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Sunday, July 27, 2025

Hydrocortisone tablets


Hydrocortisone tablets are an oral form of synthetic cortisol, a glucocorticoid hormone naturally produced by the adrenal cortex. It is used therapeutically for hormone replacement, inflammatory disorders, autoimmune conditions, and in the management of adrenal insufficiency, including Addison’s disease. Hydrocortisone exerts effects on metabolism, inflammation, immune modulation, and water-electrolyte balance through its glucocorticoid activity and minor mineralocorticoid action.

Pharmacological Classification

  • Class: Glucocorticoid (systemic corticosteroid)

  • ATC Code: H02AB09

  • Formulation: Oral tablets (typically 5 mg, 10 mg, 20 mg)

  • Route of Administration: Oral

  • Molecular Formula: C₂₁H₃₀O₅

Mechanism of Action

Hydrocortisone acts by binding to the intracellular glucocorticoid receptors, translocating into the nucleus, and modulating gene expression. It affects:

  • Anti-inflammatory pathways: Inhibits phospholipase A2, prostaglandins, and leukotrienes

  • Immunosuppressive effects: Reduces T-cell proliferation and cytokine release

  • Metabolic effects: Increases gluconeogenesis, causes protein catabolism, and redistributes fat

  • Electrolyte regulation: Minor mineralocorticoid action can increase sodium and water retention, and potassium loss

Therapeutic Indications

Primary Indications

  • Adrenal insufficiency (Addison’s disease)

  • Congenital adrenal hyperplasia (CAH)

  • Secondary or tertiary adrenal insufficiency due to pituitary or hypothalamic dysfunction

  • Acute adrenal crisis (in combination with parenteral therapy)

  • Salt-wasting syndromes (with fludrocortisone)

Secondary Uses (anti-inflammatory or immunosuppressive)

  • Severe allergic reactions (adjunctive)

  • Autoimmune diseases (e.g., lupus, rheumatoid arthritis, vasculitis)

  • Inflammatory bowel disease (e.g., Crohn’s disease, ulcerative colitis)

  • Dermatological disorders (e.g., pemphigus vulgaris)

  • Severe asthma exacerbations

  • Replacement therapy post-adrenalectomy or hypophysectomy

Dosage and Administration

Adrenal Insufficiency (Maintenance Therapy)

  • Typical adult dose: 15–30 mg/day, divided into 2–3 doses

    • E.g.: 10 mg on waking, 5 mg at noon, 5 mg in the afternoon

  • Children: Dose based on body surface area (10–15 mg/m²/day)

Stress Dosing

  • During illness, surgery, or trauma: 2–3 times normal daily dose

  • Must be individualized and medically supervised

Anti-inflammatory/Immunosuppressive Use

  • Higher doses often required (e.g., 20–240 mg/day), tapering over time depending on the condition

Tapering Required

  • Long-term therapy must not be stopped abruptly due to risk of adrenal suppression

Pharmacokinetics

  • Absorption: Rapid and complete oral absorption

  • Onset: Within 1 hour

  • Peak: 1–2 hours post-ingestion

  • Half-life: ~1.5–2 hours (biological effects may last longer)

  • Metabolism: Liver (via CYP3A4)

  • Excretion: Renal, as metabolites

Contraindications

  • Systemic fungal infections

  • Hypersensitivity to hydrocortisone or components of the formulation

  • Live vaccinations during immunosuppressive doses

  • Untreated infections (unless appropriate therapy initiated)

Precautions

  • Long-term use requires monitoring for:

    • Adrenal suppression

    • Osteoporosis

    • Hyperglycemia

    • Hypertension

    • Infections

  • Diabetes mellitus: Risk of worsening glycemic control

  • Psychiatric disturbances: May cause mood swings, depression, or psychosis

  • Peptic ulcer disease: Increases risk of GI bleeding

  • Myopathy: Especially with high doses or concomitant neuromuscular blockers

  • Cataracts and glaucoma: With prolonged use

  • Growth retardation: In pediatric use

  • Vaccination: Avoid live vaccines during immunosuppressive therapy

Adverse Effects

Common

  • Increased appetite, weight gain

  • Mood changes (e.g., irritability, insomnia, anxiety)

  • Gastric irritation, dyspepsia

  • Acne, skin thinning

  • Muscle weakness

  • Hyperglycemia

Long-Term Effects

  • Cushingoid features (moon face, buffalo hump, central obesity)

  • Osteoporosis

  • Hypertension

  • Cataracts, glaucoma

  • Adrenal suppression

  • Increased infection risk

Rare but Serious

  • Peptic ulcer with bleeding

  • Avascular necrosis of the femoral head

  • Psychosis or severe depression

  • Seizures (at very high doses)

  • Allergic reactions (urticaria, angioedema, anaphylaxis)

Drug Interactions

  • CYP3A4 inducers (e.g., rifampicin, phenytoin, carbamazepine): May reduce hydrocortisone levels

  • CYP3A4 inhibitors (e.g., ketoconazole, erythromycin, grapefruit juice): May increase hydrocortisone toxicity

  • NSAIDs: Increased risk of GI bleeding

  • Anticoagulants (e.g., warfarin): May alter INR, monitor closely

  • Antidiabetic agents: Reduced efficacy due to hyperglycemic effect of steroids

  • Vaccines: Reduced immune response; avoid live vaccines

  • Diuretics (esp. thiazides and loop diuretics): Risk of hypokalemia

  • Estrogens: May increase hydrocortisone levels via reduced clearance

Use in Special Populations

Pregnancy

  • Category C (US); generally considered safe under supervision

  • Untreated adrenal insufficiency poses greater risk to fetus than hydrocortisone use

Breastfeeding

  • Excreted in small amounts in breast milk

  • Generally safe at physiological replacement doses

Pediatrics

  • Requires growth monitoring

  • Risk of growth suppression if supraphysiological doses used long-term

Elderly

  • Higher risk of hypertension, osteoporosis, diabetes

  • Use with caution; consider bone protection

Patient Counseling

  • Take tablets with food to minimize gastric upset

  • Never stop abruptly if on long-term therapy – tapering required

  • Wear a MedicAlert bracelet or carry steroid treatment card

  • Know stress dose protocol in case of illness or surgery

  • Monitor for signs of adrenal crisis: fatigue, hypotension, nausea

  • Regular bone density monitoring and blood pressure checks

  • Inform all healthcare providers (especially surgeons, dentists) of steroid use

Signs of Overdose or Adrenal Crisis

Overdose Symptoms (chronic)

  • Hypertension

  • Hyperglycemia

  • Psychosis

  • Cushingoid appearance

  • Myopathy

  • Edema

Adrenal Crisis (Under-dose or sudden withdrawal)

  • Hypotension

  • Vomiting

  • Dehydration

  • Hypoglycemia

  • Shock (medical emergency)

Available Brands

  • Hydrocortisone (Generic)

  • Cortef® (Pfizer)

  • Hydrocortone®

  • Florinef® (if combined with fludrocortisone)




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