Hydrocortisone
CORTEF cortisol
Pronunciation: hye-droe-KOR-ti-soen
“Hydra Court his soul”
Hydra Court his soul
Hydrocortisone is chemically identical to endogenous cortisol
cushingoid moon face → corticosteroid
What it isGlucocorticoid and mineralocorticoid agonist; adrenal replacement and anti-inflammatory treatment.
Why this oneIts short action and balanced receptor activity make it the corticosteroid that best mimics endogenous cortisol.
What limits itAdrenal replacement requires stress dosing during illness; prolonged systemic exposure suppresses the axis and cannot be stopped abruptly.
FDA-approved for
- adrenal insufficiency/inflammation (~1952)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Corticosteroid-responsive conditions | adult | 20-240 mg/day (per disease severity) | lowest dose maintaining response |
Renal Undefined
Hepatic Undefined
Instructions
- Individualize dose to disease and patient response
- After favorable response, decrease in small decrements to lowest effective maintenance dose
- Withdraw gradually after long-term therapy - do not stop abruptly
- May need temporary dose increase during stress/illness
Available strengths
- tab 5, 10, 20 mg
- granules 0.5, 1, 2, 5 mg
- sol 2.5 %
- sol 1 mg/mL
- susp 100 mg/60 mL
- cream 0.2, 1, 2.5 %
- enema 100 mg/60 mL
- foam 1500 mg/15 g
- + 16 other marketed forms not shown
Contraindications
- Systemic fungal infections
Cautions
- HPA-axis / adrenal suppression, especially under stress
- Increased infection risk / masking of infection
- Fluid and sodium retention, hypokalemia, hypertension, CHF in susceptible patients
- Hyperglycemia / decreased glucose tolerance
- Osteoporosis; growth suppression in children
- Peptic ulcer, posterior subcapsular cataracts, glaucoma
Adverse reactions
- Fluid/sodium retention, hypokalemia, hypertension
- Muscle weakness, osteoporosis, vertebral compression fracture
- Peptic ulcer, pancreatitis
- Impaired wound healing, thin fragile skin
- Cushingoid state, hyperglycemia
- Cataracts, increased intraocular pressure/glaucoma
Pregnancy Undefined
Lactation Undefined
Cost
| Strength | #/mo | generic $/unit | CostPlus | |
|---|---|---|---|---|
| 5 mg | tab | per unit | $0.14/ea | offered |
| 10 mg | tab | per unit | $0.18/ea | offered |
| 20 mg | tab | per unit | $0.30/ea | offered |
Other forms: Hydrocortisone topical (CORTIZONE-10)
Generic entryLong generic
NO BOXED WARNINGS
Principal riskAdrenal suppression with prolonged systemic use
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityGenerally tolerated at therapeutic doses; clinically important risks are agent-specific and increase with interactions or organ impairment.