Drug information of Hydrocortisone

Hydrocortisone

Drug group:

For the relief of the inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses. Also used to treat endocrine (hormonal) disorders (adrenal insufficiency, Addisons disease). It is also used to treat many immune and allergic disorders, such as arthritis, lupus, severe psoriasis, severe asthma, ulcerative colitis, and Crohn's disease.

Mechanism of effect

Hydrocortisone binds to the cytosolic glucocorticoid receptor. After binding the receptor the newly formed receptor-ligand complex translocates itself into the cell nucleus, where it binds to many glucocorticoid response elements (GRE) in the promoter region of the target genes. The DNA bound receptor then interacts with basic transcription factors, causing the increase in expression of specific target genes. The anti-inflammatory actions of corticosteroids are thought to involve lipocortins, phospholipase A2 inhibitory proteins Additionally the immune system is suppressed by corticosteroids due to a decrease in the function of the lymphatic system

Pharmacodynamic

Hydrocortisone is the most important human glucocorticoid. It is essential for life and regulates or supports a variety of important cardiovascular, metabolic, immunologic and homeostatic functions. Topical hydrocortisone is used for its anti-inflammatory or immunosuppressive properties to treat inflammation due to corticosteroid-responsive dermatoses.

Pharmacokinetics

Topical corticosteroids can be absorbed from normal intact skin. Protein binding:95%. Metabolism:Primarily hepatic via CYP3A4. Corticosteroids are metabolized primarily in the liver and are then excreted by the kidneys. Some of the topical corticosteroids and their metabolites are also excreted into the bile. Half life:6-8 hours.

Dosage

Usual Adult Dose for Adrenocortical Insufficiency Acute Adrenal Gland Failure: 100 mg IV bolus, then 300 mg/day in divided doses every 8 hours or as a continuous infusion for 48 hours. When patient stable, change to oral, 50 mg every 8 hours for 6 doses, then taper to 30 - 50 mg/day. Usual Adult Dose for Anti-inflammatory Oral, Intramuscular or Intravenous: 15 to 240 mg/day. Usual Adult Dose for Shock 200 mg per day by continuous intravenous infusion. Usual Pediatric Dose for Adrenocortical Insufficiency Acute Adrenal Gland Failure: Infants and young children: 1 to 2 mg/kg/dose intravenous bolus, then 25 to 100 mg/day in divided doses every 6 to 8 hours. Older children: 100 mg intravenous bolus, then 300 mg/day in divided doses every 8 hours or as a continuous infusion for 48 hours; once patient is stable change to 50 mg orally every 8 hours for 6 doses, then taper to 30 to 50 mg per day in divided doses. Usual Pediatric Dose for Anti-inflammatory Infants and children: Oral: 2.5 to 10 mg/kg/day divided every 6 to 8 hours. Intramuscular or intravenous: 1 to 5 mg/kg/day divided every 12 to 24 hours. Adolescents: Oral, intramuscular or intravenous: 15 to 240 mg every 12 hours.

Alerts

1-Systemic absorption of topical corticosteroids has produced reversible hypothalamic-pituitary-adrenal (HPA) axis suppression, manifestations of Cushing's syndrome, hyperglycemia, and glucosuria in some patients 2-If irritation develops, topical corticosteroids should be discontinued and appropriate therapy instituted.

Points of recommendation

1-Take with food to reduce irritation. Calcium, phosphorous, potassium, Vitamin A, C, D and zinc needs increased with long term use. 2-The urinary free cortisol test and the ACTH stimulation test may be helpful in evaluating the HPA axis suppression.

Pregnancy level

C


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