Names and pronunciation
Solu-Cortef
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Drug reference
Solu-Cortef
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Func. class.: Corticosteroid
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Chem. class.: Short-acting gluco- corticoid
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Do not confuse: hydrocortisone/HYDROcodone/hydroxy- chlorothiazide Solu-Cortef/Solu-Medrol
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ACTION: Decreases inflammation by suppression of migration of polymorpho- nuclear leukocytes, fibroblasts, reversal of increased capillary permeability, and lysosomal stabilization
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USES: Severe inflammation, adrenal insufficiency, ulcerative colitis, collagen disorders, asthma, COPD, SLE, Stevens- Johnson syndrome, ulcerative colitis, TB H
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Unlabeled uses: Carpal tunnel syn- drome, Churg-Strauss syndrome, endoph thalmitis, mixed connective-tissue disease, multiple myeloma, polyarteritis nodosa, polychondritis, pulmonary edema, tempo- ral arteritis, Wegener’s granulomatosis, septic shock
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CONTRAINDICATIONS: Fungal infection, hypersensitivity Precautions: Pregnancy, breastfeeding, children <2 yr, diabetes mellitus, glau- coma, osteoporosis, seizure disorders, ulcerative colitis, HF, myasthenia gravis, renal disease, esophagitis, peptic ulcer, metastatic carcinoma, psychosis, idio- pathic thrombocytopenia (IM), acute glomerulonephritis, amebiasis, nonasth- matic bronchial disease, AIDS, TB, recent MI (associated with left ventricu- lar rupture), Cushing syndrome, hepatic disease, hypothyroidism, coagulopathy, thromboembolism
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SIDE EFFECTS CNS: Depression, flushing, sweating, psychosis, headache, mood changes, pseudotumor cerebri, euphoria, insomnia, seizures CV: Hypertension, edema EENT: Increased intraocular pressure, blurred vision, cataracts, glaucoma GI: Diarrhea, nausea, abdominal disten- tion, GI hemorrhage, pancreatitis, vomiting HEMA: Thrombophlebitis, thromboembo- lism INTEG: Acne, poor wound healing, ecchymosis, petechiae MISC: Adrenal insufficiency (after stress/ withdrawal), pheochromocytoma MS: Fractures, osteoporosis, weakness
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INTERACTIONS Increase: GI bleeding risk—salicylates, NSAIDs, acetaminophen Increase: side effects—alcohol, ampho- tericin B, digoxin, cycloSPORINE, diuretics Increase: neurologic reactions—live virus vaccines/toxoids Decrease/Increase: anticoagulation— oral anticoagulants Decrease: hydrocortisone action— bosentan, cholestyramine, colestipol, barbiturates, rifampin, phenytoin, the- ophylline, carBAMazepine Decrease: anticoagulant effects, anticon- vulsants, antidiabetics, calcium supple- ments, toxoids, vaccines Drug/Herb Decrease: hydrocortisone levels— ephedra Drug/Lab Test Increase: cholesterol, sodium, blood glucose, uric acid, calcium, glucose Decrease: calcium, potassium, T4, T3, thyroid 131I uptake test, urine 17-OHCS, 17-KS False negative: skin allergy tests
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DOSAGE AND ROUTES Most disorders • Adult: PO 20-240 mg daily in divided doses; IM/IV 100-500 mg (succinate), may repeat q2-6hr • Child: PO 2-8 mg/kg/day (60-240 mg/ m2/day as a single or divided dose; IM/ IV 0.666-4 mg/kg (20-120 mg/m2) q12- 24hr Adrenocortical insufficiency • Child: PO 0.56 mg/kg/day (15-20 mg/m2/day) as a single dose or divided dose; IM/IV 0.186-0.28 mg/kg/day (10- 12 mg/m2/day) in 3 divided doses Shock prevention • Adult: IM/IV (succinate) 50 mg/kg repeated after 4 hr; repeat q24hr as needed Colitis • Adult: PO 20-240 mg (base)/day in 2-4 divided doses; ENEMA 100 mg nightly for 21 days; FOAM 1 applicator- ful 1-2×/day × 2-3 wk • Child: PO 2-8 mg (base)/kg/day or 60-240 mg (base)/m2/day in 3-4 divided doses
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Available forms: Hydrocortisone: enema: 100 mg/60 mL; tabs 5, 10, 20 mg; oral granules in capsule for opening; Acetate: rectal suppository: 25, 30 mg; tabs 5, 10, 20 mg; Succinate: injection 100-, 250-, 500-, 1000-mg vial
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Administer: Daily dose in AM for better results • In one dose in AM to prevent adrenal suppression; avoid SUBCUT administra- tion, may damage tissue • Do not use acetate or susp for IV; salts are not interchangeable PO route • With food or milk for GI symptoms IM route • IM inj deep in large muscle mass; ro- tate sites; avoid deltoid; use 21-G needle IV route • Succinate: IV in mix-o-vial or recon- stitute ≤250 mg/2 mL bacteriostatic wa- ter for inj (50 mg/mL); mix gently; give direct IV over ≥1 min; may be further diluted in 100, 250, 500, or 1000 mL of D5W, D5 0.9%, NaCl 0.9% given over or- dered rate; for doses ≥500 mg give over 10 min Sodium succinate Y-site compatibilities: Acyclovir, acetamin- ophen, alemtuzumab, alfentanil, allopuri- nol, amifostine, amphotericin B cholesteryl, ampicillin, amrinone, amsacrine, atracu- rium, atropine, aztreonam, betamethasone, calcium gluconate, cefepime, cefmetazole, cephalothin, chlordiazePOXIDE, chlor- proMAZINE, cisatracurium, cladribine, cyanocobalamin, cytarabine, dexametha- sone, digoxin, diphenhydrAMINE, DOPa- mine, DOXOrubicin liposome, droperidol, edrophonium, enalaprilat, EPINEPHrine, esmolol, estrogens conjugated, ethacrynate, famotidine, fentaNYL, fentaNYL/droperidol, filgrastim, fludarabine, fluorouracil, foscar- net, furosemide, gallium, granisetron, hep- arin, hydrALAZINE, insulin (regular), iso- proterenol, kanamycin, lidocaine, LORazepam, magnesium sulfate, melpha- lan, menadiol, meperidine, methicillin, methoxamine, methylergonovine, minocy- cline, morphine, neostigmine, norepineph- rine, ondansetron, oxacillin, oxytocin, PACLitaxel, pancuronium, penicillin G potassium, pentazocine, phytonadione, piperacillin/tazobactam, prednisoLONE, procainamide, prochlorperazine, propofol, propranolol, pyridostigmine, remifentanil, scopolamine, sodium bicarbonate, succi- nylcholine, tacrolimus, teniposide, theoph- ylline, thiotepa, trimethaphan, trimethoben- zamide, vecuronium, vinorelbine, zoledronic acid
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Assess: • Potassium, blood glucose, urine glu- cose while patient receiving long-term therapy; hypokalemia and hyperglyce- mia; potassium depletion: paresthesias, fatigue, nausea, vomiting, depression, polyuria, dysrhythmias, weakness • B/P, pulse; notify prescriber of chest pain • I&O ratio; be alert for decreasing uri- nary output, increasing edema; weight daily, notify prescriber of weekly gain >5 lb • Cushingoid symptoms: weight gain, purple striae, bruising skin, weakness, acne, personality changes, hypertension, unusual hair growth • Adrenal insufficiency: nausea, an- orexia, hypotension, weight loss, disori- entation, fatigue, dizziness, weakness • Plasma cortisol levels during long- term therapy (normal level: 138-635 nmol/L SI units when drawn at 8 AM) • Infection: increased temperature, WBC even after withdrawal of medica- tion; product masks infection • Mental status: affect, mood, behav- ioral changes, aggression • GI effects: nausea, vomiting, anorexia or appetite stimulation, diarrhea, consti- pation, abdominal pain, hiccups, gastri- tis, pancreatitis, GI bleeding/perforation with long-term treatment • Beers: avoid in older adults with delir- ium or at high risk for delirium • Pregnancy/breastfeeding: use only if benefits outweigh fetal risk, avoid use in 1st trimester, usually compatible with H breastfeeding
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Evaluate: Therapeutic response: decreased inflam- mation, GI symptoms
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • That emergency ID as corticosteroid user should be carried • To immediately report abdominal pain, black tarry stools because GI bleeding/ perforation can occur; if received by epi- dural route, to report immediately a change in vision, severe headache, seizures, weakness (emergency response needed) • To notify prescriber if therapeutic re- sponse decreases; that dosage adjustment may be needed; about signs of infection • Not to discontinue abruptly because adrenal crisis can result; that product should be tapered • That supplemental calcium/vit D may be needed if patient is receiving long-term therapy • That product can mask infection and cause hypo/hyperglycemia (diabetic) • To avoid OTC, herbals, supplements: salicylates, alcohol in cough products, cold preparations unless directed by prescriber • About adrenal insufficiency: nausea, anorexia, fatigue, dizziness, dyspnea, weakness, joint pain, moon face • To avoid live-virus vaccines if using steroids long term See Appendix B (OTC) (hye-droe-kor′ti-sone) Ala-Cort, Ala-Scalp, Anusol HC, Cetacort, Cortizone-10 Scalpion, Procort, Texacort
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PHARMACOKINETICS Metabolized by liver, excreted in urine (17-OHCS, 17-KS), crosses placenta PO: Peak 1-2 hr, duration 1-1½ days IM/IV: Onset 20 min, peak 4-8 hr, dura- tion 1-1½ days IV: Peak 1-2 hr RECT: Onset 3-5 hr
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• Adult: PO 20-240 mg daily in divided doses; IM/IV 100-500 mg (succinate), may repeat q2-6hr
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• Adult: IM/IV (succinate) 50 mg/kg repeated after 4 hr; repeat q24hr as needed Colitis
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• Adult: PO 20-240 mg (base)/day in 2-4 divided doses; ENEMA 100 mg nightly for 21 days; FOAM 1 applicator- ful 1-2×/day × 2-3 wk
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