hydrocortisone (Rx)
Generic: Hydrocortisone
Brand: Cortef, Colocort, Cortena
(hy-droh-kor'tih-sone)
Pharmacological Action
Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and fibroblasts and reversing increased capillary permeability and lysosomal stabilization (systemic); antipruritic, antiinflammatory (topical)
Therapeutic outcome: Decreased inflammation
Uses
Severe inflammation, septic shock, adrenal insufficiency, ulcerative colitis, collagen disorders, asthma, COPD, Hodgkin disease, SLE, Stevens-Johnson syndrome, ulcerative colitis, TB
Contraindications
Hypersensitivity, fungal infections
Precautions: Pregnancy C, breastfeeding, diabetes mellitus, glaucoma, osteoporosis, seizure disorders, ulcerative colitis, CHF, myasthenia gravis, renal disease, esophagitis, peptic ulcer, metastatic carcinoma, septic shock, Cushing syndrome, hepatic disease, hypothyroidism, coagulopathy, thromboembolism, children <2 yr, psychosis, idiopathic thrombocytopenia (IM), acute glomerulonephritis, amebiasis, nonasthmatic bronchial disease, AIDS, TB, recent MI (associated with left-ventricular rupture)
Dosage & Routes
Adrenal insufficiency/inflammation
Adult: PO 20-240 mg daily in divided doses; IM/IV 100-500 mg (succinate), may repeat q2-6 hr, then 50-100 mg IM as needed Shock prevention
Adult: IM/IV 50 mg/kg repeated q4 hr; repeat q24 hr as needed (succinate)
Child: IM/IV 0.16-1 mg/kg or 6-30 mg/m2 given daily or bid (succinate) Colitis
Adult: PO 20-240 mg (base)/day in 2-4 divided doses; enema 100 mg nightly for 21 days
Child: PO 2-8 mg (base)/kg/day or 60-240 mg (base)/m2/day in 3-4 divided doses Topical route Adult and child >2 yr: Apply to affected area daily-qid
Available forms:
Hydrocortisone: enema 100 mg/60 ml; tabs 5, 10, 20 mg; acetate: rectal aerosol foam: 10%; cypionate: tabs 5, 10, 20 mg; succinate: inj 100, 250, 500, 1000 mg vial
Implementation PO route - Give with food or milk to decrease GI symptoms Rectal route - Use applicator provided - Clean applicator after each use - Retain for 1 hr if possible Topical route - Apply only to affected areas; do not get in eyes - Cleanse and dry area before applying medication, then cover with occlusive dressing (only if prescribed); seal to normal skin; change q12 hr; systemic absorption may occur; use only on dermatoses; do not use on weeping, denuded, or infected area - Use for a few days after area has cleared - Store at room temperature Nasal route - Patient should clear nasal passages before administration; use decongestant if needed; shake inhaler, invert, tilt head backward, insert nozzle into nostril, away from septum; hold other nostril closed and depress activator, inhale through nose, exhale through mouth IM route - Give deeply in large muscle mass; rotate sites; avoid deltoid; use 21-gauge needle IV route -
Succinate: IV in mix-o-vial or reconstitute 250 mg or less/2 ml bacteriostatic water for injection, mix gently; give direct IV over 1 min or more; may be further diluted in 100, 250, 500, or 1000 ml of D5 W, D5/0.9% NaCl, 0.9% NaCl given over ordered rate Sodium succinate preparations
Y-site compatibilities: Acyclovir, allopurinol, amifostine, ampicillin, amphotericin B cholesteryl, inamrinone, amsacrine, atracurium, atropine, aztreonam, betamethasone, calcium gluconate, cefepime, cefmetazole, cephalothin, cephapirin, chlordiazePOXIDE, chlorproMAZINE, cisatracurium, cladribine, cyanocobalamin, cytarabine, dexamethasone, digoxin, diphenhydrAMINE, DOPamine, DOXOrubicin liposome, droperidol, edrophonium, enalaprilat, EPINEPHrine, esmolol, conjugated estrogens, ethacrynate, famotidine, fentaNYL, fentaNYL/droperidol, filgrastim, fludarabine, fluorouracil, foscarnet, furosemide, gallium, granisetron, heparin, hydrALAZINE, regular insulin, isoproterenol, kanamycin, lidocaine, LORazepam, magnesium sulfate, melphalan, menadiol, meperidine, methicillin, methoxamine, methylergonovine, minocycline, morphine, neostigmine, norepinephrine, ondansetron, oxacillin, oxytocin, PACLitaxel, pancuronium, penicillin G potassium, pentazocine, phytonadione, piperacillin/tazobactam, prednisoLONE, procainamide, prochlorperazine, propofol, propranolol, pyridostigmine, remifentanil, scopolamine, sodium bicarbonate, succinylcholine, tacrolimus, teniposide, theophylline, thiotepa, trimethaphan, trimethobenzamide, vecuronium, vinorelbine Y-site incompatibilities: Diazepam, ergotamine tartrate, IDArubicin, phenytoin, sargramostim
Adverse Effects
CNS: Depression, flushing, sweating, headache, mood changes, pseudotumor cerebri, euphoria, insomnia, seizures
CV: Hypertension, circulatory collapse, thrombophlebitis, embolism, tachycardia, edema, heart failure
EENT: Fungal infections, increased intraocular pressure, blurred vision, cataracts, glaucoma
GI: Diarrhea, nausea, abdominal distention, GI hemorrhage, increased appetite, pancreatitis, vomiting
HEMA: Thrombocytopenia
INTEG: Acne, poor wound healing, ecchymosis, petechiae
MISC: Adrenal insufficiency (after stress/withdrawal)
MS: Fractures, osteoporosis, weakness
Pharmacokinetics
Absorption: Well absorbed (PO); systemic (topical)
Distribution: Crosses placenta
Metabolism: Liver, extensively
Excretion: Kidney
Half-life: 3-5 hr, adrenal suppression 3-4 days
Pharmacodynamics
PO: Onset 1-2 hr, Peak 1 hr, Duration 1½ days
IM: Onset 20 min, Peak 4-8 hr, Duration 1½ days
IV: Onset Rapid, Peak 1-2 hr, Duration 1½ days
TOPICAL: Onset Min to hr, Peak Hr to days, Duration Hr to days
Interactions
Individual drugs
Alcohol, amphotericin B, cycloSPORINE, digoxin: increased side effects Bosentan, carBAMazepine, cholestyramine, colestipol, ePHEDrine, phenytoin, rifampin, theophylline: decreased action of hydrocortisone
Drug classifications
Acetaminophen, NSAIDs, salicylates: increased risk of GI bleeding Anticoagulants, calcium supplements, toxoids, vaccines: decreased action of each specific drug
Anticonvulsants: decreased effects of anticonvulsant
Antidiabetics: decreased effects of antidiabetics
Barbiturates: decreased action of hydrocortisone
Diuretics: increased side effects Live virus vaccines/toxoids: increased neurologic reactions
Drug/herb
Ephedra: decreased hydrocortisone levels
Drug/lab test
Increased: cholesterol, sodium, blood glucose, uric acid, calcium, urine glucose
Decreased: calcium, potassium, T4, T3, thyroid 131 I uptake test, urine 17-OHCS, 17-KS False negative: skin allergy tests
Nursing Considerations
Assessment - Adrenal insufficiency (cushingoid symptoms): nausea, anorexia, shortness of breath, moon face, fatigue, dizziness, weakness, joint pain before and during treatment; monitor plasma cortisol levels during long-term therapy (normal level is 138-635 nmol/L when obtained at 8 am); check adrenal function periodically for hypothalamic-pituitary-adrenal axis suppression - Monitor potassium, blood glucose, urine glucose while patient is on long-term therapy; hypokalemia and hyperglycemia may occur - Monitor • I&O ratio; be alert for decreasing urinary output and increasing edema; weigh daily; notify prescriber of weekly gain >5 lb or edema, hypertension, cardiac symptoms - Assess for infection: increased temp, WBC even after withdrawal of medication; product masks infection symptoms; if fever develops, product should be discontinued - Check for potassium depletion: paresthesias, fatigue, nausea, vomiting, depression, polyuria, dysrhythmias, weakness - Assess mental status: affect, mood, behavioral changes, aggression - Check nasal passages during long-term treatment for changes in mucus (nasal) - Assess for systemic absorption: increased temp, inflammation, irritation (topical) - GI effects: nausea, vomiting, anorexia or appetite stimulation, diarrhea, constipation, abdominal pain, hiccups, gastritis, pancreatitis, GI bleeding/perforation with long-term treatment Patient/family education - Teach patient all aspects of product use, including cushingoid symptoms - Advise patient to carry/wear emergency ID as corticosteroid user; not to discontinue abruptly; adrenal crisis can result - Instruct patient to notify prescriber if therapeutic response decreases; dosage adjustment may be needed - Instruct patient to notify prescriber of signs of infection - Teach patient that product can mask infections and cause hyperglycemia (diabetic) - Teach patient to avoid live-virus vaccines if using steroids long term - Caution patient to avoid OTC products unless directed by prescriber: salicylates, alcohol in cough products, cold preparations - Teach patient symptoms of adrenal insufficiency: nausea, anorexia, fatigue, dizziness, dyspnea, weakness, joint pain; and when to notify prescriber - Advise patient that long-term therapy may be needed to resolve infection (1-2 mo depending on type of infection) - Teach patient to report immediately abdominal pain, black tarry stools, as GI bleeding/perforation can occur - Advise patient not to discontinue abruptly or adrenal crisis can result; product should be tapered Nasal route - Instruct patient to clear nasal passages if sneezing attack occurs, then repeat dose; to continue using product even if mild nasal bleeding occurs; bleeding is usually transient - Teach method of instillation after providing written instruction from manufacturer on instillation
Evaluation
Positive therapeutic outcome: Decrease in runny nose (nasal); Decreased inflammation; Absence of severe itching, patches on skin, flaking (top); Decreased GI symptoms
Reference
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