshortorlongtermvisualoutcomes.Considerroutineeyeexamsin
chronicusers.

Osteoporosis: Use with caution in patients with osteoporosis high doses and/or longterm use of
corticosteroidshavebeenassociatedwithincreasedbonelossandosteoporoticfractures.

Renalimpairment:Usewithcautioninpatientswithrenalimpairmentfluidretentionmayoccur.

Seizure disorders: Use with caution in patients with a history of seizure disorder seizures have been
reportedwithadrenalcrisis.

Thyroiddisease:Changesinthyroidstatusmaynecessitatedosageadjustmentsmetabolicclearanceof
corticosteroidsincreasesinhyperthyroidpatientsanddecreasesinhypothyroidones.

Concurrentdrugtherapyissues:

Drugdrug interactions: Potentially significant interactions may exist, requiring dose or frequency
adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions
databaseformoredetailedinformation.

Specialpopulations:

Elderly: Because of the risk of adverse effects, systemic corticosteroids should be used cautiously in
theelderlyinthesmallestpossibleeffectivedosefortheshortestduration.

Pediatric:Mayaffectgrowthvelocitygrowthshouldberoutinelymonitoredinpediatricpatients.

Dosageformspecificissues:

Benzylalcoholandderivatives:Diluentforinjectionmaycontainbenzylalcoholandsomedosageforms
maycontainsodiumbenzoate/benzoicacidbenzoicacid(benzoate)isametaboliteofbenzylalcohol
largeamountsofbenzylalcohol(99mg/kg/day)havebeenassociatedwithapotentiallyfataltoxicity
(gaspingsyndrome)inneonatesthegaspingsyndromeconsistsofmetabolicacidosis,respiratory
distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage),
hypotension and cardiovascular collapse (AAP ["Inactive" 1997] CDC, 1982) some data suggests
thatbenzoatedisplacesbilirubinfromproteinbindingsites(Ahlfors,2001)avoidorusedosageforms
containing benzyl alcohol and/or benzyl alcohol derivative with caution in neonates. See
manufacturerslabeling.

Otherwarnings/precautions:

Discontinuationoftherapy:Withdrawtherapywithgradualtaperingofdose.

Epiduralinjection:Corticosteroidsarenotapprovedforepiduralinjection.Seriousneurologicevents(eg,
spinal cord infarction, paraplegia, quadriplegia, cortical blindness, stroke), some resulting in death,
havebeenreportedwithepiduralinjectionofcorticosteroids,withandwithoutuseoffluoroscopy.

Stress:Patientsmayrequirehigherdoseswhensubjecttostress(ie,trauma,surgery,severeinfection).

Metabolism/TransportEffects SubstrateofCYP3A4(minor),PglycoproteinNote:Assignmentof
Major/Minorsubstratestatusbasedonclinicallyrelevantdruginteractionpotential

DrugInteractions
(Foradditionalinformation:LaunchLexiInteractDrugInteractionsProgram)

AcetylcholinesteraseInhibitors:Corticosteroids(Systemic)mayenhancetheadverse/toxiceffectof
AcetylcholinesteraseInhibitors.Increasedmuscularweaknessmayoccur.RiskC:Monitortherapy

Aldesleukin:CorticosteroidsmaydiminishtheantineoplasticeffectofAldesleukin.RiskX:Avoidcombination

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AmphotericinB:Corticosteroids(Systemic)mayenhancethehypokalemiceffectofAmphotericinB.RiskC:
Monitortherapy

Androgens:Corticosteroids(Systemic)mayenhancethefluidretainingeffectofAndrogens.RiskC:Monitor
therapy

Antacids:MaydecreasethebioavailabilityofCorticosteroids(Oral).Management:Considerseparatingdoses
by2ormorehours.Budesonideentericcoatedtabletscoulddissolveprematurelyifgivenwithdrugsthat
lowergastricacid,withunknownimpactonbudesonidetherapeuticeffects.RiskD:Considertherapy
modification

AntidiabeticAgents:HyperglycemiaAssociatedAgentsmaydiminishthetherapeuticeffectofAntidiabetic
Agents.RiskC:Monitortherapy

Aprepitant:MayincreasetheserumconcentrationofCorticosteroids(Systemic).Management:Nodose
adjustmentisneededforsingle40mgaprepitantdoses.Forotherregimens,reduceoraldexamethasone
ormethylprednisolonedosesby50%,andIVmethylprednisolonedosesby25%.Antiemeticregimens
containingdexamethasonereflectthisadjustment.RiskD:Considertherapymodification

BCG(Intravesical):ImmunosuppressantsmaydiminishthetherapeuticeffectofBCG(Intravesical).RiskX:
Avoidcombination

BileAcidSequestrants:MaydecreasetheabsorptionofCorticosteroids(Oral).RiskC:Monitortherapy

Calcitriol:Corticosteroids(Systemic)maydiminishthetherapeuticeffectofCalcitriol.RiskC:Monitortherapy

Calcitriol(Systemic):Corticosteroids(Systemic)maydiminishthetherapeuticeffectofCalcitriol(Systemic).
RiskC:Monitortherapy

Ceritinib:CorticosteroidsmayenhancethehyperglycemiceffectofCeritinib.RiskC:Monitortherapy

CoccidioidesimmitisSkinTest:ImmunosuppressantsmaydiminishthediagnosticeffectofCoccidioides
immitisSkinTest.RiskC:Monitortherapy

Corticorelin:CorticosteroidsmaydiminishthetherapeuticeffectofCorticorelin.Specifically,theplasmaACTH
responsetocorticorelinmaybebluntedbyrecentorcurrentcorticosteroidtherapy.RiskC:Monitor
therapy

CYP3A4Inducers(Strong):MaydecreasetheserumconcentrationofHydrocortisone(Systemic).RiskC:
Monitortherapy

CYP3A4Inhibitors(Strong):MayincreasetheserumconcentrationofCorticosteroids(Systemic).RiskC:
Monitortherapy

Deferasirox:Corticosteroids(Systemic)mayenhancetheadverse/toxiceffectofDeferasirox.Specifically,the
riskforGIulceration/irritationorGIbleedingmaybeincreased.RiskC:Monitortherapy

Deferasirox:Corticosteroidsmayenhancetheadverse/toxiceffectofDeferasirox.Specifically,theriskforGI
ulceration/irritationorGIbleedingmaybeincreased.RiskC:Monitortherapy

Denosumab:Mayenhancetheadverse/toxiceffectofImmunosuppressants.Specifically,theriskforserious
infectionsmaybeincreased.RiskC:Monitortherapy

Diltiazem:MayincreasetheserumconcentrationofCorticosteroids(Systemic).RiskC:Monitortherapy

Echinacea:MaydiminishthetherapeuticeffectofImmunosuppressants.RiskD:Considertherapy
modification

EstrogenDerivatives:MayincreasetheserumconcentrationofCorticosteroids(Systemic).RiskC:Monitor
therapy

Fingolimod:ImmunosuppressantsmayenhancetheimmunosuppressiveeffectofFingolimod.Management:
Avoidtheconcomitantuseoffingolimodandotherimmunosuppressantswhenpossible.Ifcombined,
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monitorpatientscloselyforadditiveimmunosuppressanteffects(eg,infections).RiskD:Considertherapy
modification

Fosaprepitant:MayincreasetheserumconcentrationofCorticosteroids(Systemic).Theactivemetabolite
aprepitantislikelyresponsibleforthiseffect.RiskD:Considertherapymodification

Hyaluronidase:CorticosteroidsmaydiminishthetherapeuticeffectofHyaluronidase.Management:Patients
receivingcorticosteroids(particularlyatlargerdoses)maynotexperiencethedesiredclinicalresponseto
standarddosesofhyaluronidase.Largerdosesofhyaluronidasemayberequired.RiskD:Consider
therapymodification

Indacaterol:MayenhancethehypokalemiceffectofCorticosteroids(Systemic).RiskC:Monitortherapy

Indium111CapromabPendetide:Corticosteroids(Systemic)maydiminishthediagnosticeffectofIndium111
CapromabPendetide.RiskX:Avoidcombination

Isoniazid:Corticosteroids(Systemic)maydecreasetheserumconcentrationofIsoniazid.RiskC:Monitor
therapy

Leflunomide:Immunosuppressantsmayenhancetheadverse/toxiceffectofLeflunomide.Specifically,therisk
forhematologictoxicitysuchaspancytopenia,agranulocytosis,and/orthrombocytopeniamaybe
increased.Management:Considernotusingaleflunomideloadingdoseinpatientsreceivingother
immunosuppressants.Patientsreceivingbothleflunomideandanotherimmunosuppressantshouldbe
monitoredforbonemarrowsuppressionatleastmonthly.RiskD:Considertherapymodification

LoopDiuretics:Corticosteroids(Systemic)mayenhancethehypokalemiceffectofLoopDiuretics.RiskC:
Monitortherapy

Lumacaftor:MaydecreasetheserumconcentrationofPglycoprotein/ABCB1Substrates.Lumacaftormay
increasetheserumconcentrationofPglycoprotein/ABCB1Substrates.RiskC:Monitortherapy

Mifepristone:MaydiminishthetherapeuticeffectofCorticosteroids(Systemic).Mifepristonemayincreasethe
serumconcentrationofCorticosteroids(Systemic).Management:Avoidmifepristoneinpatientswho
requirelongtermcorticosteroidtreatmentofseriousillnessesorconditions(e.g.,forimmunosuppression
followingtransplantation).Corticosteroideffectsmaybereducedbymifepristonetreatment.RiskX:Avoid
combination

Mitotane:MaydecreasetheserumconcentrationofCorticosteroids(Systemic).RiskD:Considertherapy
modification

Natalizumab:Immunosuppressantsmayenhancetheadverse/toxiceffectofNatalizumab.Specifically,therisk
ofconcurrentinfectionmaybeincreased.RiskX:Avoidcombination

NeuromuscularBlockingAgents(Nondepolarizing):Mayenhancetheadverseneuromusculareffectof
Corticosteroids(Systemic).Increasedmuscleweakness,possiblyprogressingtopolyneuropathiesand
myopathies,mayoccur.RiskD:Considertherapymodification

Nicorandil:Corticosteroids(Systemic)mayenhancetheadverse/toxiceffectofNicorandil.Gastrointestinal
perforationhasbeenreportedinassociationwiththiscombination.RiskC:Monitortherapy

Nivolumab:ImmunosuppressantsmaydiminishthetherapeuticeffectofNivolumab.RiskD:Considertherapy
modification

NSAID(COX2Inhibitor):Corticosteroids(Systemic)mayenhancetheadverse/toxiceffectofNSAID(COX2
Inhibitor).RiskC:Monitortherapy

NSAID(Nonselective):Corticosteroids(Systemic)mayenhancetheadverse/toxiceffectofNSAID
(Nonselective).RiskC:Monitortherapy

Pglycoprotein/ABCB1Inducers:MaydecreasetheserumconcentrationofPglycoprotein/ABCB1Substrates.
Pglycoproteininducersmayalsofurtherlimitthedistributionofpglycoproteinsubstratestospecific
cells/tissues/organswherepglycoproteinispresentinlargeamounts(e.g.,brain,Tlymphocytes,testes,
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etc.).RiskC:Monitortherapy

Pglycoprotein/ABCB1Inhibitors:MayincreasetheserumconcentrationofPglycoprotein/ABCB1Substrates.
Pglycoproteininhibitorsmayalsoenhancethedistributionofpglycoproteinsubstratestospecific
cells/tissues/organswherepglycoproteinispresentinlargeamounts(e.g.,brain,Tlymphocytes,testes,
etc.).RiskC:Monitortherapy

Pimecrolimus:Mayenhancetheadverse/toxiceffectofImmunosuppressants.RiskX:Avoidcombination

QuinoloneAntibiotics:Corticosteroids(Systemic)mayenhancetheadverse/toxiceffectofQuinolone
Antibiotics.Specifically,theriskoftendonitisandtendonrupturemaybeincreased.RiskC:Monitor
therapy

Ranolazine:MayincreasetheserumconcentrationofPglycoprotein/ABCB1Substrates.RiskC:Monitor
therapy

Roflumilast:MayenhancetheimmunosuppressiveeffectofImmunosuppressants.RiskD:Considertherapy
modification

Salicylates:Mayenhancetheadverse/toxiceffectofCorticosteroids(Systemic).Thesespecificallyinclude
gastrointestinalulcerationandbleeding.Corticosteroids(Systemic)maydecreasetheserumconcentration
ofSalicylates.Withdrawalofcorticosteroidsmayresultinsalicylatetoxicity.RiskC:Monitortherapy

SipuleucelT:ImmunosuppressantsmaydiminishthetherapeuticeffectofSipuleucelT.RiskC:Monitor
therapy

Tacrolimus(Topical):Mayenhancetheadverse/toxiceffectofImmunosuppressants.RiskX:Avoid
combination

Telaprevir:Corticosteroids(Systemic)maydecreasetheserumconcentrationofTelaprevir.Telaprevirmay
increasetheserumconcentrationofCorticosteroids(Systemic).Management:Concurrentuseoftelaprevir
andsystemiccorticosteroidsisnotrecommended.Whenpossible,consideralternatives.Ifusedtogether,
employextracautionandmonitorcloselyforexcessivecorticosteroideffectsanddiminishedtelaprevir
effects.RiskD:Considertherapymodification

ThiazideandThiazideLikeDiuretics:Corticosteroids(Systemic)mayenhancethehypokalemiceffectof
ThiazideandThiazideLikeDiuretics.RiskC:Monitortherapy

Tofacitinib:ImmunosuppressantsmayenhancetheimmunosuppressiveeffectofTofacitinib.Management:
Concurrentusewithantirheumaticdosesofmethotrexateornonbiologicdiseasemodifyingantirheumatic
drugs(DMARDs)ispermitted,andthiswarningseemsparticularlyfocusedonmorepotent
immunosuppressants.RiskX:Avoidcombination

Trastuzumab:MayenhancetheneutropeniceffectofImmunosuppressants.RiskC:Monitortherapy

UreaCycleDisorderAgents:Corticosteroids(Systemic)maydiminishthetherapeuticeffectofUreaCycle
DisorderAgents.Morespecifically,Corticosteroids(Systemic)mayincreaseproteincatabolismand
plasmaammoniaconcentrations,therebyincreasingthedosesofUreaCycleDisorderAgentsneededto
maintaintheseconcentrationsinthetargetrange.RiskC:Monitortherapy

Vaccines(Inactivated):ImmunosuppressantsmaydiminishthetherapeuticeffectofVaccines(Inactivated).
Management:Vaccineefficacymaybereduced.Completeallageappropriatevaccinationsatleast2
weekspriortostartinganimmunosuppressant.Ifvaccinatedduringimmunosuppressanttherapy,
revaccinateatleast3monthsafterimmunosuppressantdiscontinuation.RiskD:Considertherapy
modification

Vaccines(Live):Corticosteroids(Systemic)mayenhancetheadverse/toxiceffectofVaccines(Live).
Corticosteroids(Systemic)maydiminishthetherapeuticeffectofVaccines(Live).Management:Doses
equivalenttolessthan2mg/kgor20mgperdayofprednisoneadministeredforlessthan2weeksarenot
consideredsufficientlyimmunosuppressivetocreatevaccinesafetyconcerns.Higherdosesandlonger
durationsshouldbeavoided.RiskD:Considertherapymodification
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Warfarin:Corticosteroids(Systemic)mayenhancetheanticoagulanteffectofWarfarin.RiskC:Monitor
therapy

PregnancyRiskFactor C(showtable)
PregnancyImplications Adverseeventshavebeenobservedwithcorticosteroidsinanimal
reproductionstudies.Somestudieshaveshownanassociationbetweenfirsttrimestersystemiccorticosteroid
useandoralclefts(ParkWyllie,2000Pradat,2003).Systemiccorticosteroidsmayalsoinfluencefetalgrowth
(decreasedbirthweight)however,informationisconflicting(Lunghi,2010).Hypoadrenalismmayoccurin
newbornsfollowingmaternaluseofcorticosteroidsinpregnancy(monitor).Whensystemiccorticosteroidsare
neededinpregnancy,itisgenerallyrecommendedtousethelowesteffectivedosefortheshortestdurationof
time,avoidinghighdosesduringthefirsttrimester(Leachman,2006Lunghi,2010Makol,2011stensen,
2009).

BreastFeedingConsiderations Corticosteroidsareexcretedinbreastmilk.Themanufacturer
notesthatwhenusedsystemically,maternaluseofcorticosteroidshavethepotentialtocauseadverseevents
inanursinginfant(eg,growthsuppression,interferewithendogenouscorticosteroidproduction).Ifthereis
concernaboutexposuretotheinfant,someguidelinesrecommendwaiting4hoursafterthematernaldoseof
anoralsystemiccorticosteroidbeforebreastfeedinginordertodecreasepotentialexposuretothenursing
infant(basedonastudyusingprednisolone)(Bae,2011Leachman,2006Makol,2011Ost,1985).

DietaryConsiderations Systemicuseofcorticosteroidsmayrequireadietwithincreasedpotassium,
vitaminsA,B6,C,D,folate,calcium,zinc,phosphorus,anddecreasedsodium.Someproductsmaycontain
sodium.

Pricing:US
Solution(reconstituted)(AHydrocortInjection)

100mg(1):$2.40

Solution(reconstituted)(SoluCORTEFInjection)

100mg(1):$10.28

250mg(1):$19.03

500mg(1):$38.06

1000mg(1):$76.12

Tablets(CortefOral)

5mg(50):$40.48

10mg(100):$136.72

20mg(100):$259.14

Tablets(HydrocortisoneOral)

5mg(50):$16.95

10mg(100):$57.30

20mg(100):$108.70

Disclaimer:ThepricingdataprovidearepresentativeAWPand/orAAWPpricefromasinglemanufacturerof
thebrandand/orgenericproduct,respectively.Thepricingdatashouldbeusedforbenchmarkingpurposes
only,andassuchshouldnotbeusedtosetoradjudicateanypricesforreimbursementorpurchasing
functions.Pricingdataisupdatedmonthly.

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20/4/2016 Hydrocortisone(systemic):Druginformation

MonitoringParameters Serumglucose,electrolytesbloodpressure,weight,presenceofinfection
monitorIOPwiththerapy>6weeksbonemineraldensity,growthinchildren

InternationalBrandNames Actocortina(ES)Aftasone(ES)Biocort(PH)Clovisone(PH)
Colifoam(AE,AT,LI,MT)Coripen(UY)CortS(ET,IN,LK)Cortef(HR,HU,LI)Cortifoam(IL)Cortin(PH)
Cortis100(PH)CortisolL.C.H.(CL)Dhartisone100(ID,MY)EfcortelanSoluble(AE,BH,CY,EG,IQ,IR,
JO,KW,LB,LY,OM,QA,SA,SY,YE)Fridalit(AR)Harond(KR)Hidroaltesona(SD)Hidrocort(VE)
Hidrocortif(EC)Hycort(MY,PH)Hycortil(PH)HydroAdresonAquosum(BF,BJ,CI,ET,GH,GM,GN,KE,
LR,MA,ML,MR,MU,MW,NE,NG,SC,SD,SL,SN,TN,TZ,UG,ZM,ZW)Hydrocort(IL)Hydrocortison
(DE)HydrocortisoneUpjohn(FR)Hydrocortone(AT,PT)Hydrosone(QA)Hydrotopic(PH)Hyson(TW)
Hysone(KR)Kortef(UA)Novocortril(PE)Primacor(LK)Primacort(ET)Primacort100(ZW)Radicortin
(AE,BF,BH,BJ,CI,CY,EG,ET,GH,GM,GN,IQ,IR,JO,KE,KW,LB,LR,LY,MA,ML,MR,MU,MW,
NE,NG,OM,QA,SA,SC,SD,SL,SN,SY,TN,TZ,UG,YE,ZM,ZW)Rapison(JP,KR)Samcort(LK)
SoluCortef(AE,BD,BE,BF,BH,BJ,BR,CH,CI,CL,CO,CY,DK,EC,EE,EG,ET,FI,GB,GH,GM,GN,
GR,HK,HN,HR,IE,IQ,IR,IS,IT,JO,KE,KR,KW,LB,LI,LR,LU,LV,LY,MA,ML,MR,MU,MW,MY,
NE,NG,NL,NO,OM,PE,PH,PK,QA,RU,SA,SC,SD,SE,SG,SL,SN,SY,TH,TN,TR,TW,TZ,UG,
YE,ZA,ZM,ZW)SoluCortefM.O.V.(AE,BH,CY,EG,IQ,IR,JO,KW,LB,LY,OM,QA,SA,SY,YE)Solu
Cortef(AU,CN,EC,MT,NZ,VE,VN)SoluTisone(TW)Stericort(PH)Syntesor(PH)Zonac(PY)

MechanismofAction Shortactingcorticosteroidwithminimalsodiumretainingpotentialdecreases
inflammationbysuppressionofmigrationofpolymorphonuclearleukocytesandreversalofincreasedcapillary
permeability

PharmacodynamicsandPharmacokinetics
Onsetofaction:Hydrocortisonesodiumsuccinate(watersoluble):Rapid

Absorption:Rapid

Metabolism:Hepatic

Halflifeelimination:Biologic:8to12hours

Excretion:Urine(primarilyas17hydroxysteroidsand17ketosteroids)

UseofUpToDateissubjecttotheSubscriptionandLicenseAgreement.

REFERENCES

1. AbrahamEandEvansT,CorticosteroidsandSepticShock[editorial],JAMA,2002,288(7):8867.[PubMed12186608]
2. AhlforsCE.Benzylalcohol,kernicterus,andunboundbilirubin.JPediatr.2001139(2):317319.[PubMed11487763]
3. AhmetA,KimH,andSpierS,AdrenalSuppression:APracticalGuidetotheScreeningandManagementofthisUnder
RecognizedComplicationofInhaledCorticosteroidTherapy,AllergyAsthmaClinImmunol,2011,7:13.[PubMed
21867553]
4. AnnaneD,SebilleV,CharpentierC,etal,EffectofTreatmentWithLowDosesofHydrocortisoneandFludrocortisoneon
MortalityinPatientsWithSepticShock,JAMA,2002,288(7):86271.[PubMed12186604]
5. ArltWandAllolioB,AdrenalInsufficiency,Lancet,2003,361(9372):188193.[PubMed12788587]
6. BaeYS,VanVoorheesAS,HsuS,etal,"ReviewofTreatmentOptionsForPsoriasisinPregnantorLactatingWomen:
FromtheMedicalBoardoftheNationalPsoriasisFoundation,"JAmAcadDermatol,2012,67(3):45977.[PubMed
22018758]
7. BeckRW,ClearyPA,AndersonMMJr,etal,ARandomized,ControlledTrialofCorticosteroidsintheTreatmentofAcute
OpticNeuritis.TheOpticNeuritisStudyGroup,NEnglJMed,1992,326(9):5818.[PubMed1734247]
8. BahnRS(Chair),BurchHB,CooperDS,etal,HyperthyroidismandOtherCausesofThyrotoxicosis:Management
GuidelinesoftheAmericanThyroidAssociationandAmericanAssociationofClinicalEndocrinologists,Thyroid,2011,
21(6):593646.[PubMed21510801]
9. BrattonSL,ChestnutRM,GhajarJ,etal,GuidelinesfortheManagementofSevereTraumaticBrainInjury.XV.Steroids,
JNeurotrauma,2007,24(Suppl1):915.[PubMed17511554]
10. BrierleyJ,CarcilloJA,ChoongK,etal,ClinicalPracticeParametersforHemodynamicSupportofPediatricandNeonatal
SepticShock:2007UpdatefromtheAmericanCollegeofCriticalCareMedicine,CritCareMed,2009,37(2):66688.
[PubMed19325359]

http://www.uptodate.com/contents/hydrocortisonesystemicdruginformation?topicKey=DRUG_GEN%2F9144&elapsedTimeMs=0&source=search_res 11/13
20/4/2016 Hydrocortisone(systemic):Druginformation

11. CentersforDiseaseControl(CDC).NeonataldeathsassociatedwithuseofbenzylalcoholUnitedStates.MMWRMorb
MortalWklyRep.198231(22):290291.http://www.cdc.gov/mmwr/preview/mmwrhtml/00001109.htm[PubMed6810084]
12. CooperMSandStewartPM,CorticosteroidInsufficiencyinAcutelyIllPatients,NEnglJMed,2003,348(8):72734.
[PubMed12594318]
13. CoursinDBandWoodKE,CorticosteroidSupplementationforAdrenalInsufficiency,JAMA,2002,287(2):23640.
[PubMed11779267]
14. deJongheB,SharsharT,LefaucheurJP,etal,ParesisAcquiredintheIntensiveCareUnit.AProspectiveMulticenter
Study,JAMA,2002,288(22):285967.[PubMed12472328]
15. DellingerRP,LevyMM,RhodesA,etal,SurvivingSepsisCampaign:InternationalGuidelinesforManagementofSevere
SepsisandSepticShock,2012,CritCareMed,2013,41(2):580637.[PubMed23353941]
16. EdwardsP,ArangoM,BalicaL,etal,FinalResultsofMRCCrash,ARandomizedPlaceboControlledTrialofIntravenous
CorticosteroidinAdultsWithHeadInjuryOutcomesat6Months,Lancet,2005,365(9475):19579.[PubMed15936423]
17. GardnerDG,Chapter24.EndocrineEmergencies,GreenspansBasic&ClinicalEndocrinology,9ed.2011.
18. GoedertJJ,VitaleF,LauriaC,etal,RiskFactorsforClassicalKaposi'sSarcoma,JNatlCancerInst,2002,94(22):1712
8.[PubMed12441327]
19. GuptaPandBhatiaV,CorticosteroidPhysiologyandPrinciplesofTherapy,IndianJPediatr,2008,75(10):103944.
[PubMed19023528]
20. HotchkissRSandKarlIE,ThePathophysiologyandTreatmentofSepsis,NEnglJMed,2003,348(2):13850.[PubMed
12519925]
21. "Inactive"ingredientsinpharmaceuticalproducts:update(subjectreview).AmericanAcademyofPediatrics(AAP)
CommitteeonDrugs.Pediatrics.199799(2):268278.[PubMed9024461]
22. KornbluthAandSacharDB,UlcerativeColitisPracticeGuidelinesinAdults:AmericanCollegeofGastroenterology,
PracticeParametersCommittee,AmJGastroenterol,2010,105(3):50123.[PubMed20068560]
23. LeachmanSAandReedBR,"TheUseofDermatologicDrugsinPregnancyandLactation,"DermatolClin,2006,24(2):167
97,vi.[PubMed16677965]
24. LunghiL,PavanB,BiondiC,etal,"UseofGlucocorticoidsinPregnancy,"CurrPharmDes,2010,16(32):361637.
[PubMed20977425]
25. MaguireAM,AmblerGR,MooreB,etal,ProlongedHypocortisolemiainHydrocortisoneReplacementRegimensin
AdrenocorticotrophicHormoneDeficiency,Pediatrics,2007,120(1):e16471.[PubMed17576782]
26. MakolA,WrightK,andAminS,"RheumatoidArthritisandPregnancy:SafetyConsiderationsinPharmacological
Management,"Drugs,2011,71(15):197387.[PubMed21985166]
27. MarikPE,PastoresSM,AnnaneD,etal,RecommendationsfortheDiagnosisandManagementofCorticosteroid
InsufficiencyinCriticallyIllAdultPatients:ConsensusStatementsFromanInternationalTaskForcebytheAmerican
CollegeofCriticalCareMedicine,CritCareMed,2008,36(6):193749.[PubMed18496365]
28. McGeeSandHirschmannJ,UseofCorticosteroidsinTreatingInfectiousDiseases,ArchInternMed,2008,
168(10):103446.[PubMed18504331]
29. MentzelopoulosSD,MalachiasS,ChamosC,etal.Vasopressin,steroids,andepinephrineandneurologicallyfavorable
survivalafterinhospitalcardiacarrest:arandomizedclinicaltrial.JAMA.2013310(3):270279.[PubMed23860985]
30. MentzelopoulosSD,ZakynthinosSG,TzoufiM,etal.Vasopressin,epinephrine,andcorticosteroidsforinhospitalcardiac
arrest.ArchInternMed.2009169(1):1524.[PubMed19139319]
31. NeumarRW,ShusterM,CallawayCW,etal.Part1:ExecutiveSummary:2015AmericanHeartAssociationGuidelines
UpdateforCardiopulmonaryResuscitationandEmergencyCardiovascularCare.Circulation.2015132(suppl2):S315
S367.[PubMed26472989]
32. stensenMandForgerF,"ManagementofRAMedicationsinPregnantPatients,"NatRevRheumatol,2009,5(7):38290.
[PubMed19506586]
33. OstL,WettrellG,BjorkhemI,etal,"PrednisoloneExcretioninHumanMilk,"JPediatr,1985,106(6):100811.[PubMed
3998938]
34. ParkWyllieL,MazzottaP,PastuszakA,etal,"BirthDefectsAfterMaternalExposuretoCorticosteroids:Prospective
CohortStudyandMetaAnalysisofEpidemiologicalStudies,"Teratology,2000,62(6):38592.[PubMed11091360]
35. PradatP,RobertGnansiaE,DiTannaGL,etal,FirstTrimesterExposuretoCorticosteroidsandOralClefts,Birth
DefectsResAClinMolTeratol,2003,67(12):96870.[PubMed14745915]
36. RobertsI,YatesD,SandercockP,etal,EffectofIntravenousCorticosteroidsonDeathWithin14daysin10,008Adults
WithClinicallySignificantHeadInjury(MRCCRASHtrial):RandomisedPlaceboControlledTrial,Lancet,2004,
364(9442):13218.[PubMed15474134]
37. SalemM,TainshREJr,BrombergJ,etal,PerioperativeGlucocorticoidCoverage.AReassessment42YearsAfter
EmergenceofaProblem,AnnSurg,1994,219(4):41625.[PubMed8161268]
38. SoluCortef(hydrocortisonesodiumsuccinate)[prescribinginformation].NewYork,NY:PfizerIncJuly2014.
39. SpeiserPW,AzzizR,BaskinLS,etal,"CongenitalAdrenalHyperplasiaDuetoSteroid21HydroxylaseDeficiency:An
EndocrineSocietyClinicalPracticeGuideline,"JClinEndocrinolMetab,2010,95(9):413360publishederrratumappears
inJClinEndocrinolMetab,2010,95(11):5137.
http://www.uptodate.com/contents/hydrocortisonesystemicdruginformation?topicKey=DRUG_GEN%2F9144&elapsedTimeMs=0&source=search_res 12/13
20/4/2016 Hydrocortisone(systemic):Druginformation

40. SprungCL,AnnaneD,KehD,etal,HydrocortisoneTherapyforPatientsWithSepticShock,NEnglJMed,2008,
358(2):11124.[PubMed18184957]
41. TechnicalReport:CongenitalAdrenalHyperplasia,AmericanAcademyofPediatrics,SectiononEndocrinologyand
CommitteeonGenetics,Pediatrics,2000,106(6):15118.
42. TheCOIITSSStudyInvestigators,CorticosteroidTreatmentandIntensiveInsulinTherapyforSepticShockinAdults,
JAMA,2010,303(4):34148.[PubMed20103758]
43. WeberCarstensS,DejaM,BerckerS,etal.Impactofbolusapplicationoflowdosehydrocortisoneonglycemiccontrolin
septicshockpatients.IntensiveCareMed.200733(4):730733.[PubMed17325831]

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