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Khindivi
hydrocortisone
Adult Dosing .
Adult dosing is currently unavailable or not applicable for this drug.
Peds Dosing .
- Dosage forms: SOL: 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 dz severity and tx response; round dose to nearest 0.5 mg or 1 mg; may give total daily dose divided bid in older pts; higher doses may be required based on pt age and dz 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 dz severity and tx response; round dose to nearest 0.5 mg or 1 mg; may give total daily dose divided bid in older pts; 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 pts (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
- GI mucosal injury/bleeding risk
- hyperammonemia
- hyperglycemic effects
- hypernatremia
- hypertensive effects
- hypokalemia
- immunosuppressive effects
- interferes w/ ACTH analog test
- lowers seizure threshold
Contraindicated
- adenovirus vaccine, live
- BCG live intravesical
- chikungunya vaccine, live
- cholera vaccine, live
- dengue vaccine, live
- desmopressin
- influenza nasal vaccine, live
- iohexol
- iopamidol
- measles/mumps/rubella vaccine, live
- mifepristone
- rotavirus vaccine, live
- smallpox vaccine, live
- talimogene laherparepvec
- typhoid vaccine, live
- varicella vaccine, live
- yellow fever vaccine, live
Avoid/Use Alternative
- afamitresgene autoleucel
- aldesleukin
- amifampridine
- amphotericin
- arsenic trioxide
- astragalus
- axicabtagene ciloleucel
- betamethasone
- brexucabtagene autoleucel
- budesonide
- ciltacabtagene autoleucel
- cladribine oral
- cortisone
- deflazacort
- dexamethasone
- epinephrine inhaled
- furosemide
- idecabtagene vicleucel
- lifileucel
- lisocabtagene maraleucel
- lutetium Lu 177 dotatate
- macimorelin
- methylprednisolone
- midodrine
- natalizumab
- nevirapine
- obecabtagene autoleucel
- pimecrolimus topical
- prednisolone
- prednisone
- rabies vaccine
- tisagenlecleucel
- triamcinolone
- vamorolone
Monitor/Modify Tx
- abiraterone acetate
- acalabrutinib
- acarbose
- acebutolol
- acetazolamide
- adagrasib
- ado-trastuzumab emtansine
- afatinib
- albuterol
- albuterol inhaled
- alendronate
- aliskiren
- almotriptan
- aloe
- alogliptin
- alteplase
- amiloride
- amlodipine
- amphetamine
- anacaulase topical
- anagrelide
- angiotensin II
- anthrax vaccine
- antithrombin
- apalutamide
- apixaban
- aprepitant
- aprocitentan
- arformoterol inhaled
- argatroban
- armodafinil
- asciminib
- asparaginase
- aspirin
- atazanavir
- atenolol
- atogepant
- atomoxetine
- atropine ophthalmic
- avacopan
- avapritinib
- axitinib
- azilsartan medoxomil
- bempedoic acid
- benazepril
- benzphetamine
- berotralstat
- betaxolol
- bevacizumab
- bexagliflozin
- binimetinib
- bismuth subsalicylate
- bisoprolol
- bivalirudin
- bosentan
- brentuximab vedotin
- brigatinib
- bromelain
- bromocriptine
- bumetanide
- bupropion
- butalbital
- cabazitaxel
- cabozantinib
- caffeine
- caffeine citrate
- calaspargase
- canagliflozin
- candesartan cilexetil
- cangrelor
- cannabis
- caplacizumab
- captopril
- carbamazepine
- carboplatin
- carfilzomib
- carglumic acid
- carvedilol
- celecoxib
- cenobamate
- ceritinib
- cetuximab
- chikungunya vaccine
- chloramphenicol
- chlorothiazide
- chlorthalidone
- cholestyramine
- cilostazol
- cinacalcet
- ciprofloxacin
- cisplatin
- citalopram
- clarithromycin
- clevidipine
- clofazimine
- clonidine
- clopidogrel
- cobicistat
- cocaine
- colesevelam
- colestipol
- conivaptan
- copanlisib
- corticotropin
- cosyntropin
- COVID-19 vaccine
- crizotinib
- cyclosporine
- cysteamine
- dabigatran
- dabrafenib
- dalteparin
- danazol
- danshen
- dapagliflozin
- darbepoetin alfa
- darunavir
- dasatinib
- decitabine
- deferasirox
- defibrotide
- desvenlafaxine
- deuruxolitinib
- dexmethylphenidate
- dextroamphetamine
- dichlorphenamide
- diclofenac
- diclofenac topical
- diethylpropion
- diflunisal
- digoxin
- dihydroergotamine
- diltiazem
- dimethyl fumarate
- dinutuximab
- diosmin
- diphtheria/tetanus vaccine
- diphtheria/tetanus/pertussis vaccine
- dipyridamole
- diroximel fumarate
- dobutamine
- donepezil
- dopamine
- doxapram
- doxazosin
- dronabinol
- dronedarone
- droxidopa
- dulaglutide
- duloxetine
- duvelisib
- ebola vaccine, live
- edoxaban
- efavirenz
- eletriptan
- emapalumab
- empagliflozin
- enalapril
- enalaprilat
- encorafenib
- enoxaparin
- enzalutamide
- ephedra
- ephedrine injection
- ephedrine oral
- epinephrine
- eplerenone
- epoetin alfa
- eptifibatide
- eptinezumab
- erenumab
- ergotamine
- erlotinib
- ertugliflozin
- erythromycin
- escitalopram
- esketamine
- esmolol
- estetrol (contraceptive)
- estradiol (contraceptive)
- estradiol (hormone replacement)
- estrogens, conjugated (hormone replacement)
- estrogens, esterified (hormone replacement)
- etelcalcetide
- ethacrynic acid
- ethanol
- ethinyl estradiol (contraceptive)
- ethinyl estradiol (hormone replacement)
- etodolac
- etrasimod
- etravirine
- evening primrose oil
- everolimus
- exenatide
- fedratinib
- felodipine
- fenfluramine
- fenoldopam
- fenoprofen
- fenugreek
- fexinidazole
- fingolimod
- fluconazole
- fludrocortisone
- fluoxetine
- flurbiprofen
- fluvoxamine
- fondaparinux
- formoterol inhaled
- fosamprenavir
- foscarnet
- fosinopril
- fosphenytoin
- fostamatinib
- fremanezumab
- frovatriptan
- fruquintinib
- galantamine
- galcanezumab
- garlic
- gefitinib
- gemtuzumab ozogamicin
- ginkgo
- glimepiride
- glipizide
- glyburide
- glycerol phenylbutyrate
- grapefruit
- guanfacine
- Haemophilus b vaccine
- heparin
- hepatitis A vaccine
- hepatitis B vaccine
- hoodia
- human papillomavirus vaccine
- hydralazine
- hydrochlorothiazide
- ibandronate
- ibrutinib
- ibuprofen
- ibuprofen lysine
- idelalisib
- iloprost inhaled
- imatinib
- indapamide
- indomethacin
- influenza H5N1 vaccine
- influenza vaccine
- insulin
- irbesartan
- isavuconazonium
- isoproterenol
- isradipine
- itraconazole
- ivosidenib
- Japanese encephalitis vaccine
- ketamine
- ketoconazole
- ketoprofen
- ketorolac
- labetalol
- lanreotide
- lanthanum
- lefamulin
- leflunomide
- lenacapavir
- lenalidomide
- lenvatinib
- letermovir
- levalbuterol inhaled
- levoketoconazole
- levomilnacipran
- licorice
- linagliptin
- liraglutide
- lisdexamfetamine
- lisinopril
- lixisenatide
- lonafarnib
- lopinavir/ritonavir
- lorlatinib
- losartan
- lumacaftor/ivacaftor
- luspatercept
- magnesium citrate
- magnesium salicylate
- mannitol
- mavacamten
- meclofenamate
- mefenamic acid
- meloxicam
- meningococcal vaccine
- metformin
- methamphetamine
- methazolamide
- methotrexate
- methoxy polyethylene glycol-epoetin beta
- methyl salicylate topical
- methyldopa
- methylergonovine
- methylphenidate
- metoclopramide
- metolazone
- metoprolol
- metyrapone
- miglitol
- milnacipran
- minoxidil
- mirabegron
- mitapivat
- mitotane
- modafinil
- moexipril
- monomethyl fumarate
- motixafortide
- mycophenolate mofetil
- mycophenolic acid
- nabumetone
- nadolol
- nafcillin
- naproxen
- naratriptan
- nateglinide
- nattokinase
- naxitamab
- nebivolol
- necitumumab
- nefazodone
- nelfinavir
- neostigmine
- netupitant
- niacin (vitamin B3)
- nicardipine
- nifedipine
- nilotinib
- nimodipine
- nintedanib
- niraparib
- nirogacestat
- nisoldipine
- norepinephrine
- nusinersen
- olmesartan medoxomil
- olodaterol inhaled
- osilodrostat
- oxaliplatin
- oxaprozin
- oxcarbazepine
- oxymetazoline nasal
- oxytocin
- ozanimod
- pacritinib
- pamidronate
- panitumumab
- paroxetine
- pazopanib
- pegaspargase
- penicillin G
- pentobarbital
- pentosan polysulfate sodium
- pentoxifylline
- perindopril
- pexidartinib
- phendimetrazine
- phenobarbital
- phenoxybenzamine
- phentermine
- phentolamine
- phenylephrine
- phenylephrine injection
- phenylephrine nasal
- phenylephrine ophthalmic
- phenylephrine rectal
- phenytoin
- pindolol
- pioglitazone
- piperacillin
- piroxicam
- pirtobrutinib
- plasminogen, human
- pneumococcal vaccine
- poliovirus vaccine
- polyethylene glycol
- polyethylene glycol/electrolytes
- ponatinib
- ponesimod
- porfimer
- posaconazole
- pralsetinib
- pramlintide
- prasugrel
- prazosin
- primidone
- propranolol
- pseudoephedrine
- pyridostigmine
- quetiapine
- quinapril
- ramipril
- ramucirumab
- regorafenib
- repaglinide
- repotrectinib
- respiratory syncytial virus vaccine
- resveratrol
- reteplase
- ribociclib
- rifabutin
- rifampin
- rifapentine
- rimegepant
- ripretinib
- risedronate
- ritonavir
- rivaroxaban
- rivastigmine
- rizatriptan
- ropinirole
- rosiglitazone
- rotigotine transdermal
- sacituzumab govitecan
- salmeterol inhaled
- salsalate
- saw palmetto
- saxagliptin
- selinexor
- selpercatinib
- selumetinib
- semaglutide
- sertraline
- siponimod
- sipuleucel-T
- sirolimus albumin-bound
- sitagliptin
- smallpox/mpox vaccine, live
- sodium acid phosphate
- sodium benzoate
- sodium phenylacetate
- sodium phenylbutyrate
- sodium polystyrene sulfonate
- sodium thiosulfate
- solriamfetol
- sorafenib
- sotatercept
- sotorasib
- spironolactone
- St. John's wort
- sulfate bowel prep
- sulindac
- sumatriptan
- sunitinib
- tacrolimus
- tafasitamab
- tagraxofusp
- telmisartan
- temsirolimus
- tenecteplase
- terazosin
- terbutaline
- teriflunomide
- testosterone
- ticagrelor
- tick-borne encephalitis vaccine
- timolol
- tipranavir
- tirofiban
- tirzepatide
- tisotumab vedotin
- tivozanib
- tocilizumab
- tolmetin
- topiramate
- torsemide
- tovorafenib
- trametinib
- trandolapril
- trastuzumab
- trazodone
- treprostinil
- triamterene
- tucatinib
- typhoid vaccine
- ubrogepant
- upadacitinib
- vadadustat
- valproic acid
- valsartan
- vandetanib
- vasopressin
- venlafaxine
- verapamil
- vilanterol inhaled
- vilazodone
- viloxazine
- vinpocetine
- voclosporin
- vorapaxar
- voriconazole
- vortioxetine
- warfarin
- willow bark
- yohimbe
- zanubrutinib
- zavegepant
- ziv-aflibercept
- zolmitriptan
- zonisamide
Caution Advised
- abatacept
- abemaciclib
- abrocitinib
- adalimumab
- alemtuzumab
- anakinra
- anifrolumab
- anti-thymocyte globulin
- artemether/lumefantrine
- atidarsagene autotemcel
- azacitidine
- azathioprine
- baricitinib
- beclomethasone inhaled
- beclomethasone nasal
- belimumab
- belinostat
- belzutifan
- bendamustine
- bexarotene
- bimekizumab
- blinatumomab
- bortezomib
- brodalumab
- budesonide inhaled
- budesonide nasal
- budesonide rectal
- busulfan
- canakinumab
- carmustine
- cat's claw
- certolizumab pegol
- chlorambucil
- cladribine injection
- clobazam
- clobetasol ophthalmic
- clofarabine
- clomipramine
- clozapine
- crovalimab
- cyclophosphamide
- cytarabine
- dactinomycin
- danicopan
- daratumumab
- darolutamide
- daunorubicin
- deucravacitinib
- dexamethasone ophthalmic
- dicloxacillin
- difluprednate ophthalmic
- docetaxel
- doxorubicin
- dupilumab
- echinacea
- eculizumab
- efgartigimod alfa
- elafibranor
- elagolix
- eleuthero
- elivaldogene autotemcel
- elotuzumab
- elranatamab
- enasidenib
- epcoritamab
- epirubicin
- eribulin
- eslicarbazepine acetate
- etanercept
- etoposide
- felbamate
- floxuridine
- fludarabine
- flunisolide nasal
- fluocinolone intravitreal
- fluorometholone ophthalmic
- fluorouracil
- fluticasone furoate
- fluticasone propionate
- gemcitabine
- ginseng, Asian
- glofitamab
- golimumab
- griseofulvin
- guselkumab
- hydrocortisone ophthalmic
- hydroxychloroquine
- hydroxyurea
- ibritumomab tiuxetan
- idarubicin
- ifosfamide
- inebilizumab
- infliximab
- inotuzumab ozogamicin
- iptacopan
- irinotecan
- isatuximab
- isoniazid
- isotretinoin
- ixabepilone
- ixekizumab
- lebrikizumab
- levofloxacin
- linvoseltamab
- lomustine
- loncastuximab tesirine
- loteprednol ophthalmic
- lymphocyte immune globulin, anti-thymocyte globulin
- melphalan
- mercaptopurine
- meropenem
- methacholine inhaled
- methyltestosterone
- mirikizumab
- mitoxantrone
- mobocertinib
- mogamulizumab
- momelotinib
- mometasone implant
- mometasone inhaled
- mometasone nasal
- mosunetuzumab
- moxifloxacin
- nadofaragene firadenovec intravesical
- nafarelin
- nelarabine
- nipocalimab
- obinutuzumab
- ocrelizumab
- odevixibat
- ofatumumab
- ofloxacin
- olutasidenib
- omaveloxolone
- paclitaxel
- panobinostat
- pegcetacoplan
- pentostatin
- perampanel
- polatuzumab vedotin
- pomalidomide
- pozelimab
- prednisolone ophthalmic
- procarbazine
- promethazine
- quizartinib
- ravulizumab
- rilonacept
- risankizumab
- ritlecitinib
- rituximab
- romidepsin
- ropeginterferon alfa-2b
- rozanolixizumab
- rufinamide
- ruxolitinib
- ruxolitinib topical
- sarilumab
- satralizumab
- secukinumab
- siltuximab
- sirolimus
- sodium picosulfate
- somatrogon
- somatropin
- spesolimab
- stiripentol
- sulfasalazine
- sutimlimab
- suzetrigine
- talquetamab
- tarlatamab
- tazemetostat
- teclistamab
- tecovirimat
- telotristat ethyl
- temozolomide
- teplizumab
- teriparatide
- tezepelumab
- thioguanine
- thiotepa
- tildrakizumab
- tofacitinib
- topotecan
- tralokinumab
- tramadol
- treosulfan
- tuberculin purified protein derivative
- ublituximab
- ustekinumab
- vaborbactam
- vedolizumab
- vemurafenib
- venetoclax
- vilobelimab
- vinblastine
- vincristine
- vinorelbine
- vorasidenib
- zilucoplan
Adverse Reactions .
Serious Reactions
- hypersensitivity rxn
- 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 sx 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, s/sx 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 pts incr. hyperosmolarity risk; metabolic acidosis, hypoglycemia, hepatorenal injury, CNS toxicity, GI rxn may occur; consider combined daily amt from all sources and ingredients w/ 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, esp. in 1st trimester; risk of fetal harm not expected w/ 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 w/ 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 w/ high-dose depot steroid injection
Pharmacology .
Metabolism: liver; CYP450: 3A4 substrate
Excretion: urine (minimally unchanged); Half-life: 0.95h (solution form), 1.5h (cap form)
Subclass: Corticosteroids, Systemic
Mechanism of Action
inhibits multiple inflammatory cytokines; produces multiple glucocorticoid and mineralocorticoid effects
Formulary .
No Formulary Selected
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