Hydrocortisone is a naturally occurring corticosteroid hormone produced by the adrenal cortex and is also available as a synthetic medication. It plays a vital role in regulating metabolism, immune response, and stress reactions in the body. Clinically, hydrocortisone is widely used for its anti-inflammatory, anti-allergic, and immunosuppressive properties. It is prescribed in conditions such as asthma, eczema, arthritis, adrenal insufficiency, and allergic disorders. Hydrocortisone helps reduce redness, swelling, itching, and pain associated with inflammation. It is available in various dosage forms including tablets, injections, creams, ointments, and suppositories. The drug closely resembles the body’s natural cortisol, making it suitable for hormone replacement therapy. It can be used for both systemic and topical treatment depending on the condition. Careful dosing is important to avoid side effects. Overall, hydrocortisone is an essential and commonly used corticosteroid in medical practice.
BRAND NAMES
Hydrocortisone is available under several brand names depending on its formulation and route of administration. Common oral and injectable brands include Cortef and Solu-Cortef. For topical use, it is sold as Hydrocortone and Hycort. Rectal preparations are marketed as Anusol-HC. These brand names are widely used in clinical practice.
MECHANISM OF ACTION
Hydrocortisone is a corticosteroid that acts by mimicking the natural hormone cortisol produced by the adrenal cortex. It binds to glucocorticoid receptors inside cells and modifies gene expression. This leads to decreased synthesis of inflammatory mediators such as prostaglandins and cytokines. As a result, inflammation, swelling, and immune responses are suppressed. It also affects carbohydrate, protein, and fat metabolism.
PHARMACOKINETICS
Absorption:
Hydrocortisone is well absorbed from the gastrointestinal tract after oral administration. It is rapidly absorbed when given intravenously, while topical absorption depends on skin condition.
Distribution:
Hydrocortisone is widely distributed throughout body tissues and fluids. It is highly bound to plasma proteins, mainly corticosteroid-binding globulin and albumin.
Metabolism:
Hydrocortisone is primarily metabolized in the liver. It is converted into inactive metabolites through enzymatic reactions.
Excretion:
Hydrocortisone metabolites are mainly excreted by the kidneys in urine. A small amount is eliminated in unchanged form.
PHARMACODYNAMICS
Hydrocortisone exerts strong anti-inflammatory, anti-allergic, and immunosuppressive effects. It reduces capillary permeability and inhibits leukocyte migration. The drug decreases redness, pain, and swelling at sites of inflammation. It suppresses immune system activity, reducing autoimmune reactions. It also influences electrolyte and glucose balance in the body.
ADMINISTRATION
Hydrocortisone can be administered orally, intravenously, intramuscularly, topically, or rectally. The route chosen depends on the condition being treated and its severity. Intravenous administration is used in emergency conditions such as adrenal crisis. Topical forms are used for inflammatory skin disorders. Rectal preparations are used in hemorrhoids and ulcerative colitis.
DOSAGE AND STRENGTH
Hydrocortisone tablets are commonly available in strengths of 5 mg, 10 mg, and 20 mg. Injectable doses vary depending on the severity of the condition. Topical preparations are usually available in concentrations ranging from 0.5% to 2.5%. Pediatric dosing is calculated based on body weight. Gradual dose tapering is necessary after long-term therapy.
DRUG INTERACTIONS
Hydrocortisone interacts with NSAIDs, increasing the risk of gastrointestinal bleeding. Enzyme-inducing drugs such as phenytoin can reduce its effectiveness. It can alter the effects of anticoagulants like warfarin. Diuretics may increase the risk of hypokalemia when used together. Vaccines may have reduced effectiveness during corticosteroid therapy.
FOOD INTERACTIONS
Taking hydrocortisone with food helps reduce stomach irritation. A high-salt diet can worsen fluid retention and hypertension. Alcohol increases the risk of gastric ulcers and bleeding. Potassium-rich foods may help counteract potassium loss. There are no major effects of food on drug absorption.
CONTRAINDICATIONS
Hydrocortisone is contraindicated in patients with systemic fungal infections. It should not be used in individuals with known hypersensitivity to corticosteroids. Live vaccines should be avoided during high-dose therapy. Caution is required in patients with diabetes, hypertension, or peptic ulcer disease. Use should be carefully monitored in immunocompromised patients.
SIDE EFFECTS
Common side effects include weight gain, fluid retention, and increased blood sugar levels. Patients may experience mood changes, insomnia, or irritability. Gastrointestinal irritation and ulcer formation can occur. Long-term use may cause adrenal suppression. Prolonged therapy increases the risk of infections.
OVER DOSE
Acute overdose of hydrocortisone is uncommon. Symptoms may include hypertension, electrolyte imbalance, and hyperglycemia. Chronic excessive dosing can lead to hormonal disturbances. Management is usually supportive and symptomatic. Dose reduction is required in long-term overuse.
TOXICITY
Hydrocortisone toxicity is usually associated with prolonged high-dose therapy. It may cause Cushing’s syndrome-like features such as moon face and truncal obesity. Suppression of the hypothalamic-pituitary-adrenal axis may occur. Bone loss and muscle weakness are possible with chronic use. Most toxic effects are reversible after discontinuation or dose adjustment.
