From the Guidelines
Hydrocortisone capsules should be taken at a dose of 15-20 mg in divided doses for the management of adrenal insufficiency, with the goal of mimicking the natural diurnal rhythm of cortisol, as recommended by the most recent guidelines 1. The dosage may vary depending on the severity of the condition, with more severe cases requiring higher doses, such as 30-50 mg total dose for moderate symptoms, and IV stress dose steroids, such as hydrocortisone 50-100 mg Q 6-8 hours, for severe symptoms 1. Key considerations for hydrocortisone therapy include:
- Taking the medication with food to minimize stomach irritation
- Never stopping the medication suddenly, as this can cause adrenal crisis
- Tapering the medication gradually under medical supervision
- Regular monitoring of blood pressure, blood sugar, and electrolytes with long-term use
- Carrying medical identification indicating corticosteroid use in case of emergency
- Potential need for stress dosing during illness, surgery, or significant physical stress It is also important to note that hydrocortisone allows for the recreation of the diurnal rhythm of cortisol, with typically 2/3 of the dose given in the morning and 1/3 in the early afternoon, as stated in the guidelines 1. Additionally, patients with primary adrenal insufficiency should wear Medic Alert identification jewelry and carry a steroid/alert card, and receive sufficient education to manage daily medications and situations of minor to moderate concurrent illnesses, as recommended by previous guidelines 1.
From the FDA Drug Label
ACTIONS Naturally occurring glucocorticoids (hydrocortisone and cortisone), which also have salt-retaining properties, are used as replacement therapy in adrenocortical deficiency states. Their synthetic analogs are primarily used for their potent anti-inflammatory effects in disorders of many organ systems. Glucocorticoids cause profound and varied metabolic effects. In addition, they modify the body's immune responses to diverse stimuli. The FDA drug label does not answer the question.
From the Research
Hydrocortisone in Cap
- Hydrocortisone 17-butyrate is a non-fluorinated topical corticosteroid used to treat psoriasis, eczema, and other inflammatory dermatoses 2
- It has been shown to be effective in treating facial lesions, including those with atrophy superimposed on rosacea and perioral dermatitis, with minimal risk of skin atrophy and adrenal suppression 2
- Topical corticosteroids, including hydrocortisone, are classified by strength and risk of adverse effects, and the risk of adverse effects increases with prolonged use, large area of application, higher potency, occlusion, and application to areas of thinner skin 3
Application and Dosage
- The quantity of corticosteroid prescribed depends on the duration of treatment, frequency of application, skin location, and total surface area treated 3
- Correct patient application is critical to successful use, and patients may be taught application using the fingertip unit method 3
- Hydrocortisone butyrate 0.1% cream has been shown to be effective and safe in pediatric patients 3 months and older with extensive atopic dermatitis, with minimal risk of adrenal suppression 4, 5
Safety and Efficacy
- Hydrocortisone 17-butyrate 21-propionate has a favorable benefit/risk ratio for the treatment of inflammatory skin disorders, with a strong topical anti-inflammatory activity and weak systemic action 6
- It has been shown to be effective in the treatment of various oozing and lichenified eczematous skin diseases, including atopic dermatitis and psoriasis vulgaris, with a therapeutic index of 2.0 6
- A lipid-rich, moisturizing formulation of hydrocortisone butyrate 0.1% has been shown to be well-tolerated and beneficial in the treatment of atopic dermatitis in children, with no evidence of adrenal suppression 5