OLCORT CREAM

Indications

• Adrenal insufficiency (Addison's disease)
• Inflammatory conditions (e.g., arthritis, dermatitis)
• Allergic reactions
• Autoimmune diseases (e.g., lupus, multiple sclerosis)
• Certain cancers as part of chemotherapy regimens

Dosage

Children: Refer to BNF for Children for appropriate dosing information.

Adults: Dosage varies widely depending on the condition being treated. Refer to specific guidelines or BNF for precise dosing recommendations.

Mechanism of action

Hydrocortisone exerts its effects by binding to the glucocorticoid receptor, leading to the regulation of gene expression. This results in decreased production of pro-inflammatory cytokines and mediators, thus reducing inflammation and immune responses. It also promotes gluconeogenesis and affects protein and lipid metabolism.

Pharmacodynamics

Hydrocortisone demonstrates anti-inflammatory effects by inhibiting the migration of leukocytes and the accumulation of these cells at sites of inflammation. It also stabilizes lysosomal membranes, reducing the release of inflammatory mediators. Furthermore, it influences carbohydrate metabolism, increasing blood glucose levels through gluconeogenesis and glycogenolysis.

Pharmacokinetics

Hydrocortisone is rapidly absorbed following oral administration, with peak plasma concentrations occurring within 1-2 hours. It has a bioavailability of approximately 80%. The drug is highly protein-bound, primarily to corticosteroid-binding globulin and albumin. Metabolism occurs mainly in the liver via conjugation and oxidation, resulting in inactive metabolites that are excreted in the urine. The elimination half-life is approximately 1-2 hours, but effects can last longer due to receptor binding.

Contra-indications

• Systemic fungal infections
• Hypersensitivity to hydrocortisone or any component of the formulation

Adverse effects

• Increased risk of infections
• Cushing's syndrome
• Hyperglycemia
• Hypertension
• Osteoporosis
• Weight gain
• Mood changes
• Gastrointestinal disturbances

Interactions

• Non-steroidal anti-inflammatory drugs (NSAIDs) may increase the risk of gastrointestinal adverse effects
• Anticoagulants may have altered effects
• Live vaccines may be less effective or increase the risk of infection

Precautions

• Use with caution in patients with diabetes mellitus
• Caution in patients with cardiovascular disease
• Monitor for signs of infection
• Taper dosage when discontinuing long-term therapy

Pregnancy

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

Breast-feeding

Hydrocortisone is excreted in breast milk. Caution should be exercised when administered to nursing mothers.

Storage

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

Formulations

• Topical cream
• Topical ointment
• Oral tablet
• Injection solution