Other Names/Brands

Berlicort, Cortigra, Dermacoid, Fartison, Lexakorton, Miracort Krim, Omninicort

Mechanism of Action

Hydrocortisone works by mimicking the hormone cortisol, which is naturally produced by the adrenal glands in the body. This medication belongs to the corticosteroid class and functions to reduce inflammation and allergic reactions and suppress the immune system.

When applied, hydrocortisone enters cells and influences the activity of certain genes to inhibit the production of inflammatory chemicals such as prostaglandins and leukotrienes. This relieves symptoms such as swelling, redness, itching, and pain.

Indications

Hydrocortisone is indicated for treating various conditions involving inflammation and an overactive immune response. This medication is commonly used to treat skin conditions such as eczema, dermatitis, and psoriasis in topical cream form.

In addition, in oral or injectable form, hydrocortisone is used to treat conditions such as severe allergic reactions, asthma, lupus, arthritis, Addison's disease (adrenal hormone deficiency), and other autoimmune disorders. The use of hydrocortisone should be tailored to the type and severity of the condition.

Contraindication

Hydrocortisone is contraindicated in patients with hypersensitivity or allergy to hydrocortisone or any other component of the formulation. Furthermore, topical hydrocortisone is not recommended for untreated viral skin infections (such as herpes simplex and chickenpox) or fungal or bacterial infections, as it may worsen the infection.

In systemic forms (oral or injectable), hydrocortisone is also contraindicated in patients with untreated systemic infections, such as active tuberculosis or systemic fungal infections. Use in pregnant or breastfeeding women should be based on careful medical consideration, as it may affect the fetus or the breastfed infant.

Side Effects

Side effects of hydrocortisone can vary depending on the form and duration of use.

• When used topically, common side effects include skin irritation, mild burning, thinning skin, skin discoloration, and excess hair growth in the area where it is applied.
• When used systemically (orally or by injection), side effects can include increased blood pressure, fluid retention, increased blood sugar levels, sleep disturbances, mood swings, and impaired adrenal function if used long-term.
• Long-term use or high doses can also lead to Cushing's syndrome, osteoporosis, and decreased immunity to infections.

Preparations

Hydrocortisone is available in various forms, such as topical creams, tablets, or injections, depending on the condition being treated.

• Topical forms such as creams, ointments, and lotions are generally used to treat inflammation or irritation of the skin, such as eczema and dermatitis.
• For systemic conditions, hydrocortisone is available in oral tablet form, used to treat endocrine disorders, severe inflammation, or autoimmune diseases.
• It is also available in intravenous or intramuscular injection forms, used in emergency situations, such as severe allergic reactions or adrenal crisis.

Each preparation has different effectiveness and usage instructions, so the choice should be based on a doctor's recommendation.

Dosage

The dosage of hydrocortisone varies depending on the dosage form, the patient's age, and the medical condition being treated.

• For topical use, hydrocortisone is usually applied in a thin layer to the affected skin area once or twice daily, as directed by a doctor.
• For oral preparations, the general adult dose ranges from 20 to 240 mg per day, divided into several doses, depending on the severity of the condition.
• Meanwhile, for injectable preparations, the dosage can vary and is typically used in acute conditions or medical emergencies, such as shock or adrenal insufficiency, with an initial dose of 100 mg or more, then adjusted based on the patient's response.

The dosage should be determined individually and adjusted according to the response to therapy and monitored by a healthcare professional to avoid side effects.

Safety of Drugs

Hydrocortisone is classified as a pregnancy safety category C by the FDA, meaning animal studies have shown adverse effects on the fetus, but there are no adequately controlled studies in humans. Therefore, the use of hydrocortisone during pregnancy is only recommended if the potential benefits outweigh the potential risks to the fetus.

For breastfeeding mothers, hydrocortisone can pass into breast milk, especially if used orally or in injectable form. Therefore, use should be done with caution and under a doctor's supervision.

Short-term, limited-area topical use is generally considered relatively safe, but excessive or extensive use without medical advice should be avoided.

Drug Interactions

Hydrocortisone can interact with various other medications, affecting their effectiveness or increasing the risk of side effects. For example, medications such as rifampin, phenytoin, and carbamazepine can decrease hydrocortisone levels in the body by increasing their metabolism in the liver.

Medications like ketoconazole can increase hydrocortisone levels by inhibiting their metabolism. Furthermore, concomitant use with nonsteroidal anti-inflammatory drugs (NSAIDs) can increase the risk of stomach ulcers or gastrointestinal bleeding. Hydrocortisone can also interact with anticoagulants like warfarin, which can affect the effectiveness of blood thinners.

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