What is Solu-Cortef (hydrocortisone) used for?

What is Solu-Cortef Used For?

Solu-Cortef (hydrocortisone sodium succinate) is primarily used for treating adrenal insufficiency and adrenal crisis, providing glucocorticoid replacement when oral therapy is not feasible, and managing severe inflammatory and allergic conditions requiring parenteral corticosteroid therapy. 1

Primary Indications

Adrenal Insufficiency and Crisis

• Solu-Cortef is the drug of choice for primary or secondary adrenocortical insufficiency, particularly when oral administration is not possible. 1

• For acute adrenal crisis, the standard treatment is an immediate 100 mg IV bolus of hydrocortisone, followed by 100-300 mg per day as continuous infusion or frequent boluses every 6 hours. 2

• The continuous IV infusion method is superior to intermittent bolus administration for maintaining physiological cortisol concentrations during major stress. 2, 3

• During adrenal crisis, Solu-Cortef must be accompanied by rapid IV administration of 0.9% saline (1 liter over the first hour) to address volume depletion and hypotension. 2, 4

Perioperative Stress Coverage

• For major surgery with long recovery time, 100 mg hydrocortisone IM should be given just before anesthesia, followed by 100 mg IM every 6 hours until the patient can eat and drink. 2

• For moderate surgical stress, a single dose of 100 mg hydrocortisone IV is recommended. 2

• The perioperative approach prevents potentially fatal adrenal insufficiency in patients on chronic glucocorticoid therapy or with known adrenal dysfunction. 2

Septic Shock

• Hydrocortisone is indicated for patients with septic shock who remain hemodynamically unstable despite adequate fluid resuscitation and vasopressor therapy, at a dose of 200 mg per day. 5

• Treatment should continue until shock resolves, with a minimum duration of 3 days at full dose. 5

• In pediatric septic shock, approximately 25% of children have absolute adrenal insufficiency requiring stress-dose hydrocortisone (50 mg/m²/24 hours, up to 50 mg/kg/day if needed). 2, 5

Pregnancy and Delivery

• During delivery, a parenteral bolus of 100 mg hydrocortisone (Solu-Cortef) should be given at the onset of labor and repeated every 6 hours if necessary. 2, 6

• This prevents adrenal crisis during the physiological stress of childbirth in women with adrenal insufficiency. 2

Secondary Indications

Severe Allergic and Inflammatory Conditions

• Solu-Cortef is FDA-approved for severe or incapacitating allergic conditions intractable to conventional treatment, including severe asthma, drug hypersensitivity reactions, serum sickness, and transfusion reactions. 1

• It is used for severe dermatologic diseases including bullous dermatitis herpetiformis, pemphigus, and Stevens-Johnson syndrome. 1

Rheumatic and Autoimmune Disorders

• Indicated as adjunctive therapy for acute episodes of rheumatoid arthritis, acute gouty arthritis, acute rheumatic carditis, and systemic lupus erythematosus. 1

• Used in the treatment of dermatomyositis, temporal arteritis, and polymyositis. 1

Hematologic Disorders

• Solu-Cortef is indicated for acquired hemolytic anemia, idiopathic thrombocytopenic purpura in adults (IV administration only), and congenital hypoplastic anemia. 1

Neurological Conditions

• Used for acute exacerbations of multiple sclerosis and cerebral edema associated with primary or metastatic brain tumor or craniotomy. 1

Other Conditions

• Indicated for tuberculous meningitis with subarachnoid block when used with appropriate antituberculous chemotherapy. 1

• Used for symptomatic sarcoidosis, berylliosis, and idiopathic eosinophilic pneumonias. 1

• Palliative management of leukemias and lymphomas. 1

Critical Dosing Considerations

Route and Formulation Advantages

• Continuous IV infusion of 200 mg hydrocortisone over 24 hours, preceded by an initial bolus of 50-100 mg, is the optimal method for maintaining cortisol concentrations during major stress. 3

• Continuous infusion prevents the significant blood glucose peaks seen with repetitive bolus administration. 2

• Intramuscular administration has a long tradition of safety and effectiveness when IV infusion is impractical. 2

Important Warnings

• Dexamethasone, while sometimes used for postoperative nausea prophylaxis (8 mg = approximately 200 mg hydrocortisone equivalent), lacks mineralocorticoid activity and is inadequate for primary adrenal insufficiency. 2

• Treatment of suspected adrenal crisis must never be delayed for diagnostic procedures—immediate administration is life-saving. 2, 4

• Every patient with adrenal insufficiency should carry an emergency card and be provided with an emergency kit for parenteral hydrocortisone self-administration. 4