Hydrocortisone
CORTEF cortisol
What it isGlucocorticoid and mineralocorticoid agonist; adrenal replacement and anti-inflammatory treatment.
Why this oneIts short action and balanced receptor activity make it the corticosteroid that best mimics endogenous cortisol.
What limits itAdrenal replacement requires stress dosing during illness; prolonged systemic exposure suppresses the axis and cannot be stopped abruptly.
FDA-approved for
- adrenal insufficiency/inflammation (~1952)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Corticosteroid-responsive conditions | adult | 20-240 mg/day (per disease severity) | lowest dose maintaining response |
Renal Undefined
Hepatic Undefined
Instructions
- Individualize dose to disease and patient response
- After favorable response, decrease in small decrements to lowest effective maintenance dose
- Withdraw gradually after long-term therapy - do not stop abruptly
- May need temporary dose increase during stress/illness
Contraindications
- Systemic fungal infections
Cautions
- HPA-axis / adrenal suppression, especially under stress
- Increased infection risk / masking of infection
- Fluid and sodium retention, hypokalemia, hypertension, CHF in susceptible patients
- Hyperglycemia / decreased glucose tolerance
- Osteoporosis; growth suppression in children
- Peptic ulcer, posterior subcapsular cataracts, glaucoma
Adverse reactions
- Fluid/sodium retention, hypokalemia, hypertension
- Muscle weakness, osteoporosis, vertebral compression fracture
- Peptic ulcer, pancreatitis
- Impaired wound healing, thin fragile skin
- Cushingoid state, hyperglycemia
- Cataracts, increased intraocular pressure/glaucoma
Pregnancy Undefined
Lactation Undefined
NO BOXED WARNINGS
Principal riskAdrenal suppression with prolonged systemic use
Cost, est. cash$200–$1,500/month
Generic entryLong generic
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityGenerally tolerated at therapeutic doses; clinically important risks are agent-specific and increase with interactions or organ impairment.
Mechanism of action: Hydrocortisone ballicule
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Hydra Court his soul
Hydrocortisone is chemically identical to endogenous cortisol
cushingoid moon face → corticosteroid