Oral Hydrocortisone (Cortef) Side Effects & Dosage

What is hydrocortisone, oral, and how does it work (mechanism of action)?

Hydrocortisone is a naturally-occurring
corticosteroid produced by the adrenal glands. Corticosteroids have potent
anti-inflammatory properties and are used in a wide variety of inflammatory
conditions such as:

• arthritis,
• colitis,
• asthma,
• bronchitis,
• certain skin rashes, and
• allergic or inflammatory conditions of the nose and eyes.

There are numerous
preparations of corticosteroids including oral tablets, capsules, liquids,
topical creams and gels, inhalers and eye drops, and injectable and intravenous
solutions. Hydrocortisone that is prescribed in oral, tablet and liquid forms is
addressed in this article.

Dosage requirements of corticosteroids vary among
individuals and the diseases being treated. In general, the lowest possible
effective dose is used. Corticosteroids given in multiple doses throughout the
day are more effective but also more toxic than if the same total dose is given
once daily or every other day. The FDA approved hydrocortisone in December 1952.

What brand names are available for hydrocortisone, oral?

A-Hydrocort, Solu-CORTEE, Cortef

Is hydrocortisone, oral available as a generic drug?

GENERIC AVAILABLE: Yes

Do I need a prescription for hydrocortisone, oral?

Yes

What are the side effects of hydrocortisone, oral?

Hydrocortisone side effects depend on the dose, the
duration and the frequency of administration. Short courses of hydrocortisone
usually are well tolerated with few and mild side effects. Long term, high doses
of hydrocortisone usually will produce predictable, and potentially serious side
effects. Whenever possible, the lowest effective doses of hydrocortisone should
be used for the shortest possible length of time to minimize side effects.
Alternate day dosing also can help reduce side effects.

Side effects of
hydrocortisone and other corticosteroids range from mild to serious. Side
effects include:

• fluid retention,
• weight gain,
• high blood pressure,
• potassium loss,
• headache,
• muscle weakness,
• puffiness of and hair growth on the face,
• thinning and easy bruising of the skin,
• glaucoma,
• cataracts,
• peptic ulceration,
• worsening of diabetes,
• irregular menses,
• growth retardation in children,
• convulsions, and
• psychic disturbances.

Psychic disturbances can include:

• depression,
• euphoria,
• insomnia,
• mood swings,
• personality changes, and
• psychotic behavior.

Hydrocortisone and other corticosteroids can mask signs of
infection and impair the body’s natural immune response to infection. Patients
on corticosteroids are more susceptible to infections, and can develop more
serious infections than healthy individuals. For instance,
chickenpox and
measles viruses can produce serious and even fatal illnesses in patients on high
doses of hydrocortisone. Live virus vaccines, such as the small pox vaccine,
should be avoided in patients taking high doses of hydrocortisone, since even
vaccine viruses may cause disease in these patients.

Some infectious organisms,
such as tuberculosis (TB) and malaria, can remain dormant in a patient for
years. Hydrocortisone and other corticosteroids can reactivate dormant
infections in these patients and cause serious illness. Patients with dormant TB
may require anti-TB medications while undergoing prolonged corticosteroid
treatment. Prolonged use of hydrocortisone can depress the ability of body’s
adrenal glands to produce corticosteroids.

Abruptly stopping hydrocortisone in
these individuals can cause symptoms of corticosteroid insufficiency, with
accompanying nausea, vomiting, and even shock. Therefore, withdrawal of
hydrocortisone is usually accomplished by gradual tapering. Gradually tapering
hydrocortisone not only minimizes the symptoms of corticosteroid insufficiency,
it also reduces the risk of an abrupt flare of the disease under treatment. The
insufficient adrenal gland function may not recover fully for many months after
stopping hydrocortisone. These patients need additional hydrocortisone treatment
during periods of stress, such as surgery, to avoid symptoms of corticosteroid
insufficiency and shock, while the adrenal gland is not responding by producing
its own corticosteroid.

Hydrocortisone impairs calcium absorption and new bone
formation. Patients on prolonged treatment with hydrocortisone and other
corticosteroids can develop osteoporosis and an increased risk of bone
fractures. Supplemental calcium and vitamin D are encouraged to slow this
process of bone thinning.

In rare individuals, destruction of large joints
(aseptic necrosis) can occur while undergoing treatment with hydrocortisone or
other corticosteroids. These patients experience severe pain in the joints
involved, and can require joint replacements. The reason behind such destruction
is not clear.

What is the dosage for hydrocortisone, oral?

Hydrocortisone should be taken with food. The recommended
dosage range is 10 mg to 300 mg per day depending on the disease administered in
3 to 4 divided doses.

Which drugs or supplements interact with hydrocortisone, oral?

By interfering with the patient’s immune response,
hydrocortisone can impede the effectiveness of vaccinations. Hydrocortisone also
can interfere with the tuberculin skin test and cause false negative results in
patients with
tuberculosis infection.

Rifampin and phenytoin
(Dilantin, Dilantin-125) may increase the
elimination of hydrocortisone from the body, reducing its effectiveness. Troleandomycin and ketoconazole may reduce the elimination of hydrocortisone,
possibly leading to increased side effects.

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Is hydrocortisone, oral safe to take if I’m pregnant or breastfeeding?

Hydrocortisone has not been adequately evaluated
during
pregnancy.

Hydrocortisone can appear in
breast milk, and can
have adverse effects on the baby. Therefore, mothers taking hydrocortisone
should discontinue nursing.

What else should I know about hydrocortisone, oral?

What preparations of hydrocortisone, oral are available?

Tablets: 5, 10 and 20 mg; Oral Suspension: 10 mg/5 ml.

How should I keep hydrocortisone, oral stored?

Hydrocortisone should be stored at room temperature at 20 C – 25
C (68 F – 77 F) in a sealed container.