Hydrocortisone Acetate 25 MG Suppository Quantity Calculation
For a 30-day treatment course with one suppository daily, dispense 30 suppositories.
Calculation Breakdown
- Daily dose: 1 suppository (25 mg hydrocortisone acetate) 1
- Treatment duration: 30 days
- Total quantity needed: 1 suppository/day × 30 days = 30 suppositories
Clinical Context for Rectal Corticosteroid Therapy
Indication and Efficacy
- Rectal corticosteroids are effective for mild-to-moderate ulcerative proctitis, with budesonide foam (2-4 g/day) showing significant superiority over placebo for inducing remission (RR 0.73,95% CI 0.66-0.80) 1
- However, rectal mesalamine suppositories (1 g once daily) are preferred as first-line therapy over rectal corticosteroids for proctitis, as they are more effective (RR 0.74,95% CI 0.61-0.90) 1
- Topical corticosteroids are typically reserved for patients who fail or cannot tolerate 5-ASA therapy 1
Important Limitations of This Formulation
- Hydrocortisone acetate suppositories are NOT appropriate for emergency treatment of adrenal insufficiency 2
- Rectal administration of corticosteroid suppositories shows inferior pharmacokinetics compared to parenteral hydrocortisone for systemic conditions 2
- For adrenal crisis or critical illness requiring corticosteroids, intravenous hydrocortisone (100 mg bolus, then 200 mg/24 hours) is the standard of care 3, 4
Duration Considerations
- Corticosteroids should not be used for long-term maintenance therapy in ulcerative colitis 1
- The 30-day course prescribed here is appropriate for induction therapy, but maintenance should transition to 5-ASA or other steroid-sparing agents 1
- If symptoms do not respond within 2-4 weeks, escalation to oral corticosteroids or advanced therapies should be considered 1
Common Pitfalls to Avoid
- Do not confuse rectal corticosteroid suppositories (used for local inflammatory bowel disease) with systemic corticosteroid therapy for adrenal insufficiency or septic shock 3, 2
- Avoid abrupt discontinuation after 30 days if the patient has been on concurrent systemic corticosteroids—taper gradually over 6-14 days to prevent adrenal insufficiency 3, 5
- Monitor for hyperglycemia, hypertension, and secondary infections during treatment 1, 3