Short-acting systemic glucocorticoid, identical to endogenous cortisol
ATC code: H02AB09 (Hydrocortisone)
Brand names
Cortef, Solu-Cortef, Plenadren
Identical to endogenous cortisol. Active immediately, no liver conversion required. Binds the glucocorticoid receptor and induces lipocortin synthesis (phospholipase A2 inhibitor) – blocking arachidonic acid, leukotriene and prostaglandin formation. Half-life 1–2 hours, biological action 8–12 hours.
First line
Replacement therapy for primary (Addison) and secondary adrenal insufficiency. SEEN recommends hydrocortisone 15–25 mg/day in 2–3 doses with the larger dose in the morning to mimic the circadian rhythm. Double or triple the dose during intercurrent illness (fever, surgery).
Second line
Intravenous hydrocortisone 100–200 mg in severe allergic reactions and anaphylaxis as adjunct to adrenaline (never replaces adrenaline). Effect develops in 4–6 hours, used to prevent biphasic recurrence.
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FDA Category C. Replacement dosing in Addison disease is not teratogenic and continues throughout pregnancy with up-titration in the 2nd-3rd trimesters. Pharmacological high-dose use follows the same principles as prednisone.
Compatible. Hale L2. Identical to endogenous cortisol – transfers into milk at physiological concentrations. Replacement doses require no infant monitoring; high doses follow the same approach as prednisone.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Hydrocortisone is evaluated for the following indications with varying evidence strength: Adrenal insufficiency (evidence tier A), Severe allergic reactions (evidence tier A). See the full indication matrix with dosing and citations above on this page.
Common side effects of Hydrocortisone (≥ 1 in 100): Weight gain (at above-replacement doses), Sodium retention and oedema, Hyperglycaemia, Gastritis, Mood changes. See the Safety section for uncommon and serious reactions.
FDA category C. FDA Category C. Replacement dosing in Addison disease is not teratogenic and continues throughout pregnancy with up-titration in the 2nd-3rd trimesters. Pharmacological high-dose use follows the same principles as prednisone.
Compatible. Hale L2. Identical to endogenous cortisol – transfers into milk at physiological concentrations. Replacement doses require no infant monitoring; high doses follow the same approach as prednisone.
Hydrocortisone is contraindicated in: Hypersensitivity to hydrocortisone; Systemic fungal infections; Live vaccines at immunosuppressive doses. Full list in the Safety section.