hydrocortisone: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
hydrocortisone: clinical details
Prescribing considerations
- Confirm the indication and formulation; immediate-release, dispersible and modified-release oral products have different characteristics.
- For replacement treatment, provide written illness and emergency plans and appropriate steroid emergency identification.
- Avoid abrupt withdrawal where adrenal suppression or established adrenal insufficiency is possible.
- Review infection risk, psychiatric history, diabetes, hypertension, osteoporosis, gastrointestinal disease and ocular disease before substantial systemic exposure.
- For topical treatment, consider site, skin integrity, treated area, occlusion, age and infection.
Contraindications and cautions
- Hypersensitivity to hydrocortisone or a formulation excipient.
- Selected systemic tablets: systemic fungal infection, untreated systemic infection or concurrent live vaccination, according to the product SmPC.
- Topical products: untreated viral, fungal or bacterial skin infection; some products additionally exclude acne, rosacea and perioral dermatitis.
- Check excipient-specific restrictions, including lactose-containing tablets and contact allergens in some creams.
Monitoring
- Evidence of under-replacement, over-replacement and adrenal-crisis risk.
- Blood pressure, weight, glucose and electrolytes where systemic exposure warrants it.
- Growth and development in children receiving ongoing systemic treatment.
- Bone, eye and infection risks during prolonged or substantial systemic exposure.
- For congenital adrenal hyperplasia, formulation-appropriate biochemical sampling and specialist targets.
- Topical response, infection, atrophy, withdrawal-type rebound and systemic effects when absorption may be increased.
Clinical pharmacology
Hydrocortisone is cortisol and has glucocorticoid activity with some mineralocorticoid activity. Oral hydrocortisone is readily absorbed and mainly metabolised in the liver and other tissues. CYP3A4-modifying medicines can alter systemic exposure. Topical absorption rises through damaged or thin skin, large treated areas and occlusion.
Formulation and product differences
- Efmody is a modified-release capsule designed to produce a delayed and sustained cortisol profile; capsules must not be chewed.
- Sontirco is an immediate-release tablet with systemic replacement and selected emergency anti-inflammatory indications.
- Dispersible tablets can be dispersed in water or swallowed whole, subject to product instructions.
- Creams are generally less greasy and may suit moist or weeping lesions; ointments are more occlusive and may suit dry or scaly lesions.
- Mildison Lipocream has a lipid-rich base and excipients that may cause local reactions; paraffin-containing products present a fabric fire hazard.
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%
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.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.