Description and indication for use

Hydrocortisone is the main adrenal corticosteroid and has mainly glucocorticoid effects. These include enhancement of vascular reactivity to vasoactive substances, stimulation of the production of glucose in the liver, and increased deposition of glucose as Glycogen. Hydrocortisone also decreases peripheral glucose utilisation, and increases protein breakdown and lipolysis. It also has anti-inflammatory and immunosuppressive properties.

Hydrocortisone is used as steroid replacement in adrenal insufficiency, and in the treatment of refractory hypotension and hypoglycaemia.

Dose

Early Neonatal Hypotension

IV:

2 mg/kg/dose stat, then 1 mg/kg/dose 8 to12-hourly.

Acute adrenal insufficiency

IV:

1 to 2 mg/kg/dose stat, then 1 to 2 mg/kg/dose 6-hourly.

Congenital Adrenal Hyperplasia

IV:

0.5 to 0.7 mg/kg/DAY in divided doses initially, then adjust dose according to response.

Anti-inflammatory

IV AND IM:

2.5 mg/kg/dose 6-hourly.

Do not cease suddenly if given in high doses for longer than two weeks.

Reconstitution/Dilution

Vial = 100 mg.

IV:

To reconstitute 100 mg vial, add 2 mL of water for injection to vial = 100 mg in 2 mL = 50 mg/mL.

Dilute as required to measure dose:

For dilution to 1 mg/mL:

Withdraw 0.2 mL of 50 mg/mL solution from vial and add to 9.8 mL of sodium chloride 0.9% in a 10 mL syringe = 10 mg in 10 mL = 1 mg/mL.

For dilution to 5 mg/mL:

Withdraw 1 mL of 50 mg/mL solution from vial and add to 9 mL of sodium chloride 0.9% in a 10 mL syringe = 50 mg in 10 mL = 5 mg/mL.

Route and method of administration

IV:

Give by slow IV push over at least 5 minutes. Flush with sodium chloride 0.9%.

Contraindications

Untreated systemic bacterial infection.

Systemic fungal infection.

CAUTION in hypertension.

CAUTION in hyperglycaemia.

Drug interactions