Hydrocortisone
Overview
Hydrocortisone a naturally occuring corticosteroid used princially for its anti-inflammatory and immunosuppressive actions or as a hormone replacement therapy. Used to reduce swelling and inflammation. Hydrocortisone used in a variety of disorders including allergic conditions, respiratory conditions, blood disorders, digestive problems, eyes, skin, and rheumatic disorders etc.
Primary Characteristics
Hydrocortisone Natural origin and belongs to Steroid. It belongs to Glucocorticoid agonist pharmacological group on the basis of mechanism of action and also classified in Adrenal Cortical Steroids pharmacological group. The Molecular Weight of Hydrocortisone is 362.50.
Its pKa is 13.81.
Indications
Hydrocortisone primarily indicated in conditions like Adrenal insufficiency, Anaphylactic reactions, Apthous ulcers, Atopic eczema, Collagen disease, Congenital adrenal hyperplasia, Contact allergic dermatitis, Discoid eczema, Flexural psoriasis, Graft rejection, Hypercalcaemia, Infantile eczema. Inflammation, Irritant dermatitis, Itching, Joint inflammation, Perineal trauma, Seborrheic dermatitis, Shock, Soft tissue inflammation, Status asthmaticus, Ulcerative protocolitis, and can also given in adjunctive therapy as an alternative drug of choice in Anaphylactic shock, Insect bites and Otitis externa, Sunburn, Ulcerative colitis.
Pharmacokinetics
Oral absorption of Hydrocortisone found to be 100% . Volume of distribution found to be 0.4-0.7 l/kg and plasma protein binding >90%. Presystemic metabolism noted to be 37% ±37 and metabolism reported extensively via liver. Renal Excretion accounts for major and plasma half life is 6-120 min.
Mechanism of action
The short term effects of corticosteroids are decreased vasodilation and permeability of capillaries, as well as decreased leukocyte migration to sites of inflammation.[A187463] Corticosteroids binding to the glucocorticoid receptor mediates changes in gene expression that lead to multiple downstream effects over hours to days.
Glucocorticoids inhibit neutrophil apoptosis and demargination, inhibit phospholipase A2. which decreases the formation of arachidonic acid derivatives and inhibit NF-Kappa B and other inflammatory transcription factors, they promote anti-inflammatory genes like interleukin-10.
Lower doses of corticosteroids provide an anti-inflammatory effect, while higher doses immunosuppressive. High doses of glucocorticoids for an extended period bind to the mineralocorticoid receptor, raising sodium levels and decreasing potassium levels.
Side Effects
The severe or irreversible adverse effects of Hydrocortisone, which give rise to further complications include Convulsions. GI bleeding, Telangiectasia, Striae, Glaucoma, Cataract, Pancreatitis. Hypersensitivity reactions, Osteoporosis, Psychosis, Increased intracranial pressure, Growth retardation, Glucose intolerance, Epidermal thinning, Vertebral fractures, Avascular necrosis, Papilloedema, Opthalmic fungal or viral disease, Dendritic corneal ulcers. Thromboembolic disorder, Long bone fractures, Hypokalemic alkalosis, Reduced visual function, Tendon rupture, Intestinal perforation, Opportunistic infections, Addisonian crises, Adrenal atrophy, Increased IOP (intraocular pressure) and Subcutaneous atrophy.
Hydrocortisone produces potentially life-threatening effects which include Anaphylactoid reactions, Addisonian crises, CHF, Opportunistic infections and Acute pancreatitis, GI hemorrhage. which are responsible for the discontinuation of Hydrocortisone therapy.
The signs and symptoms that produced after the acute overdosage of Hydrocortisone include hypomagnesaemia, Adrenal suppression and Hyperkalemia.
The symptomatic adverse reactions produced by Hydrocortisone more or less tolerable and if they become severe. they treated symptomatically, these include Insomnia, Irritation, Allergic reactions, Itching, Burning, Depression, Weight gain, Acne, Euphoria, Menstrual irregularity. Also Perioral dermatitis, Cushingoid facies, Mood swings, Dryness, Local hypopigmentation and Stinging.
Warning / Precautions
Hydrocortisone used with caution in patients with active tuberculosis infection of respiratory tract or in untreated fungal, bacterial or systemic viral infections. Corticosteroids should only be used systemically with great caution in the presence of congestive heart failure (CHF), recent myocardial infraction (MI). Hypertension, diabetes mellitus, epilepsy, glaucoma, hypothyroidism, liver failure, osteoporosis and peptic ulceration or renal impairment. Children may at increase risk of some adverse effects, corticosteroid causes growth retardation and prolonged use rarely justified. Passive immunization recommended to non-immune patients who do come in contact with chickenpox or measles.
Live vaccine not given to patients receiving high dose systemic and corticosteroid therapy nor for atleast 3 months afterwards. killed vaccine or toxoids may be given, although the response may attenuated. During prolong treatment with corticosteroids, patients examined regularly. sodium intake need to be reduced and calcium and potassium supplement may be necessary. Patient should carry cards given full details of their corticosteroid therapy. Avoid and use during pregnancy. Use nasal steroids with caution until healing has occurred. Donot take Hydrocortisone if you allergic to it. Donot exceed recommended dose. Avoid getting this medication in your eyes. Caution required in children.
Storage Conditions
Inj, Oral Susp, Dental Paste, Cream, Oint.
Store Below 40°C. Do not Freeze. Protect from Sunlight.
Suppositories
Store at room temperature, Below 15°C or in refrigerator. Do not Freeze. Protect from Sunlight and Moisture.
Tab
Store at room temperature.
Interference in Pathology
Increases Cortisol metabolites in urine.