Hydrocortisone 5mg Tablets
It is used for many health problems like allergy signs, asthma, adrenal gland problems, blood problems, skin rashes, or swelling problems. This is not a list of all health problems that this drug may be used for. Talk with the doctor.
Drug Class
Adrenal Corticosteroid
Pharmacologic Class
Glucocorticoid
Pregnancy Category
Category C
FDA Approved
Jan 1970
DEA Schedule
Not Controlled
Overview
What is this medicine?
Hydrocortisone is a type of steroid medicine that is very similar to a natural hormone your body makes. It's used to replace this hormone if your body doesn't make enough (like in adrenal insufficiency), or to reduce inflammation and suppress the immune system in conditions like allergies, arthritis, or skin problems.
How to Use This Medicine
Taking Your Medication
To use this medication correctly, follow your doctor's instructions and read all the information provided. Take the tablet with food as directed. Continue taking the medication as prescribed by your doctor or healthcare provider, even if you start to feel better.
Storing and Disposing of Your Medication
Store the medication at room temperature in a dry place, avoiding the bathroom. Keep all medications in a safe location, out of the reach of children and pets. Dispose of unused or expired medications properly. Do not flush them down the toilet or pour them down the drain unless instructed to do so. If you have questions about disposing of your medication, consult your pharmacist. You may also want to check if there are drug take-back programs available in your area.
Missing a Dose
If you miss a dose, take it as soon as you remember. However, if it's close to the time for your next scheduled dose, skip the missed dose and resume your regular dosing schedule. Do not take two doses at the same time or take extra doses to make up for the missed one.
To use this medication correctly, follow your doctor's instructions and read all the information provided. Take the tablet with food as directed. Continue taking the medication as prescribed by your doctor or healthcare provider, even if you start to feel better.
Storing and Disposing of Your Medication
Store the medication at room temperature in a dry place, avoiding the bathroom. Keep all medications in a safe location, out of the reach of children and pets. Dispose of unused or expired medications properly. Do not flush them down the toilet or pour them down the drain unless instructed to do so. If you have questions about disposing of your medication, consult your pharmacist. You may also want to check if there are drug take-back programs available in your area.
Missing a Dose
If you miss a dose, take it as soon as you remember. However, if it's close to the time for your next scheduled dose, skip the missed dose and resume your regular dosing schedule. Do not take two doses at the same time or take extra doses to make up for the missed one.
Lifestyle & Tips
- Take your medicine exactly as prescribed, usually with food or milk to prevent stomach upset.
- Do not stop taking this medication suddenly, especially if you've been on it for a long time or at high doses. Your body needs time to adjust, and stopping abruptly can lead to serious withdrawal symptoms (adrenal crisis).
- Carry a medical alert card or wear a bracelet stating you are taking hydrocortisone, especially if you have adrenal insufficiency.
- During times of stress (e.g., illness, surgery, injury, fever), your doctor may advise you to take a higher 'stress dose' of hydrocortisone. Discuss this plan with your doctor.
- Avoid close contact with people who are sick or have infections, as this medication can weaken your immune system.
- Limit sodium intake to help prevent fluid retention and high blood pressure.
- Ensure adequate calcium and vitamin D intake to help protect bone health, especially with long-term use.
Available Forms & Alternatives
Available Strengths:
- Hydrocortisone 1% Ointment 28.35gm
- Hydrocortisone 2.5% Cream 30gm
- Hydrocortisone 1% Cream 28.35gm
- Hydrocortisone 2.5% Oint 28.35gm
- Hydrocortisone Val 0.2% Cream 15gm
- Hydrocortisone Val 0.2% Cream 45gm
- Hydrocortisone Val 0.2% Cream 60gm
- Hydrocortisone Val 0.2% Oint 15gm
- Hydrocortisone Val 0.2% Ont 45gm
- Hydrocortisone Val 0.2% Ont 60gm
- Hydrocortisone 2.5% Oint 453.6gm
- Hydrocortisone 1% Ointment 453.6gm
- Hydrocortisone 2.5% Ointment 20gm
- Hydrocortisone 2.5% Cream
- Hydrocortisone AC 25mg Rectal Supp
- Hydrocortisone 1% Cream
- Hydrocort Butyrate 0.1% Soln 60ml
- Hydrocortisone Ace 30mg Suppository
- Hydrocortisone Val 0.2% Cream 45gm
- Hydrocortisone But 0.1% Oint 15gm
- Hydrocortisone But 0.1% Oint 45gm
- Hydrocortisone Val 0.2% Cream 60gm
- Hydrocortisone Val 0.2% Cream 15gm
- Hydrocortisone But 0.1% Cream 15gm
- Hydrocortisone But 0.1% Cream 45gm
- Hydrocortisone 2.5% Ointment 454gm
- Hydrocortisone 2.5% Cream 20gm
- Hydrocort Butyrate 0.1% Soln 20ml
- Hydrocortisone 2.5% Lotion 59ml
- Hydrocortisone 2.5% Lotion 118ml
- Hydrocortisone 2.5% Cream 28.35gm
- Hydrocortisone 100mg Enema 7 X 60ml
- Hydrocortisone 10mg Tablets
- Hydrocortisone 20mg Tablets
- Hydrocortisone 5mg Tablets
- Hydrocortisone Butyr 0.1% Crm 60gm
- Hydrocortisone Butyr 0.1% Crm 45gm
- Hydrocortisone 1% Cream 454gm
- Hydrocortisone 1% Ointment 28gm
- Hydrocortisone 0.5% W/aloe Cream
- Hydrocortisone 2.5% Rectal Cream
- Hydrocortisone 1% Cream 14.2gm
- Hydrocortisone 1% Rectal Crm 28.4gm
- Hydrocortisone 1%/iodoquinol 1% Crm
- Hydrocortisone 1% Cream 28gm
- Hydrocortisone 10mg Tablets
- Hydrocortisone 20mg Tablets
- Hydrocortisone 5mg Tablets
- Hydrocortisone Val 0.2% Oint 45gm
- Hydrocortisone Val 0.2% Oint 60gm
- Hydrocortisone 1% Cream 28.4gm
- Hydrocortisone 1% Cream 454gm
- Hydrocortisone 2.5% Cream 454gm
- Hydrocortisone 100mg Enema 60ml
- Hydrocortisone But 0.1% Lotion 59ml
- Hydrocortisone 1% W/aloe Cream 28gm
- Hydrocortisone 1% Plus Cream 28.4gm
Dosing & Administration
Adult Dosing
Standard Dose:
For adrenal insufficiency: 20-30 mg daily, usually given in divided doses (e.g., 10-20 mg in the morning, 5-10 mg in the afternoon). 5mg is often part of a replacement regimen.
Dose Range:
5 - 30 mg
Condition-Specific Dosing:
adrenalInsufficiency:
20-30 mg daily in divided doses (e.g., 10-20 mg AM, 5-10 mg PM)
antiInflammatory:
20-240 mg daily depending on severity and condition, often higher than 5mg for initial treatment
Pediatric Dosing
Neonatal:
Not established for routine use; specific dosing for congenital adrenal hyperplasia or other conditions.
Infant:
Adrenal insufficiency: 0.5-0.75 mg/kg/day or 20-25 mg/m2/day orally in 3 divided doses.
Child:
Adrenal insufficiency: 0.5-0.75 mg/kg/day or 20-25 mg/m2/day orally in 3 divided doses.
Adolescent:
Adrenal insufficiency: 0.5-0.75 mg/kg/day or 20-25 mg/m2/day orally in 3 divided doses, or adult dosing if weight/surface area appropriate.
Dose Adjustments
Renal Impairment:
Mild:
No adjustment needed
Moderate:
No adjustment needed
Severe:
No adjustment needed
Dialysis:
No supplemental dose needed post-dialysis
Hepatic Impairment:
Mild:
No specific adjustment needed
Moderate:
Consider dose reduction in severe impairment due to decreased metabolism
Severe:
Consider dose reduction in severe impairment due to decreased metabolism
Pharmacology
Mechanism of Action
Hydrocortisone is a naturally occurring glucocorticoid. It binds to specific intracellular glucocorticoid receptors, forming a complex that translocates to the nucleus. This complex then binds to glucocorticoid response elements (GREs) in the DNA, modulating the transcription of specific genes. This leads to diverse physiological effects, including anti-inflammatory, immunosuppressive, and metabolic actions. It inhibits the synthesis of inflammatory mediators (e.g., prostaglandins, leukotrienes), suppresses immune cell function, and affects carbohydrate, protein, and fat metabolism.
Pharmacokinetics
Absorption:
Bioavailability:
Approximately 90%
Tmax:
1-2 hours
FoodEffect:
Food may slightly delay absorption but does not significantly affect the extent of absorption.
Distribution:
Vd:
0.5-1.5 L/kg
ProteinBinding:
Approximately 90% (primarily to corticosteroid-binding globulin and albumin)
CnssPenetration:
Limited, but can affect mood and cognition
Elimination:
HalfLife:
1.5-2 hours (plasma half-life); biological half-life is 8-12 hours
Clearance:
Not available (highly variable)
ExcretionRoute:
Primarily renal (as inactive metabolites)
Unchanged:
<1%
Pharmacodynamics
OnsetOfAction:
Hours (due to genomic effects)
PeakEffect:
Variable, depends on indication and dose
DurationOfAction:
8-12 hours (physiological effects)
Safety & Warnings
Side Effects
Urgent Side Effects: Seek Medical Help Right Away
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you experience any of the following symptoms, contact your doctor or seek medical attention immediately:
Signs of an allergic reaction: rash, hives, itching, red, swollen, blistered, or peeling skin (with or without fever), wheezing, tightness in the chest or throat, trouble breathing, swallowing, or talking, unusual hoarseness, or swelling of the mouth, face, lips, tongue, or throat
Signs of infection: fever, chills, severe sore throat, ear or sinus pain, cough, increased sputum production or change in sputum color, painful urination, mouth sores, or a wound that won't heal
Signs of high blood sugar: confusion, drowsiness, excessive thirst or hunger, frequent urination, flushing, rapid breathing, or fruity-smelling breath
Signs of low potassium levels: muscle pain or weakness, muscle cramps, or an irregular heartbeat
Signs of pancreatitis (pancreas problem): severe stomach pain, severe back pain, or severe nausea and vomiting
Signs of high blood pressure: severe headache or dizziness, fainting, or changes in vision
Signs of Cushing's syndrome: weight gain in the upper back or abdomen, moon face, severe headache, or slow wound healing
Signs of adrenal gland weakness: severe nausea and vomiting, severe dizziness or fainting, muscle weakness, fatigue, mood changes, decreased appetite, or weight loss
Shortness of breath, significant weight gain, or swelling in the arms or legs
Skin changes: acne, stretch marks, slow healing, or excessive hair growth
Purple, red, blue, brown, or black bumps or patches on the skin or in the mouth
Bone or joint pain
Changes in menstrual period
Chest pain or pressure
Changes in vision, eye pain, or severe eye irritation
Changes in behavior
Depression or mood changes
Hallucinations (seeing or hearing things that are not there)
Seizures
Unexplained bruising or bleeding
Severe stomach pain
Black, tarry, or bloody stools
Vomiting blood or coffee ground-like material
Other Possible Side Effects
Like all medications, this drug can cause side effects. Many people experience no side effects or only mild ones. If you experience any of the following side effects or any other symptoms that bother you or don't go away, contact your doctor:
Upset stomach or vomiting
Trouble sleeping
Restlessness
Excessive sweating
Increased appetite
* Weight gain
This is not a complete list of possible side effects. If you have questions or concerns about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you experience any of the following symptoms, contact your doctor or seek medical attention immediately:
Signs of an allergic reaction: rash, hives, itching, red, swollen, blistered, or peeling skin (with or without fever), wheezing, tightness in the chest or throat, trouble breathing, swallowing, or talking, unusual hoarseness, or swelling of the mouth, face, lips, tongue, or throat
Signs of infection: fever, chills, severe sore throat, ear or sinus pain, cough, increased sputum production or change in sputum color, painful urination, mouth sores, or a wound that won't heal
Signs of high blood sugar: confusion, drowsiness, excessive thirst or hunger, frequent urination, flushing, rapid breathing, or fruity-smelling breath
Signs of low potassium levels: muscle pain or weakness, muscle cramps, or an irregular heartbeat
Signs of pancreatitis (pancreas problem): severe stomach pain, severe back pain, or severe nausea and vomiting
Signs of high blood pressure: severe headache or dizziness, fainting, or changes in vision
Signs of Cushing's syndrome: weight gain in the upper back or abdomen, moon face, severe headache, or slow wound healing
Signs of adrenal gland weakness: severe nausea and vomiting, severe dizziness or fainting, muscle weakness, fatigue, mood changes, decreased appetite, or weight loss
Shortness of breath, significant weight gain, or swelling in the arms or legs
Skin changes: acne, stretch marks, slow healing, or excessive hair growth
Purple, red, blue, brown, or black bumps or patches on the skin or in the mouth
Bone or joint pain
Changes in menstrual period
Chest pain or pressure
Changes in vision, eye pain, or severe eye irritation
Changes in behavior
Depression or mood changes
Hallucinations (seeing or hearing things that are not there)
Seizures
Unexplained bruising or bleeding
Severe stomach pain
Black, tarry, or bloody stools
Vomiting blood or coffee ground-like material
Other Possible Side Effects
Like all medications, this drug can cause side effects. Many people experience no side effects or only mild ones. If you experience any of the following side effects or any other symptoms that bother you or don't go away, contact your doctor:
Upset stomach or vomiting
Trouble sleeping
Restlessness
Excessive sweating
Increased appetite
* Weight gain
This is not a complete list of possible side effects. If you have questions or concerns about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- Severe fatigue, weakness, dizziness, nausea, vomiting, or fainting (signs of adrenal crisis, especially if medication is stopped suddenly)
- Fever, chills, sore throat, body aches, or other signs of infection
- Black, tarry stools or vomit that looks like coffee grounds (signs of stomach bleeding)
- Unusual weight gain, swelling in your hands or ankles, or shortness of breath (signs of fluid retention)
- Blurred vision or eye pain
- Severe mood changes, depression, or unusual thoughts
- Increased thirst or urination (signs of high blood sugar)
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the symptoms you experienced as a result of the allergy.
If you have an active infection, including bacterial, viral, or fungal infections, as well as specific conditions like:
+ Amoeba infection (e.g., traveler's diarrhea)
+ Herpes infection of the eye
+ Malaria infection in the brain
+ Threadworm infestation
+ Any other type of infection
If you have nerve problems in the eye, as this may affect your treatment.
Additionally, to ensure safe treatment, it is crucial to:
Inform your doctor and pharmacist about all medications you are taking, including prescription and over-the-counter (OTC) drugs, natural products, and vitamins.
Discuss your health problems with your doctor, as this medication may interact with certain conditions.
Never start, stop, or change the dose of any medication without first consulting your doctor to confirm it is safe to do so.
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the symptoms you experienced as a result of the allergy.
If you have an active infection, including bacterial, viral, or fungal infections, as well as specific conditions like:
+ Amoeba infection (e.g., traveler's diarrhea)
+ Herpes infection of the eye
+ Malaria infection in the brain
+ Threadworm infestation
+ Any other type of infection
If you have nerve problems in the eye, as this may affect your treatment.
Additionally, to ensure safe treatment, it is crucial to:
Inform your doctor and pharmacist about all medications you are taking, including prescription and over-the-counter (OTC) drugs, natural products, and vitamins.
Discuss your health problems with your doctor, as this medication may interact with certain conditions.
Never start, stop, or change the dose of any medication without first consulting your doctor to confirm it is safe to do so.
Precautions & Cautions
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication. Your doctor will likely recommend regular blood tests to monitor your condition. If you are taking this medication long-term, you may also need to have your eye pressure and bone density checked.
This medication may interfere with allergy skin tests, so be sure to notify your doctor and laboratory personnel that you are taking it. Long-term use of this medication may increase the risk of developing cataracts or glaucoma; discuss this with your doctor.
Prolonged use of this medication can also lead to weak bones (osteoporosis). Talk to your doctor to determine if you are at higher risk or have any questions. You may need to reduce your salt intake and take potassium supplements; consult with your doctor.
If you have diabetes, it is crucial to closely monitor your blood sugar levels. Before consuming alcohol, discuss it with your doctor. Additionally, if you regularly drink grapefruit juice or eat grapefruit, inform your doctor.
Do not exceed the prescribed dose, as taking more than recommended can increase the risk of severe side effects. Before receiving any vaccines, consult with your doctor, as some vaccines may not be effective or may increase the risk of infection when taken with this medication.
If you have not had chickenpox or measles before, avoid exposure to these diseases, as they can be severe or even fatal in people taking steroid medications like this one. If you have been exposed, notify your doctor immediately.
Steroid medications, including this one, can increase the risk of infection, which can be mild or severe, and even life-threatening. The risk of infection is higher with higher doses of steroids. To minimize the risk, wash your hands frequently, avoid people with infections, colds, or flu, and notify your doctor if you experience any signs of infection.
Some infections, such as tuberculosis and hepatitis B, can reactivate in patients taking this medication. If you have a history of these infections, inform your doctor. This medication can also lower the level of natural steroids in your body. If you experience a fever, infection, surgery, or injury, consult with your doctor, as you may need additional oral steroids to help your body cope with these stresses. Carry a warning card indicating that you may require extra steroids in certain situations.
If you have been taking this medication for an extended period, consult with your doctor before stopping, as you may need to gradually taper off the medication. If you have missed a dose or recently stopped taking this medication and experience fatigue, weakness, shakiness, rapid heartbeat, confusion, sweating, or dizziness, notify your doctor.
Long-term use of this medication has been associated with an increased risk of a type of cancer called Kaposi's sarcoma; discuss this with your doctor. If you have or may have a condition called pheochromocytoma, inform your doctor, as this medication can have severe and potentially fatal effects in patients with this condition.
Patients with cancer may be at higher risk of developing a life-threatening condition called tumor lysis syndrome (TLS); discuss this with your doctor. If you are 65 or older, use this medication with caution, as you may be more susceptible to side effects.
This medication can affect growth in children and adolescents; they may require regular growth checks. If the patient is a premature infant, inform your doctor, as this medication can increase the risk of a certain heart problem.
If you are pregnant, plan to become pregnant, or are breastfeeding, discuss the benefits and risks of this medication with your doctor. If you took this medication during pregnancy, inform your baby's doctor.
For patients with poor adrenal function, stopping this medication, taking too low a dose, or switching between different forms of this medication can lead to severe and potentially life-threatening adrenal gland problems. If you have questions or concerns, consult with your doctor.
This medication may interfere with allergy skin tests, so be sure to notify your doctor and laboratory personnel that you are taking it. Long-term use of this medication may increase the risk of developing cataracts or glaucoma; discuss this with your doctor.
Prolonged use of this medication can also lead to weak bones (osteoporosis). Talk to your doctor to determine if you are at higher risk or have any questions. You may need to reduce your salt intake and take potassium supplements; consult with your doctor.
If you have diabetes, it is crucial to closely monitor your blood sugar levels. Before consuming alcohol, discuss it with your doctor. Additionally, if you regularly drink grapefruit juice or eat grapefruit, inform your doctor.
Do not exceed the prescribed dose, as taking more than recommended can increase the risk of severe side effects. Before receiving any vaccines, consult with your doctor, as some vaccines may not be effective or may increase the risk of infection when taken with this medication.
If you have not had chickenpox or measles before, avoid exposure to these diseases, as they can be severe or even fatal in people taking steroid medications like this one. If you have been exposed, notify your doctor immediately.
Steroid medications, including this one, can increase the risk of infection, which can be mild or severe, and even life-threatening. The risk of infection is higher with higher doses of steroids. To minimize the risk, wash your hands frequently, avoid people with infections, colds, or flu, and notify your doctor if you experience any signs of infection.
Some infections, such as tuberculosis and hepatitis B, can reactivate in patients taking this medication. If you have a history of these infections, inform your doctor. This medication can also lower the level of natural steroids in your body. If you experience a fever, infection, surgery, or injury, consult with your doctor, as you may need additional oral steroids to help your body cope with these stresses. Carry a warning card indicating that you may require extra steroids in certain situations.
If you have been taking this medication for an extended period, consult with your doctor before stopping, as you may need to gradually taper off the medication. If you have missed a dose or recently stopped taking this medication and experience fatigue, weakness, shakiness, rapid heartbeat, confusion, sweating, or dizziness, notify your doctor.
Long-term use of this medication has been associated with an increased risk of a type of cancer called Kaposi's sarcoma; discuss this with your doctor. If you have or may have a condition called pheochromocytoma, inform your doctor, as this medication can have severe and potentially fatal effects in patients with this condition.
Patients with cancer may be at higher risk of developing a life-threatening condition called tumor lysis syndrome (TLS); discuss this with your doctor. If you are 65 or older, use this medication with caution, as you may be more susceptible to side effects.
This medication can affect growth in children and adolescents; they may require regular growth checks. If the patient is a premature infant, inform your doctor, as this medication can increase the risk of a certain heart problem.
If you are pregnant, plan to become pregnant, or are breastfeeding, discuss the benefits and risks of this medication with your doctor. If you took this medication during pregnancy, inform your baby's doctor.
For patients with poor adrenal function, stopping this medication, taking too low a dose, or switching between different forms of this medication can lead to severe and potentially life-threatening adrenal gland problems. If you have questions or concerns, consult with your doctor.
Overdose Information
Overdose Symptoms:
- Fluid retention (swelling, weight gain)
- High blood pressure
- High blood sugar (increased thirst, urination)
- Muscle weakness
- Mood changes (irritability, anxiety)
- Moon face, buffalo hump, thinning skin, easy bruising (signs of Cushing's syndrome with chronic overdose)
What to Do:
In case of suspected overdose, seek immediate medical attention or call a poison control center (1-800-222-1222). Treatment is symptomatic and supportive. Chronic overdose may require gradual tapering of the dose.
Drug Interactions
Contraindicated Interactions
- Live or live-attenuated vaccines (when hydrocortisone is used in immunosuppressive doses)
Major Interactions
- CYP3A4 inducers (e.g., rifampin, phenytoin, barbiturates, carbamazepine, primidone): May decrease hydrocortisone levels, reducing efficacy.
- CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, ritonavir, clarithromycin): May increase hydrocortisone levels, increasing risk of side effects.
- NSAIDs (e.g., ibuprofen, naproxen): Increased risk of gastrointestinal ulceration and bleeding.
- Anticoagulants (e.g., warfarin): May alter anticoagulant effect (either increase or decrease), requiring close INR monitoring.
- Diuretics (e.g., thiazide, loop diuretics): Increased risk of hypokalemia.
- Antidiabetic agents (e.g., insulin, oral hypoglycemics): May increase blood glucose levels, requiring dose adjustment of antidiabetics.
Moderate Interactions
- Cardiac glycosides (e.g., digoxin): Increased risk of digitalis toxicity if hypokalemia occurs.
- Cholestyramine, colestipol: May decrease absorption of hydrocortisone.
- Oral contraceptives/estrogens: May increase hydrocortisone levels due to increased corticosteroid-binding globulin.
- Vaccines (inactivated): Reduced immune response to vaccines.
Minor Interactions
- Antacids: May reduce absorption if taken concurrently (separate administration times).
Monitoring
Baseline Monitoring
Blood pressure
Rationale: Risk of hypertension
Timing: Before initiation
Weight
Rationale: Risk of fluid retention and weight gain
Timing: Before initiation
Serum electrolytes (especially potassium)
Rationale: Risk of hypokalemia and fluid/electrolyte imbalance
Timing: Before initiation
Blood glucose
Rationale: Risk of hyperglycemia, especially in diabetics
Timing: Before initiation
Adrenal function tests (e.g., cortisol, ACTH) if for adrenal insufficiency
Rationale: To establish baseline and guide replacement therapy
Timing: Before initiation
Routine Monitoring
Blood pressure
Frequency: Regularly (e.g., monthly or as clinically indicated)
Target: Within normal limits for patient
Action Threshold: Persistent elevation requiring intervention
Weight
Frequency: Regularly (e.g., monthly)
Target: Stable or within acceptable limits
Action Threshold: Significant, unexplained weight gain
Serum electrolytes (especially potassium)
Frequency: Periodically (e.g., every 3-6 months or as clinically indicated)
Target: Within normal limits
Action Threshold: Hypokalemia or other imbalances
Blood glucose
Frequency: Periodically (e.g., every 3-6 months, more frequently in diabetics)
Target: Within normal limits or target for diabetics
Action Threshold: Persistent hyperglycemia
Growth (in pediatric patients)
Frequency: Regularly (e.g., every 3-6 months)
Target: Normal growth velocity
Action Threshold: Growth retardation
Bone mineral density (for long-term therapy)
Frequency: Baseline and then every 1-2 years
Target: Stable or improving
Action Threshold: Significant bone loss (osteoporosis)
Symptom Monitoring
- Signs of infection (fever, sore throat, malaise)
- Gastrointestinal symptoms (abdominal pain, black/tarry stools, vomiting blood)
- Mood changes (irritability, depression, euphoria)
- Fluid retention (swelling in ankles, weight gain)
- Muscle weakness or pain
- Vision changes (blurred vision, cataracts)
- Signs of adrenal insufficiency (fatigue, weakness, dizziness, nausea, vomiting, hypotension) if dose is missed or stopped abruptly
Special Patient Groups
Pregnancy
Hydrocortisone is classified as Pregnancy Category C. It should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Corticosteroids can cross the placenta. Infants born to mothers who have received substantial doses of corticosteroids during pregnancy should be carefully observed for signs of hypoadrenalism.
Trimester-Specific Risks:
First Trimester:
Potential for increased risk of cleft palate in animal studies, but human data are inconclusive. Generally, avoid if possible, but essential for adrenal insufficiency.
Second Trimester:
Generally considered safer than first trimester, but continued monitoring for fetal growth and adrenal suppression is warranted.
Third Trimester:
Risk of fetal adrenal suppression, which may require monitoring and temporary corticosteroid replacement in the neonate. May also be associated with low birth weight.
Lactation
Hydrocortisone is excreted into breast milk. However, at typical replacement doses (e.g., 5mg), the amount transferred to breast milk is generally considered low and unlikely to cause adverse effects in the infant. Higher doses or prolonged use may warrant monitoring the infant for signs of adrenal suppression (e.g., poor weight gain, irritability).
Infant Risk:
Low risk with typical replacement doses; moderate risk with high or prolonged doses.
Pediatric Use
Children receiving corticosteroids should be carefully monitored for growth and development, as long-term use can cause growth retardation. They are also at increased risk of adverse effects such as cataracts, glaucoma, and intracranial hypertension. Dosing should be individualized and the lowest effective dose used.
Geriatric Use
Elderly patients may be at increased risk of adverse effects associated with corticosteroids, including osteoporosis, diabetes, hypertension, fluid retention, and skin fragility. Close monitoring and the lowest effective dose are recommended.
Clinical Information
Clinical Pearls
- For adrenal insufficiency, hydrocortisone is the preferred replacement therapy due to its combined glucocorticoid and mineralocorticoid activity, mimicking natural cortisol.
- Administer daily doses to mimic the body's natural cortisol rhythm, typically with the largest dose in the morning and smaller doses in the afternoon/evening.
- Patients on long-term hydrocortisone therapy should be educated about 'stress dosing' and carry emergency hydrocortisone (e.g., injectable) for severe illness or trauma.
- Always taper the dose gradually when discontinuing, especially after prolonged use, to prevent adrenal crisis.
- Advise patients to report any signs of infection promptly, as corticosteroids can mask symptoms and increase susceptibility.
Alternative Therapies
- Other glucocorticoids (e.g., prednisone, methylprednisolone, dexamethasone) for anti-inflammatory or immunosuppressive effects.
- For adrenal insufficiency, fludrocortisone may be added for mineralocorticoid replacement if hydrocortisone alone is insufficient.
- Non-steroidal anti-inflammatory drugs (NSAIDs) for inflammatory conditions (less potent, different mechanism).
- Disease-modifying antirheumatic drugs (DMARDs) or biologics for autoimmune conditions.
Cost & Coverage
Average Cost:
$10 - $30 per 30 tablets (5mg generic)
Generic Available:
Yes
Insurance Coverage:
Tier 1 or Tier 2 (preferred generic)
General Drug Facts
If your symptoms or health issues persist or worsen, it is essential to contact your doctor promptly. To ensure safe and effective treatment, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so it's a good idea to check with your pharmacist for more information. If you have any questions or concerns about this medication, don't hesitate to discuss them with your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek emergency medical attention. When reporting the incident, be prepared to provide details about the medication taken, the amount, and the time it occurred.