Hydrocortisone
CORTEF cortisol
Pronunciation: hye-droe-KOR-ti-soen
“Hydra Court his soul”
Hydra Court his soul
Hydrocortisone is chemically identical to endogenous cortisol
cushingoid moon face → corticosteroid
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.
Hydrocortisone prescription history
Animated chart of estimated U.S. prescriptions per year, Corticosteroids (systemic) (1950–2026). Hydrocortisone enters in 1953 (estimated).
FDA-approved for
- adrenal insufficiency/inflammation (~1952)
Principal riskAdrenal suppression with prolonged systemic use
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.
FDA label
Read the full label on DailyMed ↗
NO BOXED WARNINGS
| 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
Available strengths
- tab 5, 10, 20 mg
- granules 0.5, 1, 2, 5 mg
- sol 2.5 %
- sol 1 mg/mL
- susp 100 mg/60 mL
- cream 0.2, 1, 2.5 %
- enema 100 mg/60 mL
- foam 1500 mg/15 g
- + 16 other marketed forms not shown
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
Cost
| Strength | #/mo | generic $/unit | CostPlus | |
|---|---|---|---|---|
| 5 mg | tab | per unit | $0.14/ea | offered |
| 10 mg | tab | per unit | $0.18/ea | offered |
| 20 mg | tab | per unit | $0.30/ea | offered |
Other forms: Hydrocortisone topical (CORTIZONE-10)
Generic entryLong generic
Open Hydrocortisone in the interactive console ↗
Self-check
- What dose change is needed during illness for hydrocortisone adrenal replacement?
Stress dosing. - May prolonged systemic hydrocortisone be stopped abruptly?
No.