Hydrocortisone is a corticosteroid.

It works by decreasing or preventing tissues from responding

to inflammation. It also modifies the body's response to certain immune stimulation.

Indications

Replacement therapy in adrenal cortical insufficiency

Allergic statessevere or incapacitating allergic conditions

Hypercalcemia associated with cancer

Short-term inflammatory and allergic disorders, such as rheumatoid arthritis, collagen

diseases (SLE), dermatologic diseases (pemphigus), status asthmaticus, and autoimmune
disorders

Hematologic disordersthrombocytopenic purpura, erythroblastopenia

Trichinosis with neurologic or myocardial involvement

Ulcerative colitis, acute exacerbations of MS, and palliation in some leukemias and
lymphomas

Intra-articular or soft-tissue administration: Arthritis, psoriatic plaques

Retention enema: For ulcerative colitis, proctitis

Dermatologic preparations: To relieve inflammatory and pruritic manifestations of

dermatoses that are steroid responsive

Anorectal cream, suppositories: To relieve discomfort of hemorrhoids and perianal

itching or irritation

Interventions
Systemic administration

WARNING: Give daily before 9 AM to mimic normal peak diurnal corticosteroid levels
and minimize HPA suppression.

Space multiple doses evenly throughout the day.

Do not give IM injections if patient has thrombocytopenic purpura.

Rotate sites of IM repository injections to avoid local atrophy.

Use minimal doses for minimal duration to minimize adverse effects.

Taper doses when discontinuing high-dose or long-term therapy.

Arrange for increased dosage when patient is subject to unusual stress.

Ensure that adequate amount of Ca2+ is taken if prolonged administration of steroids.

Use alternate-day maintenance therapy with short-acting corticosteroids whenever

possible.

WARNING: Do not give live virus vaccines with immunosuppressive doses of

hydrocortisone.

Provide antacids between meals to help avoid peptic ulcer.

Topical dermatologic administration

Use caution with occlusive dressings; tight or plastic diapers over affected area can
increase systemic absorption.

Avoid prolonged use, especially near eyes, in genital and rectal areas, on face, and in skin
creases.

Teaching points
Systemic administration

Take this drug exactly as prescribed. Do not stop taking this drug without notifying your
health care provider; slowly taper dosage to avoid problems.

Dosage reductions may create adrenal insufficiency. Report any fatigue, muscle and joint
pains, anorexia, nausea, vomiting, diarrhea, weight loss, weakness, dizziness, or low
blood sugar (if you monitor blood sugar).

Take with meals or snacks if GI upset occurs.

Take single daily or alternate-day doses before 9 AM; mark calendar or use other
measures as reminder of treatment days.

Do not overuse joint after intra-articular injections, even if pain is gone.

Frequent follow-up visits to your health care provider are needed to monitor drug
response and adjust dosage.

Wear a medical alert ID (if you ae using long-term therapy) so that any emergency
medical personnel will know that you are taking this drug.

You may experience these side effects: Increase in appetite, weight gain (some of gain
may be fluid retention; monitor intake); heartburn, indigestion (eat frequent small meals;
use of antacids may help); increased susceptibility to infection (avoid crowds during peak
cold or flu seasons, and avoid anyone with a known infection); poor wound healing (if
injured or wounded, consult health care provider); muscle weakness, fatigue (frequent
rest periods may help).

Report unusual weight gain, swelling of lower extremities, muscle weakness, black or
tarry stools, vomiting of blood, epigastric burning, puffing of face, menstrual
irregularities, fever, prolonged sore throat, cold or other infection, worsening of
symptoms.

Intra-articular, intralesional administration

Do not overuse the injected joint even if the pain is gone. Adhere to rules of proper rest
and exercise.

Topical dermatologic administration

Apply sparingly, and rub in lightly

Avoid contacting your eye with the medication.

Report burning, irritation, or infection of the site, worsening of the condition.

Avoid prolonged use.

Anorectal preparations

Maintain normal bowel function with proper diet, adequate fluid intake, and regular
exercise.

Use stool softeners or bulk laxatives if needed.

Notify your health care provider if symptoms do not improve in 7 days or if bleeding,
protrusion, or seepage occurs.