hydrocortisone (hi dro CORT ah zon)
What is hydrocortisone?
Hydrocortisone is a steroid drug. It is similar to cortisone, which is made in the adrenal glands. The drug has anti-inflammatory effects in the body which is the desired action.
What is it used for?
Hydrocortisone is used to treat a wide range of disorders such as asthma and arthritis. In gastroenterology, it is effective in the treatment of several inflammatory conditions such as ulcerative and microscopic colitis, Crohn’s disease and autoimmune hepatitis.
How do I take it?
Follow your physician’s instructions carefully. The medication is usually taken once or twice a day. For long-term use, physicians will often try to use alternate day treatment, taking a dose one day and nothing the next. At one time, the drug was thought to be a stomach irritant and even cause ulcers. It is now known that this is not true. The drug can be taken with or without food. It may be crushed and mixed with food. Keep all medications away from children. Never share your medications with anyone else.
The rectal preparations come with instructions on the best method of use. Follow these carefully.
What do I do for a missed dose?
If you take the drug once a day, take it as soon as you remember that day. If you do not remember until the next day, skip the missed dose and do not double up. If you take the drug twice or more daily, take the missed dose as soon as you remember that day. If you don’t remember until the next morning, then double just that dose. If you are on alternate day treatment, take the dose whenever you remember and adjust your schedule to every other day afterwards.
If you miss a rectal preparation, take it as soon as you remember, up to 12 hours. If it is after this time, pick up your regular schedule the next day. Do not double up.
Are there interactions with food or beverages?
There are no known interactions with any foods or beverages. However, hydrocortisone may cause retention of sodium (salt), so keep your sodium intake to a minimum. The drug may also result in excess urine secretion of potassium, so foods high in potassium are recommended. See the diet section for details. There are no known interactions with alcohol.
Are there interactions with other drugs?
An interaction generally means that one drug may increase or decrease the effect of another drug. Also, the more medications a person takes, the more likely there will be a drug interaction.
Interactions with this drug may occur with the following:
- amphotericin B (Fungizone)
- estrogen (Premarin)
- ketoconazole (Nizoral)
- barbiturates (phenobarbital, Donnatal)
- birth control pills
- blood thinners (Coumadin)
- phenytoin (Dilantin)
- carbamazepine (Tegretol)
- rifampin (Rifadin)
- cyclosporine (Sandimmune, Neoral)
Is there a problem if I have another disorder or disease?
At times, a drug may have a different or enhanced effect when other diseases are present. At other times, the drug may worsen or effect another disease.
With this drug, the following disorders may be a problem:
- Osteoporosis is a particular concern because the drug causes loss of calcium from bone. Extra calcium and vitamin D in the diet are generally recommended. The physician may recommend a drug to prevent osteoporosis
- Tuberculosis or a positive TB skin test
- Diabetes treatment may require adjustment since the drug tends to raise blood sugar
- Seizures or convulsions
- High blood pressure
What about allergies?
People who have known allergies or asthma may be at an increased risk for a reaction from any new medication. The physician should always know a patient’s allergy history. Signs of an allergic reaction are skin rash, hives and itching. Of course, a person should not take hydrocortisone if there has been a previous reaction to this or a similar drug.
What if I’m pregnant, considering pregnancy or breast-feeding?
Most females now know that, if possible, no drug, including alcohol, should be taken during pregnancy or lactation. The potential danger, of course, is an injury to the baby. However, some drugs are much safer than others in this regard. So, the FDA has a grading system for each drug which reflects what is known medically. It ranks drugs from A, where medical studies show no evidence for danger to the fetus or mother, to B, C, D and X, where the medical evidence indicates that the risk to the fetus outweighs any benefit to the mother. Hydrocortisone is ranked C. Always consult your physician before taking any drug during or when planning pregnancy.
What are the effects on sexual function?
It is common for this drug to cause changes in menstrual function. If depression occurs, reduced sexual desire may develop.
Are there other precautions?
- If you take the drug long-term, carry a drug alert card or neckwear
- Do not stop taking this drug suddenly because your own adrenal glands cannot quickly produce enough needed cortisone
- The drug may prevent a good response to vaccinations
- Hydrocortisone increases appetite! Weight gain will occur if you are not careful in controlling your calorie intake
- Follow-up medical tests needed: blood potassium, blood pressure, regular eye exam. If you are an older patient, consider bone densitometry to check for early osteoporosis
How long is it safe to take hydrocortisone?
Since there may be some distressing side effects on appearance, weight gain and, especially, calcium loss in bone, physicians always use the lowest dose and for the shortest time possible. Still, there are instances where long-term, indefinite hydrocortisone therapy is needed. You just have to be followed carefully.
How about side effects?
Adverse reactions can occur with any drug, even over-the-counter medications. Some of these are mild such as a stomach upset, which may be avoided by taking the medication with food. Minor reactions may go away on their own but if they persist, contact the physician. For major reactions, the patient should contact the physician immediately.
With hydrocortisone, the most annoying side effect for patients generally is the puffiness in the face and neck that can occur. Increased appetite and weight gain are very real problems, especially for females. The drug may cause some mental changes and, particularly, may worsen an underlying depression. While major side effects are unusual, a serious one is a condition called osteonecrosis. This causes weakness and even fracture of the hip or shoulder which would require major orthopedic surgery.
The value of the rectal preparations is that it places the drug in a high concentration where it is needed the most. However, some of this drug is absorbed into the body. The higher the dose, the frequency of use and length of treatment all determine the amount absorbed. Discuss this with your physician.
For hydrocortisone, the following are the observed side effects:
- weight gain
- facial swelling
- unusual fatigue or weakness
- blurred vision
- abdominal pain
- bloody or black stools
- painful hips or shoulders
A physician’s comment…
Steroid drugs have a very important role in gastroenterology. They are life-saving in treating autoimmune hepatitis. For acute inflammatory conditions such as ulcerative colitis and Crohn’s disease, they are able to bring symptoms under control very quickly. Whenever possible, the physician tries to taper the patient off the drug and so avoid long-term use. He or she will always use the lowest effective dose. Alternate day therapy can frequently avoid many of the side effects. A new steroid called budesonide may become available in 1998. It has the same beneficial properties as hydrocortisone without many of the major side effects. Finally, newer forms of treatment for some of these conditions are coming along and, hopefully, the chronic use of steroid drugs can be reduced further.