From the Guidelines
Hydrocortisone can cause several serious side effects, including hypertension, hyperglycemia, sleep and mood disturbances, gastric irritation or ulcer formation, glaucoma, myopathy, and osteoporosis, which necessitate close monitoring by the treating physician. These side effects can significantly impact the patient's quality of life, and it is essential to assess HRQoL (depression, fatigue, mental status, etc.) while patients are receiving corticosteroids 1. Common side effects of hydrocortisone include:
- Fluid retention leading to swelling in the lower legs
- Increased blood pressure
- Elevated blood sugar levels
- Mood changes (including irritability, anxiety, or euphoria)
- Insomnia
- Increased appetite
- Weight gain
- Thinning of the skin With prolonged use, hydrocortisone may cause more serious effects such as:
- Adrenal suppression (where your body reduces its natural cortisol production)
- Increased susceptibility to infections
- Osteoporosis (bone thinning)
- Muscle weakness
- Cataracts
- Glaucoma
- Impaired wound healing It is crucial for patients to report any concerning side effects to their healthcare provider, especially unusual weight gain, swelling, visual changes, severe mood alterations, or signs of infection 1. Never stop taking prescribed hydrocortisone suddenly, as this can lead to adrenal crisis, a potentially life-threatening condition. The treating physician should ensure that the patient is adequately monitored for potential corticosteroid side effects regardless of duration or type of corticosteroid selected 1.
From the FDA Drug Label
Warnings For external use only Do not use in the genital area if you have a vaginal discharge. Consult a doctor. for the treatment of diaper rash. Consult a doctor. When using this product avoid contact with eyes do not use more than directed unless told to do so by a doctor do not put directly into the rectum by using fingers or any mechanical device or applicator Stop use and ask a doctor if condition worsens, symptoms persist for more than 7 days or clear up and occur again within a few days, and do not begin use of any other hydrocortisone product unless you have asked a doctor rectal bleeding occurs
- Side effects of hydrocortisone include:
- Condition worsens
- Symptoms persist for more than 7 days
- Symptoms clear up and occur again within a few days
- Rectal bleeding The FDA drug label warns against using the product in certain ways that could lead to these side effects, and advises users to stop use and ask a doctor if they occur 2
From the Research
Hydrocortisone Side Effects
Hydrocortisone, a type of glucocorticoid, can have various side effects due to its potent medication properties. Some of the possible side effects include:
- Musculoskeletal side effects, such as osteoporosis, which can occur in about 30-50% of chronic glucocorticoid users 3
- Gastrointestinal side effects
- Cardiovascular side effects
- Endocrine side effects
- Neuropsychiatric side effects
- Dermatologic side effects
- Ocular side effects, including ocular hypertension and glaucoma, which can be caused by increased aqueous outflow resistance owing to an accumulation of extracellular matrix material in the trabecular meshwork 4
- Immunologic side effects
Minimizing Side Effects
To minimize the risk of side effects, it is essential to use hydrocortisone properly, with careful monitoring and appropriate preventive strategies 5. This can include:
- Prescribing glucocorticoids at the lowest dose and shortest duration
- Counseling patients on lifestyle measures to maintain bone strength, such as nutrition and weight-bearing exercise 3
- Considering pharmacological therapy for patients at moderate to high risk of fracture
- Monitoring patients for signs of ocular hypertension and glaucoma, particularly those with risk factors such as primary open-angle glaucoma, status as a glaucoma suspect, and a family history of glaucoma 4