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Sunday, July 27, 2025

Hydrocortisone buccal tablets


Hydrocortisone buccal tablets (also known as hydrocortisone mucoadhesive tablets) are a specialized formulation of topical corticosteroid therapy used specifically for oral inflammatory conditions, most commonly oral lichen planus and recurrent aphthous stomatitis (mouth ulcers). These tablets are formulated to dissolve slowly in the mouth, delivering anti-inflammatory medication locally at the site of inflammation, without significant systemic absorption.

Pharmacological Classification

  • Drug Class: Glucocorticoid (topical corticosteroid for oral mucosa)

  • Active Ingredient: Hydrocortisone hemisuccinate

  • Available Strengths: 2.5 mg buccal tablets

  • Formulation Type: Mucoadhesive, meaning it sticks to the mucosa and dissolves gradually

  • Route of Administration: Buccal (oral cavity mucosa; not swallowed or chewed)

  • Brand Example: Corlan®, Oracortin® (in some regions)

Mechanism of Action

Hydrocortisone exerts anti-inflammatory, immunosuppressive, and anti-pruritic effects. When administered in buccal tablet form:

  • It acts locally on oral mucosa to suppress cytokine release, immune cell activation, and inflammatory enzyme production (such as prostaglandins and leukotrienes)

  • Reduces pain, swelling, redness, and ulceration in inflamed oral lesions

  • Minimizes systemic side effects due to low systemic absorption

The mucoadhesive formulation ensures prolonged local contact, enhancing efficacy without needing systemic corticosteroid exposure.

Indications

Licensed or Common Uses

  • Oral lichen planus (autoimmune mucosal condition)

  • Recurrent aphthous stomatitis (canker sores, mouth ulcers)

  • Traumatic ulceration (e.g., from dentures or braces)

  • Erythema multiforme of oral mucosa (adjunctive use)

  • Desquamative gingivitis

  • Pemphigus vulgaris or mucous membrane pemphigoid (localized lesions)

Off-label or less common use

  • Behçet’s disease (oral ulcers)

  • Radiation-induced oral mucositis (experimental use)

  • Graft-versus-host disease (oral manifestation)

Dosage and Administration

  • Usual Dose: One 2.5 mg buccal tablet applied 2–4 times daily

  • Timing: Ideally after meals and before bedtime

  • The tablet should be placed on a non-movable area in the mouth—commonly the upper gum, cheek, or roof of the mouth

  • Do not chew, suck, or swallow the tablet

  • Allow it to dissolve slowly over 1–2 hours

  • Avoid eating or drinking for at least 30 minutes after application

  • Treatment typically continues for 5–10 days, depending on the lesion and response

  • Always wash hands before and after handling the tablet

Contraindications

  • Known hypersensitivity to hydrocortisone or any excipients in the formulation

  • Presence of oral fungal infection (e.g., candidiasis/thrush) unless antifungal is also prescribed

  • Untreated oral bacterial or viral infections (e.g., herpes simplex)

  • Caution in immunocompromised patients, as corticosteroids may exacerbate infections

Precautions and Warnings

  • Avoid swallowing the tablet to maintain high local concentration and prevent systemic effects

  • Do not apply to open wounds, bleeding gums, or broken oral mucosa

  • If symptoms persist longer than 7 days, seek medical reassessment

  • Long-term or frequent use can increase risk of oral candidiasis

  • Instruct patients to monitor for white patches, burning, or persistent irritation (signs of thrush)

  • For diabetic patients, monitor for any blood glucose fluctuation (rare but possible)

  • Although systemic absorption is minimal, caution in patients with adrenal suppression or chronic steroid use

Side Effects

Local Side Effects

  • Oral candidiasis (thrush) – most common with prolonged or repeated use

  • Mucosal thinning or atrophy with long-term use

  • Delayed healing of ulcers

  • Taste disturbance or bitter taste

  • Mild burning or irritation at the application site

Systemic Effects (rare)

  • Adrenal suppression (if swallowed or used excessively over long periods)

  • Cushingoid features (very rare; likely only in chronic or inappropriate use)

  • Hyperglycemia, hypertension, or mood changes (extremely rare)

Drug Interactions

Due to minimal systemic absorption, drug interactions are unlikely, but:

  • Concomitant antifungals (e.g., miconazole oral gel) may be prescribed prophylactically

  • Do not use at the same time as strong antiseptics or mouthwashes (e.g., chlorhexidine) as they may interfere with tablet adhesion or efficacy

  • If systemic corticosteroids are being used simultaneously, adrenal function should be monitored (e.g., ACTH suppression risk)

Use in Special Populations

Children

  • Use under strict medical supervision

  • Buccal tablets may not adhere well in younger children

  • Risk of swallowing the tablet—alternate formulations (e.g., mouth rinses) may be preferred

Pregnant Women

  • Category C – no definitive studies, but short-term, local use is unlikely to pose fetal risk

  • Use only if clearly needed and prescribed

Breastfeeding

  • Likely safe, especially with localized application and minimal systemic absorption

  • Avoid application near time of breastfeeding

  • Rinse mouth before nursing if hydrocortisone was recently applied orally

Storage Instructions

  • Store below 25°C

  • Keep away from moisture

  • Keep tablets in original sealed container

  • Do not refrigerate or freeze

  • Keep out of reach of children

Patient Instructions

  • Apply the tablet exactly as directed

  • Do not chew, swallow, or move it once placed

  • Expect slow dissolving (up to 2 hours) – this is normal

  • Avoid eating or drinking for at least 30 minutes post-application

  • If multiple lesions are present, place tablet near the most symptomatic area

  • If a dose is missed, skip and resume with the next scheduled application

Alternatives and Adjuncts

  • Topical corticosteroid pastes: e.g., triamcinolone dental paste

  • Corticosteroid mouthwashes (e.g., dexamethasone elixir)

  • Topical calcineurin inhibitors (e.g., tacrolimus 0.03% ointment – off-label)

  • Antiseptic rinses (chlorhexidine)

  • Systemic corticosteroids for severe or widespread lesions

  • Antifungals (if candidiasis is suspected or recurrent)

Brand Names and Availability

  • Corlan® 2.5 mg buccal tablets (UK)

  • Oracortin® (Europe – discontinued in some markets)

  • Generic hydrocortisone mucoadhesive tablets (limited availability globally)

  • Not always available in all countries – some prescribers may use compounded alternatives

Clinical Monitoring

  • Reevaluate if:

    • Lesions persist beyond 10–14 days

    • Oral candidiasis develops

    • Recurrent ulcers occur (evaluate for systemic causes)

  • Consider biopsy if diagnosis is uncertain (especially in oral lichen planus with atypical features)



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