Hydrocortisone

Oral: Administer with food or milk to decrease GI upset.

Hypersensitivity to hydrocortisone or any component of the formulation; systemic fungal infections

Interactions:

Acetylcholinesterase Inhibitors: Corticosteroids (Systemic) may enhance the adverse/toxic effect of Acetylcholinesterase Inhibitors. Increased muscular weakness may occur. Risk C: Monitor therapy

Aldesleukin: Corticosteroids may diminish the antineoplastic effect of Aldesleukin. Risk X: Avoid combination

Amphotericin B: Corticosteroids (Systemic) may enhance the hypokalemic effect of Amphotericin B. Risk C: Monitor therapy

Androgens: Corticosteroids (Systemic) may enhance the fluid-retaining effect of Androgens. Risk C: Monitor therapy

 Antacids: May decrease the bioavailability of Corticosteroids (Oral). Management: Consider separating doses by 2 or more hours. Budesonide enteric coated tablets could dissolve prematurely if given with drugs that lower gastric acid, with unknown impact on budesonide therapeutic effects. Risk D: Consider therapy modification

 Antidiabetic Agents: Hyperglycemia-Associated Agents may diminish the therapeutic effect of Antidiabetic Agents. Risk C: Monitor therapy

Pregnancy and Lactation:

Some studies have shown an association between first trimester systemic corticosteroid use and oral clefts or decreased birth weight; however, information is conflicting and may be influenced by maternal dose/indication for use. Hypoadrenalism may occur in newborns following maternal use of corticosteroids in pregnancy; monitor.

Corticosteroids are present in breast milk. Corticosteroids are generally considered acceptable in breastfeeding patients when used in usual doses; however, monitoring of the infant is recommended.

Warning and Precaution:

• Adrenal suppression: May cause hypercortisolism or suppression of hypothalamic-pituitary-adrenal (HPA) axis, particularly in younger children or in patients receiving high doses for prolonged periods. HPA axis suppression may lead to adrenal crisis. Withdrawal and discontinuation of a corticosteroid should be done slowly and carefully. Particular care is required when patients are transferred from systemic corticosteroids to inhaled products due to possible adrenal insufficiency or withdrawal from steroids, including an increase in allergic symptoms. Patients receiving >20 mg per day of prednisone (or equivalent) may be most susceptible. Fatalities have occurred due to adrenal insufficiency in asthmatic patients during and after transfer from systemic corticosteroids to aerosol steroids; aerosol steroids do not provide the systemic steroid needed to treat patients having trauma, surgery, or infections.
• Anaphylactoid reactions: Rare cases of anaphylactoid reactions have been observed in patients receiving corticosteroids.
• Dermal changes: Avoid injection or leakage into the dermis; dermal and/or subdermal skin depression may occur at the site of injection. Avoid deltoid muscle injection; subcutaneous atrophy may occur.
• Immunosuppression: Prolonged use of corticosteroids may increase the incidence of secondary infection, mask acute infection (including fungal infections), prolong or exacerbate viral infections, or limit response to killed or inactivated vaccines. Exposure to chickenpox or measles should be avoided. Corticosteroids should not be used for cerebral malaria, fungal infections, or viral hepatitis. Close observation is required in patients with latent tuberculosis (TB) and/or TB reactivity; restrict use in active TB (only fulminating or disseminated TB in conjunction with antituberculosis treatment). Latent or active amebiasis should be ruled out in any patient with recent travel to tropical climates or unexplained diarrhea prior to corticosteroid initiation. Use with extreme caution in patients with Strongyloides infections; hyperinfection, dissemination and fatalities have occurred.

Adverse Reactions:

Cardiovascular: Bradycardia, cardiac arrhythmia, cardiac failure (especially in susceptible patients), cardiomegaly, circulatory shock, embolism (fat), hypertension, hypertrophic cardiomyopathy (premature infants), myocardial rupture (post-myocardial infarction), syncope, tachycardia, thromboembolism, thrombophlebitis, vasculitis

Dermatologic: Acne vulgaris, allergic dermatitis, atrophic striae, burning sensation of skin (especially in the perineal area after IV injection), diaphoresis, ecchymoses, erythema of skin, facial erythema, hyperpigmentation, hypertrichosis, hypopigmentation, inadvertent suppression of skin test reaction, skin rash, thinning hair, urticaria, xeroderma

Endocrine & metabolic: Adrenocortical insufficiency (secondary unresponsiveness, particularly during trauma, surgery, or illness), Cushing syndrome, decreased serum potassium, drug-induced Cushing’s syndrome, fluid retention, glycosuria, growth retardation, hirsutism, HPA-axis suppression, hyperglycemia (including increased requirements for insulin or oral hypoglycemic agents in diabetes mellitus), hypokalemic alkalosis, impaired glucose tolerance/prediabetes, lipodystrophy, manifestation of prediabetes, menstrual disease, moon face, negative nitrogen balance (due to protein catabolism), pituitary insufficiency (secondary unresponsiveness, particularly during trauma, surgery, or illness), protein catabolism, sodium retention, weight gain

Gastrointestinal: Abdominal distention, gastrointestinal perforation (small and large intestine, particularly in patients with inflammatory bowel disease), hiccups, impaired intestinal carbohydrate absorption, increased appetite, nausea, pancreatitis, peptic ulcer (with possible perforation and hemorrhage), ulcerative esophagitis

Storage:

Store below 30ºC and protect from light and moisture.