hydrocortisone
Brand: Solu-Cortef, Cortef, Hydrocortone
Prototype: prednisone
Drug Class: corticosteroid
Drug Family: corticosteroid
Subclass: natural glucocorticoid with mineralocorticoid activity
Organ Systems: endocrineimmunology
Mechanism of Action
Identical to cortisol, the principal endogenous glucocorticoid. Binds glucocorticoid receptors, translocates to the nucleus, and modifies gene transcription to broadly suppress inflammation and immune activation. Also has significant mineralocorticoid activity, promoting sodium retention and potassium excretion.
glucocorticoid receptor (GR)mineralocorticoid receptor (MR)
Indications
- adrenal insufficiency (primary and secondary) — first-choice for physiologic replacement
- adrenal crisis (IV)
- severe inflammation or immune reactions
- septic shock (physiologic doses)
Contraindications
- systemic fungal infections (except replacement therapy)
- hypersensitivity to corticosteroids
Adverse Effects
Common
- hyperglycemia
- insomnia
- increased appetite
- weight gain
- mood changes
Serious
- adrenal suppression
- Cushing's syndrome
- osteoporosis
- peptic ulcer
- increased infection susceptibility
- electrolyte abnormalities (hypokalemia, hypernatremia)
Pharmacokinetics (ADME)
| Absorption | oral, IV, IM; excellent oral bioavailability |
| Distribution | widely distributed; crosses BBB and placenta |
| Metabolism | hepatic to inactive metabolites |
| Excretion | renal |
| Half-life | 1.5–2 hours (plasma); 8–12 hours (biologic effect) |
| Onset | 1–2 hours (IV immediate) |
| Peak | varies by route |
| Duration | 8–12 hours (biologic effect) |
| Protein Binding | 90% |
| Vd | 0.5 L/kg |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| NSAIDs | additive GI ulceration risk | major |
| potassium-depleting diuretics | additive hypokalemia | moderate |
| live vaccines | impaired immune response to vaccine; may cause disseminated infection | major |
Nursing Considerations
- For adrenal crisis: administer 100 mg IV bolus immediately followed by continuous infusion or q8h dosing; this is a life-saving emergency measure.
- Administer oral hydrocortisone in two doses mimicking diurnal cortisol pattern: larger morning dose (e.g., 20 mg) and smaller afternoon dose (e.g., 10 mg).
- Teach 'sick day rules' for adrenal insufficiency patients: double/triple dose during febrile illness, injury, or minor surgery; provide injectable hydrocortisone for emergencies.
- Monitor for signs of Cushing's (moon face, buffalo hump, striae) and signs of adrenal insufficiency on dose changes.
Clinical Pearls
- Hydrocortisone is the preferred corticosteroid for physiologic adrenal replacement because it is bioidentical to cortisol and has the closest mineralocorticoid:glucocorticoid activity ratio to endogenous cortisol.
- In septic shock, physiologic-dose hydrocortisone (200 mg/day) is recommended by the 2021 Surviving Sepsis Campaign for patients not responsive to fluids and vasopressors.
Safety Profile
Pregnancy avoid
Lactation use-with-caution
Renal Adjustment Not required
Hepatic Adjustment Not required
TDM Not required
Concordance Terms
Cross-referenced clinical concepts — click any term to see all content where it appears.