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Khindivi
hydrocortisone
Adult Dosing .
Adult dosing is currently unavailable or not applicable for this drug.
Peds Dosing .
- Dosage forms: SOLUTION: 1 mg per mL
adrenal insufficiency, chronic
- [5 yo and older]
- Dose: 8-10 mg/m^2/day PO divided tid; Info: individualize dose based on disease severity and tx response; round dose to nearest 0.5 mg or 1 mg; may give total daily dose divided bid in older patients; higher doses may be required based on patient age and disease severity; switch to other hydrocortisone product during periods of stress or acute events; taper dose gradually to D/C
congenital adrenal hyperplasia, maintenance tx
- [5 yo and older]
- Dose: 10-15 mg/m^2/day PO divided tid; Info: individualize dose based on disease severity and tx response; round dose to nearest 0.5 mg or 1 mg; may give total daily dose divided bid in older patients; taper dose gradually to D/C
renal dosing
- [no adjustment]
- renal impairment: no adjustment
- HD/PD: no adjustment; no supplement
hepatic dosing
- [not defined]
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- abrupt withdrawal
- caution: hypersensitivity to corticosteroids
- caution: other hydrocortisone PO form use, recent
- caution: immunosuppressed patients (high-dose use)
- caution: infection, active (high-dose use)
- caution: infection risk (high-dose use)
- caution: HTN
- caution: pheochromocytoma risk
- caution: CHF
- caution: MI, recent
- caution: diabetes mellitus
- caution: PUD
- caution: ulcerative colitis
- caution: diverticulitis
- caution: intestinal anastomosis, recent
- caution: GI perforation risk
- caution: seizure disorder
- caution: psychiatric disorder
- caution: thyroid disorder
- caution: osteoporosis
- caution: osteoporosis risk
- caution: myasthenia gravis
- caution: optic neuritis
- caution: renal impairment
- caution: cirrhosis
Drug Interactions .
Overview
hydrocortisone
corticosteroid
- CYP3A4 substrate
- affects growth hormone diagnostic test results
- binds to anion exchange resin/polymer
- corticosteroid
- GI mucosal injury/bleeding risk
- hyperammonemia
- hyperglycemic effects
- hypernatremia
- hypertensive effects
- hypokalemia
- immunomodulatory effects
- interferes w/ ACTH analog test
- lowers seizure threshold
Contraindicated
Avoid/Use Alternative
Monitor/Modify Tx
Caution Advised
Adverse Reactions .
Serious Reactions
- hypersensitivity reaction
- anaphylaxis
- adrenal insufficiency
- steroid psychosis
- steroid myopathy
- Cushing syndrome (prolonged high-dose use)
- diabetes mellitus
- pseudotumor cerebri
- ICP incr.
- seizures
- hypokalemic alkalosis
- HTN
- CHF
- pancreatitis
- GI perforation
- PUD
- exophthalmos
- osteonecrosis
- tendon rupture
- osteoporosis (long-term use)
- infection (high-dose use)
- immunosuppression (high-dose use)
- Kaposi sarcoma (prolonged high-dose use)
- growth suppression (long-term use)
- glaucoma (prolonged high-dose use)
- cataracts (prolonged high-dose use)
- central serous chorioretinopathy (prolonged high-dose use)
- withdrawal symptoms if abrupt D/C
Common Reactions
- fever
- gastroenteritis
- URI
- vomiting
- viral infection
- conjunctivitis
- otitis media
- tonsillitis
- bronchitis
- dental caries
- diarrhea
- pharyngitis
- rhinitis
- weight gain
- appetite incr.
- fluid retention
- BP elevated
- behavior changes
- glucose intolerance
- depression
Safety/Monitoring .
Monitoring Parameters
BP, glucose, height, weight, signs/symptoms of depression, behavior changes q6mo; electrolytes; ophthalmic exam if changes in vision
Polyethylene Glycol, Propylene Glycol, Glycerin Content
contains 500 mg polyethylene glycol 400, 50 mg propylene glycol, and 623 mg glycerin per mL; incomplete alcohol dehydrogenase maturity in peds patients incr. hyperosmolarity risk; metabolic acidosis, hypoglycemia, hepatorenal injury, CNS toxicity, GI reaction may occur; consider combined daily amount from all sources and ingredients with same metabolic pathways
Look/Sound-Alike Drug Names
hydrocortisone confused with: cortisone; fludrocortisone; hydrALAZINE; hydroCHLOROthiazide; HYDROcodone; hydroxychloroquine; predniSONE
Pregnancy/Lactation .
Pregnancy
Clinical Summary
weigh risk/benefit during pregnancy, especially in 1st trimester; risk of fetal harm not expected with physiologic doses based on human data, though possible risk of orofacial cleft based on conflicting human data and animal data; possible risk of low birth wt and premature birth based on limited human data; possible risk of fetal adrenal suppression based on drug's mechanism of action
Lactation
Clinical Summary
weigh risk/benefit while breastfeeding, consider holding breastfeeding x4h after dose if prolonged high-dose use; no human data available, though risk of infant harm not expected based on limited human data with other corticosteroids and drug properties; possible risk of suppressed infant growth and endogenous steroid production based on drug's mechanism of action; no human data available, though possible transient decr. milk production based on limited human data with high-dose depot steroid injection
Pharmacology .
Metabolism: for hydrocortisone: liver; CYP450: 3A4 substrate
Excretion: for hydrocortisone: urine (minimally unchanged); Half-life: 0.95h (solution form), 1.5h (cap form), 8-12h (biological)
Subclass: Corticosteroids, Systemic
Mechanism of Action
for hydrocortisone: inhibits multiple inflammatory cytokines; produces multiple glucocorticoid and mineralocorticoid effects
Formulary .
No Formulary Selected
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