Hydrocortisone

Hydrocortisone is the name for the hormone cortisol when supplied as a medication.[2] Uses include conditions such as adrenocortical insufficiency, adrenogenital syndrome, high blood calcium, thyroiditis, rheumatoid arthritis, dermatitis, asthma, and COPD.[1] It is the treatment of choice for adrenocortical insufficiency.[3] It can be given by mouth, topically, or by injection.[1] Stopping treatment after long-term use should be done slowly.[1]

Hydrocortisone
Clinical data
Trade namesA-hydrocort, Cortef, Solu-cortef, others[1]
Other namesCortisol; 11β,17α,21-Trihydroxypregn-4-ene-3,20-dione
AHFS/Drugs.comMonograph
MedlinePlusa682206
License data
Pregnancy
category
  • AU: A
  • US: C (Risk not ruled out)
    Routes of
    administration
    By mouth (tablets), intravenous, topical, rectal
    Drug classGlucocorticoid
    ATC code
    Legal status
    Legal status
    • AU: S4 (Prescription only) For oral use. S3(Pharmacist only medication) for 1% topical preparations. S2(Pharmacy medicine) for 0.5% topical preparations.
    • UK: POM; OTC for topical administration;
    • US: OTC for topical administration; Rx-only for tablets by mouth, rectal use and intravenous therapy
    Identifiers
    CAS Number
    PubChem CID
    DrugBank
    ChemSpider
    UNII
    KEGG
    ChEBI
    ChEMBL
    Chemical and physical data
    FormulaC21H30O5
    Molar mass362.460 g/mol g·mol−1
    3D model (JSmol)
     NY (what is this?)  (verify)

    Side effects may include mood changes, increased risk of infection, and swelling.[1] With long-term use common side effects include osteoporosis, upset stomach, physical weakness, easy bruising, and yeast infections.[1] While used, it is unclear if it is safe during pregnancy.[4] Hydrocortisone is a glucocorticoid and works as an anti-inflammatory and by immune suppression.[1]

    Hydrocortisone was patented in 1936 and approved for medical use in 1941.[5] It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system.[6] It is available as a generic medication.[1] The wholesale cost in the developing world is about US$0.27 per day as of 2014 for the form taken by mouth.[7] In the United States, it costs less than US$25 for a typical month of treatment.[3] In 2016, it was the 143rd most prescribed medication in the United States, with more than 4 million prescriptions.[8]

    Pharmacology

    Cortisol for injection
    A tube of hydrocortisone cream, purchased over the counter

    Hydrocortisone is the pharmaceutical term for cortisol used in oral administration, intravenous injection, or topical application. It is used as an immunosuppressive drug, given by injection in the treatment of severe allergic reactions such as anaphylaxis and angioedema, in place of prednisolone in patients needing steroid treatment but unable to take oral medication, and perioperatively in patients on long-term steroid treatment to prevent an adrenal crisis. It may also be injected into inflamed joints resulting from diseases such as gout.

    Compared to hydrocortisone, prednisolone is about four times as strong and dexamethasone about forty times as strong in their anti-inflammatory effect.[9] Prednisolone can also be used as cortisol replacement, and at replacement dose levels (rather than anti-inflammatory levels), prednisolone is about eight times more potent than cortisol.[10] For side effects, see corticosteroid and prednisolone.

    It may be used topically for allergic rashes, eczema, psoriasis, itching and other inflammatory skin conditions. Topical hydrocortisone creams and ointments are available in most countries without prescription in strengths ranging from 0.05% to 2.5% (depending on local regulations) with stronger forms available by prescription only. Covering the skin after application increases the absorption and effect. Such enhancement is sometimes prescribed, but otherwise should be avoided to prevent overdose and systemic impact.

    Protein binding and pharmacodynamics

    Most serum cortisol (all but about 4%) is bound to proteins, including corticosteroid binding globulin (CBG) and serum albumin. Free cortisol passes easily through cellular membranes, where it binds to intracellular cortisol receptors.[11]

    Chemistry

    Hydrocortisone, also known as 11β,17α,21-trihydroxypregn-4-ene-3,20-dione, is a naturally occurring pregnane steroid.[12]

    See also

    References

    1. "Hydrocortisone". Drugs.com. American Society of Health-System Pharmacists. February 9, 2015. Archived from the original on 20 September 2016. Retrieved 30 August 2016.
    2. Becker, Kenneth L. (2001). Principles and Practice of Endocrinology and Metabolism. Lippincott Williams & Wilkins. p. 762. ISBN 9780781717502. Archived from the original on 2016-09-14.
    3. Hamilton, Richart (2015). Tarascon Pocket Pharmacopoeia 2015 Deluxe Lab-Coat Edition. Jones & Bartlett Learning. p. 202. ISBN 9781284057560.
    4. "Hydrocortisone Pregnancy and Breastfeeding Warnings". Drugs.com. Archived from the original on 20 September 2016. Retrieved 1 September 2016.
    5. Fischer, Jnos; Ganellin, C. Robin (2006). Analogue-based Drug Discovery. John Wiley & Sons. p. 484. ISBN 9783527607495.
    6. "WHO Model List of Essential Medicines (19th List)" (PDF). World Health Organization. April 2015. Archived (PDF) from the original on 13 December 2016. Retrieved 8 December 2016.
    7. "Hydrocortisone". International Drug Price Indicator Guide. Retrieved 1 September 2016.
    8. "The Top 300 of 2019". clincalc.com. Retrieved 22 December 2018.
    9. "Dexamethasone". drugs.com. Archived from the original on 21 June 2013. Retrieved 14 June 2013.
    10. Caldato, Milena C. F.; Fernandes, Vânia T.; Kater, Claudio E. (2004-10-01). "One-year clinical evaluation of single morning dose prednisolone therapy for 21-hydroxylase deficiency". Arquivos Brasileiros de Endocrinologia e Metabologia. 48 (5): 705–712. doi:10.1590/S0004-27302004000500017. ISSN 0004-2730. PMID 15761542.
    11. Boron WF, Boulpaep EL (2011). Medical Physiology (2nd ed.). Philadelphia: Saunders. ISBN 1-4377-1753-5.
    12. J. Elks (14 November 2014). The Dictionary of Drugs: Chemical Data: Chemical Data, Structures and Bibliographies. Springer. p. 316. ISBN 978-1-4757-2085-3. Archived from the original on 8 September 2017.
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