What is the recommended dose of Solucortef (hydrocortisone) for intravenous administration?

Recommended Dosage of Solucortef (Hydrocortisone) for Intravenous Administration

For adults with adrenal insufficiency undergoing surgery, the recommended intravenous dose of Solucortef (hydrocortisone) is 100 mg at induction, followed by continuous infusion of 200 mg over 24 hours. 1

Adult Dosing Based on Clinical Scenario

Surgery and Procedures

• For major surgery under general or regional anesthesia: 100 mg IV at induction, followed by continuous infusion of 200 mg/24 hours 1, 2
• Alternative postoperative regimen if continuous infusion not available: 50 mg IV/IM every 6 hours 1
• For bowel procedures requiring laxatives/enema: 100 mg IV/IM at the start of procedure 1
• Once enteral route is available: Double usual oral hydrocortisone doses for 48 hours or up to a week following major surgery 1

Labor and Delivery

• For labor and vaginal delivery: 100 mg IV at onset of labor, followed by continuous infusion of 200 mg/24 hours 1
• Alternative regimen: 100 mg IM followed by 50 mg every 6 hours IM 1
• For cesarean section: Same as major surgery protocol 1

Patients on Chronic Steroid Therapy

• For patients receiving adrenosuppressive doses of steroids (prednisolone equivalent ≥5 mg for 4 weeks or longer): Same dosing as for adrenal insufficiency 1
• Alternative for major surgery: Dexamethasone 6-8 mg IV, which will suffice for 24 hours 1

Pediatric Dosing

• Weight-based dosing: 2 mg/kg IV/IM at induction for surgery 1, 2
• Continuous infusion based on weight:
  • Up to 10 kg: 25 mg/24 hours 1, 2
  • 11-20 kg: 50 mg/24 hours 1, 2
  • Over 20 kg (prepubertal): 100 mg/24 hours 1
  • Over 20 kg (pubertal): 150 mg/24 hours 1
• Postoperative: 2 mg/kg every 4 hours IV/IM until stable 1

Special Considerations

Monitoring and Administration

• High doses of corticosteroids (≥500 mg) should be administered over 30-60 minutes 3
• Patients should be observed for at least 30-60 minutes after administration to monitor for allergic reactions 3
• There is no established biomarker for monitoring cortisol activity; clinical symptoms guide dose adjustments 4

Potential Adverse Effects

• Allergic reactions can occur with corticosteroids, ranging from rash to anaphylaxis 3
• Asthmatics, renal transplant patients, and hemodynamically unstable patients may be at higher risk for adverse events 3
• Adverse events from short-term stress dosing are relatively uncommon when used appropriately 1

Recent Evidence for Other Indications

• In severe community-acquired pneumonia requiring ICU admission, hydrocortisone 200 mg daily (for 4-7 days followed by tapering) has been shown to reduce 28-day mortality compared to placebo (6.2% vs 11.9%) 5
• In septic shock with relative adrenal insufficiency, hydrocortisone 50 mg IV every 6 hours has shown mortality benefit 6

Clinical Pitfalls to Avoid

• Underdosing during stress can lead to adrenal crisis with hypotension, electrolyte abnormalities, and shock 2
• Patients with primary adrenal insufficiency typically also require mineralocorticoid replacement (fludrocortisone) 2
• Patients on chronic glucocorticoid therapy may have hypothalamic-pituitary-adrenal axis suppression requiring stress-dose coverage during illness or surgery 2
• Worsening of symptoms after administration may indicate an allergic reaction rather than treatment failure 3