hydrocortisone at a glance
Medicine class
Corticosteroid (glucocorticoid).
Oral hydrocortisone
Replaces cortisol when the body cannot make enough.
Hydrocortisone for skin
A mild topical steroid that reduces redness, itching and swelling.
Do not stop oral replacement suddenly
Abrupt interruption can cause adrenal insufficiency or an adrenal crisis.
What is hydrocortisone used for?
Licensed uses vary by product and formulation.
Oral replacement treatment for adrenal insufficiency, including selected products for children, adolescents or adults.
Treatment of congenital adrenal hyperplasia.
Selected immediate-release tablets are licensed for emergency treatment of severe asthma and serious hypersensitivity reactions, including anaphylaxis and angioedema.
Topical treatment of steroid-responsive eczema and dermatitis.
Selected topical products are licensed for insect-bite reactions and otitis externa.
How does hydrocortisone work?
Hydrocortisone acts like cortisol, a hormone made by the adrenal glands. It binds glucocorticoid receptors and changes gene activity involved in metabolism, stress responses and immunity. On inflamed skin, it reduces redness, swelling and itching.
hydrocortisone preparations and strengths
Cream
Route: Cutaneous
Strengths: 0.5%, 1%, 1% w/w, 2.5%
Ointment
Route: Cutaneous
Strengths: 0.5%, 1.0%, 1%, 1% w/w, 2.5%
How to take hydrocortisone
Follow the instructions for the exact formulation because immediate-release tablets, dispersible tablets, modified-release capsules and skin products are not interchangeable.
Swallow Efmody capsules with water without chewing them and follow the product's food-separation instructions.
Dispersible tablets may be dispersed in water and swallowed immediately; rinse the glass with more water and drink it to collect remaining particles.
Apply skin preparations in a thin layer, wash your hands afterwards unless treating them, and keep the product away from eyes, wounds and untreated infection.
Do not cover treated skin with a dressing unless advised by a clinician.
Keep paraffin-containing skin products away from smoking and naked flames because contaminated fabrics burn more easily.
hydrocortisone side effects
Common or expected effects
- Oral products: headache, dizziness, tiredness or weakness.
- Some oral formulations: nausea, abdominal discomfort, muscle aches, sleep or mood changes, and appetite or weight changes.
- Skin products: local irritation, burning, itching or contact dermatitis.
- With greater or prolonged topical exposure: skin thinning, stretch marks, visible small blood vessels or skin-colour changes.
Get urgent medical advice
- Adrenal insufficiency or adrenal crisis, especially after missed treatment, vomiting, illness or sudden withdrawal.
- Serious allergic reaction with breathing difficulty or swelling of the face, lips, tongue or throat.
- Severe mood disturbance, hallucinations or suicidal thoughts.
- Severe or unusual infection.
- New blurred vision or another significant eyesight change.
- Vomiting blood, black stools or severe persistent abdominal pain.
hydrocortisone in pregnancy
Hydrocortisone replacement can be used during pregnancy. Treatment for adrenal insufficiency should not be stopped without specialist advice, as replacement needs may change. Most topical products can also be used when advised by a pharmacist or prescriber.
hydrocortisone while breastfeeding
Hydrocortisone replacement is generally compatible with breastfeeding when the baby is healthy. Higher or prolonged systemic exposure may warrant monitoring of feeding, growth and adrenal function. Topical hydrocortisone can usually be used, but wash medicine from the breast or nipple before feeding.
hydrocortisone interactions
Systemic hydrocortisone has clinically important interactions; interactions are much less likely with limited topical use.
CYP3A4 inducers, including rifampicin, carbamazepine, phenytoin and St John’s wort
Can lower hydrocortisone exposure and increase the risk of inadequate cortisol replacement or adrenal crisis.
CYP3A4 inhibitors, including clarithromycin, azole antifungals and ritonavir
Can raise hydrocortisone exposure and increase corticosteroid adverse effects.
Insulin and other glucose-lowering medicines
Systemic corticosteroids can raise blood glucose and reduce their glucose-lowering effect.
Common questions about hydrocortisone
Answers are fully visible for fast scanning and source review.
Is hydrocortisone the same as cortisol?
Hydrocortisone is the pharmaceutical form of cortisol, the glucocorticoid hormone normally produced by the adrenal glands.
Why must oral hydrocortisone not be stopped suddenly?
Sudden interruption can cause withdrawal symptoms and, in people dependent on replacement treatment, potentially life-threatening adrenal crisis.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.