hydrocortisone sodium succinate: IV, IM injection: Solu-Cortef

Drug classes: Corticosteroid, short acting Glucocorticoid, Adrenal cortical steroid, Hormonal agent
Therapeutic actions:
Enters target cells and binds to cytoplasmic receptors; initiates many complex reactions that are
responsible for its anti-inflammatory, immunosuppressive (glucocorticoid), and salt-retaining
(mineralocorticoid) actions. Some actions may be undesirable, depending on drug use.
Indications
• Replacement therapy in adrenal cortical insufficiency
• Allergic states—severe or incapacitating allergic conditions
• Hypercalcemia associated with cancer
• Short-term inflammatory and allergic disorders, such as rheumatoid arthritis, collagen diseases (SLE),
dermatologic diseases (pemphigus), status asthmaticus, and autoimmune disorders
• Hematologic disorders—thrombocytopenic purpura, erythroblastopenia
• Trichinosis with neurologic or myocardial involvement
• Ulcerative colitis, acute exacerbations of multiple sclerosis, and palliation in some leukemias and
lymphomas
• Intra-articular or soft-tissue administration: Arthritis, psoriatic plaques
• Retention enema: For ulcerative colitis, proctitis
• Dermatologic preparations: To relieve inflammatory and pruritic manifestations of dermatoses that are
steroid responsive
• Anorectal cream, suppositories: To relieve discomfort of hemorrhoids and perianal itching or irritation
Contraindications and cautions
Systemic administration
• Contraindicated with fungal infections, amebiasis, hepatitis B, vaccinia, or varicella, and antibiotic-resistant infections.

• Use cautiously with kidney disease (risk to edema); liver disease, cirrhosis, hypothyroidism; ulcerative colitis with impending
perforation; diverticulitis; recent GI surgery; active or latent peptic ulcer; inflammatory bowel disease (risks exacerbations or bowel
perforation); hypertension, CHF; thromboembolitic tendencies, thrombophlebitis, osteoporosis, seizure disorders, metastatic carcinoma,
diabetes mellitus; TB; lactation.
Retention enemas, intrarectal foam
• Contraindicated with systemic fungal infections, recent intestinal surgery, extensive fistulas.

• Use cautiously with pregnancy.

Topical dermatologic administration
• Contraindicated with fungal, tubercular, herpes simplex skin infections; vaccinia, varicella; ear application when eardrum is
perforated.

• Use cautiously with pregnancy, lactation.

Available forms: Tablets—5, 10, 20 mg; oral suspension—10 mg/5 mL, 25, 50 mg/mL; injection—50 mg/mL, 100, 250, 500, 1,000 mg/vial; topical lotion
—1%, 2%, 2.5%; topical liquid—1%; topical oil—1%; topical solution—1%; topical spray—1%; cream—0.5%

Dosages: ADULTS
Individualize dosage, based on severity and response. Give daily dose before 9 AM to minimize adrenal suppression. If
long-term therapy is needed, alternate-day therapy should be considered. After long-term therapy, withdraw drug slowly to
avoid adrenal insufficiency. For maintenance therapy, reduce initial dose in small increments at intervals until lowest
clinically satisfactory dose is reached.
IM, IV (hydrocortisone sodium succinate) :100–500 mg initially and q 2–10 hr, based on condition and response.
• Acute adrenal insufficiency (hydrocortisone sodium phosphate): 100 mg IV followed by 100 mg q 8 hr
 in IV fluids.
Adverse effects
Systemic
• CNS: Vertigo, headache, paresthesias, insomnia, convulsions, psychosis
• CV: Hypotension, shock, hypertension and CHF secondary to fluid retention, thromboembolism,
thrombophlebitis, fat embolism, cardiac arrhythmias secondary to electrolyte disturbances
• Dermatologic: Thin, fragile skin; petechiae; ecchymoses; purpura; striae; subcutaneous fat atrophy
• EENT: Cataracts, glaucoma (long-term therapy), increased IOP
• Endocrine: Amenorrhea, irregular menses, growth retardation, decreased carbohydrate tolerance and
diabetes mellitus, cushingoid state (long-term therapy), hypothalamic-pituitary-adrenal (HPA) suppression
systemic with therapy longer than 5 days
• GI: Peptic or esophageal ulcer, pancreatitis, abdominal distention, nausea, vomiting, increased appetite
and weight gain (long-term therapy)
• Hematologic: Na+ and fluid retention, hypokalemia, hypocalcemia, increased blood sugar, increased
serum cholesterol, decreased serum T1 and T4 levels

• Hypersensitivity: Anaphylactoid or hypersensitivity reactions

• Musculoskeletal: Muscle weakness, steroid myopathy and loss of muscle mass, osteoporosis,
spontaneous fractures (long-term therapy)
• Other: Immunosuppression, aggravation or masking of infections, impaired wound healing
Nursing considerations
Assessment
• History: Infections; kidney disease; liver disease, hypothyroidism; ulcerative colitis with impending
perforation; diverticulitis; recent GI surgery; active or latent peptic ulcer; inflammatory bowel disease;
hypertension, CHF; thromboembolitic tendencies, thrombophlebitis, osteoporosis, seizure disorders, metastatic
carcinoma, diabetes mellitus; lactation. Retention enemas, intrarectal foam: Systemic fungal infections; recent
intestinal surgery, extensive fistulas. Topical dermatologic administration: Fungal, tubercular, herpes simplex skin
infections; vaccinia, varicella; ear application when eardrum is perforated
• Physical: Systemic administration: Weight, T; reflexes, affect, bilateral grip strength, ophthalmologic
exam; BP, P, auscultation, peripheral perfusion, discoloration, pain or prominence of superficial vessels; R,
adventitious sounds, chest x-ray; upper GI x-ray (history or symptoms of peptic ulcer), liver palpation; CBC, serum
electrolytes, 2-hr postprandial blood glucose, urinalysis, thyroid function tests, serum cholesterol. Topical,
dermatologic preparations: Affected area, integrity of skin