hydrocortisone sodium phosphate: clinical use

Prescribing considerations

• Confirm the indication and formulation; oral replacement products, soluble emergency treatment, injection and eye drops are not interchangeable.
• For adrenal insufficiency, provide illness and emergency-management education and ensure eligible patients carry the appropriate steroid card.
• Avoid abrupt withdrawal after clinically significant systemic exposure; assess HPA-axis suppression risk.
• Systemic corticosteroids may mask infection and cause psychiatric, metabolic, cardiovascular, gastrointestinal, musculoskeletal and ocular complications.
• Do not use ocular corticosteroids for an undiagnosed red eye. Exclude infection and corneal disease first.

Contraindications and cautions

• Hypersensitivity to the active substance or formulation excipients.
• Systemic injection in systemic infection without appropriate anti-infective treatment or with live-virus immunisation; do not inject directly into tendons.
• Soluble tablets in systemic fungal infection.
• Eye drops in corticosteroid-induced or other ocular hypertension, acute ulcerative viral corneal infection, ocular tuberculosis or fungal disease, and acute purulent ocular infection.

Monitoring

• With systemic exposure, monitor clinical response and features of excess or inadequate glucocorticoid effect; consider blood pressure, weight, glucose, electrolytes, infection, mood, bone health and growth in children.
• Review interacting medicines whenever treatment starts, stops or changes.
• During prolonged ocular treatment or in susceptible patients, monitor intraocular pressure, cataract formation, infection and corneal integrity.
• Monitor cardiac structure and function in prematurely born infants receiving systemic hydrocortisone because hypertrophic cardiomyopathy has been reported.

Clinical pharmacology

Hydrocortisone is the principal endogenous glucocorticoid and also has mineralocorticoid activity. It modifies glucocorticoid-responsive gene expression, suppressing immune responses and inflammatory-mediator production. Systemic hydrocortisone is extensively protein-bound, metabolised mainly in the liver and tissues, and excreted chiefly as conjugated urinary metabolites.

Formulation and product differences

• Oral solutions are licensed for paediatric adrenal-insufficiency replacement, include oral syringes and can be given through specified gastric feeding tubes.
• The soluble tablet must be dissolved in water and taken immediately; licensed indications include selected replacement and emergency systemic uses.
• Injection can be given intravenously, intramuscularly or into appropriate soft tissues by trained personnel. Transient paraesthesia can occur after intravenous administration and appears related to the phosphate salt.
• Eye drops are preservative-free single-dose containers. Paediatric safety and efficacy have not been established, and damaged corneas may rarely develop calcification with phosphate-containing drops.

Eye drops

Route: Ophthalmic

Strengths: 3.35 mg/mL

Oral solution

Route: Oral

Strengths: 5 mg/5 mL, 10 mg/5 mL

Tablet

Route: Oral

Strengths: 10 mg