Hydrocortisone (Oral)

Overview

Hydrocortisone is a versatile anti-inflammatory medication that is only available when prescribed by a physician. It provides relief from inflammation of many different organs of the body that can be caused by many different conditions. It acts as a glucocorticoid or adrenocortical steroid which is easily absorbed into the intestinal tract when taken as an oral medication. This corticosteroid is naturally-occurring in the body and works to reduce inflammation by changing the body's immune system. While this can provide significant relief, like all glucocorticoids Hydrocortisone may cause a profound change in the metabolic state of the body. It has been known to change the immune system's response to stimuli that the body normally would not be affected by.

Hydrocortisone is an anti-inflammatory treatment that can provide quick relief for many conditions including allergies, multiple sclerosis, ulcerative colitis, skin conditions, lupus, vision problems, bone marrow problems, asthma, arthritis, adrenal problems, and other conditions which cause inflammation and swelling. It is important to note that it is not a cure for any of these conditions and will not help treat any other symptoms of these conditions that are not caused by inflammation.

Conditions Treated

  • Inflammation
  • Alleriges
  • Autoimmune Disorders
  • Arthritis
  • Asthma
  • Multiple sclerosis
  • Skin Disorders
  • Eye or vision problems

Type Of Medicine?

  • Corticosteroid

Side Effects

Hydrocortisone may have some side effects in certain patients when it is prescribed for the treatment of inflammation. These side effects may be unpredictable and there is no way on knowing if a patient will have them or not, so it is best to be informed of the possibility of these serious side effects before taking Hydrocortisone. Some of the more serious side effects may call for medical attention or even hospitalization.

If any of the following serious side effects occur while taking hydrocortisone it is recommended that the patient or their caregiver contact emergency medical attention:

  • Irritability
  • Mental depression
  • Mood changes
  • Nervousness
  • Noisy, rattling breathing
  • Numbness or tingling in the arms or legs
  • Pounding in the ears
  • Restlessness
  • Shaking
  • Swelling of the fingers, hands, feet, or lower legs
  • Trouble thinking, speaking, or walking
  • Trouble breathing
  • ?Troubled breathing at rest
  • Trouble sleeping
  • Weight gain
  • Some side effects have an incidence that is not known, but the effects can be just as severe. Contact a medical professional if any of these symptoms emerge while taking hydrocortisone.
  • Abdominal or stomach cramping and/or burning (severe)
  • Abdominal or stomach pain
  • Backache
  • Bloody, black, or tarry stools
  • Cough or hoarseness
  • Darkening of the skin
  • Decrease in height
  • Decreased vision
  • Diarrhea
  • Eye pain
  • Eye tearing
  • Facial hair growth in females
  • Fainting
  • Fever or chills
  • Flushed, dry skin
  • Fractures
  • Fruit-like breath odor
  • Full or round face, neck, or trunk
  • Heartburn or indigestion (severe and continuous)
  • Increased hunger
  • Increased thirst
  • Increased urination
  • Loss of appetite
  • Loss of sexual desire or ability
  • Lower back or side pain
  • Menstrual irregularities
  • Muscle pain or tenderness
  • Muscle wasting or weakness
  • Nausea
  • Pain in the back, ribs, arms, or legs
  • Painful or difficult urination
  • Skin rash
  • Sweating
  • Trouble healing
  • Unexplained weight loss
  • Unusual tiredness or weakness
  • Vision changes
  • Vomiting
  • Vomiting of material that looks like coffee grounds

In addition to these serious side effects, hydrocortisone also has also produced side effects that are temporary and usually subside before requiring medical attention. The effects are a result of the body getting used to having this steroid introduced to the system and will fade as the body adjusts to the presence of the medication. Some of the more common temporary side effects include an increase in appetite or thirst when first using the drug. Some patients have also noticed an increase in abnormal-looking fat deposits in the face, neck, or torso. Skin conditions such as acne, dry scalp, redness of the face, or a lightening of normal skin color have been observed when first taking hydrocortisone. This may sometimes be accompanied by purple lines or very visible capillaries/veins in the arms, face, torso, or groin area. Swelling of the stomach area or thinning hair have been known to occur when the medication is first taken, but these symptoms are temporary and not normally cause for concern. If any of these side effects are more severe than expected or last longer than predicted contact a medical professional as they may be an indication of a more serious medical condition.

Dosage

Hydrocortisone is a medication that calls for a precise dose that is customized to the specific needs of the patient that is taking it. It may be harmful if taken in greater doses or for a longer duration of time than is indicated in the prescription. Failure to use this medication as directed increases the chances of unwanted side effects including immune system problems. If hydrocortisone is taken for a long duration it is very important that it does not cease abruptly or without the guidance of the prescribing physician. The body will be dependant on it to maintain a stable immune system response and the body may need to adjust to gradually reduced doses before stopping completely.

The dose of hydrocortisone that is prescribed will vary based on the condition that the patient is afflicted with, its severity, and the duration of time that they have had it. While manufacturer recommendations come with this drug, they are an average dose and should not be used in contradiction to the directions given by the prescribing physician. This average dose can change based on a number of factors which the doctor is taking into consideration when prescribing the medication.

When taken as an oral medication for the treatment of inflammation, hydrocortisone is normally prescribed to adults at a dose of between 20-240mg per day depending on the specific condition it is prescribed to treat. When prescribed to children, the dose must be determined by a qualified pediatrician based on the child's age, weight, and other mitigating factors. If a dose of hydrocortisone is missed this can have a severe effect on the immune system so it is recommended that the missed dose be taken as soon as possible. If it is too close to the time of the next dose it may be better to skip to the next dose of the schedule. Every step possible should be taken to prevent a double dose of this medication.

Interactions

Hydrocortisone is a potent medication that can have adverse reactions when it is mixed with other drugs. Some of these medications should not be used at the same time as hydrocortisone but - in some cases - it may represent the best course of treatment for multiple illnesses. In these situations, the prescribing physician will weigh the risk versus the potential benefits to give a more definitive recommendation for a safe treatment plan. The following medications are not normally recommended to be used with hydrocortisone:

  • Rotavirus Vaccine
  • Aceclofenac
  • Acemetacin
  • Aldesleukin
  • Amtolmetin Guacil
  • Bemiparin
  • Bromfenac
  • Bufexamac
  • Bupropion
  • Celecoxib
  • Choline Salicylate
  • Clonixin
  • Conivaptan
  • Dexibuprofen
  • Dexketoprofen
  • Diclofenac
  • Diflunisal
  • Dipyrone
  • Droxicam
  • Etodolac
  • Etofenamate
  • Etoricoxib
  • Felbinac
  • Fenoprofen
  • Fepradinol
  • ?Feprazone
  • Floctafenine
  • Flufenamic Acid
  • Flurbiprofen
  • Ibuprofen
  • Indomethacin
  • Ketoprofen
  • Ketorolac
  • Lornoxicam
  • Loxoprofen
  • Lumiracoxib
  • Meclofenamate
  • Mefenamic Acid
  • Meloxicam
  • Morniflumate
  • Nabumetone
  • Nadroparin
  • Naproxen
  • Nepafenac
  • Niflumic Acid
  • Nimesulide
  • Nimesulide Beta Cyclodextrin
  • Oxaprozin
  • Oxyphenbutazone
  • Parecoxib
  • Phenylbutazone
  • Piketoprofen
  • Piroxicam
  • Pixantrone
  • Pranoprofen
  • Proglumetacin
  • Propyphenazone
  • Proquazone
  • Rofecoxib
  • Salicylic Acid
  • Salsalate
  • Sodium Salicylate
  • Sulindac
  • Tenoxicam
  • Tiaprofenic Acid
  • Tolfenamic Acid
  • Tolmetin
  • Valdecoxib

Some medications may cause an increased chance of the side effects of one or both medications and should be used with caution. In some cases they may represent the best or only treatment option and in these cases precautions such or adjusting doses or schedules for both medications may help prevent these side effects. These drugs include the following:

  • Alcuronium
  • Atracurium
  • Balofloxacin
  • Besifloxacin
  • Ciprofloxacin
  • Colestipol
  • Enoxacin
  • Fleroxacin
  • Flumequine
  • Gallamine
  • Gatifloxacin
  • Gemifloxacin
  • Hexafluorenium
  • Levofloxacin
  • Licorice
  • Lomefloxacin
  • Metocurine
  • Moxifloxacin
  • Nadifloxacin
  • Norfloxacin
  • Ofloxacin
  • Pazufloxacin
  • Pefloxacin
  • Primidone
  • Prulifloxacin
  • Rifapentine
  • Rufloxacin
  • Saiboku-To
  • Sparfloxacin

Tosufloxacin

These interactions represent the most notable interactions that hydrocortisone has, but it is not a complete list. There may also be interactions with certain food, drink, or other consumable products that may occur. A patient taking this medication needs to keep their physician fully appraised of all prescription drugs, over-the-counter medications, supplements, vitamins, and herbal remedies that they are taking as they may have an effect on how effective hydrocortisone can be in treating inflammation.

In addition to the drug interactions which may occur, some medical conditions will affect the physician's decision to use hydrocortisone. Some of these medical problems will keep hydrocortisone from working as intended while other conditions may be exacerbated by the use of this medication. Patients should inform their doctor if they have a history of any of the following conditions or are currently suffering from them:

  • Cataracts
  • Congestive heart failure
  • Cushing's syndrome (adrenal gland problem)
  • Diabetes
  • Eye infection (eg, herpes infection of the eyes)
  • Glaucoma
  • Hyperglycemia (high blood sugar)
  • Hypertension (high blood pressure)
  • Hypothyroidism (underactive thyroid)
  • Infection (eg, bacterial, virus, or fungus)
  • Liver disease (including cirrhosis)
  • Mood changes, including depression
  • Myasthenia gravis (severe muscle weakness)
  • Osteoporosis (weak bones)
  • Peptic ulcer, active or history of
  • Personality changes
  • Pheochromocytoma (adrenal tumor)
  • Stomach or intestinal problems (eg, diverticulitis, ulcerative colitis)
  • Tuberculosis, inactive
  • Weak immune system (eg, Kaposi sarcoma)
  • Fungal infections

Warnings

Hydrocortisone should be used with caution for many different reasons. If it is taken for a long period of time, regular doctor visits and examinations are crucial to monitor progress and ensure that the medication is working as intended. Regular blood and urine tests will need to be performed to check for healthy hormone levels and potential side effects. Patients who use too much hydrocortisone or take it for a very long duration may also develop problems with the adrenal gland. Symptoms of this condition include any of the following: blurred vision, dizziness or fainting, a fast, irregular, or pounding heartbeat, increased thirst or urination, irritability, or unusual tiredness or weakness

The effect that hydrocortisone has on a patient may be affected by their general stress level but especially by high levels of stress. A patient who is experiencing high amounts of stress may need to have the amount of hydrocortisone they are taking reduced for a short amount of time or until less stressful times. Patients who are taking hydrocortisone may find that they are more prone to bacterial and viral infection than they would normally be as a result of the effects that the steroid has on the immune system. Patients should take care to avoid the presence of sick people and wash their hands often throughout the day. If a patient has reason to suspect that they have been exposed to viruses such as chickenpox or measles or they begin to have flu-like symptoms such as fever, chills, sore throat or nasal congestion they need to contact a doctor immediately.

Some patients taking hydrocortisone may experience problems with their eyes or vision while using the medication. If a patient notices blurred vision, difficulty reading, eye pain, or any unexplained change in their vision they need to ask their doctor to refer them to an ophthalmologist. Patients who are being treated with hydrocortisone will need to suspend any immunizations pending a doctor's approval to ensure that it is safe to take. The steroid may lower the body's resistance to the vaccine and some live vaccines even have the potential to transmit the disease itself instead of inoculating the patient when their immune system is in a compromised state. This also applies to avoiding people who have been injected with live vaccines because there is a danger of person-to-person transmittal. These live vaccines may include measles, mumps, influenza, poliovirus, rotavirus, and rubella. If a family member receives any of these shots the patient should avoid close contact and not stay in the same room with them for a long period of time for a certain period of time that depends on the expected duration of the virus.

There are certain changes to mood or behavior which may be prompted by taking hydrocortisone. These mood changes may include depression, wide mood swings, unexplained euphoria, difficulty sleeping, or noticeable changes in personality. A doctor should be informed of any of these changes as they may be an indication of a more serious mood disorder or serious side effects of the medication. Additionally, there are concerns surrounding bone health when using this medication, especially for children who are using it for a long period of time. Hydrocortisone may cause thinning of the bones or slow growth in children if used for too long. This effect may also be of concern for populations who are vulnerable to osteoporosis. Children's growth needs to be carefully monitored when using this medication and any bone pain experienced by older adults needs to be reported.

The use of hydrocortisone may affect a number of medical treatments including routine procedures or surgeries. Doctors or dentists treating a patient using hydrocortisone needs to know that they are taking this medication before performing these procedures or any tests as this drug may affect the results of lab tests.

Storage

Careful storage of hydrocortisone is important as it can be harmful when taken by anyone other than the patient it was prescribed for. The tablets should be kept in their original container or another approved child-proofed container. It is not recommended that these tablets be stored in the bathroom as they need to be kept away from heat and moisture. They also should not be kept in a car or glove compartment as this may expose them to freezing temperatures or direct sunlight. Ideally, the medication should be stored at room temperature in a secured drawer or cabinet away from the reach of children. Hydrocortisone should not be maintained in the home if it is no longer needed but rather disposed of in accordance with local guidelines for disposing of medical waste.

Summary

For patients who are suffering from inflammation of the organs, hydrocortisone is a very effective treatment option. However, like all steroids it has profound effects on the physiology and must be prescribed with caution. The effects that it can have on the immune system and bodily growth and development over a long period of time needs to be carefully weighed before using it to treat children.