hydrocortisone Nursing Considerations & Management

Drug Name

Generic Name :  hydrocortisone, hydrocortisone acetate , hydrocortisone butyrate , hydrocortisone cypionate, hydrocortisone sodium succinate , hydrocortisone valerate

Brand Name:

  • Dermatologic cream, ointment: Cortaid with Aloe, Cortef Cream (CAN), Cortef Feminine Itch, Corticaine, Cortoderm (CAN), Gynecort Female Creme, Lanacort-5, Lanacort-10, Maximum Strength Caldecort, Maximum Strength Cortaid
  • Dermatologic ointment and cream: Locoid
  • Oral suspension: Cortate (CAN), Cortef
  • IV, IM, or subcutaneous injection: Hydrocortone phosphate
  • IV, IM injection: Solu-Cortef
  • Dermatologic cream, ointment, lotion: Westcort

Classification: Corticosteroid (short acting), Glucocorticoid, Adrenal cortical steroid hormone

Pregnancy Category C

Dosage & Route
  • Individualize dosage, based on severity and response. Give daily dose before 9 AM to minimize adrenal suppression. If long-term therapy is needed, alternate-day therapy should be considered. After long-term therapy, withdraw drug slowly to avoid adrenal insufficiency. For maintenance therapy, reduce initial dose in small increments at intervals until lowest clinically satisfactory dose is reached.

IM, IV (hydrocortisone sodium succinate)

  • 100–500 mg initially and q 2–10 hr, based on condition and response.
  • Acute adrenal insufficiency (hydrocortisone sodium phosphate): 100 mg IV followed by 100 mg q 8 hr in IV fluids.
  • Individualize dosage based on severity and response rather than on formulae that correct adult doses for age or weight. Carefully observe growth and development in infants and children on prolonged therapy.

Oral (hydrocortisone and cypionate)

  • 20–240 mg/day in single or divided doses.

IV, IM or subcutaneous (hydrocortisone and hydrocortisone sodium phosphate)

  • 20–240 mg/day usually in divided doses q 12 hr.

IM, IV (hydrocortisone sodium succinate)

  • Reduce dose, based on condition and response, but give no less than 25 mg/day.
  • Retention enema (hydrocortisone): 100 mg nightly for 21 days.

Intrarectal foam (hydrocortisone acetate)

  • 1 applicator daily or bid for 2 wk and every second day thereafter.

Intra-articular, intralesional (hydrocortisone acetate)

  • 5–25 mg, depending on joint or soft-tissue injection site.

Topical dermatologic preparations

  • Apply sparingly to affected area bid–qid.
Therapeutic actions
  • Hydrocortisone is a corticosteroid used for its anti-inflammatory and immunosuppressive effects. Its anti-inflammatory action is due to the suppression of migration of polymorphonuclear leukocytes and reversal of increased capillary permeability. It may also be used as replacement therapy in adrenocortical insufficiency.
  • Replacement therapy in adrenal cortical insufficiency
  • Allergic states—severe or incapacitating allergic conditions
  • Hypercalcemia associated with cancer
  • Short-term inflammatory and allergic disorders, such as rheumatoid arthritis, collagen diseases (SLE), dermatologic diseases (pemphigus), status asthmaticus, and autoimmune disorders
  • Hematologic disorders—thrombocytopenic purpura, erythroblastopenia
  • Trichinosis with neurologic or myocardial involvement
  • Ulcerative colitis, acute exacerbations of MS, and palliation in some leukemias and lymphomas
  • Intra-articular or soft-tissue administration: Arthritis, psoriatic plaques
  • Retention enema: For ulcerative colitis, proctitis
  • Dermatologic preparations: To relieve inflammatory and pruritic manifestations of dermatoses that are steroid responsive
  • Anorectal cream, suppositories: To relieve discomfort of hemorrhoids and perianal itching or irritation
Adverse effects
  • Sodium and fluid retention. Potassium and calcium depletion. Muscle wasting, weakness, osteoporosis. GI disturbances and bleeding. Increased appetite and delayed wound healing. Bruising, striae, hirsutism, acne, flushing. Raised intracranial pressure, headache, depression, psychosis, menstrual irregularities. Hyperglycaemia, glycosuria, DM, obesity, moon-face, buffalo hump. Suppression of pituitary-adrenocortical system. Growth retardation in childn (prolonged therapy). Increased susceptibility for infection. Topical use: Dermal atrophy, local irritation, folliculitis, hypertrichosis. Inhaled corticosteroids: May cause hoarseness, candidiasis of mouth and throat. Topical application to the eye: Can produce corneal ulcers, raised IOP and reduced visual function. Intralesional injection: Local hypopigmentation of deeply pigmented skin. Intra-articular injection: Joint damage, fibrosis esp in load bearing joints.
  • Potentially Fatal: Abrupt withdrawal leading to acute adrenal insufficiency. Rapid IV Inj may cause CV collapse.
  • Viral/fungal infections, tubercular or syphilitic lesions, bacterial infections unless used in conjunction with appropriate chemotherapy.
Nursing considerations
  • History: Infections; kidney disease; liver disease, hypothyroidism; ulcerative colitis with impending perforation; diverticulitis; recent GI surgery; active or latent peptic ulcer; inflammatory bowel disease; hypertension, CHF; thromboembolitic tendencies, thrombophlebitis, osteoporosis, seizure disorders, metastatic carcinoma, diabetes mellitus; lactation. Retention enemas, intrarectal foam: Systemic fungal infections; recent intestinal surgery, extensive fistulas. Topical dermatologic administration: Fungal, tubercular, herpes simplex skin infections; vaccinia, varicella; ear application when eardrum is perforated
  • Physical: Systemic administration: Weight, T; reflexes, affect, bilateral grip strength, ophthalmologic examination; BP, P, auscultation, peripheral perfusion, discoloration, pain or prominence of superficial vessels; R, adventitious sounds, chest x-ray; upper GI x-ray (history or symptoms of peptic ulcer), liver palpation; CBC, serum electrolytes, 2-hr postprandial blood glucose, urinalysis, thyroid function tests, serum cholesterol. Topical, dermatologic preparations: Affected area, integrity of skin
Systemic administration
  • WARNING: Give daily before 9 AM to mimic normal peak diurnal corticosteroid levels and minimize HPA suppression.
  • Space multiple doses evenly throughout the day.
  • Do not give IM injections if patient has thrombocytopenic purpura.
  • Rotate sites of IM repository injections to avoid local atrophy.
  • Use minimal doses for minimal duration to minimize adverse effects.
  • Taper doses when discontinuing high-dose or long-term therapy.
  • Arrange for increased dosage when patient is subject to unusual stress.
  • Ensure that adequate amount of Ca2+ is taken if prolonged administration of steroids.
  • Use alternate-day maintenance therapy with short-acting corticosteroids whenever possible.
  • WARNING: Do not give live virus vaccines with immunosuppressive doses of hydrocortisone.
  • Provide antacids between meals to help avoid peptic ulcer.

Topical dermatologic administration

  • Use caution with occlusive dressings; tight or plastic diapers over affected area can increase systemic absorption.
  • Avoid prolonged use, especially near eyes, in genital and rectal areas, on face, and in skin creases.
Teaching points

Systemic administration

  • Take this drug exactly as prescribed. Do not stop taking this drug without notifying your health care provider; slowly taper dosage to avoid problems.
  • Dosage reductions may create adrenal insufficiency. Report any fatigue, muscle and joint pains, anorexia, nausea, vomiting, diarrhea, weight loss, weakness, dizziness, or low blood sugar (if you monitor blood sugar).
  • Take with meals or snacks if GI upset occurs.
  • Take single daily or alternate-day doses before 9 AM; mark calendar or use other measures as reminder of treatment days.
  • Do not overuse joint after intra-articular injections, even if pain is gone.
  • Frequent follow-up visits to your health care provider are needed to monitor drug response and adjust dosage.
  • Wear a medical alert ID (if you ae using long-term therapy) so that any emergency medical personnel will know that you are taking this drug.
  • You may experience these side effects: Increase in appetite, weight gain (some of gain may be fluid retention; monitor intake); heartburn, indigestion (eat frequent small meals; use of antacids may help); increased susceptibility to infection (avoid crowds during peak cold or flu seasons, and avoid anyone with a known infection); poor wound healing (if injured or wounded, consult health care provider); muscle weakness, fatigue (frequent rest periods may help).
  • Report unusual weight gain, swelling of lower extremities, muscle weakness, black or tarry stools, vomiting of blood, epigastric burning, puffing of face, menstrual irregularities, fever, prolonged sore throat, cold or other infection, worsening of symptoms.

Intra-articular, intralesional administration

  • Do not overuse the injected joint even if the pain is gone. Adhere to rules of proper rest and exercise.

Topical dermatologic administration

  • Apply sparingly, and rub in lightly
  • Avoid contacting your eye with the medication.
  • Report burning, irritation, or infection of the site, worsening of the condition.
  • Avoid prolonged use.

Anorectal preparations

  • Maintain normal bowel function with proper diet, adequate fluid intake, and regular exercise.
  • Use stool softeners or bulk laxatives if needed.
  • Notify your health care provider if symptoms do not improve in 7 days or if bleeding, protrusion, or seepage occurs.