Short-acting systemic glucocorticoid, identical to endogenous cortisol
Brand names: Cortef, Solu-Cortef, Plenadren
Updated · Methodology
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).
Sources
ICD-10: E27 · ICD-11: 5A74
Adjunct
The only first-line treatment for anaphylaxis is intramuscular adrenaline; hydrocortisone never replaces it. Corticosteroids are used as an adjunct to adrenaline, mainly when bronchospasm accompanies the reaction. They do not reliably prevent biphasic reactions (US Practice Parameter 2020, Cochrane 2012). The Resuscitation Council UK (2021) and (2021) no longer recommend corticosteroids for routine emergency treatment of anaphylaxis; 2020 and the AEMPS label keep them as a second-line adjunct.
Sources
ICD-10: T78.2 · ICD-11: 4A84
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.
AEMPS summary of product characteristics (section 4.6): hydrocortisone can cross the placenta. There is no evidence that corticosteroids increase the incidence of congenital anomalies when given to pregnant women, although animal studies suggest a very small risk of cleft palate and intrauterine growth restriction in the fetus. When corticosteroids are essential, patients with normal pregnancies can be treated as if they were not pregnant, while those with pre-eclampsia or fluid retention need close monitoring. Some retrospective studies found a higher rate of low birth weight in babies of mothers taking corticosteroids (in humans the risk seems dose-related and may be reduced with lower doses), and cataracts have been seen in babies of mothers on long-term corticosteroid treatment. Newborns may in theory develop hypoadrenalism after prenatal exposure, so they are observed for its signs and treated if these appear.
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.
Verbatim lines from the interaction sections, in the language of the label
«Advertencias especiales: Se espera que el tratamiento conjunto con inhibidores de CYP3A, incluidos los productos que contienen cobicistat, aumente el riesgo de efectos secundarios sistémicos. Se debe…»AEMPS, section 4.4 · Open on CIMA
«Drug Interactions: The pharmacokinetic interactions listed below are potentially clinically important. Drugs that induce hepatic enzymes such as phenobarbital, phenytoin and rifampin may increase the…»FDA, section 7 · Open on DailyMed
«Drug Interactions: The pharmacokinetic interactions listed below are potentially clinically important. Drugs that induce hepatic enzymes such as phenobarbital, phenytoin and rifampin may increase the…»FDA, section 7 · Open on DailyMed
«Drug Interactions: The pharmacokinetic interactions listed below are potentially clinically important. Drugs that induce hepatic enzymes such as phenobarbital, phenytoin and rifampin may increase the…»FDA, section 7 · Open on DailyMed
«Advertencias especiales: La aspirina y los agentes antiinflamatorios no esteroideos deben usarse con precaución junto con corticosteroides (ver sección 4.5).»AEMPS, section 4.4 · Open on CIMA
«Interacción/AEMPS, section 4.5 · Open on CIMA
«Interacción/AEMPS, section 4.5 · Open on CIMA
«Drug Interactions: The pharmacokinetic interactions listed below are potentially clinically important. Drugs that induce hepatic enzymes such as phenobarbital, phenytoin and rifampin may increase the…»FDA, section 7 · Open on DailyMed
«Interacción/AEMPS, section 4.5 · Open on CIMA
«Interacción/AEMPS, section 4.5 · Open on CIMA
«Inhibidores de CYP3A4 - pueden disminuir el aclaramiento hepático y aumentar la concentración plasmática de hidrocortisona. En presencia de un inhibidor de CYP3A4 (p. ej., Ketoconazol, itraconazol…»AEMPS, section 4.5 · Open on CIMA
«Interacción/AEMPS, section 4.5 · Open on CIMA
«Interacción/AEMPS, section 4.5 · Open on CIMA
«Inhibidores de CYP3A4 - pueden disminuir el aclaramiento hepático y aumentar la concentración plasmática de hidrocortisona. En presencia de un inhibidor de CYP3A4 (p. ej., Ketoconazol, itraconazol…»AEMPS, section 4.5 · Open on CIMA
«Inhibidores de CYP3A4 - pueden disminuir el aclaramiento hepático y aumentar la concentración plasmática de hidrocortisona. En presencia de un inhibidor de CYP3A4 (p. ej., Ketoconazol, itraconazol…»AEMPS, section 4.5 · Open on CIMA
«Inhibidores de CYP3A4 - pueden disminuir el aclaramiento hepático y aumentar la concentración plasmática de hidrocortisona. En presencia de un inhibidor de CYP3A4 (p. ej., Ketoconazol, itraconazol…»AEMPS, section 4.5 · Open on CIMA
«Interacción/AEMPS, section 4.5 · Open on CIMA
«Interacción/AEMPS, section 4.5 · Open on CIMA
«Interacción/AEMPS, section 4.5 · Open on CIMA
«Interacción/AEMPS, section 4.5 · Open on CIMA
«Inductores de CYP3A4 - pueden aumentar el aclaramiento hepático y disminuir las concentraciones plasmáticas de hidrocortisona. En presencia de un inductor de CYP3A4 (p. ej., Rifampicina…»AEMPS, section 4.5 · Open on CIMA
«Interacción/AEMPS, section 4.5 · Open on CIMA
«Interacción/AEMPS, section 4.5 · Open on CIMA
«Interacción/AEMPS, section 4.5 · Open on CIMA
«Interacción/AEMPS, section 4.5 · Open on CIMA
«Inductores de CYP3A4 - pueden aumentar el aclaramiento hepático y disminuir las concentraciones plasmáticas de hidrocortisona. En presencia de un inductor de CYP3A4 (p. ej., Rifampicina…»AEMPS, section 4.5 · Open on CIMA
«Interacción/AEMPS, section 4.5 · Open on CIMA
«Inductores de CYP3A4 - pueden aumentar el aclaramiento hepático y disminuir las concentraciones plasmáticas de hidrocortisona. En presencia de un inductor de CYP3A4 (p. ej., Rifampicina…»AEMPS, section 4.5 · Open on CIMA
«Inductores de CYP3A4 - pueden aumentar el aclaramiento hepático y disminuir las concentraciones plasmáticas de hidrocortisona. En presencia de un inductor de CYP3A4 (p. ej., Rifampicina…»AEMPS, section 4.5 · Open on CIMA
«Inductores de CYP3A4 - pueden aumentar el aclaramiento hepático y disminuir las concentraciones plasmáticas de hidrocortisona. En presencia de un inductor de CYP3A4 (p. ej., Rifampicina…»AEMPS, section 4.5 · Open on CIMA
«Interacción/AEMPS, section 4.5 · Open on CIMA
«Interacción/AEMPS, section 4.5 · Open on CIMA
«Corticoides (glucocorticoides sistémicos y mineralocorticoides) : disminución de la eficacia. Las consecuencias de esta situación son particularmente significativas en pacientes con la enfermedad de…»AEMPS, section 4.5 · Open on CIMA
«Drug Interactions: Amphotericin B injection and potassium-depleting agents: When corticosteroids are administered concomitantly with potassium-depleting agents (e.g., amphotericin B, diuretics)…»FDA, section 7 · Open on DailyMed
«- Algunos informes describen que prednisona e hidrocortisona antagonizan el bloqueo neuromuscular en pacientes con insuficiencia corticosuprarrenal tratados con pancuronio.»AEMPS, section 4.5 · Open on CIMA
«Bloqueantes neuromusculares no despolarizantes: algunos informes describen que prednisona e hidrocortisona antagonizan el bloqueo neuromuscular en pacientes con insuficiencia corticosuprarrenal…»AEMPS, section 4.5 · Open on CIMA
«Drug Interactions:: hydrocortisone theophylline absorption)»FDA, section 7 · Open on DailyMed
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Hydrocortisone is evaluated for the following indications with varying evidence strength: Adrenal insufficiency (evidence tier A), Severe allergic reactions (evidence tier B). 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.
AEMPS summary of product characteristics (section 4.6): hydrocortisone can cross the placenta. There is no evidence that corticosteroids increase the incidence of congenital anomalies when given to pregnant women, although animal studies suggest a very small risk of cleft palate and intrauterine growth restriction in the fetus. When corticosteroids are essential, patients with normal pregnancies can be treated as if they were not pregnant, while those with pre-eclampsia or fluid retention need close monitoring. Some retrospective studies found a higher rate of low birth weight in babies of mothers taking corticosteroids (in humans the risk seems dose-related and may be reduced with lower doses), and cataracts have been seen in babies of mothers on long-term corticosteroid treatment. Newborns may in theory develop hypoadrenalism after prenatal exposure, so they are observed for its signs and treated if these appear.
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.
Direct links to regulator labels. Open in a new tab.
Betamethasone, Deflazacort, Dexamethasone, Fludrocortisone, Methylprednisolone, Prednisolone, Prednisone