HYDRCORTISONE 1% CREAM

Indications

• Adrenal insufficiency (Addison's disease)
• Inflammatory conditions (e.g., rheumatoid arthritis)
• Allergic reactions (e.g., anaphylaxis)
• Skin disorders (e.g., eczema, psoriasis)
• Asthma exacerbations
• Certain autoimmune disorders

Dosage

Children: Refer to the BNF for Children for specific dosing recommendations for paediatric patients.

Adults: Refer to the BNF for specific dosing information based on the condition being treated.

Mechanism of action

Hydrocortisone exerts its effects by binding to glucocorticoid receptors in the cytoplasm of target cells, forming a complex that translocates to the nucleus. This complex regulates gene expression, leading to decreased production of pro-inflammatory cytokines and increased production of anti-inflammatory proteins. This mechanism results in reduced inflammation and immune response.

Pharmacodynamics

Hydrocortisone demonstrates anti-inflammatory, immunosuppressive, and anti-allergic effects. It helps to stabilize cell membranes, inhibit the migration of inflammatory cells to sites of injury, and suppress the immune response. These actions are particularly relevant in conditions characterized by excessive inflammation or immune activation.

Pharmacokinetics

Hydrocortisone is well-absorbed when administered orally. It has a bioavailability of approximately 100% with oral administration. The drug is extensively metabolized in the liver, primarily by the cytochrome P450 enzyme system, particularly CYP3A4. The elimination half-life is around 1 to 2 hours, and it is excreted primarily in the urine as metabolites. Plasma protein binding is significant, with about 90% of hydrocortisone bound to albumin and corticosteroid-binding globulin.

Contra-indications

• Systemic fungal infections
• Hypersensitivity to hydrocortisone or any of its components
• Live vaccines in patients on immunosuppressive doses

Adverse effects

• Increased risk of infections
• Cushing's syndrome
• Hyperglycemia
• Gastrointestinal disturbances
• Mood changes
• Osteoporosis
• Adrenal suppression

Interactions

• Non-steroidal anti-inflammatory drugs (NSAIDs) may increase the risk of gastrointestinal side effects
• Antidiabetic agents may require dosage adjustments due to hyperglycemic effects
• Vaccines may be less effective or cause infection in patients receiving high doses
• Anticoagulants may have altered effects

Precautions

• Use with caution in patients with diabetes mellitus
• Monitor for signs of infection
• Long-term use requires careful monitoring of adrenal function
• Taper dosage gradually to avoid adrenal crisis after prolonged therapy

Pregnancy

Hydrocortisone is classified as category C. It should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Breast-feeding

Hydrocortisone is excreted in breast milk, caution should be exercised when administering to nursing mothers.

Storage

Store at room temperature, away from light and moisture. Keep out of reach of children.

Formulations

• Oral tablet
• Topical cream
• Injection solution
• Rectal foam