Drug Action
Hydrocortisone has equal glucocorticoid and mineralocorticoid activity.
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Drug reference
Hydrocortisone has equal glucocorticoid and mineralocorticoid activity.
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Thyrotoxic crisis (thyroid storm) ▶BY INTRAVENOUS INJECTION ▶Adult: 100 mg every 6 hours, to be administered as sodium succinate Adrenocortical insufficiency resulting from septic shock ▶BY INTRAVENOUS INJECTION ▶Adult: 50 mg every 6 hours, given in combination with fludrocortisone Acute hypersensitivity reactions such as angioedema of the upper respiratory tract and anaphylaxis (adjunct to adrenaline) ▶BY INTRAVENOUS INJECTION ▶Adult: 100–300 mg, to be administered as sodium succinate Corticosteroid replacement, in patients who have taken more than 10 mg prednisolone daily (or equivalent) within 3 months of minor surgery under general anaesthesia ▶BY INTRAVENOUS INJECTION, OR BY INTRAVENOUS INFUSION ▶Adult: Initially 25–50 mg, to be administered at induction of surgery, the patient’s usual oral corticosteroid dose is recommenced after surgery continued → Corticosteroid replacement, in patients who have taken more than 10 mg prednisolone daily (or equivalent) within 3 months of moderate or major surgery ▶INITIALLY BY INTRAVENOUS INJECTION, OR BY INTRAVENOUS INFUSION ▶Adult: Initially 25–50 mg, to be administered at induction of surgery (following usual oral corticosteroid dose on the morning of surgery), followed by (by intravenous injection) 25–50 mg 3 times a day for 24 hours after moderate surgery and Endocrine system for 48–72 hours after major surgery Adrenocortical insufficiency in Addison’s disease or following adrenalectomy ▶BY MOUTH USING IMMEDIATE-RELEASE MEDICINES ▶Adult: 20–30 mg daily in 2 divided doses, the larger dose to be given in the morning and the smaller in the evening, mimicking the normal diurnal rhythm of cortisol secretion, the optimum daily dose is determined on the basis of clinical response Adrenocortical insufficiency ▶BY INTRAMUSCULAR INJECTION, OR BY SLOW INTRAVENOUS INJECTION, OR BY INTRAVENOUS INFUSION ▶Adult: 100–500 mg 3–4 times a day or when required Severe inflammatory bowel disease ▶BY SLOW INTRAVENOUS INJECTION, OR BY INTRAVENOUS INFUSION ▶Adult: 100–500 mg 3–4 times a day or when required Replacement in adrenocortical insufficiency ▶BY MOUTH USING MODIFIED-RELEASE MEDICINES ▶Adult: 20–30 mg once daily, adjusted according to response, dose to be taken in the morning ▶BY MOUTH USING IMMEDIATE-RELEASE MEDICINES ▶Adult: 20–30 mg daily in divided doses, adjusted according to response Ulcerative colitis | Proctitis | Proctosigmoiditis ▶BY RECTUM USING RECTAL FOAM ▶Adult: Initially 1 metered application 1–2 times a day for 2–3 weeks, then reduced to 1 metered application once daily on alternate days, to be inserted into the rectum Acute hypersensitivity reactions | Angioedema ▶BY INTRAMUSCULAR INJECTION, OR BY INTRAVENOUS INJECTION ▶Child 1–5 months: Initially 25 mg 3 times a day, adjusted according to response ▶Child 6 months–5 years: Initially 50 mg 3 times a day, adjusted according to response ▶Child 6–11 years: Initially 100 mg 3 times a day, adjusted according to response ▶Child 12–17 years: Initially 200 mg 3 times a day, adjusted according to response Severe acute asthma | Life-threatening acute asthma ▶BY INTRAVENOUS INJECTION ▶Child 1 month–1 year: 4 mg/kg every 6 hours (max. per dose 100 mg), alternatively 25 mg every 6 hours until conversion to oral prednisolone is possible, dose given, preferably, as sodium succinate ▶Child 2–4 years: 4 mg/kg every 6 hours (max. per dose 100 mg), alternatively 50 mg every 6 hours until conversion to oral prednisolone is possible, dose given, preferably, as sodium succinate ▶Child 5–11 years: 4 mg/kg every 6 hours (max. per dose 100 mg), alternatively 100 mg every 6 hours until conversion to oral prednisolone is possible, dose given, preferably, as sodium succinate ▶Child 12–17 years: 4 mg/kg every 6 hours (max. per dose 100 mg), alternatively 100 mg every 6 hours until conversion to oral prednisolone is possible, dose given, preferably, as sodium succinate ▶Adult: 100 mg every 6 hours until conversion to oral prednisolone is possible, dose given, preferably, as sodium succinate DOSE EQUIVALENCE AND CONVERSION ▶With oral use ▶When switching from immediate-release hydrocortisone tablets to modified release Plenadren ® use same total daily dose. Bioavailability of Plenadren ® lower than immediate release tablets—monitor clinical response.
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▶With rectal use Abdominal or local infection. abscess. bowel perforation. extensive fistulas. intestinal obstruction. recent intestinal anastomoses
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▶With rectal use Systemic absorption may occur
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Scottish Medicines Consortium (SMC) decisions SMC No. 848/12 ▶With oral use in adults The Scottish Medicines Consortium has advised (December 2016) that hydrocortisone modified release (Plenadren ®) is not recommended for use within NHS Scotland for treatment of adrenal insufficiency in adults as there was insufficient evidence submitted. l LESS SUITABLE FOR PRESCRIBING ▶With intravenous use Hydrocortisone as the sodium phosphate is less suitable for prescribing as paraesthesia and pain (particularly in the perineal region) may follow intravenous injection.
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▶With intramuscular use or intravenous use Prescription only medicine restriction does not apply where administration is for saving life in emergency.
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→Appendix 1: corticosteroids
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▶With oral use Dyslipidaemia. myocardial rupture (following recent myocardial infarction). oedema ▶With parenteral use Hiccups. Kaposi’s sarcoma. lipomatosis . myocardial rupture (following recent myocardial infarction)
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▶With intravenous use in children For intravenous administration, dilute with Glucose 5% or Sodium Chloride 0.9%. For intermittent infusion give over 20–30 minutes. ▶With intravenous use in adults For intravenous infusion (SoluCortef ®), give continuously or intermittently or via drip tubing in Glucose 5% or Sodium chloride 0.9%.
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There can be variation in the licensing of different medicines containing the same drug. Forms available from special-order manufacturers include: capsule, oral suspension, oral solution Modified-release tablet CAUTIONARY AND ADVISORY LABELS 10, 22, 25 ▶Plenadren (Shire Pharmaceuticals Ltd) Hydrocortisone 5 mg Plenadren 5mg modified-release tablets | 50 tablet P £242.50 DT = £242.50 Hydrocortisone 20 mg Plenadren 20mg modified-release tablets | 50 tablet P £400.00 DT = £400.00 Soluble tablet ▶Hydrocortisone (Non-proprietary) Hydrocortisone (as Hydrocortisone sodium phosphate) 10 mg Hydrocortisone 10mg soluble tablets sugar-free | 30 tablet P £37.50 DT = £37.50 Tablet CAUTIONARY AND ADVISORY LABELS 10, 21 ▶Hydrocortisone (Non-proprietary) Hydrocortisone 10 mg Hydrocortisone 10mg tablets | 30 tablet P £84.45 DT = £7.52 Hydrocortisone 20 mg Hydrocortisone 20mg tablets | 30 tablet P £147.26 DT = £7.04 ▶Hydventia (OcXia) Hydrocortisone 10 mg Hydventia 10mg tablets | 30 tablet P £10.47 DT = £7.52 Hydrocortisone 20 mg Hydventia 20mg tablets | 30 tablet P £20.94 DT = £7.04 Powder for solution for injection ▶Solu-Cortef (Pfizer Ltd) Hydrocortisone (as Hydrocortisone sodium succinate) 100 mg Solu-Cortef 100mg powder for solution for injection vials | 10 vial P £9.17 DT = £9.17 Suspension for injection ▶Hydrocortistab (Advanz Pharma) Hydrocortisone acetate 25 mg per 1 ml Hydrocortistab 25mg/1ml suspension for injection ampoules | 10 ampoule P £68.72 DT = £68.72 Powder and solvent for solution for injection CAUTIONARY AND ADVISORY LABELS 10 ▶Solu-Cortef (Pfizer Ltd) Hydrocortisone (as Hydrocortisone sodium succinate) 100 mg Solu-Cortef 100mg powder and solvent for solution for injection vials | 1 vial P £1.16 DT = £1.16 Solution for injection CAUTIONARY AND ADVISORY LABELS 10 ▶Hydrocortisone (Non-proprietary) Hydrocortisone (as Hydrocortisone sodium phosphate) 100 mg per 1 ml Hydrocortisone sodium phosphate 100mg/1ml solution for injection ampoules | 5 ampoule P £10.60 DT = £10.60 eiiii F 709
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Patient counselling is advised for hydrocortisone tablets and injections (steroid card).
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100 mg every 6 hours, to be administered as
First-line fragment. Read the complete Indications and Dose section above.
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50 mg every 6 hours, given in combination with
First-line fragment. Read the complete Indications and Dose section above.
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100–300 mg, to be administered as sodium
First-line fragment. Read the complete Indications and Dose section above.
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Initially 25–50 mg, to be administered at
First-line fragment. Read the complete Indications and Dose section above.
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Initially 25–50 mg, to be administered at
First-line fragment. Read the complete Indications and Dose section above.
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20–30 mg daily in 2 divided doses, the larger
First-line fragment. Read the complete Indications and Dose section above.
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100–500 mg 3–4 times a day or when required
First-line fragment. Read the complete Indications and Dose section above.
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100–500 mg 3–4 times a day or when required
First-line fragment. Read the complete Indications and Dose section above.
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20–30 mg once daily, adjusted according to
First-line fragment. Read the complete Indications and Dose section above.
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20–30 mg daily in divided doses, adjusted
First-line fragment. Read the complete Indications and Dose section above.
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Initially 1 metered application 1–2 times a day
First-line fragment. Read the complete Indications and Dose section above.
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Initially 25 mg 3 times a day, adjusted
First-line fragment. Read the complete Indications and Dose section above.
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Initially 50 mg 3 times a day,
First-line fragment. Read the complete Indications and Dose section above.
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Initially 100 mg 3 times a day, adjusted
First-line fragment. Read the complete Indications and Dose section above.
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Initially 200 mg 3 times a day,
First-line fragment. Read the complete Indications and Dose section above.
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4 mg/kg every 6 hours (max. per
First-line fragment. Read the complete Indications and Dose section above.
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4 mg/kg every 6 hours (max. per dose
First-line fragment. Read the complete Indications and Dose section above.
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4 mg/kg every 6 hours (max. per dose
First-line fragment. Read the complete Indications and Dose section above.
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4 mg/kg every 6 hours (max. per dose
First-line fragment. Read the complete Indications and Dose section above.
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100 mg every 6 hours until conversion to oral
First-line fragment. Read the complete Indications and Dose section above.
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