BMA Concise Guide to Medicine & Drugs

Hydrocortisone

Brand names Colifoam, Corlan, Dioderm, Efcortelan, Efcortesol, Hydrocortistab, Hydrocortone, Mildison, Solu-Cortef

Used in the following combined preparations Alphaderm, Xyloproct, and many others

QUICK REFERENCE

Drug group Corticosteroid

Overdose danger rating Low

Dependence rating Low

Prescription needed Yes (except for some topical preparations)

Available as generic Yes

GENERAL INFORMATION

Hydrocortisone is chemically identical to the hormone cortisol, produced by the adrenal glands and is therefore prescribed to replace natural hormones in adrenal insufficiency (Addison’s disease).The drug’s main use is in the treatment of a variety of allergic and inflammatory conditions. In topical preparations, it gives prompt relief from inflammation of the skin, eye, and outer ear. It is also used orally or by injection to relieve asthma, inflammatory bowel disease, and many rheumatic and allergic disorders. Injected directly into the joints, the drug relieves pain and stiffness.

Overuse of skin preparations can lead to permanent thinning of the skin. Taken by mouth, long-term treatment with high doses may cause serious side effects.

INFORMATION FOR USERS

Your drug prescription is tailored for you. Do not alter dosage without checking with your doctor.

How taken/used Tablets, lozenges, injection, rectal foam, cream, ointment, eye/ear ointment/drops.

Frequency and timing of doses Varies according to condition and preparation.

Dosage range Varies according to condition and preparation.

Onset of effect Within hours. Full effect may not be felt for several days.

Duration of action Up to 12 hours.

Diet advice Salt intake may need to be restricted when the drug is taken by mouth. It may also be necessary to take potassium supplements.

Storage Keep in original container at room temperature out of the reach of children.

Missed dose Take as soon as you remember. If your next dose is due within 2 hours, take a single dose now and skip the next.

Stopping the drug Do not stop taking the drug without consulting your doctor. A gradual reduction in dosage is required following prolonged treatment with oral hydrocortisone.

Exceeding the dose An occasional unintentional extra dose is unlikely to be a cause for concern. But if you notice any unusual symptoms, or if a large overdose has been taken, notify your doctor.

POSSIBLE ADVERSE EFFECTS

Taken by mouth, hydrocortisone may cause indigestion, weight gain, acne, and fluid retention. Discuss with your doctor if any of these are severe. High doses may cause muscle weakness, mood changes, and menstrual irregularities; consult your doctor if any of these symptoms occur. Long-term use of high doses of hydrocortisone, especially when taken orally, may cause various serious adverse effects (see Prolonged use). These are carefully monitored during treatment.

INTERACTIONS

Barbiturates, anticonvulsants, and rifampicin These drugs reduce the effectiveness of hydrocortisone.

Antidiabetic drugs Hydrocortisone reduces the action of these drugs.

Antihypertensive drugs Hydrocortisone reduces the effects of these drugs.

Vaccines Severe reactions can occur if certain vaccines are given while taking hydrocortisone.

Aspirin and other NSAIDs Increased risk of peptic ulcer and bleeding from the stomach with hydrocortisone.

SPECIAL PRECAUTIONS

Be sure to tell your doctor if:

· You have liver or kidney problems.

· You have had a peptic ulcer.

· You have had a mental illness or epilepsy.

· You have glaucoma.

· You have had tuberculosis.

· You have diabetes or heart problems.

· You are taking other medicines.

Pregnancy No evidence of risk with topical preparations. Oral doses may adversely affect the developing baby. Discuss with your doctor.

Breast-feeding The drug passes into the breast milk and may affect the baby. Discuss with your doctor.

Infants and children Reduced dose necessary.

Over 60 Reduced dose may be necessary.

Driving and hazardous work No special problems.

Alcohol Avoid. Alcohol may increase the risk of peptic ulcer when this drug is taken by mouth.

Surgery and general anaesthetics Notify your doctor; you may need to have hydrocortisone by injection in hospital.

Infection Avoid exposure to chickenpox, shingles, or measles if you are on systemic treatment.

PROLONGED USE

Prolonged high dosage can lead to peptic ulcers, glaucoma, muscle weakness, osteoporosis, and growth retardation in children. People on long-term treatment should carry a steroid treatment card.

Monitoring Periodic checks on blood pressure and blood sugar levels are usually required (oral forms).