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    Hydrocortisone

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    Jun.12.2024

    Hydrocortisone

    Indications/Dosage

    Labeled

    • acute lymphocytic leukemia (ALL)
    • Addison's disease
    • adrenocortical insufficiency
    • adrenogenital syndrome
    • allergic conjunctivitis
    • allergic rhinitis
    • alopecia
    • anaphylactic shock
    • anaphylaxis
    • angioedema
    • ankylosing spondylitis
    • anterior segment inflammation
    • asthma exacerbation
    • atopic dermatitis
    • berylliosis
    • bursitis
    • chorioretinitis
    • chronic lymphocytic leukemia (CLL)
    • chronic obstructive pulmonary disease (COPD)
    • congenital adrenal hyperplasia
    • contact dermatitis
    • corneal ulcer
    • corticosteroid-responsive dermatoses
    • Crohn's disease
    • cutaneous T-cell lymphoma (CTCL)
    • dermatitis herpetiformis
    • dermatomyositis
    • diaper dermatitis
    • discoid lupus erythematosus
    • drug-resistant tuberculosis infection
    • drug-susceptible tuberculosis infection
    • eczema
    • epicondylitis
    • erythema multiforme
    • erythroblastopenia
    • exfoliative dermatitis
    • food allergy
    • gouty arthritis
    • graft-versus-host disease (GVHD)
    • granuloma annulare
    • Graves' ophthalmopathy
    • hemolytic anemia
    • hemorrhoids
    • herpes zoster ocular infection
    • Hodgkin lymphoma
    • hypercalcemia
    • hypoplastic anemia
    • immune thrombocytopenic purpura (ITP)
    • insect bites or stings
    • iritis
    • juvenile rheumatoid arthritis (JRA)/juvenile idiopathic arthritis (JIA)
    • keloids
    • keratitis
    • lichen planus
    • lichen simplex
    • lichen striatus
    • Loeffler's syndrome
    • mycosis fungoides
    • necrobiosis lipoidica diabeticorum
    • nephrotic syndrome
    • non-Hodgkin's lymphoma (NHL)
    • optic neuritis
    • osteoarthritis
    • pemphigus
    • perennial allergies
    • phimosis
    • pityriasis rosea
    • pneumonitis
    • polymorphous light eruption
    • polymyositis
    • pompholyx
    • postoperative ocular inflammation
    • proctitis
    • proteinuria
    • pruritus
    • psoriasis
    • psoriatic arthritis
    • rheumatic carditis
    • rheumatoid arthritis
    • Rhus dermatitis
    • sarcoidosis
    • seasonal allergies
    • seborrheic dermatitis
    • serum sickness
    • Stevens-Johnson syndrome
    • systemic lupus erythematosus (SLE)
    • temporal arteritis
    • tenosynovitis
    • thrombocytopenia
    • thyroiditis
    • trichinosis
    • tuberculosis infection
    • ulcerative colitis
    • urticaria
    • uveitis
    • vernal keratoconjunctivitis
    • xerosis

    General dosing information for systemic therapy:

    • Dosage requirements are variable. Individualize dosage based on the condition being treated and the response of the patient.[32057][54049]
    • Gradual withdrawal of hydrocortisone after high-dose or prolonged therapy is recommended due to the possibility of hypothalamic-pituitary-adrenal (HPA) axis suppression. The following recommendations for withdrawal of corticosteroids based on the duration of therapy have been made: Less than 2 weeks - may abruptly discontinue; 2 to 4 weeks - taper dose over 1 to 2 weeks; more than 4 weeks - taper slowly over 1 to 2 months to physiologic dose (approximately 10 mg/m2/day of hydrocortisone) and discontinue after assessment of adrenal function has demonstrated recovery.[54137]

     

    Estimated equivalent systemic Glucocorticoid dosages. These are general approximations and may not apply to all diseases or routes of administration.[54049]

    Cortisone-25 mg

    Hydrocortisone-20 mg

    Prednisolone-5 mg

    Prednisone-5 mg

    Methylprednisolone-4 mg

    Triamcinolone-4 mg

    Dexamethasone-0.75 mg

    Betamethasone-0.75 mg

    Off-Label

    • carpal tunnel syndrome
    • chronic lung disease (CLD)
    • Churg-Strauss syndrome
    • coronavirus disease 2019 (COVID-19)
    • encephalitis
    • endophthalmitis
    • granulomatosis with polyangiitis
    • hypoglycemia
    • hypotension
    • mixed connective tissue disease
    • multiple myeloma
    • polyarteritis nodosa
    • polychondritis
    • septic shock
    • severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection
    • thyrotoxicosis
    † Off-label indication

    INVESTIGATIONAL USE: For adjunctive use in the treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection†, the virus that causes coronavirus disease 2019 (COVID-19)†

    Intravenous dosage

    Adults

    50 mg IV every 8 hours for 7 to 10 days. The World Health Organization strongly recommends the use of systemic corticosteroids in patients with severe or critical COVID-19.[65876] The National Institutes of Health (NIH) COVID-19 treatment guidelines recommend hydrocortisone as an alternative corticosteroid for hospitalized patients who require supplemental oxygen, including those on high-flow oxygen, noninvasive ventilation, mechanical ventilation, or extracorporeal membrane oxygenation (ECMO). The NIH recommends 160 mg IV in 2 to 4 divided doses for up to 10 days or until hospital discharge (whichever comes first). The NIH advises clinicians to review the patient's medical history and assess the potential risks and benefits before starting hydrocortisone.[65314]

    For the treatment of primary adrenocortical insufficiency (e.g., Addison's Disease, congenital adrenal hyperplasia, adrenogenital syndrome) or secondary adrenocortical insufficiency

    Oral dosage (tablet)

    Adults

    20 to 240 mg/day PO given in 2 to 4 divided doses.[32057]

    Children and Adolescents

    8 to 20 mg/m2/day PO given in 3 divided doses initially; individualize doses to minimize symptoms of adrenal insufficiency while avoiding growth retardation and Cushingoid symptoms that occur with overdosage. A usual dose of 5 to 10 mg/day PO 3 times daily has been recommended by the American Academy of Pediatrics. Doses more than 17 mg/m2/day in adolescents have been associated with loss of height and shorter adult height. Patients with primary adrenal insufficiency may require higher initial doses than those with secondary adrenal insufficiency.[54122] [54123] [54137] [54138] Hydrocortisone cypionate suspension (Cortef) and hydrocortisone tablets are not bioequivalent; therefore, the suspension is not recommended for the treatment of patients with congenital adrenal hyperplasia (CAH). Patients with classic CAH also require treatment with fludrocortisone (0.05 to 0.3 mg/day PO given in 1 to 2 divided doses).[54122] [54123]

    Infants

    8 to 20 mg/m2/day PO given in 3 divided doses initially; individualize doses to minimize symptoms of adrenal insufficiency while avoiding growth retardation and Cushingoid symptoms that occur with overdosage. A usual dose of 2.5 to 5 mg/day PO 3 times daily has been recommended by the American Academy of Pediatrics (AAP). Doses more than 20 mg/m2/day PO have been associated with loss of height and shorter adult height. Patients with primary adrenal insufficiency may require higher initial doses than those with secondary adrenal insufficiency.[54122] [54123] [54137] [54138] Hydrocortisone cypionate suspension (Cortef) and hydrocortisone tablets are not bioequivalent; therefore, the suspension is not recommended for the treatment of patients with congenital adrenal hyperplasia (CAH). Neonates and infants with classic CAH also require treatment with fludrocortisone (0.05 to 0.3 mg/day PO given in 1 to 2 divided doses) and sodium chloride supplementation (1 to 2 grams/day or 17 to 34 mEq/day PO divided and given with several feedings).[54122] [54123]

    Neonates

    8 to 20 mg/m2/day PO given in 3 divided doses initially; individualize doses to minimize symptoms of adrenal insufficiency while avoiding growth retardation and Cushingoid symptoms that occur with overdosage. A usual dose of 2.5 to 5 mg/day PO 3 times daily has been recommended by the American Academy of Pediatrics (AAP). Doses more than 20 mg/m2/day PO have been associated with loss of height and shorter adult height. Patients with primary adrenal insufficiency may require higher initial doses than those with secondary adrenal insufficiency.[54122] [54123] [54137] [54138] Hydrocortisone cypionate suspension (Cortef) and hydrocortisone tablets are not bioequivalent; therefore, the suspension is not recommended for the treatment of patients with congenital adrenal hyperplasia (CAH). Neonates and infants with classic CAH also require treatment with fludrocortisone (0.05 to 0.3 mg/day PO given in 1 to 2 divided doses) and sodium chloride supplementation (1 to 2 grams/day or 17 to 34 mEq/day PO divided and given with several feedings).[54122] [54123]

    Oral dosage (granules)

    Children and Adolescents

    8 to 10 mg/m2/day PO given in 3 divided doses initially; older pediatric patients may have their daily dose divided by 2 and administered twice daily. Higher doses may be needed based on patient's age and symptoms of the disease. Lower starting doses may be sufficient in patients with residual but decreased endogenous cortisol production. Round the dose to the nearest 0.5 or 1 mg. Individualize doses to minimize symptoms of adrenal insufficiency while avoiding growth retardation and Cushingoid symptoms that occur with overdosage. Patients may need higher doses during acute febrile illness, gastroenteritis, surgery, or major trauma. Use the same total daily dose when switching patients from oral hydrocortisone therapy to the oral granules. If symptoms of adrenal insufficiency occur after switching, increase the total daily dosage of the oral granules.[66033]

    Infants

    8 to 10 mg/m2/day PO given in 3 divided doses initially. Higher doses may be needed based on patient's age and symptoms of the disease. Lower starting doses may be sufficient in patients with residual but decreased endogenous cortisol production. Round the dose to the nearest 0.5 or 1 mg. Individualize doses to minimize symptoms of adrenal insufficiency while avoiding growth retardation and Cushingoid symptoms that occur with overdosage. Patients may need higher doses during acute febrile illness, gastroenteritis, surgery, or major trauma. Use the same total daily dose when switching patients from oral hydrocortisone therapy to the oral granules. If symptoms of adrenal insufficiency occur after switching, increase the total daily dosage of the oral granules.[66033]

    Neonates

    8 to 10 mg/m2/day PO given in 3 divided doses initially. Higher doses may be needed based on patient's age and symptoms of the disease. Lower starting doses may be sufficient in patients with residual but decreased endogenous cortisol production. Round the dose to the nearest 0.5 or 1 mg. Individualize doses to minimize symptoms of adrenal insufficiency while avoiding growth retardation and Cushingoid symptoms that occur with overdosage. Patients may need higher doses during acute febrile illness, gastroenteritis, surgery, or major trauma. Use the same total daily dose when switching patients from oral hydrocortisone therapy to the oral granules. If symptoms of adrenal insufficiency occur after switching, increase the total daily dosage of the oral granules.[66033]

    Intramuscular or Intravenous dosage (hydrocortisone sodium succinate injection)

    Adults

    100 to 500 mg IM or IV. Repeat doses at 2, 4, or 6 hour intervals.[54049]

    for adrenal crisis prophylaxis in adult patients with known or suspected adrenal insufficiency undergoing minor surgery or with a minor illness (e.g., inguinal hernia repair, colonoscopy, mild febrile illness, gastroenteritis)

    Intravenous or Intramuscular dosage (hydrocortisone sodium succinate injection)

    Adults

    Although the manufacturer recommends 200 to 500 mg IV or IM every 2 to 6 hours starting at the beginning of the surgical procedure or the onset of the acute physiologic stressor, recommendations developed from the literature and expert opinion suggest lower doses are effective and decrease the risk of adverse effects (e.g., hyperglycemia, immunosuppression).[54049] A single dose of 25 mg IV/IM is recommended by 1 author, and 50 to 100 mg IV/IM is recommended by another.[35398] [35399] In the case of surgeries, the dose should be administered before the procedure. Although hydrocortisone has historically been the preferred agent, some experts recommend longer acting steroids such as methylprednisolone or dexamethasone. In addition to the supplementation doses, patients who are treated with chronic steroids should also be given their usual dose or equivalent for the acute period; patients receiving the equivalent to prednisone 5 mg/day (i.e., hydrocortisone 20 mg/day) or less do not require additional supplementation.[35398]

    for adrenal crisis prophylaxis in adult patients with known or suspected adrenal insufficiency undergoing moderate surgery or with a moderate illness (e.g., open cholecystectomy, hemicolectomy, significant febrile illness, pneumonia, severe gastroenteritis)

    Intravenous or Intramuscular dosage (hydrocortisone sodium succinate injection)

    Adults

    Although the manufacturer recommends 200 to 500 mg IV or IM every 2 to 6 hours starting at the beginning of the surgical procedure or the onset of the acute physiologic stressor, recommendations developed from the literature and expert opinion suggest lower doses are effective and decrease the risk of adverse effects (e.g., hyperglycemia, immunosuppression).[54049] One author recommends 50 to 75 mg IV/IM on the day of the procedure; then, taper to the usual dose over the next 1 to 2 days.[35398] Another author recommends 50 mg IV/IM every 6 hours during the medical or surgical stress; then, taper the dose by 50% every day until the usual dose is reached.[35399] Although hydrocortisone has historically been the preferred agent, some experts recommend longer acting steroids such as methylprednisolone or dexamethasone. In addition to the supplementation doses, patients who are treated with chronic steroids should also be given their usual dose or equivalent for the acute period; patients receiving the equivalent to prednisone 5 mg/day (i.e., hydrocortisone 20 mg/day) or less do not require additional supplementation.[35398]

    for adrenal crisis prophylaxis in adult patients with known or suspected adrenal insufficiency undergoing major surgery, or with other acute stressors (e.g., major cardiothoracic surgery, Whipple procedure, liver resection, pancreatitis, acute systemic infection, shock)

    Intravenous or Intramuscular dosage (hydrocortisone sodium succinate injection)

    Adults

    Although the manufacturer recommends 200 to 500 mg IV or IM every 2 to 6 hours starting at the beginning of surgical procedure or the onset of the acute physiologic stressor, recommendations developed from the literature and expert opinion suggest lower doses are effective and decrease the risk of adverse effects (e.g., hyperglycemia, immunosuppression).[54049] In severe illnesses or major surgeries, 1 author recommends 100 to 150 mg IV/IM on the day of the procedure; taper to the usual dose over the next 1 to 2 days.[35398] Another author recommends 50 mg IV/IM every 6 hours during the medical or surgical stress; then, taper the dose by 50% every day until the usual dose is reached.[35399] Although hydrocortisone has historically been the preferred agent, some experts recommend longer acting steroids such as methylprednisolone or dexamethasone. In addition to the supplementation doses, patients who are treated with chronic steroids should also be given their usual dose or equivalent for the acute period; patients receiving the equivalent to prednisone 5 mg/day (i.e., hydrocortisone 20 mg/day) or less do not require additional supplementation.[35398]

    for adrenal crisis prophylaxis in adult patients with known or suspected adrenal insufficiency and a critical illness (e.g., shock)

    Intravenous or Intramuscular dosage (hydrocortisone sodium succinate injection)

    Adults

    Although the manufacturer recommends 200 to 500 mg IV or IM every 2 to 6 hours starting at the beginning of the acute physiologic stressor, recommendations developed from the literature and expert opinion suggest lower doses are effective.[54049] In critically ill patients, 50 to 100 mg IV every 6 to 8 hours or 0.18 mg/kg/hour as a continuous IV infusion until the shock is resolved has been recommended; 50 mcg/day of fludrocortisone is also recommended in this situation. Once the shock is resolved, the hydrocortisone can be gradually tapered; follow vital signs and serum sodium concentrations closely. Although, hydrocortisone has historically been the preferred agent, some experts recommend longer acting steroids such as methylprednisolone or dexamethasone. In addition to the supplementation doses, patients who are treated with chronic steroids should also be given their usual dose or equivalent for the acute period; patients receiving the equivalent to prednisone 5 mg/day (i.e., hydrocortisone 20 mg/day) or less do not require additional supplementation.[35398]

    for adrenal crisis prophylaxis in pediatric patients with known or suspected adrenal insufficiency with other acute stressors (e.g., febrile illness with a temperature more than 38.5 degrees Celsius, gastroenteritis with dehydration, major trauma)

    Intramuscular or Intravenous dosage (hydrocortisone sodium succinate injection)

    Children and Adolescents 6 to 17 years

    50 mg/m2 IM will provide 6 to 8 hours of coverage. If the patient's condition does not improve or worsens during this time, initiate IV stress dosing (3 to 4 times the daily maintenance dose divided every 6 hours).[54138] Alternatively, an initial dose of 100 mg IM has been recommended for patients with congenital adrenal hyperplasia.[54123] [54155]

    Children 1 to 5 years

    50 mg/m2 IM will provide 6 to 8 hours of coverage. If the patient's condition does not improve or worsens during this time, initiate IV stress dosing (3 to 4 times the daily maintenance dose divided every 6 hours).[54138] Alternatively, an initial dose of 50 mg IM has been recommended for patients with congenital adrenal hyperplasia.[54123] [54155]

    Infants

    50 mg/m2 IM will provide 6 to 8 hours of coverage. If the patient's condition does not improve or worsens during this time, initiate IV stress dosing (3 to 4 times the daily maintenance dose divided every 6 hours).[54138] Alternatively, an initial dose of 25 mg IM has been recommended for patients with congenital adrenal hyperplasia.[54123] [54155]

    Neonates

    50 mg/m2 IM will provide 6 to 8 hours of coverage. If the patient's condition does not improve or worsens during this time, initiate IV stress dosing (3 to 4 times the daily maintenance dose divided every 6 hours).[54138] Alternatively, an initial dose of 25 mg IM has been recommended for patients with congenital adrenal hyperplasia.[54123] [54155]

    Oral dosage

    Infants, Children, and Adolescents

    30 to 50 mg/m2/day PO given in 3 to 4 divided doses (approximately triple the daily maintenance dose) is commonly recommended.[54138] Varying recommendations of increases in the daily maintenance dose anywhere from 2 to 10 times have been made depending on the level of stress and the patient's individual needs.[54138] [54155] Hydrocortisone cypionate suspension (Cortef) and hydrocortisone tablets are not bioequivalent; therefore, the suspension is not recommended for the treatment of patients with congenital adrenal hyperplasia (CAH).[54123]

    Neonates

    30 to 50 mg/m2/day PO given in 3 to 4 divided doses (approximately triple the daily maintenance dose) is commonly recommended.[54138] Varying recommendations of increases in the daily maintenance dose anywhere from 2 to 10 times have been made depending on the level of stress and the patient's individual needs.[54138] [54155] Hydrocortisone cypionate suspension (Cortef) and hydrocortisone tablets are not bioequivalent; therefore, the suspension is not recommended for the treatment of patients with congenital adrenal hyperplasia (CAH).[54123]

    Rectal dosage†

    Infants, Children, and Adolescents

    100 mg/m2/dose PR every 8 hours has been recommended as an alternative to parenteral administration in patients who cannot tolerate oral administration due to illness. Due to large interindividual differences in bioavailability, higher doses (150 to 200 mg/m2/dose PR) may be required in patients who do not show an adequate response (serum cortisol concentration more than 1,000 nmol/L 3 hours after administration). It is recommended that the patient's response to rectal hydrocortisone be tested prior to use during illness. In a study of patients with adrenal insufficiency (n = 57, age 1 month to 17 years), 43 patients responded adequately to a dose of 100 mg/m2 rectally. Risk factors for failed response included younger age and obesity. Suppositories used in this study were compounded in a Witepsol W45 base.[54162]

    for adrenal crisis prophylaxis in pediatric patients with known or suspected adrenal insufficiency undergoing surgery accompanied by general anesthesia

    Intramuscular or Intravenous dosage (hydrocortisone sodium succinate injection)

    Children and Adolescents 6 to 17 years

    50 mg/m2 IV 30 to 60 minutes prior to induction of anesthesia with repeat doses of 50 mg/m2/dose IV every 6 hours or as a continuous infusion until the patient has recovered.[54138] For patients with congenital adrenal hyperplasia (CAH), 2 mg/kg/dose IV at induction of anesthesia with repeat doses every 4 hours or as a continuous IV infusion for prolonged procedures or recovery times has also been recommended.[54160] Alternatively, an initial stress dose of 100 mg IM followed by IV doses equivalent to 3 to 4 times the daily maintenance dose divided every 6 hours has been recommended.[54123] [54155]

    Children 1 to 5 years

    50 mg/m2 IV 30 to 60 minutes prior to induction of anesthesia with repeat doses of 50 mg/m2/dose IV every 6 hours or as a continuous infusion until the patient has recovered.[54138] For patients with congenital adrenal hyperplasia (CAH), 2 mg/kg/dose IV at induction of anesthesia with repeat doses every 4 hours or as a continuous IV infusion for prolonged procedures or recovery times has also been recommended.[54160] Alternatively, an initial stress dose of 50 mg IM followed by IV doses equivalent to 3 to 4 times the daily maintenance dose divided every 6 hours has been recommended.[54123] [54155]

    Infants

    50 mg/m2 IV 30 to 60 minutes prior to induction of anesthesia with repeat doses of 50 mg/m2/dose IV every 6 hours or as a continuous infusion until the patient has recovered.[54138] For patients with congenital adrenal hyperplasia (CAH), 2 mg/kg/dose IV at induction of anesthesia with repeat doses every 4 hours or as a continuous IV infusion for prolonged procedures or recovery times has also been recommended.[54160] Alternatively, an initial stress dose of 25 mg IM followed by IV doses equivalent to 3 to 4 times the daily maintenance dose divided every 6 hours has been recommended.[54123] [54155]

    Neonates

    50 mg/m2 IV 30 to 60 minutes prior to induction of anesthesia with repeat doses of 50 mg/m2/dose IV every 6 hours or as a continuous infusion until the patient has recovered.[54138] For patients with congenital adrenal hyperplasia (CAH), 2 mg/kg/dose IV at induction of anesthesia with repeat doses every 4 hours or as a continuous IV infusion for prolonged procedures or recovery times has also been recommended.[54160] Alternatively, an initial stress dose of 25 mg IM followed by IV doses equivalent to 3 to 4 times the daily maintenance dose divided every 6 hours has been recommended.[54123] [54155]

    for the treatment of acute adrenocortical insufficiency

    Intramuscular or Intravenous dosage (hydrocortisone sodium succinate injection)

    Adults

    100 to 500 mg IM or IV. May repeat every 2 to 6 hours depending upon patient condition and response.[54049]

    Children and Adolescents 6 to 17 years

    2 mg/kg/dose (Max: 100 mg) [weight-based], 50 to 100 mg/dose [flat dose], or 50 to 100 mg/m2/dose [BSA-based] IV or IM load, followed by 50 to 100 mg/day [flat dose] or 50 to 100 mg/m2/day [BSA-based] IV or IM in divided doses at 6-hour intervals for 24 hours.[54138] [64934] [64993] [64994] [64995] [64996] [64997]

    Children 1 to 5 years

    2 mg/kg/dose (Max: 100 mg) [weight-based], 25 to 50 mg/dose [flat dose], or 50 to 100 mg/m2/dose [BSA-based] IV or IM load, followed by 25 to 50 mg/day [flat dose] or 50 to 100 mg/m2/day [BSA-based] IV or IM in divided doses at 6-hour intervals for 24 hours.[54138] [64934] [64993] [64994] [64995] [64996] [64997]

    Infants

    2 mg/kg/dose [weight-based], 10 to 25 mg/dose [flat dose], or 50 to 100 mg/m2/dose [BSA-based] IV or IM load, followed by 10 to 25 mg/day [flat dose] or 50 to 100 mg/m2/day [BSA-based] IV or IM in divided doses at 6-hour intervals for 24 hours.[54138] [64934] [64993] [64994] [64995] [64996] [64997]

    Neonates

    2 mg/kg/dose [weight-based], 10 to 25 mg/dose [flat dose], or 50 to 100 mg/m2/dose [BSA-based] IV or IM load, followed by 10 to 25 mg/day [flat dose] or 50 to 100 mg/m2/day [BSA-based] IV or IM in divided doses at 6-hour intervals for 24 hours.[54138] [64934] [64993] [64994] [64995] [64996] [64997]

    for normal physiologic replacement in pediatric patients

    Oral dosage

    Infants and Children

    8 to 10 mg/m2/day PO in 3 divided doses; initial doses up to 12 mg/m2/day have also been recommended. Administer the highest doses in the morning and at lunchtime with a lower dose in the evening to replicate normal physiological cortisol secretion.[67297] [67298]

    For use in nonspecific proctitis, postirradiation (factitial) proctitis, cryptitis, or for other non-specific inflammatory conditions of the anorectum

    Rectal dosage (rectal suppositories)

    Adults

    For nonspecific proctitis, insert 1 suppository PR twice per day, morning and evening, for 2 weeks. May give 1 suppository PR 3 times per day, or 2 suppositories PR twice per day, if needed. For factitial proctitis, the recommended duration of therapy is 6 to 8 weeks or less, depending on response.[54060]

    For the treatment of Crohn's disease

    Oral dosage (tablets)

    Adults

    20 to 240 mg/day PO in 2 to 4 divided doses.[32057] Because of the potential complications of steroid use, steroids should be used selectively and in the lowest dose possible for the shortest duration as possible.[64397]

    Children and Adolescents

    0.56 to 8 mg/kg/day or 16 to 240 mg/m2/day PO in 3 to 4 divided doses.[52618] Adjust according to patient response. Because of the potential complications of steroid use, steroids should be used selectively and in the lowest dose possible for the shortest duration as possible.[64397]

    Intravenous or Intramuscular dosage (hydrocortisone sodium succinate)

    Adults

    100 to 500 mg IV or IM every 2 to 6 hours.[54049] Because of the potential complications of steroid use, steroids should be used selectively and in the lowest dose possible for the shortest duration as possible.[64397]

    Children and Adolescents

    0.56 to 8 mg/kg/day or 20 to 240 mg/m2/day IV or IM in 3 to 4 divided doses. Adjust according to patient response.[54049] Because of the potential complications of steroid use, steroids should be used selectively and in the lowest dose possible for the shortest duration as possible.[64393] [64397]

    For the treatment of hemorrhoids

    Rectal dosage (hydrocortisone acetate rectal suppository)

    Adults

    25 mg (1 suppository) rectally twice daily for 2 weeks. May use 25 mg (1 suppository) rectally 3 times daily or 50 mg (2 suppositories) twice daily for more severe cases.[54060]

    Intravenous dosage (hydrocortisone sodium succinate injection)

    Adults

    The FDA-approved general dosage range is 100 to 500 mg IV; repeat doses at 2, 4, or 6 hour intervals as indicated. Adjust to patient response.[54049] In certain acute, life-threatening situations, higher doses (e.g., 5 to 10 mg/kg/dose IV [Max: 625 mg/dose]) may be justified.[60464] [66106] Corticosteroids are not indicated as initial treatment for anaphylaxis, but can be given as adjunctive therapy after the administration of epinephrine.[66106] [64564]

    Adolescents, Children, and Infants

    The FDA-approved general dosage range is 0.56 to 8 mg/kg/day or 20 to 240 mg/m2/day IV given in 3 to 4 divided doses. Adjust according to patient response.[54049] In certain acute, life-threatening situations, higher doses may be justified. Corticosteroids are not indicated as initial treatment for anaphylaxis, but can be given as adjunctive therapy after the administration of epinephrine.[66106] [64564]

    for the non-emergent treatment of hypersensitivity or allergic conditions

    Oral dosage

    Adults

    The initial dosage may vary from 20 to 240 mg/day PO, given in 2 to 4 divided doses, depending on the specific condition being treated. Adjust according to patient response.[32057]

    Adolescents, Children, and Infants

    The initial dosage may vary from 20 to 240 mg/day PO, given in 2 to 4 divided doses, depending on the specific condition being treated. Adjust according to patient response.[32057] A general pediatric weight-based dose range of 0.56 to 8 mg/kg/day or 16 to 240 mg/m2/day PO, given in 3 to 4 divided doses, has been recommended.[52618]

    For the treatment of corticosteroid-responsive dermatoses (e.g., alopecia areata, atopic dermatitis, bullous dermatitis herpetiformis, contact dermatitis including Rhus dermatitis due to poison ivy, poison oak, poison sumac, diaper dermatitis, discoid lupus erythematosus, eczema, exfoliative dermatitis, graft-versus-host disease (GVHD), granuloma annulare, insect bites or stings, keloids, lichen striatus, lichen planus, lichen simplex, necrobiosis lipoidica diabeticorum, pemphigus, phimosis, pityriasis rosea, polymorphous light eruption, pompholyx (dyshidrosis), pruritus, psoriasis, seborrheic dermatitis, xerosis)

    for the general treatment of mild to moderate corticosteroid-responsive dermatoses

    Topical dosage (hydrocortisone or hydrocortisone acetate cream, foam, gel, lotion, ointment, or solution)

    Adults

    Apply a thin layer topically to the affected skin area(s) 2 to 4 times daily.[54074] [54365]

    Infants, Children, and Adolescents

    Apply a thin layer topically to the affected skin area(s) 2 to 4 times daily.[54074] [54365]

    Topical dosage (hydrocortisone butyrate cream, ointment, or solution)

    Adults

    Apply a thin layer topically to the affected skin area(s) 2 to 3 times daily.[54372]

    Infants, Children, and Adolescents

    Apply a thin layer topically to the affected skin area(s) 2 to 3 times daily.[54372]

    Topical dosage (hydrocortisone butyrate lipocream)

    Adults

    Apply a thin layer topically to the affected skin area(s) 2 or 3 times daily. If no improvement is seen within 2 weeks, reassess diagnosis. Safety and efficacy have not been established beyond 4 weeks of therapy.[54371]

    Topical dosage (hydrocortisone probutate cream)

    Adults

    Apply a thin layer topically to the affected skin area(s) once or twice daily. If no improvement is seen within 2 weeks, reassess diagnosis.[62344]

    Topical dosage (hydrocortisone valerate cream or ointment)

    Adults

    Apply a thin layer topically to the affected skin area(s) 2 to 3 times daily. If no improvement is seen within 2 weeks, reassess diagnosis.[62348]

    for the treatment of mild to moderate atopic dermatitis

    Topical dosage (hydrocortisone or hydrocortisone acetate cream, foam, gel, lotion, ointment, or solution)

    Adults

    Apply a thin layer topically to the affected skin area(s) 2 times daily until symptoms resolve. If no improvement is seen within 2 weeks, reassess diagnosis.[54074] [68576] Proactive, intermittent application of topical corticosteroids 1 to 2 times weekly to areas that commonly flare is recommended to help prevent relapses.[65339]

    Infants, Children, and Adolescents

    Apply a thin layer topically to the affected skin area(s) 2 times daily until symptoms resolve. If no improvement is seen within 2 weeks, reassess diagnosis.[54074] [68576] Proactive, intermittent application of topical corticosteroids 1 to 2 times weekly to areas that commonly flare is recommended to help prevent relapses.[65339]

    Topical dosage (hydrocortisone butyrate cream, ointment, or solution)

    Adults

    Apply a thin layer topically to the affected skin area(s) 2 times daily until symptoms resolve.[54372] [65339] Proactive, intermittent application of topical corticosteroids 1 to 2 times weekly to areas that commonly flare is recommended to help prevent relapses.[65339]

    Infants, Children, and Adolescents

    Apply a thin layer topically to the affected skin area(s) 2 times daily until symptoms resolve.[54372] [65339] Proactive, intermittent application of topical corticosteroids 1 to 2 times weekly to areas that commonly flare is recommended to help prevent relapses.[65339]

    Topical dosage (hydrocortisone butyrate lipocream and lotion)

    Adults

    Apply a thin layer topically to the affected skin area(s) 2 times daily until symptoms resolve. If no improvement is seen within 2 weeks, reassess diagnosis. Safety and efficacy have not been established beyond 4 weeks of therapy.[54371] Proactive, intermittent application of topical corticosteroids 1 to 2 times weekly to areas that commonly flare is recommended to help prevent relapses.[65339]

    Infants, Children, and Adolescents 3 months to 17 years

    Apply a thin layer topically to the affected skin area(s) 2 times daily until symptoms resolve. If no improvement is seen within 2 weeks, reassess diagnosis. Safety and efficacy have not been established beyond 4 weeks of therapy.[43359] [54371] Proactive, intermittent application of topical corticosteroids 1 to 2 times weekly to areas that commonly flare is recommended to help prevent relapses.[65339]

    Topical dosage (hydrocortisone probutate cream)

    Adults

    Apply a thin layer topically to the affected skin area(s) once or twice daily. If no improvement is seen within 2 weeks, reassess diagnosis.[62344] [65339] Proactive, intermittent application of topical corticosteroids 1 to 2 times weekly to areas that commonly flare is recommended to help prevent relapses.[65339]

    Topical dosage (hydrocortisone valerate cream or ointment)

    Adults

    Apply a thin layer topically to the affected skin area(s) 2 times daily until symptoms resolve. If no improvement is seen within 2 weeks, reassess diagnosis.[62348] [65339] Proactive, intermittent application of topical corticosteroids 1 to 2 times weekly to areas that commonly flare is recommended to help prevent relapses.[65339]

    for the treatment of diaper dermatitis

    Topical dosage (hydrocortisone or hydrocortisone acetate 0.5% to 2.5% cream or ointment)

    Adults

    Apply a thin layer topically to the affected skin area(s) 2 to 4 times daily for up to 2 weeks.[54074] [54365] [68176] Avoid the use of tight-fitting diapers or plastic pants on persons being treated in the diaper area as these may act as an occlusive dressing.[54074]

    Infants, Children, and Adolescents

    Apply a thin layer topically to the affected skin area(s) 2 to 4 times daily for up to 2 weeks.[54074] [54365] [68176] Avoid the use of tight-fitting diapers or plastic pants on persons being treated in the diaper area as these may act as an occlusive dressing.[54074]

    for the treatment of GVHD

    Topical dosage (hydrocortisone or hydrocortisone acetate 1% cream, gel, lotion, ointment, or solution)

    Adults

    Apply a thin layer topically to the affected skin area(s) 2 times daily.[54365] [55032] [55037] [69614] The FDA-approved dosage is a thin layer topically to the affected skin area(s) 2 to 4 times daily.[54365]

    Infants, Children, and Adolescents

    Apply a thin layer topically to the affected skin area(s) 2 times daily.[54365] [55032] [55037] [69614] The FDA-approved dosage is a thin layer topically to the affected skin area(s) 2 to 4 times daily.[54365]

    for the treatment of phimosis

    Topical dosage (hydrocortisone or hydrocortisone acetate 1% cream, lotion, ointment, or solution)

    Infants, Children, and Adolescents

    Apply a thin layer topically to the affected skin area(s) 2 times daily for 4 to 8 weeks.[69510] [69512] [69580] The FDA-approved dosage is a thin layer topically to the affected skin area(s) 2 to 4 times daily.[54074] [54365]

    Topical dosage (hydrocortisone butyrate cream, ointment, or solution)

    Infants, Children, and Adolescents

    Apply a thin layer topically to the affected skin area(s) 2 times daily for 4 to 8 weeks.[69510] [69516] [69580]The FDA-approved dosage is a thin layer topically to the affected skin area(s) 2 to 3 times daily.[54372]

    for the treatment of psoriasis

    Topical dosage (hydrocortisone or hydrocortisone acetate cream, foam, gel, lotion, ointment, or solution)

    Adults

    Apply a thin layer topically to the affected skin area(s) 2 to 4 times daily.[54074] [54365] The duration of the therapy depends on factors such as the topical corticosteroid potency, disease severity and anatomic location, and age. After improvement, may consider transitioning to lower-potency corticosteroid, using intermittent therapy, and combining treatment with noncorticosteroidal agents. Taper by reducing use to every other day, then twice weekly, then discontinue if adequate control is maintained. Guidelines recommend class 1 to 5 topical corticosteroids for up to 4 weeks for plaque psoriasis not involving intertriginous areas and class 1 to 7 topical corticosteroids for a minimum of up to 4 weeks for scalp psoriasis. Use of topical corticosteroids for more than 12 weeks may be considered under careful supervision.[69175]

    Infants, Children and Adolescents

    Apply a thin layer topically to the affected skin area(s) 2 to 4 times daily.[54074] [54365] Guidelines recommend topical corticosteroids as monotherapy for short-term treatment of localized psoriasis.[69176]

    Topical dosage (hydrocortisone butyrate cream, ointment, or solution)

    Adults

    Apply a thin layer topically to the affected skin area(s) 2 to 3 times daily.[54372] The duration of the therapy depends on factors such as the topical corticosteroid potency, disease severity and anatomic location, and age. After improvement, may consider transitioning to lower-potency corticosteroid, using intermittent therapy, and combining treatment with noncorticosteroidal agents. Taper by reducing use to every other day, then twice weekly, then discontinue if adequate control is maintained. Guidelines recommend class 1 to 5 topical corticosteroids for up to 4 weeks for plaque psoriasis not involving intertriginous areas and class 1 to 7 topical corticosteroids for a minimum of up to 4 weeks for scalp psoriasis. Use of topical corticosteroids for more than 12 weeks may be considered under careful supervision.[69175]

    Infants, Children, and Adolescents

    Apply a thin layer topically to the affected skin area(s) 2 to 3 times daily.[54372] Guidelines recommend topical corticosteroids as monotherapy for short-term treatment of localized psoriasis.[69176]

    Topical dosage (hydrocortisone butyrate lipocream)

    Adults

    Apply a thin layer topically to the affected skin area(s) 2 or 3 times daily. If no improvement is seen within 2 weeks, reassess diagnosis. Safety and efficacy have not been established beyond 4 weeks of therapy.[54371] The duration of the therapy depends on factors such as the topical corticosteroid potency, disease severity and anatomic location, and age. After improvement, may consider transitioning to lower-potency corticosteroid, using intermittent therapy, and combining treatment with noncorticosteroidal agents. Taper by reducing use to every other day, then twice weekly, then discontinue if adequate control is maintained. Guidelines recommend class 1 to 5 topical corticosteroids for up to 4 weeks for plaque psoriasis not involving intertriginous areas and class 1 to 7 topical corticosteroids for a minimum of up to 4 weeks for scalp psoriasis. Use of topical corticosteroids for more than 12 weeks may be considered under careful supervision.[69175]

    Topical dosage (hydrocortisone probutate cream)

    Adults

    Apply a thin layer topically to the affected skin area(s) once or twice daily. If no improvement is seen within 2 weeks, reassess diagnosis.[62344] The duration of the therapy depends on factors such as the topical corticosteroid potency, disease severity and anatomic location, and age. After improvement, may consider transitioning to lower-potency corticosteroid, using intermittent therapy, and combining treatment with noncorticosteroidal agents. Taper by reducing use to every other day, then twice weekly, then discontinue if adequate control is maintained. Guidelines recommend class 1 to 5 topical corticosteroids for up to 4 weeks for plaque psoriasis not involving intertriginous areas and class 1 to 7 topical corticosteroids for a minimum of up to 4 weeks for scalp psoriasis. Use of topical corticosteroids for more than 12 weeks may be considered under careful supervision.[69175]

    Topical dosage (hydrocortisone valerate cream or ointment)

    Adults

    Apply a thin layer topically to the affected skin area(s) 2 to 3 times daily. If no improvement is seen within 2 weeks, reassess diagnosis.[62348] The duration of the therapy depends on factors such as the topical corticosteroid potency, disease severity and anatomic location, and age. After improvement, may consider transitioning to lower-potency corticosteroid, using intermittent therapy, and combining treatment with noncorticosteroidal agents. Taper by reducing use to every other day, then twice weekly, then discontinue if adequate control is maintained. Guidelines recommend class 1 to 5 topical corticosteroids for up to 4 weeks for plaque psoriasis not involving intertriginous areas and class 1 to 7 topical corticosteroids for a minimum of up to 4 weeks for scalp psoriasis. Use of topical corticosteroids for more than 12 weeks may be considered under careful supervision.[69175]

    For the systemic treatment of severe inflammatory dermatoses, like severe exfoliative dermatitis, erythema multiforme, Stevens-Johnson syndrome, or psoriasis unresponsive to topical treatment

    Oral dosage

    Adults

    20 to 240 mg/day PO, given in 2 to 4 divided doses.[32057]

    Adolescents, Children, and Infants

    A general dose range of 0.56 to 8 mg/kg/day or 16 to 240 mg/m2/day PO given in 3 to 4 divided doses has been recommended.[52618] Adjust according to patient response.

    Intramuscular or Intravenous dosage (hydrocortisone sodium succinate injection)

    Adults

    100 to 500 mg IM or IV. Repeat doses at 2, 4, or 6 hour intervals.[54049]

    Adolescents, Children, and Infants

    0.56 to 8 mg/kg/day or 20 to 240 mg/m2/day IM or IV given in 3 to 4 divided dose is the FDA-approved general dosage range. Adjust according to patient response.[54049]

    Oral dosage

    Adults

    20 to 240 mg/day PO, given in 2 to 4 divided doses.[32057]

    Infants, Children, and Adolescents

    A general dose range of 0.56 to 8 mg/kg/day or 16 to 240 mg/m2/day PO given in 3 to 4 divided doses has been recommended.[52618] Adjust according to patient response.

    Intramuscular or Intravenous dosage (hydrocortisone sodium succinate injection)

    Adults

    100 to 500 mg IM or IV. Repeat doses at 2, 4, or 6 hour intervals.[54049]

    Infants, Children, and Adolescents

    0.56 to 8 mg/kg/day or 20 to 240 mg/m2/day IM or IV given in 3 to 4 divided dose is the FDA-approved general dosage range. Adjust according to patient response.[54049]

    For adjunctive therapy in the treatment of rheumatic disorders including acute gouty arthritis, ankylosing spondylitis, rheumatoid arthritis, juvenile rheumatoid arthritis (JRA)/juvenile idiopathic arthritis (JIA), post-traumatic osteoarthritis, pseudogout†, or psoriatic arthritis

    Oral dosage

    Adults

    20 to 240 mg/day PO, given in 2 to 4 divided doses.[32057]

    Adolescents, Children, and Infants

    A general dose range of 0.56 to 8 mg/kg/day or 16 to 240 mg/m2/day PO given in 3 to 4 divided doses has been recommended.[52618] Adjust according to patient response.

    Intramuscular or Intravenous dosage (hydrocortisone sodium succinate injection)

    Adults

    100 to 500 mg IM or IV. Repeat doses at 2, 4, or 6 hour intervals.[54049]

    Adolescents, Children, and Infants

    0.56 to 8 mg/kg/day or 20 to 240 mg/m2/day IM or IV given in 3 to 4 divided dose is the FDA-approved general dosage range. Adjust according to patient response.[54049]

    For the treatment of acute episodes or exacerbation of non-rheumatic inflammation including acute and subacute bursitis, epicondylitis, and acute non-specific tenosynovitis

    Oral dosage

    Adults

    20 to 240 mg/day PO, given in 2 to 4 divided doses.[32057]

    Adolescents, Children, and Infants

    A general dose range of 0.56 to 8 mg/kg/day or 16 to 240 mg/m2/day PO given in 3 to 4 divided doses has been recommended.[52618] Adjust according to patient response.

    For the treatment of corticosteroid-responsive hematologic disorders, like immune thrombocytopenic purpura (ITP), secondary thrombocytopenia in adults, acquired (autoimmune) hemolytic anemia, erythroblastopenia, and congenital hypoplastic anemia; OR for the palliative treatment of neoplastic disease in adults and acute leukemias of childhood including acute lymphocytic leukemia (ALL), chronic lymphocytic leukemia (CLL), Hodgkin lymphoma, non-Hodgkin's lymphoma (NHL), cutaneous T-cell lymphoma (CTCL) (aka mycosis fungoides), or multiple myeloma†

    Oral dosage

    Adults

    20 to 240 mg/day PO, given in 2 to 4 divided doses.[32057]

    Adolescents, Children, and Infants

    A general dose range of 0.56 to 8 mg/kg/day or 16 to 240 mg/m2/day PO given in 3 to 4 divided doses has been recommended.[52618] Adjust according to patient response.

    Intramuscular or Intravenous dosage (hydrocortisone sodium succinate injection)

    Adults

    100 to 500 mg IM or IV. Repeat doses at 2, 4, or 6 hour intervals.[54049]

    Adolescents, Children, and Infants

    0.56 to 8 mg/kg/day or 20 to 240 mg/m2/day IM or IV given in 3 to 4 divided dose is the FDA-approved general dosage range. Adjust according to patient response.[54049]

    For the short-term treatment of hypercalcemia associated with neoplastic disease

    Intravenous or Intramuscular dosage (hydrocortisone sodium succinate injection)

    Adults

    200 to 300 mg IV once per day for 3 to 5 days has been recommended.[23973]

    Adolescents, Children, and Infants

    0.56 to 8 mg/kg/day or 20 to 240 mg/m2/day IM or IV given in 3 to 4 divided dose is the FDA-approved general dosage range. Adjust according to patient response.[54049]

    For the treatment of respiratory inflammatory conditions including aspiration pneumonitis, berylliosis, chronic obstructive pulmonary disease (COPD) exacerbations, Loeffler's syndrome

    Oral dosage

    Adults

    20 to 240 mg/day PO, given in 2 to 4 divided doses.[32057] Administer hydrocortisone IV or IM initially for the treatment of severe respiratory conditions or those compromising the airway.

    Adolescents, Children, and Infants

    A general dose range of 0.56 to 8 mg/kg/day or 16 to 240 mg/m2/day PO given in 3 to 4 divided doses has been recommended.[52618] Adjust according to patient response. Administer hydrocortisone IV or IM initially for the treatment of severe respiratory conditions or those compromising the airway.

    Intramuscular or Intravenous dosage (hydrocortisone sodium succinate injection)

    Adults

    100 to 500 mg IM or IV. Repeat doses at 2, 4, or 6 hour intervals.[54049]

    Adolescents, Children, and Infants

    0.56 to 8 mg/kg/day or 20 to 240 mg/m2/day IM or IV given in 3 to 4 divided dose is the FDA-approved general dosage range. Adjust according to patient response.[54049]

    For the treatment of drug-susceptible tuberculosis infection or drug-resistant tuberculosis infection as adjunctive therapy in combination with antituberculous therapy

    Oral dosage (tablets)

    Adults

    10.67 mg/kg/day PO with a taper over 6 to 8 weeks. Guidelines recommend as adjunct therapy for meningitis. Routine use outside of CNS involvement is not recommended; however, select patients may benefit.[32057] [61094] [69585] [69587] [69589]

    Infants, Children, and Adolescents

    8 to 16 mg/kg/day PO for 4 to 6 weeks, then taper over 2 to 4 weeks. Guidelines recommend as adjunct therapy for meningitis. Routine use outside of CNS involvement is not recommended; however, select patients may benefit.[32057] [34361] [54278] [61094] [66745] [69585] [69587] [69589]

    Intravenous or Intramuscular dosage (hydrocortisone sodium succinate)

    Adults

    10.67 mg/kg/day IV or IM with a taper over 6 to 8 weeks. Guidelines recommend as adjunct therapy for meningitis. Routine use outside of CNS involvement is not recommended; however, select patients may benefit.[54278] [61094] [69585] [69587] [69589]

    Infants, Children, and Adolescents

    8 to 16 mg/kg/day IV or IM for 4 to 6 weeks, then taper over 2 to 4 weeks. Guidelines recommend as adjunct therapy for meningitis. Routine use outside of CNS involvement is not recommended; however, select patients may benefit.[34361] [54278] [61094] [66745] [69585] [69587] [69589]

    For the treatment of hypotension† in patients with septic shock† who are poorly responsive to adequate fluid resuscitation and vasopressor therapy

    Intravenous dosage (hydrocortisone sodium succinate)

    Adults

    50 mg IV every 6 hours or 200 mg/day continuous IV infusion. Guidelines suggest IV corticosteroids for patients with septic shock and ongoing requirements for vasopressor therapy, defined as a norepinephrine or epinephrine dose of 0.25 mcg/kg/minute or more at least 4 hours after initiation.[67037]

    Adolescents

    2 mg/kg (Max: 100 mg) [weight-based], 100 mg [flat-dose], or 100 mg/m2 [BSA-based] IV bolus, followed by 1 to 2 mg/kg/day [weight-based] or 50 to 100 mg/m2/day [BSA-based] IV in divided doses at 6-hour intervals or as a continuous IV infusion.[52079] [54210] [54211] [64934] [64994] Infusions up to 50 mg/kg/day may be required to reverse shock short-term; however, this recommendation is based on very limited data that did not demonstrate improvement in mortality.[52079] [54210] [65000] Guidelines state hydrocortisone may or may not be used for fluid- and vasopressor-refractory septic shock.[64985]

    Children 3 to 12 years

    2 mg/kg (Max: 100 mg) [weight-based], 50 mg [flat-dose], or 100 mg/m2 [BSA-based] IV bolus, followed by 1 to 2 mg/kg/day [weight-based] or 50 to 100 mg/m2/day [BSA-based] IV in divided doses at 6-hour intervals or as a continuous IV infusion.[52079] [54210] [54211] [64934] [64994] Infusions up to 50 mg/kg/day may be required to reverse shock short-term; however, this recommendation is based on very limited data that did not demonstrate improvement in mortality.[52079] [54210] [65000] Guidelines state hydrocortisone may or may not be used for fluid- and vasopressor-refractory septic shock.[64985]

    Infants and Children 1 month to 2 years

    2 mg/kg [weight-based], 25 mg [flat-dose], or 100 mg/m2 [BSA-based] IV bolus, followed by 1 to 2 mg/kg/day [weight-based] or 50 to 100 mg/m2/day [BSA-based] IV in divided doses at 6-hour intervals or as a continuous IV infusion.[52079] [54210] [54211] [64934] [64994] Infusions up to 50 mg/kg/day may be required to reverse shock short-term; however, this recommendation is based on very limited data that did not demonstrate improvement in mortality.[52079] [54210] [65000] Guidelines state hydrocortisone may or may not be used for fluid- and vasopressor-refractory septic shock.[64985]

    Neonates

    1 mg/kg/dose IV every 8 to 12 hours for 1 to 5 days has been studied (combined n from 3 studies = 89, gestational age 23 to 40 weeks).[54201] [54202] [54206] An initial loading dose of 2 mg/kg IV was used in 1 retrospective study and another prospective, observational study used a higher maintenance dose of 3 to 6 mg/kg/day IV divided 2 to 4 times daily in a small number of patients (n = 5) with severe capillary leak syndrome and/or previous steroid treatment.[54202] [54206] Guidelines state hydrocortisone may or may not be used for fluid- and vasopressor-refractory septic shock.[64985]

    For the management of nephrotic syndrome to induce diuresis or decrease proteinuria

    Oral dosage

    Adults

    20 to 240 mg/day PO, given in 2 to 4 divided doses.[32057]

    Infants, Children, and Adolescents

    A general dose range of 0.56 to 8 mg/kg/day or 16 to 240 mg/m2/day PO given in 3 to 4 divided doses has been recommended.[52618] Adjust according to patient response.

    Intramuscular or Intravenous dosage (hydrocortisone sodium succinate injection)

    Adults

    100 mg to 500 mg IM or IV. Repeat doses at 2, 4, or 6 hour intervals.[54049]

    Infants, Children, and Adolescents

    0.56 to 8 mg/kg/day or 20 to 240 mg/m2/day IM or IV given in 3 to 4 divided dose is the FDA-approved general dosage range. Adjust according to patient response.[54049]

    For the prevention of chronic lung disease (CLD)†, specifically bronchopulmonary dysplasia (BPD)†

    Intravenous dosage

    Premature neonates

    1 mg/kg/day IV divided every 12 hours for 7 to 12 days then 0.5 mg/kg/day IV divided every 12 to 24 hours for 3 days, starting within the first 24 to 48 hours of life for premature neonates at high risk for BPD. Early systemic corticosteroids increase the rate of survival without BPD without adverse effects on neurodevelopment. However, an increased risk for late-onset sepsis may be associated with treatment. Do not administer with indomethacin prophylaxis due to increased potential for gastrointestinal perforation.[54304] [54338] [67301] [67302] [67303] [67304] [67305]

    For the treatment of neurologic or myocardial involvement associated with trichinosis

    Oral dosage

    Adults

    20 to 240 mg (base)/day PO, given in 2 to 4 divided doses.[32057]

    Adolescents, Children, and Infants

    A general dose range of 0.56 to 8 mg/kg/day or 16 to 240 mg/m2/day PO given in 3 to 4 divided doses has been recommended.[52618] Adjust according to patient response.

    Intramuscular or Intravenous dosage (hydrocortisone sodium succinate injection)

    Adults

    100 mg to 500 mg IM or IV. Repeat doses at 2, 4, or 6 hour intervals.[54049]

    Adolescents, Children, and Infants

    0.56 to 8 mg/kg/day or 20 to 240 mg/m2/day IM or IV given in 3 to 4 divided dose is the FDA-approved general dosage range. Adjust according to patient response.[54049]

    For the treatment of refractory neonatal hypoglycemia†

    Intravenous dosage (hydrocortisone sodium succinate injection)

    Neonates

    5 mg/kg/day IV given in 2 divided doses has been recommended in neonates not responding to glucose infusions of 12 to 15 mg/kg/minute.[54439] [54440]

    Oral dosage

    Neonates

    5 mg/kg/day PO given in 2 divided doses has been recommended in neonates not responding to glucose infusions of 12 to 15 mg/kg/minute.[54439] [54440]

    For the treatment of thyroiditis

    Oral dosage

    Adults

    20 to 240 mg (base)/day PO, given in 2 to 4 divided doses.[32057]

    Infants, Children, and Adolescents

    A general dose range of 0.56 to 8 mg/kg/day or 16 to 240 mg/m2/day PO given in 3 to 4 divided doses has been recommended.[52618] Adjust according to patient response.

    Intramuscular or Intravenous dosage (hydrocortisone sodium succinate injection)

    Adults

    100 to 500 mg IM or IV. Repeat doses at 2, 4, or 6 hour intervals.[54049]

    Infants, Children, and Adolescents

    0.56 to 8 mg/kg/day or 20 to 240 mg/m2/day IM or IV given in 3 to 4 divided dose is the FDA-approved general dosage range. Adjust according to patient response.[54049]

    For the treatment of corticosteroid-responsive ophthalmic disorders, including allergic conjunctivitis (not controlled topically), allergic marginal corneal ulcer, anterior segment inflammation, chorioretinitis, endophthalmitis†, Graves' ophthalmopathy, herpes zoster ocular infection (herpes zoster ophthalmicus), iritis, keratitis, postoperative ocular inflammation, optic neuritis, diffuse posterior uveitis, or vernal keratoconjunctivitis

    Oral dosage

    Adults

    20 to 240 mg/day PO, given in 2 to 4 divided doses.[32057]

    Adolescents, Children, and Infants

    A general dose range of 0.56 to 8 mg/kg/day or 16 to 240 mg/m2/day PO given in 3 to 4 divided doses has been recommended.[52618] Adjust according to patient response.

    Intramuscular or Intravenous dosage (hydrocortisone sodium succinate injection)

    Adults

    100 to 500 mg IM or IV. Repeat doses at 2, 4, or 6 hour intervals.[54049]

    Adolescents, Children, and Infants

    0.56 to 8 mg/kg/day or 20 to 240 mg/m2/day IM or IV given in 3 to 4 divided dose is the FDA-approved general dosage range. Adjust according to patient response.[54049]

    For adjunctive therapy in the treatment of carpal tunnel syndrome†

    Local injection (hydrocortisone acetate suspension for injection)

    Adults

    25 mg as a single injection adjacent to the carpal tunnel has been effective for conservative therapy. Reassess at 6 to 8 weeks. To avoid median-nerve injury, use specialized administration techniques. Use of more than 2 or 3 repeat injections is not advised; local tendon damage may occur. The definitive treatment for median-nerve entrapment is surgery. Corticosteroids are temporary measures; patients who have intermittent pain and paresthesias without any fixed motor-sensory deficits may respond to conservative therapy.[18192]

    For asthma exacerbation

    Oral dosage

    Adults

    Usual dose is 200 mg/day PO, given in divided doses. A 5 to 7-day course produces similar outcome to using the same dose for a longer duration (i.e., 10 to 14 days).[64807] Dose Range: 20 to 240 mg/day PO, given in 2 to 4 divided doses.[32057] Oral corticosteroids (CS) are just as effective as IV for exacerbations. Although prednisone, prednisolone, or methylprednisolone are typically the systemic corticosteroids of choice, other CS such as hydrocortisone, given in equipotent daily doses are likely to be as effective. IV or IM CS may be used for the treatment of severe respiratory conditions or those compromising the airway.[64807]

    Children and Adolescents 12 years and older

    Usual pediatric dose is 1 to 2 mg/kg/day PO (Adult Usual: 200 mg/day), given in divided doses. A 3 to 5-day course is usually sufficient.[64807] FDA-approved Dose Range: 20 to 240 mg/day PO, given in 2 to 4 divided doses. Titrate to patient response.[32057] Oral corticosteroids (CS) are just as effective as IV for exacerbations. Although prednisone, prednisolone, or methylprednisolone are typically the systemic corticosteroids of choice, other CS such as hydrocortisone, given in equipotent daily doses are likely to be as effective. IV or IM CS may be used for the treatment of severe respiratory conditions or those compromising the airway.[64807]

    Children 6 to 11 years

    Usual dose is 1 to 2 mg/kg/day PO (Max: 40 mg/day), given in divided doses. A 3 to 5-day course is usually sufficient for most pediatric patients.[64807] Titrate to patient response up to 8 mg/kg/day, given in divided doses.[52618] Oral corticosteroids (CS) are just as effective as IV for exacerbations. Although prednisone, prednisolone, or methylprednisolone are typically the systemic corticosteroids of choice, other CS such as hydrocortisone, given in equipotent daily doses are likely to be as effective. IV or IM CS may be used for the treatment of severe respiratory conditions or those compromising the airway.[64807]

    Intramuscular or Intravenous dosage (hydrocortisone sodium succinate injection)

    Adults

    100 to 500 mg IM or IV. Repeat doses at 2, 4, or 6-hour intervals. Titrate to patient response.[54049] A usual dose is 200 mg/day in divided doses; a 5 to 7-day course produces similar outcome to use for a longer duration (i.e., 10 to 14 days).[64807]

    Adolescents

    0.56 to 8 mg/kg/day or 20 to 240 mg/m2/day IM or IV given in 3 to 4 divided doses is the FDA-approved general dosage range. Adjust to patient response.[54049] A 3 to 5-day course of corticosteroids is usually sufficient for most.[64807]

    Infants and Children

    0.56 to 8 mg/kg/day or 20 to 240 mg/m2/day IM or IV given in 3 to 4 divided doses is the FDA-approved general dosage range. Adjust to patient response.[54049] A 3 to 5-day course of corticosteroids is usually sufficient for most pediatric patients.[64807] An initial dose of 6 mg/kg IV followed by 8 to 10 mg/kg/day IV given in 4 divided doses for 1 to 2 days was used in 2 studies (age 2 months to 11 years) of pediatric patients with acute asthma.[54357] [54359]

    For the treatment of severe perennial allergies or seasonal allergies, including allergic rhinitis, that are intractable to adequate trials of conventional treatment

    Oral dosage

    Adults

    The initial dosage may vary from 20 to 240 mg/day PO, given in 2 to 4 divided doses, depending on the specific condition being treated. Adjust according to patient response.[32057]

    Infants, Children, and Adolescents

    The initial dosage may vary from 20 to 240 mg/day PO, given in 2 to 4 divided doses, depending on the specific condition being treated. Adjust according to patient response.[32057] A general pediatric weight-based dose range of 0.56 to 8 mg/kg/day or 16 to 240 mg/m2/day PO, given in 3 to 4 divided doses, has been recommended.[52618]

    For the treatment of thyrotoxicosis†, including thyroid storm†

    Intravenous dosage

    Adults

    300 mg IV bolus then 100 mg IV every 8 hours.[61515] [64934] Taper dose based on clinical response and the duration of steroid therapy.[64934] [68189]

    Adolescents

    2 mg/kg (Max: 100 mg) [weight-based] or 100 mg [flat-dose] IV bolus then 25 mg IV every 6 hours for 24 hours.[64934] Alternatively, 100 to 150 mg/m2/day (Max: 100 mg/dose) divided every 8 hours.[53789] [65001] [65002] [65003] Taper dose based on clinical response and the duration of steroid therapy.[64934] [68189]

    Children 3 to 12 years

    2 mg/kg (Max: 100 mg) [weight-based] or 50 mg [flat-dose] IV bolus then 12.5 mg IV every 6 hours for 24 hours.[64934] Alternatively, 100 to 150 mg/m2/day (Max: 100 mg/dose) IV divided every 8 hours.[53789] [65001] [65002] [65003] Taper dose based on clinical response and the duration of steroid therapy.[64934] [68189]

    Infants and Children 1 to 2 years

    2 mg/kg [weight-based] or 25 mg [flat-dose] IV bolus then 6.25 mg IV every 6 hours for 24 hours.[64934] Alternatively, 100 to 150 mg/m2/day IV divided every 8 hours.[65001] [65002] [65003] Taper dose based on clinical response and the duration of steroid therapy.[64934] [68189]

    For the treatment of ulcerative colitis

    Oral dosage (tablets)

    Adults

    20 to 240 mg/day PO in 3 to 4 divided doses, initially.[32057] [64393] Taper dose based on clinical symptoms, cumulative steroid exposure, and onset of action of alternate therapies; limit use to the shortest duration possible with early initiation of steroid-sparing therapy. Guidelines recommend oral corticosteroids to induce remission in persons with ulcerative colitis; however, guidelines recommend against systemic corticosteroids for the maintenance of remission.[64393]

    Children and Adolescents

    0.56 to 8 mg/kg/day or 16 to 240 mg/m2/day PO in 3 to 4 divided doses, initially.[52618] Taper dose based on clinical symptoms, cumulative steroid exposure, and onset of action of alternate therapies; limit use to the shortest duration possible with early initiation of steroid-sparing therapy. Guidelines recommend oral corticosteroids to induce remission in persons with ulcerative colitis; however, guidelines recommend against systemic corticosteroids for the maintenance of remission.[64393]

    Intravenous or Intramuscular dosage (hydrocortisone sodium succinate)

    Adults

    100 mg IV or IM 3 to 4 times daily, initially.[54049] [64393] Taper dose based on clinical symptoms, cumulative steroid exposure, and onset of action of alternate therapies; limit use to the shortest duration possible with early initiation of steroid-sparing therapy. Guidelines recommend intravenous hydrocortisone in persons with acute severe ulcerative colitis; however, guidelines recommend against systemic corticosteroids for the maintenance of remission.[64393]

    Children and Adolescents

    0.56 to 8 mg/kg/day or 20 to 240 mg/m2/day IV or IM in 3 to 4 divided doses, initially.[54049] Taper dose based on clinical symptoms, cumulative steroid exposure, and onset of action of alternate therapies; limit use to the shortest duration possible with early initiation of steroid-sparing therapy. Guidelines recommend intravenous hydrocortisone in persons with acute severe ulcerative colitis; however, guidelines recommend against systemic corticosteroids for the maintenance of remission.[64393]

    Rectal dosage (enema)

    Adults

    100 mg rectally once daily at bedtime for 21 days or until remission, initially. Discontinue therapy if inadequate response by 2 or 3 weeks. Difficult cases may require 2 or 3 months of treatment; when the course extends beyond 21 days, discontinue therapy gradually by decreasing the dose to every other day for 2 to 3 weeks.[62343] Guidelines recommend rectal corticosteroids for induction of remission in persons with mildly to moderately active ulcerative proctitis or proctosigmoiditis who are intolerant of or refractory to mesalamine suppositories.[64377]

    Rectal dosage (rectal foam)

    Adults

    90 mg rectally once or twice daily for 2 to 3 weeks, initially, then 90 mg rectally every other day. Taper dose in small decrements at appropriate time intervals until the lowest dose which will maintain an adequate clinical response is reached. Withdraw long-term therapy gradually.[60551] Guidelines recommend rectal corticosteroids for induction of remission in persons with mildly to moderately active ulcerative proctitis or proctosigmoiditis who are intolerant of or refractory to mesalamine suppositories. Persons who place a higher value on avoiding difficulties associated with mesalamine enemas and a lower value on effectiveness may reasonably select rectal corticosteroid foam preparations.[64377]

    Rectal dosage (suppository)

    Adults

    25 or 30 mg rectally twice daily, initially; for more severe disease, 25 or 30 mg rectally 3 times daily or 50 or 60 mg rectally twice daily.[54060] [67787] Guidelines recommend rectal corticosteroids for induction of remission in persons with mildly to moderately active ulcerative proctitis or proctosigmoiditis who are intolerant of or refractory to mesalamine suppositories.[64377]

    For the treatment of anthrax encephalitis† as adjunctive therapy

    Intravenous dosage

    Adults

    100 mg IV every 6 hours.[53314]

    Therapeutic Drug Monitoring

    Maximum Dosage Limits

      Patients with Hepatic Impairment Dosing

      Hydrocortisone is a synthetic preparation of the steroid hormone cortisol and does not undergo bioconversion in the liver to active form; it appears no systemic dosage adjustments are necessary in patients with hepatic disease. There is an enhanced effect due to decreased metabolism of corticosteroids in patients with cirrhosis.[54049][68680]

      Patients with Renal Impairment Dosing

      Specific guidelines for dosage adjustments in renal impairment are not available; it appears that no dosage adjustments are needed.

      † Off-label indication
      Revision Date: 06/12/2024, 01:59:00 AM

      References

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N Engl J Med 2003;348:727-734.43359 - Locoid (hydrocortisone butyrate lotion) package insert. Bridgewater, NJ: Bausch Health US, LLC; 2023 Oct.52079 - Brierley J, Carcillo JA, Choong K, et al. Clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock: 2007 update from the American College of Critical Care Medicine. Crit Care Med 2009;37:666-688.52618 - Tschudy MM, Arcara KM. The Harriet Lane handbook: a manual for pediatric house officers 19th ed. Philadelphia, PA: Mosby;2012.53314 - World Health Organization. Anthrax in humans and animals - 4th ed. In: WHO Library Cataloguing-in-Publication Data. 2008.53789 - Lee HS, Hwang JS. Seizure and encephalopathy associated with thyroid storm in children. J Child Neurol 2011;26:526-528.54049 - Solu-cortef (hydrocortisone sodium succinate) injection package insert. New York, NY: Pharmacia & Upjohn Co.; 2023 Dec.54060 - Anusol HC (hydrocortisone acetate) suppository package insert. Bridgewater, NJ: Valeant Pharmaceuticals North America LLC; 2017 OCt.54074 - Hydrocortisone 2.5% cream and ointment package insert. Bronx, NY: Perrigo; 2012 Dec.54122 - American Academy of Pediatrics Section on Endocrinology and Committee on Genetics. Technical report: congenital adrenal hyperplasia. Pediatrics 2000;106:1511-8.54123 - Speiser PW, Azziz R, Baskin LS, et al. Congenital adrenal hyperplasia due to steroid 21-hydroxylase deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2010;95:4133-60.54137 - Gupta P, Bhatia V. Corticosteroid physiology and principles of therapy. Indian J Pediatr 2008;75:1039-44.54138 - Shulman DI, Palmert MR, Kemp SF. Adrenal insufficiency: still a cause of morbidity and death in childhood. Pediatrics 2007;119(2):e484-494.54155 - Claahsen-van der Grinten HL, Stikkelbroeck NM, Otten BJ, et al. Congenital adrenal hyperplasia-pharmacologic interventions from the prenatal phase to adulthood. Pharmacol Ther 2011;132:1-14.54160 - Hindmarsh PC. Management of the child with congenital adrenal hyperplasia. Best Pract Res Clin Endocrinol Metab 2009;23:193-208.54162 - De Vroede M, Beukering R, Spit M, et al. Rectal hydrocortisone during stress in patients with adrenal insufficiency. Arch Dis Child 1998;78:544-7.54201 - Ng PC, Lee CH, Bnur FL, et al. A double-blind, randomized, controlled, study of a "stress dose" of hydrocortisone for rescue treatment of refractory hypotension in preterm infants. Pediatrics 2006;117:367-75.54202 - Noori S, Friedlich P, Wong P, et al. Hemodynamic changes after low-dosage hydrocortisone administration in vasopressor-treated preterm and term neonates. Pediatrics 2006;118:1456-66.54206 - Seri I, Tan R, Evans J. Cardiovascular effects of hydrocortisone in preterm infants with pressor-resistant hypotension. Pediatrics 2001;107:1070-4.54210 - Dellinger RP, Levy MM, Rhodes A, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med 2013;41:580-637.54211 - Hebbar KB, Stockwell JA, Fortenberry JD. Clinical effects of adding fludrocortisone to a hydrocortisone-based shock protocol in hypotensive critically ill children. Intensive Care Med 2011;37:518-24.54278 - Solu-Cortef (hydrocortisone sodium succinate) injection package insert. New York, NY: Pharmacia and Upjohn Co.; 2023 Dec.54304 - Watterberg KL, Gerdes JS, Cole CH, et al. Prophylaxis of early adrenal insufficiency to prevent bronchopulmonary dysplasia: a multicenter trial. Pediatrics 2004;114:1649-57.54338 - American Academy of Pediatrics Committee on Fetus and Newborn. Postnatal corticosteroids to prevent or treat bronchopulmonary dysplasia. Pediatrics 2010;126:800-8.54357 - Ebrahimi S, Sarkari B. Comparative efficacy of dexamethasone versus hydrocortisone in severe acute pediatric asthma. 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Br J Haematol 2012;158(1):30-45.55037 - Dignan FL, Amrolia P, Clark A, et al. Diagnosis and management of chronic graft-versus-host disease. British Journal of Haematology 2012;158:46-61.60464 - Lieberman P, Nicklas RA, Randolf C, et al. Anaphylaxis - a practice parameter update 2015. Ann Allergy Asthma Immunol 2015;115(5):341-84.60551 - Cortifoam (hydrocortisone acetate 10% aerosol, foam) package label. Somerset, NJ: Meda Pharmaceuticals, Inc.; 2024 March.61094 - Nahid P, Dorman SE, Alipanah N, et al. Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America clinical practice guidelines: treatment of drug-susceptible tuberculosis. Clin Infect Dis 2016.61515 - Ross DS, Burch HB, Cooper DS, et al. 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid 2016;26:1343-1421.62343 - Cortenema (hydrocortisone retention enema) package insert. Baltimore, MD. ANI Pharmaceuticals, Inc.; 2007 Sept.62344 - Pandel (hydrocortisone probutate cream) package insert. Melville, NY. Fougera Pharmaceuticals, Inc.; 2017 Jan.62348 - Hydrocortisone valerate 0.2% cream and ointment package insert. Haethorne, NY: Taro Pharmaceuticals USA, Inc; 2015 Oct.64377 - Ko CW, Singh S, Feuerstein JD, et al; American Gastroenterological Association Institute Clinical Guidelines Committee. AGA Clinical Practice Guidelines on the Management of Mild-to-Moderate Ulcerative Colitis. Gastroenterology. 2019;156:748-764.64393 - Rubin DT, Ananthakrishnan AN, Siegel CA, et al.; American College of Gastroenterology Clinical Guideline: Ulcerative Colitis in Adults. Am J Gastroenterol. 2019;114:384–413.64397 - Lichtenstein GR, Loftus EV, Isaacs KL, et al. American College of Gastroenterology Clinical Guideline: Management of Crohn's Disease in Adults. Am J Gastroenterol. 2018;113:481–517.64564 - Liyanage CK, Galappatthy P, Seneviratne SL. Corticosteroids in management of anaphylaxis; a systematic review of evidence. Eur Ann Allergy Clin Immunol 2017;49:196-207.64807 - Global Strategy for Asthma Management and Prevention. Global Initiative for Asthma (GINA) 2020. Available from: http://www.ginasthma.org. Accessed May 20th, 2020.64934 - Shenoi RP, Timm N, AAP Committee on Drugs, AAP Committee on Emergency Medicine. Drugs used to treat pediatric emergencies. Pediatrics 2020;145:e20193450.64985 - Weiss SL, Peters MJ, Alhazzani W, et al. Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children. Pediatr Crit Care Med 2020;21:e52-e106.64993 - Ahmet A, Kim H, Spier S. Adrenal suppression: a practical guide to the screening and management of this under-recognized complication of inhaled corticosteroid therapy. Allergy Asthma Clin Immunol 2011;7:doi: 10.1186/1710-1492-7-13.64994 - Davis AL, Carcillo JA, Aneja RK, et al. 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Anaphylaxis - a 2020 practice parameter update, systematic review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis. J Allergy Clin Immunol 2020;145:1082-1123.66745 - American Academy of Pediatrics. Red Book: 2021-2024 Report of the Committee on Infectious Diseases. 32nd ed. Elk Grove Village, IL: American Academy of Pediatrics; 2021.67037 - Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med 2021; doi: 10.1097/CCM.0000000000005337. Epub ahead of print.67297 - Elder CJ, Dimitri P. Hydrocortisone for adrenal insufficiency. Arch Dis Child Edu Pract Ed 2015; 100: 272-276.67298 - Shulman DI, Palmert MR, Kemp SF, et al. Adrenal insufficiency: still a cause of morbidity and death in childhood. Pediatrics 2007; 119(2): e484-e494.67301 - Lemyre B, Dunn, M, Thebaud B et al. Canadian Paediatric Society Position statement: Postnatal corticosteroids to prevent or treat bronchopulmonary dysplasia in preterm infants. Paediatrics and Child Health 2020.67302 - Baud O, Watterberg KL. Prophylactic postnatal corticosteroids: early hydrocortisone. Seminars in Fetal and Neonatal Medicine. 2019; 24: 202-206.67303 - Baud O, Maury L, Lebail F, et al. Effect of early low-dose hydrocortisone on survival without bronchopulmonary dysplasia in extremely preterm infants (PREMILOC): a double-blind, placebo-controlled, multicentre, randomised trial. Lancet 2016; 387: 1827-36.67304 - Doyle LW, Cheong JL, Hay S, Manley BJ, Halliday HL. Early (7 days) systemic postnatal corticostroids for prevention of bronchopulmonary dysplasia in preterm infants. Cochrane Database of Systematic Reviews 2021, Issue 10. Art. No.: CD001146.67305 - Shaffer ML, Baud O, Lacaze-Masmonteil T, et al. Effect of prophylaxis for early adrenal insufficiency using low-dose hydrocortisone in very preterm infants: an individual patient data meta-analysis. J Pediatr 2019; 207: 136-42.67787 - Proctocort (hydrocortisone acetate) suppository package insert. Bridgewater, NJ: Salix Pharmaceuticals; 2016 Apr.68176 - Shin HT. Diagnosis and management of diaper dermatitis. Pediatr Clin North Am. 2014 Apr;61:367-82.68189 - Carroll R, Matfin G. Endocrine and metabolic emergencies: thyroid storm. Ther Adv Endocrinol Metab. 2010 Jun;1:139-45.68576 - Frazier W, Bhardwaj N. Atopic Dermatitis: Diagnosis and Treatment. Am Fam Physician. 2020 May 15;101:590-598.68680 - Williams DM. Clinical Pharmacology of Corticosteroids. Respir Care. 2018;63:655-670.69175 - Elmets CA, Korman NJ, Prater EF, et al. Joint AAD-NPF Guidelines of care for the management and treatment of psoriasis with topical therapy and alternative medicine modalities for psoriasis severity measures. 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Organ-specific management and supportive care in chronic graft-versus-host disease. Br J Haematol 2012;158:62-78.

      How Supplied

      Diphenhydramine Hydrochloride, Zinc Acetate Topical spray, solution

      Walgreens Anti-Itch 1% Topical Spray (null) (Walgreens Co) null

      Hydrocortisone Acetate Rectal foam

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      Hemril 30mg Rectal Suppository (00245-0112) (Upsher-Smith Laboratories, LLC) (off market)Hemril 30mg Rectal Suppository package photo

      Hydrocortisone Acetate Rectal suppository

      Hydrocortisone Acetate 30mg Rectal Suppository (24689-0103) (Apnar Pharma LP) nullHydrocortisone Acetate 30mg Rectal Suppository package photo

      Hydrocortisone Acetate Rectal suppository

      Hydrocortisone Acetate 30mg Rectal Suppository (71321-0603) (Brandywine Pharmaceuticals, Inc.) null

      Hydrocortisone Acetate Rectal suppository

      Hydrocortisone Acetate 30mg Rectal Suppository (42494-0302) (Cameron Pharmaceuticals, LLC) (off market)

      Hydrocortisone Acetate Rectal suppository

      Hydrocortisone Acetate 30mg Rectal Suppository (42494-0342) (Cameron Pharmaceuticals, LLC) null

      Hydrocortisone Acetate Rectal suppository

      Hydrocortisone Acetate 30mg Rectal Suppository (00713-0493) (Cosette Pharmaceuticals, Inc.) null

      Hydrocortisone Acetate Rectal suppository

      Hydrocortisone Acetate 30mg Rectal Suppository (00574-7093) (Paddock Laboratories Inc, a Perrigo Family) nullHydrocortisone Acetate 30mg Rectal Suppository package photo

      Hydrocortisone Acetate Rectal suppository

      Hydrocortisone Acetate 30mg Rectal Suppository (39328-0129) (Patrin Pharma Inc) null

      Hydrocortisone Acetate Rectal suppository

      Proctocort 30mg Rectal Suppository (65649-0511) (Bausch Health US, LLC) nullProctocort 30mg Rectal Suppository package photo

      Hydrocortisone Acetate Rectal suppository

      Proctocort 30mg Rectal Suppository (61570-0025) (Monarch Pharmaceuticals Inc a Pfizer Company) (off market)

      Hydrocortisone Acetate Rectal suppository

      Proctosert HC 30mg Rectal Suppository (00603-8136) (Endo USA, Inc.) (off market)Proctosert HC 30mg Rectal Suppository package photo

      Hydrocortisone Acetate Suspension for injection

      Hydrocortone 25mg/ml Suspension for Injection (00006-7501) (Merck Sharp & Dohme Corp., a Subsidiary of Merck & Co., Inc.) (off market)

      Hydrocortisone Acetate Suspension for injection

      Hydrocortone 50mg/ml Suspension for Injection (00006-7519) (Merck Sharp & Dohme Corp., a Subsidiary of Merck & Co., Inc.) (off market)

      Hydrocortisone Acetate Topical cream

      Cortaid 0.5% Sensitive Skin Topical Cream (null) (Johnson & Johnson Healthcare Products Division of McNeil-PPC, Inc) (off market)

      Hydrocortisone Acetate Topical cream

      Hycort 1% Topical Cream (00642-0071) (Exeltis USA, Inc. formerly Everett Laboratories Inc) (off market)

      Hydrocortisone Acetate Topical cream

      Hycort 1% Topical Cream (00642-0073) (Exeltis USA, Inc. formerly Everett Laboratories Inc) (off market)

      Hydrocortisone Acetate Topical cream

      Hydrocortisone 1% Topical Cream (52297-0009) (Cardinal Health, Inc.) (off market)

      Hydrocortisone Acetate Topical cream

      Hydrocortisone 1% Topical Cream (52297-0104) (Cardinal Health, Inc.) (off market)

      Hydrocortisone Acetate Topical cream

      Hydrocortisone 1% Topical Cream (59618-0390) (Global Source Management & Consulting) (off market)

      Hydrocortisone Acetate Topical cream

      Hydrocortisone 1% Topical Cream (00839-7721) (HL Moore Drug Exchange) (off market)

      Hydrocortisone Acetate Topical cream

      Hydrocortisone 1% Topical Cream (00839-7722) (HL Moore Drug Exchange) (off market)

      Hydrocortisone Acetate Topical cream

      Hydrocortisone 1% Topical Cream (00839-8020) (HL Moore Drug Exchange) (off market)

      Hydrocortisone Acetate Topical cream

      Hydrocortisone 1% Topical Cream (00904-7624) (Major Pharmaceuticals Inc, a Harvard Drug Group Company) (off market)

      Hydrocortisone Acetate Topical cream

      Hydrocortisone 1% Topical Cream (45802-0274) (Perrigo Pharmaceuticals Company) (off market)

      Hydrocortisone Acetate Topical cream

      Hydrocortisone 1% Topical Cream (45802-0278) (Perrigo Pharmaceuticals Company) (off market)

      Hydrocortisone Acetate Topical cream

      Hydrocortisone 1% Topical Cream (45802-0003) (Perrigo Pharmaceuticals Company) (off market)

      Hydrocortisone Acetate Topical cream

      Hydrocortisone 1% Topical Cream (00122-0877) (Rexall Group) (off market)

      Hydrocortisone Acetate Topical cream

      Hydrocortisone 1% Topical Cream (00677-1426) (Sun Pharmaceutical Industries, Inc.) (off market)

      Hydrocortisone Acetate Topical cream

      Hydrocortisone 1% Topical Cream (00677-1427) (Sun Pharmaceutical Industries, Inc.) (off market)

      Hydrocortisone Acetate Topical cream

      Hydrocortisone 1% Topical Cream (23317-0321) (Teva/Actavis US) (off market)

      Hydrocortisone Acetate Topical cream

      Hydrocortisone 1% Topical Cream (23317-0331) (Teva/Actavis US) (off market)

      Hydrocortisone Acetate Topical cream

      Hydrocortisone 1% Topical Cream (23317-0343) (Teva/Actavis US) (off market)

      Hydrocortisone Acetate Topical cream

      Hydrocortisone 1% Topical Cream (49158-0227) (Thames Pharmaceuticals Inc a Division of Taro) (off market)

      Hydrocortisone Acetate Topical cream

      Hydrocortisone 1% Topical Cream (49158-0338) (Thames Pharmaceuticals Inc a Division of Taro) (off market)

      Hydrocortisone Acetate Topical cream

      Vagisil Anti-Itch Maximum Strength Sensitive Skin Topical Cream (11509-5101) (Combe Inc) null

      Hydrocortisone Acetate Topical cream

      MiCort-HC 2.5% Topical Cream (54766-0835) (Sebela Pharmaceuticals Inc) (off market)MiCort-HC 2.5% Topical Cream package photo

      Hydrocortisone Acetate Topical foam

      Cortifoam 10% Rectal Foam (00037-6830) (Meda Pharmaceuticals, Inc., a division Mylan Specialty L.P.) nullCortifoam 10% Rectal Foam package photo

      Hydrocortisone Acetate Topical gel

      CortAlo 2% Topical Gel (43234-0110) (Aletheia LLC) (off market)CortAlo 2% Topical Gel package photo

      Hydrocortisone Acetate Topical gel

      Hydrocortisone Acetate 2% with Aloe Topical Gel (60258-0048) (Cypress Pharmaceutical Inc. a wholly-owned subsidiary of Currax Pharmaceuticals, LLC) (off market)

      Hydrocortisone Acetate Topical gel

      NuZon 2% Topical Gel (66992-0180) (WraSer Pharmaceuticals) null

      Hydrocortisone Acetate Topical lotion

      Cetacort 1% Topical Lotion (00299-3949) (Galderma Laboratories Inc) (off market)

      Hydrocortisone Acetate Topical lotion

      Hydrocortisone 1% Topical Lotion (00677-1428) (Sun Pharmaceutical Industries, Inc.) (off market)

      Hydrocortisone Acetate Topical lotion

      Hydrocortisone Acetate 2% with Aloe Topical Lotion (68032-0443) (Kylemore Pharmaceuticals) (off market)

      Hydrocortisone Acetate Topical lotion

      Hydrocortisone Acetate 2% with Aloe Topical Lotion (68032-0443) (Rivers Edge Pharmaceuticals) (off market)

      Hydrocortisone Acetate Topical lotion

      NuCort 2% Topical Lotion (15014-0185) (Gentex Pharma LLC) (off market)

      Hydrocortisone Acetate Topical lotion

      NuCort 2% Topical Lotion (15014-0185) (Marnel Pharmaceuticals Inc) null

      Hydrocortisone Acetate Topical lotion

      NuCort 2% Topical Lotion (66992-0185) (WraSer Pharmaceuticals) (off market)

      Hydrocortisone Acetate Topical ointment

      Aquaphor Children's Itch Relief 1% Topical Ointment (null) (Beiersdorf, Inc.) null

      Hydrocortisone Acetate Topical ointment

      Aquaphor Itch Relief 1% Maximum Strength Topical Ointment (null) (Beiersdorf, Inc.) null

      Hydrocortisone Acetate Topical ointment

      Aquaphor Itch Relief 1% Maximum Strength Topical Ointment (null) (Beiersdorf, Inc.) null

      Hydrocortisone Acetate Topical ointment

      Aquaphor Itch Relief 1% Topical Ointment (null) (Beiersdorf, Inc.) null

      Hydrocortisone Acetate Topical ointment

      CVS Hydrocortisone 1% Topical Ointment (59779-0998) (CVS Health) nullCVS Hydrocortisone 1% Topical Ointment package photo

      Hydrocortisone Acetate Topical ointment

      Hydrocortisone 1% Maximum Strength Topical Ointment (50090-5856) (A-S Medication Solutions LLC) null

      Hydrocortisone Acetate Topical ointment

      Hydrocortisone 1% Maximum Strength Topical Ointment (61269-0345) (H2-Pharma, LLC) (off market)

      Hydrocortisone Acetate Topical ointment

      Hydrocortisone 1% Topical Ointment (69396-0003) (Trifecta Pharmaceuticals USA) null

      Hydrocortisone Acetate Topical ointment

      Leader Hydrocortisone 1% Topical Ointment (70000-0489) (Cardinal Health, Inc.) null

      Hydrocortisone Butyrate Topical cream

      Hydrocortisone Butyrate 0.1% Topical Cream (68682-0270) (Bausch Health US, LLC) (off market)

      Hydrocortisone Butyrate Topical cream

      Hydrocortisone Butyrate 0.1% Topical Cream (43478-0270) (Rouses Point Pharmaceuticals, LLC) nullHydrocortisone Butyrate 0.1% Topical Cream package photo

      Hydrocortisone Butyrate Topical cream

      Hydrocortisone Butyrate 0.1% Topical Cream (51672-4074) (Taro Pharmaceuticals USA Inc) nullHydrocortisone Butyrate 0.1% Topical Cream package photo

      Hydrocortisone Butyrate Topical cream

      Hydrocortisone Butyrate 0.1% Topical Cream (14290-0270) (Triax Pharmaceuticals, LLC) (off market)

      Hydrocortisone Butyrate Topical cream

      Locoid 0.1% Topical Cream (14290-0310) (Bausch Health US, LLC) (off market)

      Hydrocortisone Butyrate Topical cream

      Locoid 0.1% Topical Cream (16781-0382) (Bausch Health US, LLC) (off market)

      Hydrocortisone Butyrate Topical cream

      Locoid 0.1% Topical Cream (16781-0382) (Bausch Health US, LLC) (off market)

      Hydrocortisone Butyrate Topical cream

      Locoid 0.1% Topical Cream (00496-0802) (Ferndale Laboratories Inc) (off market)Locoid 0.1% Topical Cream package photo

      Hydrocortisone Butyrate Topical cream

      Locoid 0.1% Topical Cream (00496-0802) (Triax Pharma LLC) (off market)

      Hydrocortisone Butyrate Topical cream

      Locoid 0.1% Topical Cream (14290-0310) (Triax Pharma LLC) (off market)

      Hydrocortisone Butyrate Topical Lipocream

      Hydrocortisone Butyrate 0.1% Lipid Topical Cream (49808-0384) (Bausch Health US, LLC) (off market)Hydrocortisone Butyrate 0.1% Lipid Topical Cream package photo

      Hydrocortisone Butyrate Topical Lipocream

      Hydrocortisone Butyrate 0.1% Lipid Topical Cream (68682-0384) (Bausch Health US, LLC) (off market)

      Hydrocortisone Butyrate Topical Lipocream

      Hydrocortisone Butyrate 0.1% Lipid Topical Cream (49808-0384) (Metacon Labs) (off market)

      Hydrocortisone Butyrate Topical Lipocream

      Hydrocortisone Butyrate 0.1% Lipophilic Topical Cream (68462-0464) (Glenmark Pharmaceuticals) (off market)Hydrocortisone Butyrate 0.1% Lipophilic Topical Cream package photo

      Hydrocortisone Butyrate Topical Lipocream

      Hydrocortisone Butyrate 0.1% Lipophilic Topical Cream (00472-0490) (Teva/Actavis US) (off market)Hydrocortisone Butyrate 0.1% Lipophilic Topical Cream package photo

      Hydrocortisone Butyrate Topical Lipocream

      Locoid Lipocream 0.1% Topical Cream (14290-0313) (Bausch Health US, LLC) (off market)

      Hydrocortisone Butyrate Topical Lipocream

      Locoid Lipocream 0.1% Topical Cream (14290-0313) (Bausch Health US, LLC) (off market)

      Hydrocortisone Butyrate Topical Lipocream

      Locoid Lipocream 0.1% Topical Cream (16781-0384) (Bausch Health US, LLC) nullLocoid Lipocream 0.1% Topical Cream package photo

      Hydrocortisone Butyrate Topical Lipocream

      Locoid Lipocream 0.1% Topical Cream (00496-0821) (Ferndale Laboratories Inc) (off market)Locoid Lipocream 0.1% Topical Cream package photo

      Hydrocortisone Butyrate Topical Lipocream

      Locoid Lipocream 0.1% Topical Cream (00496-0821) (Triax Pharma LLC) (off market)Locoid Lipocream 0.1% Topical Cream package photo

      Hydrocortisone Butyrate Topical Lipocream

      Locoid Lipocream 0.1% Topical Cream (14290-0313) (Triax Pharmaceuticals, LLC) (off market)Locoid Lipocream 0.1% Topical Cream package photo

      Hydrocortisone Butyrate Topical lotion

      Hydrocortisone Butyrate 0.1% Topical Lotion (68682-0392) (Bausch Health US, LLC) null

      Hydrocortisone Butyrate Topical lotion

      Hydrocortisone Butyrate 0.1% Topical Lotion (68180-0951) (Lupin Pharmaceuticals, Inc.) null

      Hydrocortisone Butyrate Topical lotion

      Hydrocortisone Butyrate 0.1% Topical Lotion (51862-0159) (Mayne Pharma) null

      Hydrocortisone Butyrate Topical lotion

      Hydrocortisone Butyrate 0.1% Topical Lotion (70512-0032) (Sola Pharmaceuticals) null

      Hydrocortisone Butyrate Topical lotion

      Hydrocortisone Butyrate 0.1% Topical Lotion (52565-0087) (Teligent, Inc.) null

      Hydrocortisone Butyrate Topical lotion

      Hydrocortisone Butyrate 0.1% Topical Lotion (83148-0012) (The J. Molner Company) nullHydrocortisone Butyrate 0.1% Topical Lotion package photo

      Hydrocortisone Butyrate Topical lotion

      Locoid 0.1% Topical Lotion (14290-0314) (Bausch Health US, LLC) (off market)

      Hydrocortisone Butyrate Topical lotion

      Locoid 0.1% Topical Lotion (16781-0392) (Bausch Health US, LLC) (off market)

      Hydrocortisone Butyrate Topical lotion

      Locoid 0.1% Topical Lotion (16781-0392) (Bausch Health US, LLC) nullLocoid 0.1% Topical Lotion package photo

      Hydrocortisone Butyrate Topical lotion

      Locoid 0.1% Topical Lotion (14290-0314) (Triax Pharmaceuticals, LLC) (off market)Locoid 0.1% Topical Lotion package photo

      Hydrocortisone Butyrate Topical ointment

      Hydrocortisone Butyrate 0.1% Topical Ointment (68682-0271) (Bausch Health US, LLC) null

      Hydrocortisone Butyrate Topical ointment

      Hydrocortisone Butyrate 0.1% Topical Ointment (43478-0271) (Rouses Point Pharmaceuticals, LLC) null

      Hydrocortisone Butyrate Topical ointment

      Hydrocortisone Butyrate 0.1% Topical Ointment (51672-4083) (Taro Pharmaceuticals USA Inc) nullHydrocortisone Butyrate 0.1% Topical Ointment package photo

      Hydrocortisone Butyrate Topical ointment

      Hydrocortisone Butyrate 0.1% Topical Ointment (14290-0271) (Triax Pharmaceuticals, LLC) (off market)

      Hydrocortisone Butyrate Topical ointment

      Locoid 0.1% Topical Ointment (14290-0311) (Bausch Health US, LLC) (off market)

      Hydrocortisone Butyrate Topical ointment

      Locoid 0.1% Topical Ointment (16781-0389) (Bausch Health US, LLC) (off market)

      Hydrocortisone Butyrate Topical ointment

      Locoid 0.1% Topical Ointment (16781-0389) (Bausch Health US, LLC) (off market)

      Hydrocortisone Butyrate Topical ointment

      Locoid 0.1% Topical Ointment (00496-0803) (Ferndale Laboratories Inc) (off market)Locoid 0.1% Topical Ointment package photo

      Hydrocortisone Butyrate Topical ointment

      Locoid 0.1% Topical Ointment (00496-0803) (Triax Pharma LLC) (off market)Locoid 0.1% Topical Ointment package photo

      Hydrocortisone Butyrate Topical ointment

      Locoid 0.1% Topical Ointment (14290-0311) (Triax Pharmaceuticals, LLC) (off market)

      Hydrocortisone Butyrate Topical solution

      Hydrocortisone Butyrate 0.1% Topical Solution (68682-0273) (Bausch Health US, LLC) (off market)

      Hydrocortisone Butyrate Topical solution

      Hydrocortisone Butyrate 0.1% Topical Solution (43478-0273) (Rouses Point Pharmaceuticals, LLC) null

      Hydrocortisone Butyrate Topical solution

      Hydrocortisone Butyrate 0.1% Topical Solution (51672-4061) (Taro Pharmaceuticals USA Inc) nullHydrocortisone Butyrate 0.1% Topical Solution package photo

      Hydrocortisone Butyrate Topical solution

      Hydrocortisone Butyrate 0.1% Topical Solution (14290-0273) (Triax Pharmaceuticals, LLC) (off market)

      Hydrocortisone Butyrate Topical solution

      Locoid 0.1% Topical Solution (14290-0312) (Bausch Health US, LLC) (off market)

      Hydrocortisone Butyrate Topical solution

      Locoid 0.1% Topical Solution (16781-0391) (Bausch Health US, LLC) (off market)

      Hydrocortisone Butyrate Topical solution

      Locoid 0.1% Topical Solution (16781-0391) (Bausch Health US, LLC) (off market)

      Hydrocortisone Butyrate Topical solution

      Locoid 0.1% Topical Solution (00496-0804) (Ferndale Laboratories Inc) (off market)Locoid 0.1% Topical Solution package photo

      Hydrocortisone Butyrate Topical solution

      Locoid 0.1% Topical Solution (00496-0804) (Triax Pharma LLC) (off market)

      Hydrocortisone Butyrate Topical solution

      Locoid 0.1% Topical Solution (14290-0312) (Triax Pharmaceuticals, LLC) (off market)

      Hydrocortisone Cypionate Oral suspension

      Cortef 10mg/5mL Suspension (00009-0142) (Pfizer Inc.) (off market)

      Hydrocortisone Oral granules

      Alkindi Sprinkle 0.5mg Granules (71863-0109) (Eton Pharmaceuticals, Inc) null

      Hydrocortisone Oral granules

      Alkindi Sprinkle 1mg Granules (71863-0110) (Eton Pharmaceuticals, Inc) null

      Hydrocortisone Oral granules

      Alkindi Sprinkle 2mg Granules (71863-0111) (Eton Pharmaceuticals, Inc) null

      Hydrocortisone Oral granules

      Alkindi Sprinkle 5mg Granules (71863-0112) (Eton Pharmaceuticals, Inc) null

      Hydrocortisone Oral tablet

      Cortef 5mg Tablet (00009-0012) (Pfizer Inc.) null

      Hydrocortisone Oral tablet

      Hydrocortisone 5mg Tablet (68084-0789) (American Health Packaging) nullHydrocortisone 5mg Tablet package photo

      Hydrocortisone Oral tablet

      Hydrocortisone 5mg Tablet (59651-0413) (Aurobindo Pharma Limited) nullHydrocortisone 5mg Tablet package photo

      Hydrocortisone Oral tablet

      Hydrocortisone 5mg Tablet (50268-0405) (AvPAK; a Division of AvKARE Inc) nullHydrocortisone 5mg Tablet package photo

      Hydrocortisone Oral tablet

      Hydrocortisone 5mg Tablet (62135-0551) (Chartwell RX LLC) null

      Hydrocortisone Oral tablet

      Hydrocortisone 5mg Tablet (64720-0331) (CorePharma, LLC) (off market)

      Hydrocortisone Oral tablet

      Hydrocortisone 5mg Tablet (00603-3899) (Endo USA, Inc.) (off market)

      Hydrocortisone Oral tablet

      Hydrocortisone 5mg Tablet (59366-2807) (Glades Pharmaceuticals, LLC) (off market)

      Hydrocortisone Oral tablet

      Hydrocortisone 5mg Tablet (59762-0073) (Greenstone Ltd) null

      Hydrocortisone Oral tablet

      Hydrocortisone 5mg Tablet (00115-1696) (Impax Generics, a division of Impax Laboratories, Inc.) (off market)

      Hydrocortisone Oral tablet

      Hydrocortisone 5mg Tablet (00115-1696) (Impax Generics, a division of Impax Laboratories, Inc.) null

      Hydrocortisone Oral tablet

      Hydrocortisone 5mg Tablet (54505-0331) (Lineage Therapeutics) (off market)

      Hydrocortisone Oral tablet

      Hydrocortisone 5mg Tablet (72789-0095) (PD-Rx Pharmaceuticals, Inc.) (off market)

      Hydrocortisone Oral tablet

      Hydrocortisone 5mg Tablet (72789-0227) (PD-Rx Pharmaceuticals, Inc.) null

      Hydrocortisone Oral tablet

      Hydrocortisone 5mg Tablet (42543-0140) (Strides Pharma, Inc.) null

      Hydrocortisone Oral tablet

      Hydrocortisone 5mg Tablet (42543-0970) (Strides Pharma, Inc.) null

      Hydrocortisone Oral tablet

      Hydrocortisone 5mg Tablet (64380-0970) (Strides Pharma., Inc.) nullHydrocortisone 5mg Tablet package photo

      Hydrocortisone Oral tablet

      Cortef 10mg Tablet (00009-0031) (Pfizer Inc.) null

      Hydrocortisone Oral tablet

      Hydrocortisone 10mg Tablet (68084-0469) (American Health Packaging) (off market)

      Hydrocortisone Oral tablet

      Hydrocortisone 10mg Tablet (60687-0511) (American Health Packaging) null

      Hydrocortisone Oral tablet

      Hydrocortisone 10mg Tablet (60687-0582) (American Health Packaging) null

      Hydrocortisone Oral tablet

      Hydrocortisone 10mg Tablet (59651-0414) (Aurobindo Pharma Limited) nullHydrocortisone 10mg Tablet package photo

      Hydrocortisone Oral tablet

      Hydrocortisone 10mg Tablet (50268-0406) (AvPAK; a Division of AvKARE Inc) nullHydrocortisone 10mg Tablet package photo

      Hydrocortisone Oral tablet

      Hydrocortisone 10mg Tablet (62135-0552) (Chartwell RX LLC) null

      Hydrocortisone Oral tablet

      Hydrocortisone 10mg Tablet (64720-0332) (CorePharma, LLC) (off market)

      Hydrocortisone Oral tablet

      Hydrocortisone 10mg Tablet (00603-3900) (Endo USA, Inc.) (off market)

      Hydrocortisone Oral tablet

      Hydrocortisone 10mg Tablet (59366-2817) (Glades Pharmaceuticals, LLC) (off market)

      Hydrocortisone Oral tablet

      Hydrocortisone 10mg Tablet (59762-0074) (Greenstone Ltd) null

      Hydrocortisone Oral tablet

      Hydrocortisone 10mg Tablet (00115-1697) (Impax Generics, a division of Impax Laboratories, Inc.) (off market)

      Hydrocortisone Oral tablet

      Hydrocortisone 10mg Tablet (00115-1697) (Impax Generics, a division of Impax Laboratories, Inc.) null

      Hydrocortisone Oral tablet

      Hydrocortisone 10mg Tablet (54505-0332) (Lineage Therapeutics) (off market)

      Hydrocortisone Oral tablet

      Hydrocortisone 10mg Tablet (00904-7188) (Major Pharmaceuticals Inc, a Harvard Drug Group Company) nullHydrocortisone 10mg Tablet package photo

      Hydrocortisone Oral tablet

      Hydrocortisone 10mg Tablet (43063-0208) (PD-Rx Pharmaceuticals, Inc.) (off market)

      Hydrocortisone Oral tablet

      Hydrocortisone 10mg Tablet (72789-0094) (PD-Rx Pharmaceuticals, Inc.) (off market)

      Hydrocortisone Oral tablet

      Hydrocortisone 10mg Tablet (72789-0228) (PD-Rx Pharmaceuticals, Inc.) null

      Hydrocortisone Oral tablet

      Hydrocortisone 10mg Tablet (42543-0141) (Strides Pharma, Inc.) null

      Hydrocortisone Oral tablet

      Hydrocortisone 10mg Tablet (42543-0971) (Strides Pharma, Inc.) null

      Hydrocortisone Oral tablet

      Hydrocortisone 10mg Tablet (64380-0971) (Strides Pharma., Inc.) null

      Hydrocortisone Oral tablet

      Hydrocortone 10mg Tablet (00006-0619) (Merck Sharp & Dohme Corp., a Subsidiary of Merck & Co., Inc.) (off market)

      Hydrocortisone Oral tablet

      Cortef 20mg Tablet (00009-0044) (Pfizer Inc.) null

      Hydrocortisone Oral tablet

      Hydrocortisone 20mg Tablet (68084-0930) (American Health Packaging) (off market)

      Hydrocortisone Oral tablet

      Hydrocortisone 20mg Tablet (59651-0415) (Aurobindo Pharma Limited) nullHydrocortisone 20mg Tablet package photo

      Hydrocortisone Oral tablet

      Hydrocortisone 20mg Tablet (50268-0407) (AvPAK; a Division of AvKARE Inc) nullHydrocortisone 20mg Tablet package photo

      Hydrocortisone Oral tablet

      Hydrocortisone 20mg Tablet (62135-0186) (Chartwell RX LLC) null

      Hydrocortisone Oral tablet

      Hydrocortisone 20mg Tablet (64720-0333) (CorePharma, LLC) (off market)

      Hydrocortisone Oral tablet

      Hydrocortisone 20mg Tablet (00603-3901) (Endo USA, Inc.) (off market)

      Hydrocortisone Oral tablet

      Hydrocortisone 20mg Tablet (59366-2827) (Glades Pharmaceuticals, LLC) (off market)

      Hydrocortisone Oral tablet

      Hydrocortisone 20mg Tablet (59762-0075) (Greenstone Ltd) null

      Hydrocortisone Oral tablet

      Hydrocortisone 20mg Tablet (00143-1254) (Hikma Pharmaceuticals USA inc.) (off market)

      Hydrocortisone Oral tablet

      Hydrocortisone 20mg Tablet (00143-1254) (Hikma Pharmaceuticals USA Inc.) null

      Hydrocortisone Oral tablet

      Hydrocortisone 20mg Tablet (00115-1700) (Impax Generics, a division of Impax Laboratories, Inc.) (off market)

      Hydrocortisone Oral tablet

      Hydrocortisone 20mg Tablet (00115-1700) (Impax Generics, a division of Impax Laboratories, Inc.) null

      Hydrocortisone Oral tablet

      Hydrocortisone 20mg Tablet (54505-0333) (Lineage Therapeutics) (off market)

      Hydrocortisone Oral tablet

      Hydrocortisone 20mg Tablet (00904-2674) (Major Pharmaceuticals Inc, a Harvard Drug Group Company) (off market)

      Hydrocortisone Oral tablet

      Hydrocortisone 20mg Tablet (43063-0386) (PD-Rx Pharmaceuticals, Inc.) null

      Hydrocortisone Oral tablet

      Hydrocortisone 20mg Tablet (72789-0062) (PD-Rx Pharmaceuticals, Inc.) (off market)

      Hydrocortisone Oral tablet

      Hydrocortisone 20mg Tablet (72789-0229) (PD-Rx Pharmaceuticals, Inc.) null

      Hydrocortisone Oral tablet

      Hydrocortisone 20mg Tablet (42543-0142) (Strides Pharma, Inc.) null

      Hydrocortisone Oral tablet

      Hydrocortisone 20mg Tablet (42543-0972) (Strides Pharma, Inc.) null

      Hydrocortisone Oral tablet

      Hydrocortisone 20mg Tablet (64380-0972) (Strides Pharma., Inc.) null

      Hydrocortisone Oral tablet

      Hydrocortisone 20mg Tablet (00677-0076) (Sun Pharmaceutical Industries, Inc.) (off market)

      Hydrocortisone Probutate Topical cream

      Pandel 0.1% Topical Cream (62559-0325) (ANI Pharmaceuticals, Inc.) null

      Hydrocortisone Probutate Topical cream

      Pandel 0.1% Topical Cream (64682-0200) (CollaGenex Pharmaceuticals a Division of Galderma ) (off market)Pandel 0.1% Topical Cream package photo

      Hydrocortisone Probutate Topical cream

      Pandel 0.1% Topical Cream (00281-0153) (CollaGenex Pharmaceuticals a Division of Galderma ) (off market)

      Hydrocortisone Probutate Topical cream

      Pandel 0.1% Topical Cream (10337-0153) (PharmaDerm a division of Fougera Pharmaceuticals Inc.) nullPandel 0.1% Topical Cream package photo

      Hydrocortisone Probutate Topical cream

      Pandel 0.1% Topical Cream (00462-0153) (Sandoz Inc. a Novartis Company) (off market)Pandel 0.1% Topical Cream package photo

      Hydrocortisone Probutate Topical cream

      Pandel 0.1% Topical Cream (00281-0153) (Savage Laboratories Inc Div Altana Inc) (off market)

      Hydrocortisone Rectal cream

      Proctocort 1% Rectal Cream (61570-0070) (Monarch Pharmaceuticals Inc a Pfizer Company) (off market)Proctocort 1% Rectal Cream package photo

      Hydrocortisone Rectal cream

      Procto-Kit 1% Rectal Cream (63304-0405) (Sun Pharmaceutical Industries, Inc.) (off market)Procto-Kit 1% Rectal Cream package photo

      Hydrocortisone Rectal cream

      Anusol HC 2.5% Rectal Cream (61570-0313) (Monarch Pharmaceuticals Inc a Pfizer Company) (off market)Anusol HC 2.5% Rectal Cream package photo

      Hydrocortisone Rectal cream

      Proctocream-HC 2.5% Rectal Cream (00091-4640) (Meda Pharmaceuticals, Inc., a division Mylan Specialty L.P.) (off market)

      Hydrocortisone Rectal cream

      Proctocream-HC 2.5% Rectal Cream (68220-0141) (Meda Pharmaceuticals, Inc., a division Mylan Specialty L.P.) (off market)

      Hydrocortisone Rectal cream

      Proctocream-HC 2.5% Rectal Cream (00091-4640) (UCB Pharma Inc) (off market)Proctocream-HC 2.5% Rectal Cream package photo

      Hydrocortisone Rectal cream

      Procto-Kit 2.5% Rectal Cream (63304-0406) (Sun Pharmaceutical Industries, Inc.) (off market)Procto-Kit 2.5% Rectal Cream package photo

      Hydrocortisone Rectal cream

      Proctosol-HC 2.5% Rectal Cream (58634-0025) (American Generics Inc) (off market)

      Hydrocortisone Rectal cream

      Proctosol-HC 2.5% Rectal Cream (63304-0407) (Sun Pharmaceutical Industries, Inc.) (off market)Proctosol-HC 2.5% Rectal Cream package photo

      Hydrocortisone Rectal enema, suspension

      Colocort 100mg/60ml Rectal Enema Suspension (00574-2020) (Paddock Laboratories Inc, a Perrigo Family) (off market)Colocort 100mg/60ml Rectal Enema Suspension package photo

      Hydrocortisone Rectal enema, suspension

      Cortenema 100mg/60ml Rectal Enema (00032-1904) (AbbVie US LLC) (off market)

      Hydrocortisone Rectal enema, suspension

      Cortenema 100mg/60ml Rectal Enema (62559-1110) (ANI Pharmaceuticals, Inc.) (off market)

      Hydrocortisone Rectal enema, suspension

      Cortenema 100mg/60ml Rectal Enema (62559-0111) (ANI Pharmaceuticals, Inc.) null

      Hydrocortisone Rectal enema, suspension

      Hydrocortisone 100mg/60ml Rectal Enema Suspension (62559-0138) (ANI Pharmaceuticals, Inc.) nullHydrocortisone 100mg/60ml Rectal Enema Suspension package photo

      Hydrocortisone Rectal enema, suspension

      Hydrocortisone 100mg/60ml Rectal Enema Suspension (42769-1380) (BayPharma, Inc.) (off market)

      Hydrocortisone Rectal enema, suspension

      Hydrocortisone 100mg/60ml Rectal Enema Suspension (51991-0728) (Breckenridge Inc) null

      Hydrocortisone Rectal enema, suspension

      Hydrocortisone 100mg/60ml Rectal Enema Suspension (00093-9168) (Teva Pharmaceuticals USA) (off market)Hydrocortisone 100mg/60ml Rectal Enema Suspension package photo

      Hydrocortisone Rectal enema, suspension

      Hydrocortisone 100mg/60ml Rectal Suspension (Retention) (62135-0020) (Chartwell RX LLC) null

      Hydrocortisone Sodium Phosphate Solution for injection

      Hydrocortone 50mg/ml Solution for Injection (00006-7633) (Merck Sharp & Dohme Corp., a Subsidiary of Merck & Co., Inc.) (off market)

      Hydrocortisone Sodium Succinate Powder for solution for injection

      A-Hydrocort 100mg Powder for Injection (00074-5671) (Hospira Worldwide, Inc., a Pfizer Company) (off market)

      Hydrocortisone Sodium Succinate Powder for solution for injection

      A-Hydrocort 100mg Powder for Injection (00409-4856) (Hospira Worldwide, Inc., a Pfizer Company) (off market)

      Hydrocortisone Sodium Succinate Powder for solution for injection

      Solu-Cortef 100mg Powder for Injection (55154-3942) (Cardinal Health, Inc.) null

      Hydrocortisone Sodium Succinate Powder for solution for injection

      Solu-Cortef 100mg Powder for Injection (00009-0825) (Pfizer Inc.) nullSolu-Cortef 100mg Powder for Injection package photo

      Hydrocortisone Sodium Succinate Powder for solution for injection

      Solu-Cortef 100mg Powder for Injection (00009-0900) (Pfizer Inc.) (off market)Solu-Cortef 100mg Powder for Injection package photo

      Hydrocortisone Sodium Succinate Powder for solution for injection

      Solu-Cortef 100mg Powder for Injection (00009-0011) (Pfizer Injectables) nullSolu-Cortef 100mg Powder for Injection package photo

      Hydrocortisone Sodium Succinate Powder for solution for injection

      A-Hydrocort 250mg Powder for Injection (00074-5672) (Hospira Worldwide, Inc., a Pfizer Company) (off market)

      Hydrocortisone Sodium Succinate Powder for solution for injection

      Solu-Cortef 250mg Powder for Injection (00009-0909) (Pfizer Inc.) (off market)Solu-Cortef 250mg Powder for Injection package photo

      Hydrocortisone Sodium Succinate Powder for solution for injection

      Solu-Cortef 250mg Powder for Injection (00009-0013) (Pfizer Injectables) nullSolu-Cortef 250mg Powder for Injection package photo

      Hydrocortisone Sodium Succinate Powder for solution for injection

      A-Hydrocort 500mg Powder for Injection (00074-5673) (Hospira Worldwide, Inc., a Pfizer Company) (off market)

      Hydrocortisone Sodium Succinate Powder for solution for injection

      Solu-Cortef 500mg Powder for Injection (00009-0912) (Pfizer Inc.) (off market)Solu-Cortef 500mg Powder for Injection package photo

      Hydrocortisone Sodium Succinate Powder for solution for injection

      Solu-Cortef 500mg Powder for Injection (00009-0016) (Pfizer Injectables) null

      Hydrocortisone Sodium Succinate Powder for solution for injection

      A-Hydrocort 1000mg Powder for Injection (00074-5674) (Hospira Worldwide, Inc., a Pfizer Company) (off market)

      Hydrocortisone Sodium Succinate Powder for solution for injection

      Solu-Cortef 1000mg Powder for Injection (00009-0920) (Pfizer Inc.) (off market)

      Hydrocortisone Sodium Succinate Powder for solution for injection

      Solu-Cortef 1000mg Powder for Injection (00009-0005) (Pfizer Injectables) null

      Hydrocortisone Topical cream

      Corticaine 0.5% Topical Cream (50474-0405) (UCB Pharma Inc) (off market)

      Hydrocortisone Topical cream

      CVS Hydrocortisone 0.5% with Aloe Topical Cream (null) (CVS Health) (off market)CVS Hydrocortisone 0.5% with Aloe Topical Cream package photo

      Hydrocortisone Topical cream

      CVS Hydrocortisone 0.5% with Aloe Topical Cream (null) (CVS Health) null

      Hydrocortisone Topical cream

      CVS Hydrocortisone 0.5% with Aloe Topical Cream (69842-0192) (CVS Health) nullCVS Hydrocortisone 0.5% with Aloe Topical Cream package photo

      Hydrocortisone Topical cream

      GNP Hydrocortisone 0.5% with Aloe Topical Cream (24385-0190) (AmerisourceBergen Corporation) null

      Hydrocortisone Topical cream

      Hydrocortisone 0.5% Topical Cream (24385-0197) (AmerisourceBergen Corporation) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 0.5% Topical Cream (52297-0019) (Cardinal Health, Inc.) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 0.5% Topical Cream (52297-0111) (Cardinal Health, Inc.) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 0.5% Topical Cream (52297-0212) (Cardinal Health, Inc.) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 0.5% Topical Cream (45565-0501) (Crown Laboratories) null

      Hydrocortisone Topical cream

      Hydrocortisone 0.5% Topical Cream (42037-0408) (Dr. Rose Inc) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 0.5% Topical Cream (52735-0719) (Family Pharmacy) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 0.5% Topical Cream (00302-3382) (Genetco Inc) null

      Hydrocortisone Topical cream

      Hydrocortisone 0.5% Topical Cream (00839-5206) (HL Moore Drug Exchange) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 0.5% Topical Cream (00839-7363) (HL Moore Drug Exchange) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 0.5% Topical Cream (00839-7364) (HL Moore Drug Exchange) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 0.5% Topical Cream (00839-8019) (HL Moore Drug Exchange) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 0.5% Topical Cream (null) (Mason Vitamins) null

      Hydrocortisone Topical cream

      Hydrocortisone 0.5% Topical Cream (49348-0021) (McKesson Corporation) null

      Hydrocortisone Topical cream

      Hydrocortisone 0.5% Topical Cream (49348-0271) (McKesson Corporation) null

      Hydrocortisone Topical cream

      Hydrocortisone 0.5% Topical Cream (45802-0002) (Perrigo Pharmaceuticals Company) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 0.5% Topical Cream (45802-0009) (Perrigo Pharmaceuticals Company) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 0.5% Topical Cream (45802-0010) (Perrigo Pharmaceuticals Company) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 0.5% Topical Cream (45802-0012) (Perrigo Pharmaceuticals Company) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 0.5% Topical Cream (45802-0189) (Perrigo Pharmaceuticals Company) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 0.5% Topical Cream (45802-0190) (Perrigo Pharmaceuticals Company) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 0.5% Topical Cream (45802-0196) (Perrigo Pharmaceuticals Company) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 0.5% Topical Cream (45802-0197) (Perrigo Pharmaceuticals Company) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 0.5% Topical Cream (00536-6392) (Rugby Laboratories a Division of The Harvard Drug Group, LLC) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 0.5% Topical Cream (00536-8310) (Rugby Laboratories a Division of The Harvard Drug Group, LLC) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 0.5% Topical Cream (00536-8350) (Rugby Laboratories a Division of The Harvard Drug Group, LLC) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 0.5% Topical Cream (00168-0014) (Sandoz Inc. a Novartis Company) nullHydrocortisone 0.5% Topical Cream package photo

      Hydrocortisone Topical cream

      Hydrocortisone 0.5% Topical Cream (00781-7017) (Sandoz Inc. a Novartis Company) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 0.5% Topical Cream (00677-0711) (Sun Pharmaceutical Industries, Inc.) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 0.5% Topical Cream (00677-0721) (Sun Pharmaceutical Industries, Inc.) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 0.5% Topical Cream (51672-2010) (Taro Pharmaceuticals USA Inc) nullHydrocortisone 0.5% Topical Cream package photo

      Hydrocortisone Topical cream

      Hydrocortisone 0.5% Topical Cream (51672-2015) (Taro Pharmaceuticals USA Inc) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 0.5% Topical Cream (00182-0951) (Teva Pharmaceuticals USA) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 0.5% Topical Cream (00182-1676) (Teva Pharmaceuticals USA) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 0.5% Topical Cream (00364-7086) (Teva/Actavis US) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 0.5% Topical Cream (00472-0338) (Teva/Actavis US) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 0.5% Topical Cream (00472-0342) (Teva/Actavis US) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 0.5% Topical Cream (23317-0320) (Teva/Actavis US) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 0.5% Topical Cream (23317-0323) (Teva/Actavis US) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 0.5% Topical Cream (23317-0325) (Teva/Actavis US) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 0.5% Topical Cream (23317-0338) (Teva/Actavis US) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 0.5% Topical Cream (23317-0344) (Teva/Actavis US) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 0.5% Topical Cream (49158-0100) (Thames Pharmaceuticals Inc a Division of Taro) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 0.5% Topical Cream (49158-0102) (Thames Pharmaceuticals Inc a Division of Taro) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 0.5% Topical Cream (49158-0274) (Thames Pharmaceuticals Inc a Division of Taro) (off market)

      Hydrocortisone Topical cream

      Today's Health Hydrocortisone 0.5% Topical Cream (null) (Today's Health, Inc.) null

      Hydrocortisone Topical cream

      Walgreens Hydrocortisone 0.5% Topical Cream (null) (Walgreens Co) nullWalgreens Hydrocortisone 0.5% Topical Cream package photo

      Hydrocortisone Topical cream

      Walgreens Hydrocortisone 0.5% Topical Cream (null) (Walgreens Co) nullWalgreens Hydrocortisone 0.5% Topical Cream package photo

      Hydrocortisone Topical cream

      Ala-Cort 1% Topical Cream (00316-0126) (Crown Laboratories Inc) nullAla-Cort 1% Topical Cream package photo

      Hydrocortisone Topical cream

      Aveeno Hydrocortisone Anti-itch 1% Topical Cream (08137-0036) (Johnson & Johnson Healthcare Products Division of McNeil-PPC, Inc) null

      Hydrocortisone Topical cream

      Caldecort 1% Topical Cream (63736-0646) (Heritage Consumer Products) null

      Hydrocortisone Topical cream

      CAREALL Hydrocortisone Maximum Strength 1% Topical Cream (51824-0050) (New World Imports Inc) null

      Hydrocortisone Topical cream

      Cortaid 1% 12-Hour Advanced Anti-Itch Topical Cream (01875-0519) (Bausch Health US, LLC) null

      Hydrocortisone Topical cream

      Cortaid 1% Advanced 12 Hour Anti-Itch Topical Cream (null) (Johnson & Johnson Healthcare Products Division of McNeil-PPC, Inc) (off market)

      Hydrocortisone Topical cream

      Cortaid 1% Intensive Therapy Moisturizing Topical Cream (null) (Johnson & Johnson Healthcare Products Division of McNeil-PPC, Inc) (off market)

      Hydrocortisone Topical cream

      Cortaid 1% Maximum Strength Topical Cream (01875-0521) (Bausch Health US, LLC) null

      Hydrocortisone Topical cream

      Cortaid 1% Maximum Strength Topical Cream (null) (Johnson & Johnson Healthcare Products Division of McNeil-PPC, Inc) (off market)

      Hydrocortisone Topical cream

      Cortizone-10 1 % Creme (null) (Chattem, Inc. is a wholly-owned subsidiary of Sanofi-Aventis ) null

      Hydrocortisone Topical cream

      Cortizone-10 Creme Topical Cream (00501-3303) (GlaxoSmithKline Consumer Healthcare) (off market)

      Hydrocortisone Topical cream

      Cortizone-10 External Itch Relief Creme Topical Cream (00501-3304) (GlaxoSmithKline Consumer Healthcare) (off market)

      Hydrocortisone Topical cream

      Cortizone-10 Maximum Strength 1% Feminine Itch Relief Topical Creme (null) (Chattem, Inc. is a wholly-owned subsidiary of Sanofi-Aventis ) null

      Hydrocortisone Topical cream

      Cortizone-10 Maximum Strength 1% Overnight Itch Relief Topical Cream (null) (Chattem, Inc. is a wholly-owned subsidiary of Sanofi-Aventis ) null

      Hydrocortisone Topical cream

      Cortizone-10 Maximum Strength 1% Topical Creme (null) (Chattem, Inc. is a wholly-owned subsidiary of Sanofi-Aventis ) nullCortizone-10 Maximum Strength 1% Topical Creme package photo

      Hydrocortisone Topical cream

      Cortizone-10 Maximum Strength 1% Topical Creme (41167-0039) (Chattem, Inc. is a wholly-owned subsidiary of Sanofi-Aventis ) null

      Hydrocortisone Topical cream

      Cortizone-10 Maximum Strength Feminine Itch Relief 1% Anti-Itch Topical Cream (null) (Chattem, Inc. is a wholly-owned subsidiary of Sanofi-Aventis ) null

      Hydrocortisone Topical cream

      Cortizone-10 Maximum Strength Intensive Healing 1% Anti-Itch Topical Cream (null) (Chattem, Inc. is a wholly-owned subsidiary of Sanofi-Aventis ) null

      Hydrocortisone Topical cream

      Cortizone-10 Maximum Strength Intensive Healing 1% Anti-Itch Topical Cream (null) (Chattem, Inc. is a wholly-owned subsidiary of Sanofi-Aventis ) null

      Hydrocortisone Topical cream

      Cortizone-10 Maximum Strength Intensive Moisture 1% Anti-Itch Topical Cream (null) (Chattem, Inc. is a wholly-owned subsidiary of Sanofi-Aventis ) null

      Hydrocortisone Topical cream

      Cortizone-10 Maximum Strength Intensive Moisture 1% Anti-Itch Topical Cream (null) (Chattem, Inc. is a wholly-owned subsidiary of Sanofi-Aventis ) null

      Hydrocortisone Topical cream

      Cortizone-10 Maximum Strength Overnight 1% Anti-Itch Topical Cream (null) (Chattem, Inc. is a wholly-owned subsidiary of Sanofi-Aventis ) null

      Hydrocortisone Topical cream

      Cortizone-10 Maximum Strength Plus Creme Topical Cream (00501-3307) (GlaxoSmithKline Consumer Healthcare) (off market)

      Hydrocortisone Topical cream

      Cortizone-10 Maximum Strength Plus Ultra Moisturizing 1% Anti-Itch Topical Cream (null) (Chattem, Inc. is a wholly-owned subsidiary of Sanofi-Aventis ) null

      Hydrocortisone Topical cream

      Cortizone-10 Maximum Strength Plus Ultra Moisturizing 1% Anti-Itch Topical Cream (null) (Chattem, Inc. is a wholly-owned subsidiary of Sanofi-Aventis ) null

      Hydrocortisone Topical cream

      Cortizone-10 Maximum Strength Sensitive Skin 1% Anti-Itch Topical Cream (null) (Chattem, Inc. is a wholly-owned subsidiary of Sanofi-Aventis ) null

      Hydrocortisone Topical cream

      Cortizone-10 Maximum Strength Soothing Aloe 1% Anti-Itch Topical Cream (null) (Chattem, Inc. is a wholly-owned subsidiary of Sanofi-Aventis ) null

      Hydrocortisone Topical cream

      Cortizone-10 Maximum Strength Soothing Aloe 1% Anti-Itch Topical Cream (null) (Chattem, Inc. is a wholly-owned subsidiary of Sanofi-Aventis ) null

      Hydrocortisone Topical cream

      Cortizone-10 Maximum Strength Soothing Aloe 1% Anti-Itch Topical Cream (null) (Chattem, Inc. is a wholly-owned subsidiary of Sanofi-Aventis ) null

      Hydrocortisone Topical cream

      Cortizone-10 Maximum Strength Ultra Soothing 1% Anti-Itch Topical Cream (null) (Chattem, Inc. is a wholly-owned subsidiary of Sanofi-Aventis ) null

      Hydrocortisone Topical cream

      Cortizone-10 Maximum Strength Ultra Soothing 1% Anti-Itch Topical Cream (null) (Chattem, Inc. is a wholly-owned subsidiary of Sanofi-Aventis ) null

      Hydrocortisone Topical cream

      Cortizone-10 Maximum Strength with Aloe 1% Anti-Itch Topical Cream (null) (Chattem, Inc. is a wholly-owned subsidiary of Sanofi-Aventis ) null

      Hydrocortisone Topical cream

      Cortizone-10 Plus 1% Topical Creme (41167-0105) (Chattem, Inc. is a wholly-owned subsidiary of Sanofi-Aventis ) (off market)

      Hydrocortisone Topical cream

      CVS Anti-Itch Maximum Strength 1% Topical Cream (null) (CVS Health) (off market)

      Hydrocortisone Topical cream

      CVS Anti-Itch Maximum Strength 1% Topical Cream (59779-0844) (CVS Health) null

      Hydrocortisone Topical cream

      CVS Cortisone + Maximum Strength 1% Topical Cream (null) (CVS Health) nullCVS Cortisone + Maximum Strength 1% Topical Cream package photo

      Hydrocortisone Topical cream

      CVS Cortisone 1% with Aloe Topical Cream (59779-0319) (CVS Health) (off market)

      Hydrocortisone Topical cream

      CVS Cortisone 1% with Aloe Topical Cream (59779-0319) (CVS Health) null

      Hydrocortisone Topical cream

      CVS Cortisone Maximum Strength 1% Topical Cream (59779-0973) (CVS Health) nullCVS Cortisone Maximum Strength 1% Topical Cream package photo

      Hydrocortisone Topical cream

      CVS Cortisone Maximum Strength 1% Topical Cream (null) (CVS Health) (off market)CVS Cortisone Maximum Strength 1% Topical Cream package photo

      Hydrocortisone Topical cream

      CVS Cortisone Maximum Strength 1% Topical Cream (null) (CVS Health) (off market)CVS Cortisone Maximum Strength 1% Topical Cream package photo

      Hydrocortisone Topical cream

      CVS Cortisone Maximum Strength 1% Topical Cream (null) (CVS Health) null

      Hydrocortisone Topical cream

      CVS Cortisone Maximum Strength 1% Topical Cream (59779-0099) (CVS Health) null

      Hydrocortisone Topical cream

      CVS Cortisone Maximum Strength 1% Topical Cream (59779-0099) (CVS Health) null

      Hydrocortisone Topical cream

      CVS Cortisone Maximum Strength 1% with Aloe Topical Cream (null) (CVS Health) nullCVS Cortisone Maximum Strength 1% with Aloe Topical Cream package photo

      Hydrocortisone Topical cream

      CVS Cortisone Maximum Strength 1% with Aloe Topical Cream (null) (CVS Health) nullCVS Cortisone Maximum Strength 1% with Aloe Topical Cream package photo

      Hydrocortisone Topical cream

      CVS Cortisone Maximum Strength 1% with Aloe Topical Cream (null) (CVS Health) nullCVS Cortisone Maximum Strength 1% with Aloe Topical Cream package photo

      Hydrocortisone Topical cream

      CVS Cortisone Maximum Strength 1% with Aloe Topical Cream (59779-0319) (CVS Health) null

      Hydrocortisone Topical cream

      CVS Eczema Anti-Itch Maximum Strength 1% Topical Cream (null) (CVS Health) null

      Hydrocortisone Topical cream

      CVS Hydrocortisone 1% Maximum Strength Topical Cream (59779-0307) (CVS Health) null

      Hydrocortisone Topical cream

      Dermarest DriCort Creme (null) (Del Pharmaceuticals) (off market)

      Hydrocortisone Topical cream

      Dermarest DriCort Creme Bonus Pack (null) (Del Pharmaceuticals) (off market)

      Hydrocortisone Topical cream

      Equaline Anti-itch 1% Topical Cream (41163-0319) (Albertson's, Inc) null

      Hydrocortisone Topical cream

      Equate Hydrocortisone 1% Maximum Strength Topical Creme (49035-0369) (Wal-Mart Stores, Inc.) null

      Hydrocortisone Topical cream

      Equate Hydrocortisone Maximum Strength 1% Topical Cream (49035-0707) (Wal-Mart Stores, Inc.) null

      Hydrocortisone Topical cream

      GNP Hydrocortisone Maximum Strength 1% with Aloe Topical Cream (24385-0274) (AmerisourceBergen Corporation) null

      Hydrocortisone Topical cream

      GNP Hydrocortisone Plus 1% Topical Cream (24385-0021) (AmerisourceBergen Corporation) null

      Hydrocortisone Topical cream

      GoodSense Anti-Itch Maximum Strength 1% Topical Cream (00113-0541) (Goodsense a Division of Perrigo) nullGoodSense Anti-Itch Maximum Strength 1% Topical Cream package photo

      Hydrocortisone Topical cream

      GoodSense Anti-Itch Plus Topical Cream (00113-0973) (Goodsense a Division of Perrigo) null

      Hydrocortisone Topical cream

      Health Mart Hydrocortisone 1% Plus 12 Moisturizers Topical Cream (62011-0096) (McKesson Corporation) (off market)

      Hydrocortisone Topical cream

      Health Mart Hydrocortisone with Aloe 1% Maximum Strength Topical Cream (62011-0095) (McKesson Corporation) (off market)

      Hydrocortisone Topical cream

      HEB Hydrocortisone Maximum Strength 1% Topical Cream (37808-0369) (H-E-B) null

      Hydrocortisone Topical cream

      Hydrocortisone 1% Maximum Strength Topical Cream (70403-0923) (Aru Pharma, Inc.) null

      Hydrocortisone Topical cream

      Hydrocortisone 1% Maximum Strength Topical Cream (00603-0535) (Endo USA, Inc.) (off market)Hydrocortisone 1% Maximum Strength Topical Cream package photo

      Hydrocortisone Topical cream

      Hydrocortisone 1% Maximum Strength Topical Cream (61269-0343) (H2-Pharma, LLC) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 1% Maximum Strength Topical Cream (69396-0028) (Trifecta Pharmaceuticals USA) null

      Hydrocortisone Topical cream

      Hydrocortisone 1% Plus 12 Moisturizers Topical Cream (51672-2063) (Taro Pharmaceuticals USA Inc) null

      Hydrocortisone Topical cream

      Hydrocortisone 1% Plus 12 Topical Cream (00472-0341) (Teva/Actavis US) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 1% Plus Oatmeal Topical Cream (51672-2082) (Taro Pharmaceuticals USA Inc) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 1% Rectal Cream (61269-0101) (H2-Pharma, LLC) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 1% Topical Cream (71399-0180) (Akron Pharma Inc.) null

      Hydrocortisone Topical cream

      Hydrocortisone 1% Topical Cream (62559-0430) (ANI Pharmaceuticals, Inc.) nullHydrocortisone 1% Topical Cream package photo

      Hydrocortisone Topical cream

      Hydrocortisone 1% Topical Cream (50090-3115) (A-S Medication Solutions LLC) null

      Hydrocortisone Topical cream

      Hydrocortisone 1% Topical Cream (68001-0476) (BluePoint Laboratories) null

      Hydrocortisone Topical cream

      Hydrocortisone 1% Topical Cream (63629-1951) (Bryant Ranch Prepack, Inc.) null

      Hydrocortisone Topical cream

      Hydrocortisone 1% Topical Cream (52297-0105) (Cardinal Health, Inc.) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 1% Topical Cream (52297-0204) (Cardinal Health, Inc.) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 1% Topical Cream (00713-0626) (Cosette Pharmaceuticals, Inc.) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 1% Topical Cream (45565-0555) (Crown Laboratories) null

      Hydrocortisone Topical cream

      Hydrocortisone 1% Topical Cream (00316-0186) (Crown Laboratories, Inc.) null

      Hydrocortisone Topical cream

      Hydrocortisone 1% Topical Cream (72189-0276) (Direct Rx) null

      Hydrocortisone Topical cream

      Hydrocortisone 1% Topical Cream (42037-0409) (Dr. Rose Inc) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 1% Topical Cream (67777-0224) (Dynarex Corporation) null

      Hydrocortisone Topical cream

      Hydrocortisone 1% Topical Cream (67777-0004) (Dynarex Corporation) null

      Hydrocortisone Topical cream

      Hydrocortisone 1% Topical Cream (61678-0411) (Dynarex Corporation) null

      Hydrocortisone Topical cream

      Hydrocortisone 1% Topical Cream (00603-0534) (Endo USA, Inc.) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 1% Topical Cream (52735-0740) (Family Pharmacy) null

      Hydrocortisone Topical cream

      Hydrocortisone 1% Topical Cream (52959-0039) (HJ Harkins Co Inc) null

      Hydrocortisone Topical cream

      Hydrocortisone 1% Topical Cream (00179-8710) (Kaiser Foundation Hospitals) null

      Hydrocortisone Topical cream

      Hydrocortisone 1% Topical Cream (00904-7623) (Major Pharmaceuticals Inc, a Harvard Drug Group Company) (off market)Hydrocortisone 1% Topical Cream package photo

      Hydrocortisone Topical cream

      Hydrocortisone 1% Topical Cream (null) (Mason Vitamins) null

      Hydrocortisone Topical cream

      Hydrocortisone 1% Topical Cream (49348-0521) (McKesson Corporation) null

      Hydrocortisone Topical cream

      Hydrocortisone 1% Topical Cream (53329-0091) (Medline Industries, Inc) null

      Hydrocortisone Topical cream

      Hydrocortisone 1% Topical Cream (67234-0010) (Natureplex, LLC) null

      Hydrocortisone Topical cream

      Hydrocortisone 1% Topical Cream (45802-0438) (Padagis US LLC) nullHydrocortisone 1% Topical Cream package photo

      Hydrocortisone Topical cream

      Hydrocortisone 1% Topical Cream (63187-0567) (Proficient Rx LP) null

      Hydrocortisone Topical cream

      Hydrocortisone 1% Topical Cream (00536-1277) (Rugby Laboratories a Division of The Harvard Drug Group, LLC ) null

      Hydrocortisone Topical cream

      Hydrocortisone 1% Topical Cream (00168-0015) (Sandoz Inc. a Novartis Company) nullHydrocortisone 1% Topical Cream package photo

      Hydrocortisone Topical cream

      Hydrocortisone 1% Topical Cream (00168-0154) (Sandoz Inc. a Novartis Company) nullHydrocortisone 1% Topical Cream package photo

      Hydrocortisone Topical cream

      Hydrocortisone 1% Topical Cream (70512-0101) (Sola Pharmaceuticals) null

      Hydrocortisone Topical cream

      Hydrocortisone 1% Topical Cream (51672-2069) (Taro Pharmaceuticals USA Inc) null

      Hydrocortisone Topical cream

      Hydrocortisone 1% Topical Cream (51672-3004) (Taro Pharmaceuticals USA Inc) null

      Hydrocortisone Topical cream

      Hydrocortisone 1% Topical Cream (51672-2013) (Taro Pharmaceuticals USA Inc) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 1% Topical Cream (51672-2013) (Taro Pharmaceuticals USA Inc) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 1% Topical Cream (00182-0950) (Teva Pharmaceuticals USA) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 1% Topical Cream (00182-5060) (Teva Pharmaceuticals USA) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 1% Topical Cream (00472-0321) (Teva/Actavis US) nullHydrocortisone 1% Topical Cream package photo

      Hydrocortisone Topical cream

      Hydrocortisone 1% Topical Cream (00472-0339) (Teva/Actavis US) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 1% Topical Cream (00472-0343) (Teva/Actavis US) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 1% Topical Cream (00472-0339) (Teva/Actavis US) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 1% Topical Cream (00472-0343) (Teva/Actavis US) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 1% Topical Cream (00472-0343) (Teva/Actavis US) nullHydrocortisone 1% Topical Cream package photo

      Hydrocortisone Topical cream

      Hydrocortisone 1% Topical Cream (49158-0101) (Thames Pharmaceuticals Inc a Division of Taro) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 1% Topical Cream (51326-0105) (Topiderm Inc) null

      Hydrocortisone Topical cream

      Hydrocortisone Acetate 1% with Aloe Topical Cream (51672-2059) (Taro Pharmaceuticals USA Inc) null

      Hydrocortisone Topical cream

      Hydrocortisone Maximum Strength 1% with Aloe Vera Topical Cream (79503-0202) (EzriCare, LLC) nullHydrocortisone Maximum Strength 1% with Aloe Vera Topical Cream package photo

      Hydrocortisone Topical cream

      Hydrocortisone with Aloe 1% Maximum Strength Topical Cream (61269-0339) (H2-Pharma, LLC) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone with Aloe 1% Maximum Strength Topical Cream (00472-0339) (Teva/Actavis US) nullHydrocortisone with Aloe 1% Maximum Strength Topical Cream package photo

      Hydrocortisone Topical cream

      Hydrocortisone with Aloe Maximum Strength 1% Topical Cream (50090-3113) (A-S Medication Solutions LLC) null

      Hydrocortisone Topical cream

      Hydroskin 1% Topical Cream (00536-5108) (Rugby Laboratories a Division of The Harvard Drug Group, LLC) (off market)Hydroskin 1% Topical Cream package photo

      Hydrocortisone Topical cream

      HydroSkin 1% with Healing Aloe Topical Cream (00536-1069) (Rugby Laboratories a Division of The Harvard Drug Group, LLC) (off market)

      Hydrocortisone Topical cream

      Hytone 1% Topical Cream (00066-8042) (Bausch Health US, LLC) (off market)

      Hydrocortisone Topical cream

      Instacort 10 1% Topical Cream (59390-0023) (Altaire Pharmaceuticals Inc) null

      Hydrocortisone Topical cream

      Kirkland Hydrocortisone Maximum Strength 1% Topical Cream (63981-0973) (Costco Wholesale Corporation) null

      Hydrocortisone Topical cream

      Leader Hydrocortisone 1% Maximum Strength Topical Cream (70000-0485) (Cardinal Health, Inc.) null

      Hydrocortisone Topical cream

      Leader Hydrocortisone 1% With Aloe Vera Topical Cream (37205-0272) (Cardinal Health, Inc.) (off market)

      Hydrocortisone Topical cream

      Leader Hydrocortisone Maximum Strength 1% with Aloe Vera Topical Cream (70000-0543) (Cardinal Health, Inc.) null

      Hydrocortisone Topical cream

      Leader Hydrocortisone Maximum Strength 1% Topical Cream (37205-0162) (Cardinal Health, Inc.) (off market)

      Hydrocortisone Topical cream

      Leader Hydrocortisone Maximum Strength 1% with Aloe Topical Cream (37205-0272) (Cardinal Health, Inc.) (off market)

      Hydrocortisone Topical cream

      Medpura Hydrocortisone Anti-itch 1% Topical Cream (71399-1246) (Akron Pharma Inc.) null

      Hydrocortisone Topical cream

      Monistat Complete Care Instant Itch Relief Cream (63736-0447) (Medtech Products, Inc a Prestige Consumer Healthcare Company) null

      Hydrocortisone Topical cream

      Neosporin Eczema Anti-itch 1% Topical Cream (12547-0238) (Johnson & Johnson Consumer Inc.) (off market)

      Hydrocortisone Topical cream

      Nutracort 1% Topical Cream (00299-5821) (Galderma Laboratories Inc) (off market)

      Hydrocortisone Topical cream

      Penecort 1% Topical Cream (00023-0510) (Allergan USA, Inc.) (off market)

      Hydrocortisone Topical cream

      Premier Value Hydrocortisone 1% Topical Cream (68016-0024) (Pharmacy Value Alliance LLC formerly Chain Drug Consortium , LLC) null

      Hydrocortisone Topical cream

      Premier Value Hydrocortisone Maximum Strength 1% Topical Cream (68016-0102) (Pharmacy Value Alliance LLC formerly Chain Drug Consortium , LLC) null

      Hydrocortisone Topical cream

      Premier Value Hydrocortisone Plus 1% Topical Cream (68016-0019) (Pharmacy Value Alliance LLC formerly Chain Drug Consortium , LLC) null

      Hydrocortisone Topical cream

      Preparation H Hydrocortisone 1% Topical Cream (00573-2830) (GlaxoSmithKline Consumer Healthcare) (off market)

      Hydrocortisone Topical cream

      Preparation H Hydrocortisone 1% Topical Cream (00573-0552) (GlaxoSmithKline Consumer Healthcare) null

      Hydrocortisone Topical cream

      Preparation H Hydrocortisone 1% Topical Cream (00573-2830) (GlaxoSmithKline Consumer Healthcare) null

      Hydrocortisone Topical cream

      Proctocort 1% Cream (65649-0501) (Bausch Health US, LLC) nullProctocort 1%  Cream package photo

      Hydrocortisone Topical cream

      Procto-Kit 1% Cream (10631-0405) (Ranbaxy Laboratories, a Sun Pharma Company) null

      Hydrocortisone Topical cream

      Procto-Pak 1% Cream (64980-0302) (Rising Pharmaceuticals Inc) nullProcto-Pak 1%  Cream package photo

      Hydrocortisone Topical cream

      Publix Hydrocream 1% with Aloe Topical Cream (null) (Publix Super Markets, Inc) null

      Hydrocortisone Topical cream

      Quality Choice Anti-Itch Intensive Healing Maximum Strength 1% Topical Cream (63868-0594) (Chain Drug Marketing Association) nullQuality Choice Anti-Itch Intensive Healing Maximum Strength 1% Topical Cream package photo

      Hydrocortisone Topical cream

      Quality Choice Anti-Itch with Aloe Maximum Strength 1% Topical Cream (63868-0597) (Chain Drug Marketing Association) nullQuality Choice Anti-Itch with Aloe Maximum Strength 1% Topical Cream package photo

      Hydrocortisone Topical cream

      Quality Choice Hydrocortisone Maximum Strength 1% Topical Cream (63868-0689) (Chain Drug Marketing Association) nullQuality Choice Hydrocortisone Maximum Strength 1% Topical Cream package photo

      Hydrocortisone Topical cream

      RITE AID 1% Anti-Itch Maximum Strength Topical Cream (11822-3587) (Rite Aid Corp) null

      Hydrocortisone Topical cream

      RITE AID Anti-Itch Maximum Strength 1% Topical Cream (null) (Rite Aid Corp) null

      Hydrocortisone Topical cream

      RITE AID Anti-Itch Maximum Strength 1% Topical Cream (null) (Rite Aid Corp) null

      Hydrocortisone Topical cream

      RITE AID Anti-Itch Maximum Strength Plus Topical Cream (null) (Rite Aid Corp) null

      Hydrocortisone Topical cream

      RITE AID Hydrocortisone 1% Plus 10 Moisturizers Topical Cream (null) (Rite Aid Corp) null

      Hydrocortisone Topical cream

      Sunmark Hydrocortisone with Aloe Maximium Strength 1% Topical Cream (10939-0570) (McKesson Corporation) null

      Hydrocortisone Topical cream

      Sunmark Hydrocortisone 1% Plus 12 Moisturizers Topical Cream (49348-0441) (McKesson Corporation) null

      Hydrocortisone Topical cream

      Sunmark Hydrocortisone 1% with Aloe Maximium Strength Topical Cream (49348-0521) (McKesson Corporation) null

      Hydrocortisone Topical cream

      Sunmark Hydrocortisone with Aloe 1% Maximum Strength Topical Cream (49348-0435) (McKesson Corporation) null

      Hydrocortisone Topical cream

      Today's Health Hydrocortisone 1% Topical Cream (null) (Today's Health, Inc.) null

      Hydrocortisone Topical cream

      Today's Health Hydrocortisone 1% with Aloe Topical Cream (null) (Today's Health, Inc.) null

      Hydrocortisone Topical cream

      VANICREAM HC Anti-Itch For Sensitive Skin 1% Topical Cream (45334-0327) (Pharmaceutical Specialist, Inc.) null

      Hydrocortisone Topical cream

      Walgreens Hydrocortisone 1% Maximum Strength Topical Cream (null) (Walgreens Co) nullWalgreens Hydrocortisone 1% Maximum Strength Topical Cream package photo

      Hydrocortisone Topical cream

      Walgreens Hydrocortisone 1% Maximum Strength Topical Cream (00363-0791) (Walgreens Co) nullWalgreens Hydrocortisone 1% Maximum Strength Topical Cream package photo

      Hydrocortisone Topical cream

      Walgreens Hydrocortisone 1% Topical Cream (null) (Walgreens Co) nullWalgreens Hydrocortisone 1% Topical Cream package photo

      Hydrocortisone Topical cream

      Walgreens Hydrocortisone 1% Topical Cream (11917-0138) (Walgreens Co) null

      Hydrocortisone Topical cream

      Walgreens Hydrocortisone 1% Topical Cream (11917-0102) (Walgreens Co) null

      Hydrocortisone Topical cream

      Walgreens Hydrocortisone 1% Ultra-Moisturizing with Aloe Topical Cream (00363-1973) (Walgreens Co) null

      Hydrocortisone Topical cream

      Walgreens Hydrocortisone 1% with Aloe Topical Cream (null) (Walgreens Co) nullWalgreens Hydrocortisone 1% with Aloe Topical Cream package photo

      Hydrocortisone Topical cream

      Walgreens Hydrocortisone 1% with Aloe Topical Cream (null) (Walgreens Co) nullWalgreens Hydrocortisone 1% with Aloe Topical Cream package photo

      Hydrocortisone Topical cream

      Walgreens Hydrocortisone 1% with Oatmeal Topical Cream (null) (Walgreens Co) (off market)Walgreens Hydrocortisone 1% with Oatmeal Topical Cream package photo

      Hydrocortisone Topical cream

      Walgreens Hydrocortisone Plus Maximum Strength Topical Cream (null) (Walgreens Co) (off market)Walgreens Hydrocortisone Plus Maximum Strength Topical Cream package photo

      Hydrocortisone Topical cream

      Walgreens Intensive Healing Hydrocortisone 1% Topical Cream (00363-0236) (Walgreens Co) nullWalgreens Intensive Healing Hydrocortisone 1% Topical Cream package photo

      Hydrocortisone Topical cream

      Ala-Cort 2.5% Topical Cream (00316-0128) (Crown Laboratories Inc) null

      Hydrocortisone Topical cream

      Anusol HC 2.5% Topical Cream (65649-0401) (Bausch Health US, LLC) nullAnusol HC 2.5% Topical Cream package photo

      Hydrocortisone Topical cream

      Hydrocortisone 2.5% Topical Cream (53217-0197) (Aidarex Pharmaceuticals, LLC) null

      Hydrocortisone Topical cream

      Hydrocortisone 2.5% Topical Cream (62559-0431) (ANI Pharmaceuticals, Inc.) nullHydrocortisone 2.5% Topical Cream package photo

      Hydrocortisone Topical cream

      Hydrocortisone 2.5% Topical Cream (50090-0244) (A-S Medication Solutions LLC) null

      Hydrocortisone Topical cream

      Hydrocortisone 2.5% Topical Cream (50090-2452) (A-S Medication Solutions LLC) null

      Hydrocortisone Topical cream

      Hydrocortisone 2.5% Topical Cream (50090-0350) (A-S Medication Solutions LLC) null

      Hydrocortisone Topical cream

      Hydrocortisone 2.5% Topical Cream (50090-3434) (A-S Medication Solutions LLC) null

      Hydrocortisone Topical cream

      Hydrocortisone 2.5% Topical Cream (63629-1952) (Bryant Ranch Prepack, Inc.) null

      Hydrocortisone Topical cream

      Hydrocortisone 2.5% Topical Cream (00316-0193) (Crown Laboratories, Inc.) null

      Hydrocortisone Topical cream

      Hydrocortisone 2.5% Topical Cream (61919-0364) (Direct Rx) null

      Hydrocortisone Topical cream

      Hydrocortisone 2.5% Topical Cream (00603-7781) (Endo USA, Inc.) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 2.5% Topical Cream (52959-0019) (HJ Harkins Co Inc) null

      Hydrocortisone Topical cream

      Hydrocortisone 2.5% Topical Cream (66267-0967) (NuCare Pharmaceuticals Inc) null

      Hydrocortisone Topical cream

      Hydrocortisone 2.5% Topical Cream (45802-0004) (Padagis US LLC) nullHydrocortisone 2.5% Topical Cream package photo

      Hydrocortisone Topical cream

      Hydrocortisone 2.5% Topical Cream (45802-0287) (Perrigo Pharmaceuticals Company) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 2.5% Topical Cream (60793-0313) (Pfizer Inc.) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 2.5% Topical Cream (55700-0321) (Quality Care Products, LLC) null

      Hydrocortisone Topical cream

      Hydrocortisone 2.5% Topical Cream (00168-0080) (Sandoz Inc. a Novartis Company) nullHydrocortisone 2.5% Topical Cream package photo

      Hydrocortisone Topical cream

      Hydrocortisone 2.5% Topical Cream (00781-7011) (Sandoz Inc. a Novartis Company) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 2.5% Topical Cream (00364-2446) (Schein Pharmaceutical Inc, an Actavis Company) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 2.5% Topical Cream (00677-0718) (Sun Pharmaceutical Industries, Inc.) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 2.5% Topical Cream (51672-3003) (Taro Pharmaceuticals USA Inc) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 2.5% Topical Cream (51672-3003) (Taro Pharmaceuticals USA Inc) nullHydrocortisone 2.5% Topical Cream package photo

      Hydrocortisone Topical cream

      Hydrocortisone 2.5% Topical Cream (00182-5005) (Teva Pharmaceuticals USA) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 2.5% Topical Cream (00472-0337) (Teva/Actavis US) nullHydrocortisone 2.5% Topical Cream package photo

      Hydrocortisone Topical cream

      Hydrocortisone 2.5% Topical Cream (23317-0322) (Teva/Actavis US) (off market)

      Hydrocortisone Topical cream

      Hydrocortisone 2.5% Topical Cream (00472-0337) (Teva/Actavis US) nullHydrocortisone 2.5% Topical Cream package photo

      Hydrocortisone Topical cream

      Hydrocortisone 2.5% Topical Cream (49158-0200) (Thames Pharmaceuticals Inc a Division of Taro) (off market)

      Hydrocortisone Topical cream

      Hydroxym 2% Topical Cream (59088-0208) (PureTek Corporation) null

      Hydrocortisone Topical cream

      Hytone 2.5% Topical Cream (00066-0095) (Bausch Health US, LLC) (off market)Hytone 2.5% Topical Cream package photo

      Hydrocortisone Topical cream

      Procto-Kit 2.5% Cream (10631-0406) (Ranbaxy Laboratories, a Sun Pharma Company) nullProcto-Kit 2.5% Cream package photo

      Hydrocortisone Topical cream

      Procto-Med HC 2.5% Topical Cream (50090-2931) (A-S Medication Solutions LLC) null

      Hydrocortisone Topical cream

      Procto-Med HC 2.5% Topical Cream (69315-0302) (Leading Pharma, LLC) nullProcto-Med HC 2.5% Topical Cream package photo

      Hydrocortisone Topical cream

      Procto-Med HC 2.5% Topical Cream (69315-0312) (Leading Pharma, LLC) nullProcto-Med HC 2.5% Topical Cream package photo

      Hydrocortisone Topical cream

      Proctosol-HC 2.5% Cream (10631-0407) (Ranbaxy Laboratories, a Sun Pharma Company) nullProctosol-HC 2.5%  Cream package photo

      Hydrocortisone Topical cream

      Proctozone-HC 2.5% Cream (64980-0301) (Rising Pharmaceuticals Inc) nullProctozone-HC 2.5% Cream package photo

      Hydrocortisone Topical cream

      Proctozone-HC 2.5% Cream (64980-0324) (Rising Pharmaceuticals Inc) nullProctozone-HC 2.5% Cream package photo

      Hydrocortisone Topical cream

      Proctozone-HC 2.5% Topical Cream (63629-8847) (Bryant Ranch Prepack, Inc.) null

      Hydrocortisone Topical cream

      Proctozone-HC 2.5% Topical Cream (63629-2396) (Bryant Ranch Prepack, Inc.) null

      Hydrocortisone Topical gel

      Corticool 1% Anti-Itch Topical Gel (51879-0110) (Tec Laboratories, Inc.) nullCorticool 1% Anti-Itch Topical Gel package photo

      Hydrocortisone Topical gel

      Cortizone-10 Cooling Relief 1% Topical Gel (41167-0036) (Chattem, Inc. is a wholly-owned subsidiary of Sanofi-Aventis ) (off market)

      Hydrocortisone Topical gel

      Cortizone-10 Maximum Strength 1% Cooling Anti-Itch Topical Gel (null) (Chattem, Inc. is a wholly-owned subsidiary of Sanofi-Aventis ) null

      Hydrocortisone Topical gel

      Cortizone-10 Maximum Strength 1% Cooling Relief Anti-Itch Topical Gel (null) (Chattem, Inc. is a wholly-owned subsidiary of Sanofi-Aventis ) null

      Hydrocortisone Topical gel

      CVS Cortisone Maximum Strength Cooling Relief 1% Topical Gel (null) (CVS Health) (off market)

      Hydrocortisone Topical gel

      CVS Cortisone Maximum Strength Cooling Relief 1% Topical Gel (59779-0729) (CVS Health) null

      Hydrocortisone Topical gel

      Instacort-10 1% Topical Gel (59390-0049) (Altaire Pharmaceuticals Inc) null

      Hydrocortisone Topical gel

      Walgreens Hydrocortisone Cool Relief 1% Maximum Strength Gel (null) (Walgreens Co) nullWalgreens Hydrocortisone Cool Relief 1% Maximum Strength Gel package photo

      Hydrocortisone Topical gel

      DermacinRx Hydroxate 2% Topical Gel (59088-0328) (PureTek Corporation) null

      Hydrocortisone Topical gel

      Hydroxym 2% Topical Gel (59088-0209) (PureTek Corporation) null

      Hydrocortisone Topical lotion

      Balneol For Her 0.25% Topical Lotion (68220-0078) (Meda Pharmaceuticals, Inc., a division Mylan Specialty L.P.) (off market)

      Hydrocortisone Topical lotion

      Cetacort 0.25% Topical Lotion (00299-3947) (Galderma Laboratories Inc) (off market)

      Hydrocortisone Topical lotion

      Cetacort 0.25% Topical Lotion (00064-3947) (Smith and Nephew Biotherapeutics, formerly Healthpoint BioTherapeutics) (off market)

      Hydrocortisone Topical lotion

      Cetacort 0.5% Topical Lotion (00064-3948) (Smith and Nephew Biotherapeutics, formerly Healthpoint BioTherapeutics) (off market)

      Hydrocortisone Topical lotion

      Ala-Cort 1% Topical Lotion (00316-0131) (Crown Laboratories Inc) (off market)

      Hydrocortisone Topical lotion

      Aquanil HC Micronized Topical Lotion (00096-0732) (Person and Covey Inc) null

      Hydrocortisone Topical lotion

      Cetacort 1% Topical Lotion (00064-2000) (Bausch Health US, LLC) (off market)

      Hydrocortisone Topical lotion

      Cortaid 1% Intensive Therapy Anti-Itch Toipical Lotion (null) (Johnson & Johnson Healthcare Products Division of McNeil-PPC, Inc) (off market)

      Hydrocortisone Topical lotion

      Cortizone-10 Intensive Healing Eczema 1% Topical Lotion (41167-0331) (Chattem, Inc. is a wholly-owned subsidiary of Sanofi-Aventis ) (off market)

      Hydrocortisone Topical lotion

      Cortizone-10 Maximum Strength Diabetics' Skin 1% Anti-Itch Topical Lotion (null) (Chattem, Inc. is a wholly-owned subsidiary of Sanofi-Aventis ) null

      Hydrocortisone Topical lotion

      Cortizone-10 Maximum Strength Intensive Healing Eczema 1% Topical Lotion (null) (Chattem, Inc. is a wholly-owned subsidiary of Sanofi-Aventis ) null

      Hydrocortisone Topical lotion

      Cortizone-10 Maximum Strength Psoriasis 1% Anti-Itch Topical Lotion (null) (Chattem, Inc. is a wholly-owned subsidiary of Sanofi-Aventis ) null

      Hydrocortisone Topical lotion

      CVS Cortisone Maximum Strength 1% Lotion (59779-0878) (CVS Health) (off market)

      Hydrocortisone Topical lotion

      CVS Cortisone Maximum Strength 1% Lotion (59779-0878) (CVS Health) null

      Hydrocortisone Topical lotion

      Dermarest Eczema 1% Medicated Topical Lotion (63736-0339) (Medtech Products, Inc a Prestige Consumer Healthcare Company) null

      Hydrocortisone Topical lotion

      Dermarest Eczema 1% Topical Lotion (null) (Del Pharmaceuticals) (off market)

      Hydrocortisone Topical lotion

      Gly-Cort 1% Lotion (50434-0302) (Heran Pharmaceutical Inc) (off market)

      Hydrocortisone Topical lotion

      Gly-Cort 1% Lotion (50434-0003) (Heran Pharmaceutical Inc) (off market)

      Hydrocortisone Topical lotion

      GNP Anti-Itch Maximum Strength 1% Topical Lotion (24385-0283) (AmerisourceBergen Corporation) (off market)

      Hydrocortisone Topical lotion

      Hydro Skin 1% Maximum Strength Topical Lotion (00536-1079) (Rugby Laboratories a Division of The Harvard Drug Group, LLC) (off market)

      Hydrocortisone Topical lotion

      Hydrocortisone 1% Lotion (59366-2707) (Glades Pharmaceuticals, LLC) (off market)Hydrocortisone 1% Lotion package photo

      Hydrocortisone Topical lotion

      Hydrocortisone 1% Topical Lotion (00394-0859) (Mericon Industries Inc) null

      Hydrocortisone Topical lotion

      Hydrocortisone 1% Topical Lotion (45802-0283) (Perrigo Pharmaceuticals Company) (off market)

      Hydrocortisone Topical lotion

      Hydrocortisone 1% Topical Lotion (59366-2707) (Perrigo Pharmaceuticals Company) (off market)

      Hydrocortisone Topical lotion

      Hydrocortisone 1% Topical Lotion (45802-0933) (Perrigo Pharmaceuticals Company) (off market)

      Hydrocortisone Topical lotion

      Hydrocortisone 1% Topical Lotion (00168-0287) (Sandoz Inc. a Novartis Company) (off market)Hydrocortisone 1% Topical Lotion package photo

      Hydrocortisone Topical lotion

      Hydrocortisone 1% with Aloe Micronized Topical Lotion (71399-0120) (Akron Pharma Inc.) null

      Hydrocortisone Topical lotion

      Hydroskin 1% Topical Lotion (00536-5105) (Rugby Laboratories a Division of The Harvard Drug Group, LLC) (off market)Hydroskin 1% Topical Lotion package photo

      Hydrocortisone Topical lotion

      Hydroskin 1% Topical Lotion (00536-5105) (Rugby Laboratories a Division of The Harvard Drug Group, LLC) (off market)Hydroskin 1% Topical Lotion package photo

      Hydrocortisone Topical lotion

      Lacticare HC 1% Topical Lotion (00145-2537) (GlaxoSmithKline Group of Companies) (off market)

      Hydrocortisone Topical lotion

      Nutracort 1% Topical Lotion (00064-2200) (Bausch Health US, LLC) (off market)Nutracort 1% Topical Lotion package photo

      Hydrocortisone Topical lotion

      Nutracort 1% Topical Lotion (00064-5830) (Smith and Nephew Biotherapeutics, formerly Healthpoint BioTherapeutics) (off market)

      Hydrocortisone Topical lotion

      Rederm 1% Topical Lotion (45565-0502) (Co Med Pharmaceuticals Inc Dba Med Derm Pharms) (off market)

      Hydrocortisone Topical lotion

      Sarnol-HC 1% Topical Lotion (00145-0622) (GlaxoSmithKline Group of Companies) nullSarnol-HC 1% Topical Lotion package photo

      Hydrocortisone Topical lotion

      Walgreens Intensive Healing Eczema 1% Topical Lotion (null) (Walgreens Co) nullWalgreens Intensive Healing Eczema 1% Topical Lotion package photo

      Hydrocortisone Topical lotion

      Ala-Scalp 2% Topical Lotion (00316-0140) (Crown Laboratories, Inc.) null

      Hydrocortisone Topical lotion

      Ala-Scalp 2% Topical Lotion (77052-0010) (Derm Ventures, LLC) null

      Hydrocortisone Topical lotion

      Ala-Scalp 2% Topical Lotion (72336-0120) (Lifsa Drugs, LLC) (off market)

      Hydrocortisone Topical lotion

      AQUA GLYCOLIC HC 2% Lotion Scalp & Body Kit (00259-1802) (Merz Pharmaceuticals LLC) null

      Hydrocortisone Topical lotion

      Hydrocort 2% Lotion Complete Kit (79043-0410) (Scite Pharma, LLC) null

      Hydrocortisone Topical lotion

      Hydrocortisone 2% Lotion Complete Kit (28595-0840) (Allegis Pharmaceuticals, LLC.) null

      Hydrocortisone Topical lotion

      Hydrocortisone 2% Topical Lotion (71297-0010) (Allegis Holdings, LLC) null

      Hydrocortisone Topical lotion

      Hydrocortisone 2.5% Lotion (59366-2708) (Glades Pharmaceuticals, LLC) (off market)Hydrocortisone 2.5% Lotion package photo

      Hydrocortisone Topical lotion

      Hydrocortisone 2.5% Topical Lotion (63629-2529) (Bryant Ranch Prepack, Inc.) null

      Hydrocortisone Topical lotion

      Hydrocortisone 2.5% Topical Lotion (63629-9416) (Bryant Ranch Prepack, Inc.) null

      Hydrocortisone Topical lotion

      Hydrocortisone 2.5% Topical Lotion (00603-7785) (Endo USA, Inc.) (off market)Hydrocortisone 2.5% Topical Lotion package photo

      Hydrocortisone Topical lotion

      Hydrocortisone 2.5% Topical Lotion (59366-2708) (Perrigo Pharmaceuticals Company) (off market)

      Hydrocortisone Topical lotion

      Hydrocortisone 2.5% Topical Lotion (45802-0937) (Perrigo Pharmaceuticals Company) nullHydrocortisone 2.5% Topical Lotion package photo

      Hydrocortisone Topical lotion

      Hydrocortisone 2.5% Topical Lotion (00168-0288) (Sandoz Inc. a Novartis Company) nullHydrocortisone 2.5% Topical Lotion package photo

      Hydrocortisone Topical lotion

      Hydrocortisone 2.5% Topical Lotion (51672-3002) (Taro Pharmaceuticals USA Inc) (off market)

      Hydrocortisone Topical lotion

      Hytone 2.5% Topical Lotion (00066-0098) (Bausch Health US, LLC) (off market)Hytone 2.5% Topical Lotion package photo

      Hydrocortisone Topical lotion

      Lacticare HC 2.5% Topical Lotion (00145-2538) (GlaxoSmithKline Group of Companies) (off market)Lacticare HC 2.5% Topical Lotion package photo

      Hydrocortisone Topical lotion

      Nutracort 2.5% Topical Lotion (00064-2210) (Bausch Health US, LLC) (off market)Nutracort 2.5% Topical Lotion package photo

      Hydrocortisone Topical lotion

      Nutracort 2.5% Topical Lotion (00064-5825) (Smith and Nephew Biotherapeutics, formerly Healthpoint BioTherapeutics) (off market)

      Hydrocortisone Topical lotion

      Scalacort 2% Topical Lotion (43684-0100) (Avidas Pharmaceuticals LLC) (off market)Scalacort 2% Topical Lotion package photo

      Hydrocortisone Topical ointment

      Cortizone-5 Topical Ointment (00501-3301) (GlaxoSmithKline Consumer Healthcare) (off market)

      Hydrocortisone Topical ointment

      Hydrocortisone 0.5% Topical Ointment (00394-0839) (Mericon Industries Inc) (off market)

      Hydrocortisone Topical ointment

      Hydrocortisone 0.5% Topical Ointment (45802-0022) (Perrigo Pharmaceuticals Company) (off market)

      Hydrocortisone Topical ointment

      Hydrocortisone 0.5% Topical Ointment (00536-8330) (Rugby Laboratories a Division of The Harvard Drug Group, LLC) (off market)

      Hydrocortisone Topical ointment

      Hydrocortisone 0.5% Topical Ointment (00536-8335) (Rugby Laboratories a Division of The Harvard Drug Group, LLC) (off market)

      Hydrocortisone Topical ointment

      Hydrocortisone 0.5% Topical Ointment (00168-0016) (Sandoz Inc. a Novartis Company) nullHydrocortisone 0.5% Topical Ointment package photo

      Hydrocortisone Topical ointment

      Hydrocortisone 0.5% Topical Ointment (00677-0719) (Sun Pharmaceutical Industries, Inc.) (off market)

      Hydrocortisone Topical ointment

      Hydrocortisone 0.5% Topical Ointment (00182-1364) (Teva Pharmaceuticals USA) (off market)

      Hydrocortisone Topical ointment

      Hydrocortisone 0.5% Topical Ointment (00472-0344) (Teva/Actavis US) (off market)

      Hydrocortisone Topical ointment

      Hydrocortisone 0.5% Topical Ointment (49158-0155) (Thames Pharmaceuticals Inc a Division of Taro) (off market)

      Hydrocortisone Topical ointment

      Walgreens Hydrocortisone 0.5% Topical Ointment (null) (Walgreens Co) nullWalgreens Hydrocortisone 0.5% Topical Ointment package photo

      Hydrocortisone Topical ointment

      Cortaid 1% Maximum Strength Topical Ointment (null) (Johnson & Johnson Healthcare Products Division of McNeil-PPC, Inc) (off market)

      Hydrocortisone Topical ointment

      Cortizone-10 1% Ointment (null) (Chattem, Inc. is a wholly-owned subsidiary of Sanofi-Aventis ) null

      Hydrocortisone Topical ointment

      Cortizone-10 Maximum Strength 1% Anti-Itch Topical Ointment (null) (Chattem, Inc. is a wholly-owned subsidiary of Sanofi-Aventis ) null

      Hydrocortisone Topical ointment

      Cortizone-10 Maximum Strength 1% Anti-Itch Topical Ointment (null) (Chattem, Inc. is a wholly-owned subsidiary of Sanofi-Aventis ) null

      Hydrocortisone Topical ointment

      Cortizone-10 Maximum Strength 1% Topical Ointment (41167-0039) (Chattem, Inc. is a wholly-owned subsidiary of Sanofi-Aventis ) (off market)

      Hydrocortisone Topical ointment

      Cortizone-10 Maximum Strength Water Resistant 1% Anti-Itch Topical Ointment (null) (Chattem, Inc. is a wholly-owned subsidiary of Sanofi-Aventis ) null

      Hydrocortisone Topical ointment

      Cortizone-10 Topical Ointment (00501-3305) (GlaxoSmithKline Consumer Healthcare) (off market)

      Hydrocortisone Topical ointment

      CVS Cortisone Maximum Strength 1% Topical Ointment (59779-0471) (CVS Health) (off market)CVS Cortisone Maximum Strength 1% Topical Ointment package photo

      Hydrocortisone Topical ointment

      CVS Cortisone Maximum Strength 1% Topical Ointment (null) (CVS Health) nullCVS Cortisone Maximum Strength 1% Topical Ointment package photo

      Hydrocortisone Topical ointment

      CVS Cortisone Maximum Strength 1% Topical Ointment (59779-0034) (CVS Health) (off market)

      Hydrocortisone Topical ointment

      CVS Cortisone Maximum Strength 1% Topical Ointment (59779-0255) (CVS Health) null

      Hydrocortisone Topical ointment

      Equaline Anti-itch 1% Topical Ointment (41163-0471) (Albertson's, Inc) null

      Hydrocortisone Topical ointment

      GNP Hydrocortisone Maximum Strength 1% Topical Ointment (24385-0276) (AmerisourceBergen Corporation) null

      Hydrocortisone Topical ointment

      GoodSense Anti-Itch Maximum Strength 1% Topical Ointment (00113-0471) (Goodsense a Division of Perrigo) null

      Hydrocortisone Topical ointment

      Hydrocortisone 1% in Absorbase Topical Ointment (69499-0322) (Solubiomix, LLC) null

      Hydrocortisone Topical ointment

      Hydrocortisone 1% in Asorbase Topical Ointment (46287-0003) (CMP Pharma) (off market)Hydrocortisone 1% in Asorbase Topical Ointment package photo

      Hydrocortisone Topical ointment

      Hydrocortisone 1% Topical Ointment (59390-0080) (Altaire Pharmaceuticals Inc) (off market)

      Hydrocortisone Topical ointment

      Hydrocortisone 1% Topical Ointment (70403-0922) (Aru Pharma, Inc.) null

      Hydrocortisone Topical ointment

      Hydrocortisone 1% Topical Ointment (50090-6526) (A-S Medication Solutions LLC) null

      Hydrocortisone Topical ointment

      Hydrocortisone 1% Topical Ointment (50090-0238) (A-S Medication Solutions LLC) null

      Hydrocortisone Topical ointment

      Hydrocortisone 1% Topical Ointment (68001-0526) (BluePoint Lab Injectables) null

      Hydrocortisone Topical ointment

      Hydrocortisone 1% Topical Ointment (00713-0290) (Cosette Pharmaceuticals, Inc.) (off market)

      Hydrocortisone Topical ointment

      Hydrocortisone 1% Topical Ointment (79503-0103) (EzriCare, LLC) nullHydrocortisone 1% Topical Ointment package photo

      Hydrocortisone Topical ointment

      Hydrocortisone 1% Topical Ointment (00179-8711) (Kaiser Foundation Hospitals) null

      Hydrocortisone Topical ointment

      Hydrocortisone 1% Topical Ointment (45802-0276) (Perrigo Pharmaceuticals Company) nullHydrocortisone 1% Topical Ointment package photo

      Hydrocortisone Topical ointment

      Hydrocortisone 1% Topical Ointment (71205-0034) (Proficient Rx LP) null

      Hydrocortisone Topical ointment

      Hydrocortisone 1% Topical Ointment (00168-0020) (Sandoz Inc. a Novartis Company) nullHydrocortisone 1% Topical Ointment package photo

      Hydrocortisone Topical ointment

      Hydrocortisone 1% Topical Ointment (00168-0181) (Sandoz Inc. a Novartis Company) nullHydrocortisone 1% Topical Ointment package photo

      Hydrocortisone Topical ointment

      Hydrocortisone 1% Topical Ointment (51672-2018) (Taro Pharmaceuticals USA Inc) nullHydrocortisone 1% Topical Ointment package photo

      Hydrocortisone Topical ointment

      Hydrocortisone 1% Topical Ointment (00472-1326) (Teva/Actavis US) (off market)Hydrocortisone 1% Topical Ointment package photo

      Hydrocortisone Topical ointment

      Hydrocortisone 1% Topical Ointment (00472-0345) (Teva/Actavis US) (off market)

      Hydrocortisone Topical ointment

      Hydrocortisone 1% Topical Ointment (00472-0345) (Teva/Actavis US) (off market)Hydrocortisone 1% Topical Ointment package photo

      Hydrocortisone Topical ointment

      Hydrocortisone 1% Topical Ointment (00472-0345) (Teva/Actavis US) nullHydrocortisone 1% Topical Ointment package photo

      Hydrocortisone Topical ointment

      Hydrocortisone 1% Topical Ointment (49158-0103) (Thames Pharmaceuticals Inc a Division of Taro) (off market)

      Hydrocortisone Topical ointment

      Premier Value Hydrocortisone Maximum Strength 1% Topical Ointment (68016-0009) (Pharmacy Value Alliance LLC formerly Chain Drug Consortium , LLC) null

      Hydrocortisone Topical ointment

      RITE AID Anti-Itch Maximum Strength 1% Topical Ointment (null) (Rite Aid Corp) null

      Hydrocortisone Topical ointment

      Sunmark Hydrocortisone 1% Topical Ointment (49348-0522) (McKesson Corporation) null

      Hydrocortisone Topical ointment

      Tucks HC-1 Ointment (00501-4105) (GlaxoSmithKline Consumer Healthcare) (off market)

      Hydrocortisone Topical ointment

      Tucks HC-1 Ointment (42002-0301) (McNeil Consumer Healthcare Division of McNEIL-PPC, Inc.) (off market)

      Hydrocortisone Topical ointment

      Walgreens Hydrocortisone 1% Topical Ointment (null) (Walgreens Co) nullWalgreens Hydrocortisone 1% Topical Ointment package photo

      Hydrocortisone Topical ointment

      Walgreens Hydrocortisone 1% Topical Ointment (null) (Walgreens Co) nullWalgreens Hydrocortisone 1% Topical Ointment package photo

      Hydrocortisone Topical ointment

      Hydrocortisone 2.5% Topical Ointment (50090-0527) (A-S Medication Solutions LLC) null

      Hydrocortisone Topical ointment

      Hydrocortisone 2.5% Topical Ointment (63629-2527) (Bryant Ranch Prepack, Inc.) null

      Hydrocortisone Topical ointment

      Hydrocortisone 2.5% Topical Ointment (63629-2528) (Bryant Ranch Prepack, Inc.) null

      Hydrocortisone Topical ointment

      Hydrocortisone 2.5% Topical Ointment (63629-8817) (Bryant Ranch Prepack, Inc.) null

      Hydrocortisone Topical ointment

      Hydrocortisone 2.5% Topical Ointment (63629-9057) (Bryant Ranch Prepack, Inc.) null

      Hydrocortisone Topical ointment

      Hydrocortisone 2.5% Topical Ointment (45802-0014) (Perrigo Pharmaceuticals Company) nullHydrocortisone 2.5% Topical Ointment package photo

      Hydrocortisone Topical ointment

      Hydrocortisone 2.5% Topical Ointment (00414-0014) (Perrigo Pharmaceuticals Company) (off market)

      Hydrocortisone Topical ointment

      Hydrocortisone 2.5% Topical Ointment (00168-0146) (Sandoz Inc. a Novartis Company) nullHydrocortisone 2.5% Topical Ointment package photo

      Hydrocortisone Topical ointment

      Hydrocortisone 2.5% Topical Ointment (00677-0724) (Sun Pharmaceutical Industries, Inc.) (off market)

      Hydrocortisone Topical ointment

      Hydrocortisone 2.5% Topical Ointment (51672-3001) (Taro Pharmaceuticals USA Inc) (off market)

      Hydrocortisone Topical ointment

      Hydrocortisone 2.5% Topical Ointment (00591-2446) (Teva/Actavis US) (off market)

      Hydrocortisone Topical ointment

      Hydrocortisone 2.5% Topical Ointment (49158-0347) (Thames Pharmaceuticals Inc a Division of Taro) (off market)

      Hydrocortisone Topical ointment

      Hytone 2.5% Topical Ointment (00066-9997) (Bausch Health US, LLC) (off market)Hytone 2.5% Topical Ointment package photo

      Hydrocortisone Topical pad, cleanser

      Dermarest 1% Itch Relief Swabs (null) (Del Pharmaceuticals) (off market)

      Hydrocortisone Topical solution

      Cortizone-10 Maximum Strength Massaging Rollerball Anti-Itch 1% Topical Liquid (null) (Chattem, Inc. is a wholly-owned subsidiary of Sanofi-Aventis ) nullCortizone-10  Maximum Strength Massaging Rollerball Anti-Itch 1% Topical Liquid package photo

      Hydrocortisone Topical solution

      Cortizone-10 Maximum Strength with Aloe 1% Anti-Itch Topical Liquid (null) (Chattem, Inc. is a wholly-owned subsidiary of Sanofi-Aventis ) null

      Hydrocortisone Topical solution

      CVS Scalp Relief 1% Maximum Strength Topical Solution (null) (CVS Health) null

      Hydrocortisone Topical solution

      Hydrocortisone 1% Topical Solution (00603-7784) (Endo USA, Inc.) (off market)

      Hydrocortisone Topical solution

      Hydrocortisone 1% Topical Solution (45802-0023) (Perrigo Pharmaceuticals Company) (off market)

      Hydrocortisone Topical solution

      Hytone 1% Topical Solution (00066-8044) (Bausch Health US, LLC) (off market)

      Hydrocortisone Topical solution

      Penecort 1% Topical Solution (00023-0889) (Allergan USA, Inc.) (off market)

      Hydrocortisone Topical solution

      Scalpicin Anti-Itch 1% Maximum Strength Liquid (63824-0850) (Reckitt Benckiser LLC) (off market)

      Hydrocortisone Topical solution

      Walgreens Scalp Relief 1% Topical Solution (49022-0310) (Walgreens Co) null

      Hydrocortisone Topical solution

      Texacort 2.5% Topical Solution (65880-0293) (Cipher Pharmaceuticals US LLC.) (off market)

      Hydrocortisone Topical solution

      Texacort 2.5% Topical Solution (68712-0011) (Cipher Pharmaceuticals US LLC.) (off market)Texacort 2.5% Topical Solution package photo

      Hydrocortisone Topical solution

      Texacort 2.5% Topical Solution (00178-0455) (Mission Pharmacal Company) null

      Hydrocortisone Topical solution

      Texacort 2.5% Topical Solution (65880-0293) (Sirius Laboratories, Inc. a wholly-owned subsidiary of DUSA Pharmaceuticals Inc., a Sun Pharma Company) (off market)Texacort 2.5% Topical Solution package photo

      Hydrocortisone Topical solution

      Texacort 2.5% Topical Solution (68712-0011) (Tiber Laboratories) (off market)

      Hydrocortisone Topical spray, solution

      Cortaid 1% Intensive Therapy Cooling Topical Spray (01875-0518) (Bausch Health US, LLC) null

      Hydrocortisone Topical spray, solution

      Cortaid 1% Intensive Therapy Cooling Topical Spray (null) (Johnson & Johnson Healthcare Products Division of McNeil-PPC, Inc) (off market)

      Hydrocortisone Topical spray, solution

      Cortizone-10 Quick Shot Spray Topical Solution (00501-3306) (GlaxoSmithKline Consumer Healthcare) (off market)

      Hydrocortisone Topical spray, solution

      CVS Instant Cooling Itch Relief 1% Topical Spray (null) (CVS Health) null

      Hydrocortisone Topical spray, solution

      Walgreens Anti-Itch 1% Topical Spray (null) (Walgreens Co) null

      Hydrocortisone Topical suspension

      First-Hydrocortisone 10% Compounding Kit (65628-0010) (Azurity Pharnaceuticals, Inc formerly CutisPharma, Inc) (off market)

      Hydrocortisone Valerate Topical cream

      Hydrocortisone Valerate 0.2% Topical Cream (00713-0668) (Cosette Pharmaceuticals, Inc.) nullHydrocortisone Valerate 0.2% Topical Cream package photo

      Hydrocortisone Valerate Topical cream

      Hydrocortisone Valerate 0.2% Topical Cream (00713-0720) (Cosette Pharmaceuticals, Inc.) null

      Hydrocortisone Valerate Topical cream

      Hydrocortisone Valerate 0.2% Topical Cream (21922-0007) (Encube Ethicals Private Limited) null

      Hydrocortisone Valerate Topical cream

      Hydrocortisone Valerate 0.2% Topical Cream (68462-0575) (Glenmark Pharmaceuticals) (off market)Hydrocortisone Valerate 0.2% Topical Cream package photo

      Hydrocortisone Valerate Topical cream

      Hydrocortisone Valerate 0.2% Topical Cream (68180-0954) (Lupin Pharmaceuticals, Inc.) null

      Hydrocortisone Valerate Topical cream

      Hydrocortisone Valerate 0.2% Topical Cream (45802-0455) (Perrigo Pharmaceuticals Company) (off market)Hydrocortisone Valerate 0.2% Topical Cream package photo

      Hydrocortisone Valerate Topical cream

      Hydrocortisone Valerate 0.2% Topical Cream (59772-8100) (Sandoz Inc. a Novartis Company) (off market)Hydrocortisone Valerate 0.2% Topical Cream package photo

      Hydrocortisone Valerate Topical cream

      Hydrocortisone Valerate 0.2% Topical Cream (00781-7059) (Sandoz Inc. a Novartis Company) nullHydrocortisone Valerate 0.2% Topical Cream package photo

      Hydrocortisone Valerate Topical cream

      Hydrocortisone Valerate 0.2% Topical Cream (51672-1290) (Taro Pharmaceuticals USA Inc) nullHydrocortisone Valerate 0.2% Topical Cream package photo

      Hydrocortisone Valerate Topical cream

      Westcort 0.2% Topical Cream (00072-8100) (Bristol Myers Squibb Co) (off market)

      Hydrocortisone Valerate Topical ointment

      Hydrocortisone Valerate 0.2% Topical Ointment (00713-0669) (Cosette Pharmaceuticals, Inc.) nullHydrocortisone Valerate 0.2% Topical Ointment package photo

      Hydrocortisone Valerate Topical ointment

      Hydrocortisone Valerate 0.2% Topical Ointment (00713-0560) (Cosette Pharmaceuticals, Inc.) null

      Hydrocortisone Valerate Topical ointment

      Hydrocortisone Valerate 0.2% Topical Ointment (68462-0210) (Glenmark Pharmaceuticals) (off market)

      Hydrocortisone Valerate Topical ointment

      Hydrocortisone Valerate 0.2% Topical Ointment (68462-0836) (Glenmark Pharmaceuticals) (off market)

      Hydrocortisone Valerate Topical ointment

      Hydrocortisone Valerate 0.2% Topical Ointment (59772-7800) (Sandoz Inc. a Novartis Company) (off market)Hydrocortisone Valerate 0.2% Topical Ointment package photo

      Hydrocortisone Valerate Topical ointment

      Hydrocortisone Valerate 0.2% Topical Ointment (00781-7063) (Sandoz Inc. a Novartis Company) null

      Hydrocortisone Valerate Topical ointment

      Hydrocortisone Valerate 0.2% Topical Ointment (51672-1292) (Taro Pharmaceuticals USA Inc) nullHydrocortisone Valerate 0.2% Topical Ointment package photo

      Hydrocortisone Valerate Topical ointment

      Westcort 0.2% Topical Ointment (00072-7800) (Bristol Myers Squibb Co) (off market)Westcort 0.2% Topical Ointment package photo

      Hydrocortisone Valerate Topical ointment

      Westcort 0.2% Topical Ointment (00072-7800) (Ranbaxy Laboratories, a Sun Pharma Company) null

      Hydrocortisone Valerate Topical ointment

      Westcort 0.2% Topical Ointment (10631-0105) (Ranbaxy Laboratories, a Sun Pharma Company) null

      Description/Classification

      Description

      Hydrocortisone is a naturally-occurring steroid hormone secreted by the adrenal cortex that has glucocorticoid and mineralocorticoid activity. Synthetic hydrocortisone is available pharmaceutically in a variety of rectal, parenteral, oral, and topical dosage forms. As a naturally occurring glucocorticoid that also has salt-retaining properties systemic hydrocortisone is used primarily as replacement therapy in adrenocortical deficiency states, and when emergency anti-inflammatory treatment is needed.[64995] Rectal hydrocortisone products are particularly useful in inflammatory gastrointestinal conditions limited to the rectum and anus. Systemic hydrocortisone may be used in many other allergic, immune, and inflammatory conditions in adult and pediatric patients; however, systemic corticosteroids that have more potent glucocorticoid activity and minimal mineralocorticoid activity, such as prednisone, are preferred for such uses, as they induce better response and reduce the risks of excess mineralocorticoid side effects.[65419] Systemic corticosteroids may be added to other long-term maintenance medications in the management of uncontrolled severe persistent asthma and short courses may be used for asthma exacerbation; however, systemic hydrocortisone is rarely used for asthma and prednisone, prednisolone or methylprednisolone are mostly used instead.[64807][66299] Topical hydrocortisone is considered low potency and is used in mild to moderate corticosteroid-responsive dermatoses, and many topical dosage forms are available without a prescription. Low potency topical corticosteroids are the safest for chronic use and may be used on the face or intertriginous areas, with occlusion, and in infants and young children.[65341]

       

      Updates for coronavirus disease 2019 (COVID-19):

      The World Health Organization strongly recommends the use of systemic corticosteroids, including hydrocortisone, in patients with severe or critical COVID-19; but suggests against use in patients with non-severe COVID-19.[65876] The National Institutes of Health (NIH) COVID-19 treatment guidelines recommend using another corticosteroid, dexamethasone, in hospitalized patients with COVID-19 who require supplemental oxygen, including those on high-flow oxygen, noninvasive ventilation, mechanical ventilation, or extracorporeal membrane oxygenation (ECMO); however, hydrocortisone may be used as an alternative corticosteroid if dexamethasone is unavailable. The NIH recommends against the use of corticosteroids in patients with mild to moderate COVID-19 (i.e., non-hospitalized patients or hospitalized patients that do not require supplemental oxygen).[65314] In a randomized, double-blind, multicenter study, treatment with hydrocortisone (n = 76) provided no benefit over placebo (n = 73) in adults admitted to the ICU with COVID-19-related acute respiratory failure. Study data found no difference in the primary outcome of treatment failure (i.e., death or persistent mechanical ventilation or high-flow oxygen) on day 21 (42.1% for hydrocortisone vs. 50.7% for placebo; difference, -8.6%; 95% CI, -24.9% to 7.7%; p = 0.29). Additionally, there was no significant difference in the secondary outcomes of the need for tracheal intubation, cumulative incidences of prone position, extracorporeal membrane oxygenation, and inhaled nitric oxide. However, the study was likely underpowered, as it was terminated early following release of data from the RECOVERY trial. The study intended to enroll a sample size of 290 patients.[65981]

      Classifications

      • Alimentary Tract and Metabolism
        • Antihemorrhoidal Agents
          • Topical Anti-hemorrhoidals with Corticosteroids
      • Compounding Agents and Supplies
        • Compounding Kits Miscellaneous
      • Dermatologicals
        • Emollients, Protectives
          • Emollients and Protectants, Other
        • Topical Antihistamines
        • Topical Corticosteroids
          • Plain Topical Corticosteroids
      • Systemic Hormonal Agents (excluding Sex Hormones)
        • Systemic Corticosteroids
          • Systemic Corticosteroids, Plain
      Revision Date: 06/12/2024, 01:59:00 AM

      References

      64807 - Global Strategy for Asthma Management and Prevention. Global Initiative for Asthma (GINA) 2020. Available from: http://www.ginasthma.org. Accessed May 20th, 2020.64995 - Auron M, Raissouni N. Adrenal insufficiency. Pediatr Rev 2015;36:92-102.65314 - COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. Accessed March 1, 2024. Available at https://www.covid19treatmentguidelines.nih.gov/65341 - Das A and Panda S. Use of topical corticosteroids in dermatology: an evidence-based approach. Indian J Dermatol. 2017;62(3):237-50.65419 - Burns CM. The History of Cortisone Discovery and Development. Rheum Dis Clin North Am. 2016;42:1-14. Review.65876 - World Health Organization Guideline Panel. Corticosteroids for COVID-19. World Health Organization. Accessed September 3, 2020. Available on the World Wide Web at: https://www.who.int/publications/i/item/WHO-2019-nCoV-Corticosteroids-2020.165981 - Dequin PF, Heming N, Meziani F, et al. Effect of hydrocortisone on 21-day mortality or respiratory support among critically ill patients with COVID-19: A randomized clinical trial. JAMA. 2020;324(13):1298-1306.66299 - Expert Panel Working Group of the National Heart, Lung, and Blood Institute (NHLBI) administered and coordinated National Asthma Education and Prevention Program Coordinating Committee (NAEPPCC), et al. 2020 Focused Updates to the Asthma Management Guidelines: A Report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group. J Allergy Clin Immunol. 2020;146:1217-1270.

      Administration Information

      General Administration Information

      For storage information, see the specific product information within the How Supplied section.

      Route-Specific Administration

      Oral Administration

      • Administer with meals to minimize indigestion or GI irritation.
      • If given once daily, administer in the morning to coincide with the body's normal cortisol secretion.

      Oral Solid Formulations

      Tablets

      • May be crushed and mixed with a small amount of liquid just prior to administration for patients unable to swallow tablets.
      • Crushed tablets are recommended over oral suspension in patients with congenital adrenal hyperplasia due to results of a study showing hydrocortisone cypionate suspension (Cortef suspension) was not bioequivalent to the tablets.[54123][54462]

       

      Sprinkle capsules

      • Open before use. Do NOT swallow the capsules; small children may choke. Do NOT chew or crush the granules. Do NOT allow the granules to get wet; they may stick to the capsule.
      • Do NOT use the sprinkle granules in nasogastric or gastric tubes; it may cause tube blockage.
      • Do NOT add the granules to liquid; it may result in dose reductions and a bitter taste. Administer granules by directly pouring into the patient's mouth, pouring into a spoon and placing in the patient's mouth, or sprinkling onto a spoonful of cold or room temperature soft food (e.g., yogurt or fruit puree).
      • Swallow the granules within 5 minutes of administration to avoid a bitter taste; the outer taste masking cover can dissolve.
      • After administration, immediately follow with ingestion of fluids (e.g., water, milk, breast milk, or formula) to ensure all granules are swallowed.
      • If the full dose is not administered (e.g., regurgitating, vomiting of granules), a repeat dose may be required to avoid adrenal insufficiency.
      • Consider the potential for dosing inaccuracy when switching patients from another oral hydrocortisone formulation that has been manipulated (e.g., split or crushed tablets, compounded formulations) due to differences in hydrocortisone exposure. Closely monitor patients after switching to the sprinkle capsules to ensure the same degree of hydrocortisone exposure is provided. An increased dosage may be necessary if symptoms of adrenal insufficiency occur.[66033]

      Oral Liquid Formulations

      Oral Suspension

      • Shake well before administering. Measure dosage with calibrated measuring device.

      Extemporaneous Compounding-Oral

      Hydrocortisone 2 mg/mL Oral Suspension

      NOTE: ASHP recommends hydrocortisone 2 mg/mL as the compounded oral liquid standard concentration.[66174]

      • Grind six 10 mg hydrocortisone tablets (60 mg total) into a fine powder in a mortar.
      • Add 10 drops of suspending vehicle (Oral Mix, Medisca) to the powder and triturate to make a smooth paste.
      • Continue to add 5 to 10 mL of the suspending vehicle to the powder paste, mixing well after each addition, up to a final volume of 30 mL.
      • Storage: The resulting suspension is stable at 4 and 25 degrees C for at least 90 days in amber, plastic prescription bottles and oral syringes.[67306]

       

      Hydrocortisone 2.5 mg/mL Oral Suspension

      • Dissolve 0.02 g of methyl hydroxybenzoate, 0.08 g of propyl hydroxybenzoate, 0.6 g of citric acid monohydrate, and 10 mL of syrup BP in hot water to make the vehicle.
      • Triturate the cooled vehicle with 1 g of sodium carboxymethylcellulose and allow the solution to stand overnight.
      • Weigh out 250 mg of hydrocortisone powder or grind twelve and one-half (12.5) 20 mg hydrocortisone tablets into a fine powder in a glass mortar.
      • Combine the ground tablets or the 250 mg of hydrocortisone powder with 0.5 mL of polysorbate 80 and triturate.
      • Add the vehicle to the hydrocortisone powder mixture and transfer to amber plastic bottles.
      • Add enough water to bring the total volume to 100 mL.
      • Storage: The resulting suspension is chemically stable at 5 and 25 degrees C for 90 days; however, a 30-day expiration is suggested due to the lack of antimicrobial preservative.[54448]

      Injectable Administration

      • Visually inspect parenteral products for particulate matter and discoloration prior to administration whenever solution and container permit. Use solution only if it is clear.[54049]

      Intravenous Administration

      Reconstitution and Preparation

      • 100 mg vial: For IV injection, add 2 mL or less of Bacteriostatic Water for Injection or Bacteriostatic Sodium Chloride Injection to the contents of 1 vial.
        • Further dilution is not necessary for direct IV injection.
        • For intravenous infusion, add 2 mL or less of Bacteriostatic Water for Injection to the vial; this solution may then be added to 100 to 1,000 mL of 5% Dextrose Injection, 0.9% Sodium Chloride Injection, or 5% Dextrose with 0.9% Sodium Chloride Injection.[54049]
      • ACT-O-VIAL presentations: Press down on plastic activator to force diluent into the lower compartment. Gently agitate to effect solution. Remove plastic tab covering center of stopper, and sterilize the stopper top. Insert needle squarely through center of stopper until tip is just visible. Invert vial and withdraw dose.
        • Further dilution is not necessary for direct IV injection.
        • For intravenous infusion, add the 100 mg solution to 100 to 1,000 mL of 5% Dextrose Injection, 0.9% Sodium Chloride Injection, or 5% Dextrose with 0.9% Sodium Chloride Injection. The 250 mg solution may be added to 250 to 1,000 mL, the 500 mg solution may be added to 500 to 1,000 mL, and the 1,000 mg solution may be added to 1,000 mL of the same diluents. Alternatively, 100 to 3,000 mg may be added to 50 mL of the above diluents. Do not dilute or mix with other solutions because of possible incompatibilities. The resulting solutions are stable for at least 4 hours.[54049]

       

      IV Push

      • Inject the reconstituted solution over a period of 30 seconds (e.g., 100 mg) to 10 minutes (e.g., 500 mg or more).[54049]

       

      IV Infusion

      • Reconstituted solutions may be administered by IV piggyback, but do not dilute or mix with solutions other than 5% Dextrose Injection, 0.9% Sodium Chloride Injection, or 5% Dextrose and 0.9% Sodium Chloride Injection because of possible incompatibilities.[54049]

      Intramuscular Administration

      Reconstitution and Administration

      • 100 mg vial: Add 2 mL or less of Bacteriostatic Water for Injection or Bacteriostatic 0.9% Sodium Chloride Injection to the contents of 1 vial.
      • ACT-O-VIAL (100mg, 250 mg, 500 mg, 1,000 mg): Press down on plastic activator to force diluent into the lower compartment. Gently agitate to effect solution. Remove plastic tab covering center of stopper. Sterilize top of stopper with a suitable germicide. Insert needle squarely through center of stopper until tip is just visible. Invert vial and withdraw dose. Further dilution is not necessary for IM injection.
      • Do NOT administer hydrocortisone IM into the deltoid muscle as subcutaneous atrophy occurs with high frequency after such use.[54049]

      Topical Administration

      Cream/Ointment/Lotion Formulations

      • Cream, lotion, or ointment: Apply sparingly in a thin film and rub gently into the cleansed affected area. Occlusive dressings may be necessary for severe conditions.

      Other Topical Formulations

      • Solution or gel: Apply sparingly in a thin film and rub gently into the cleansed affected area. Occlusive dressings may be necessary for severe conditions.
      • Aerosol spray: Shake container gently once or twice each time before using. Spray each 4 square inch area for about 1 to 2 seconds from a distance of about 15 cm.

      Rectal Administration

      Aerosol Rectal Foam

      • Wash hands before and after application.
      • Place cap on top of container and shake the container vigorously for 5 to 10 seconds before each use; cap should not be removed during use.
      • Hold container upright on a level surface and gently place the tip of the applicator onto the nose of the container cap. Container must be held upright to obtain proper flow of medication.
      • Pull applicator plunger past the fill line on the applicator barrel.
      • To fill the applicator barrel, press down firmly on cap flanges, hold for 1 to 2 seconds, and release. Allow 5 to 10 seconds for foam to expand in the applicator barrel. Repeat until the foam reaches the fill line. Remove applicator from container cap. A burst of air may be released from container with the first pump.
      • Hold applicator firmly by barrel, making sure thumb and middle finger are positioned securely underneath and resting against barrel wings. Place index finger over the plunger. Gently insert tip into anus. Once in place, push plunger to expel foam, then withdraw applicator. Apply to anus only with the applicator provided with the foam. Do not insert any part of the applicator past the anus into the rectum. Fingers or any other mechanical device should not be used to administer the aerosol foam. Do not insert any part of the aerosol container directly into the anus.
      • The container and cap should be disassembled and rinsed with warm water after each use. The applicator parts should be pulled apart for thorough cleaning with warm water after each use.[60551]

       

      Rectal Retention Enema

      • Instruct patient to lie down on left side during administration and for 30 minutes afterwards to allow the medication to distribute throughout the colon. Encourage patient to retain enema for at least 1 hour or, preferably, all night before expelling.[62343]

       

      Rectal Suppository

      • Instruct patient on proper use of suppository. Unwrap the suppository prior to insertion. Moisten the suppository with water prior to insertion. If suppository is too soft because of storage in a warm place, chill in the refrigerator for 30 minutes or run cold water over it before removing wrapper.[54060]

       

      Topical Cream for hemorrhoids

      • Apply as a thin film to the cleansed affected area around the anus. Do not insert rectally.

      Clinical Pharmaceutics Information

      From Trissel's 2‚Ñ¢ Clinical Pharmaceutics Database

      Hydrocortisone sodium phosphate

      pH Range
      pH 7.5 to 8.5
      ReferencesAnon. Manufacturer's information and labeling. (Package insert).
      Osmolality/Osmolarity
      Hydrocortisone sodium phosphate 50-mg/mL injection has an osmolality of 533 mOsm/kg.
      ReferencesTrissel LA. Drug information- osmolalities. Data on file.
      Stability
      Hydrocortisone sodium phosphate injection in intact containers stored as directed by the manufacturer is stable until the labeled expiration date. Hydrocortisone sodium phosphate is heat labile and containers should not be autoclaved to sterilize their exteriors. The manufacturer recommends the use of dextrose and sodium chloride injection for dilution of hydrocortisone sodium phosphate for intravenous infusion. Packaged in Syringes: Hydrocortisone sodium phosphate 8 mg/mL in dextrose 5% and in sodium chloride 0.9% packaged in Sherwood Medical Brunswick, Becton Dickinson Plastipak, and Needle Industries Steriseal polypropylene syringes as well as Gillette UK Sabre polypropylene-polystyrene syringes. No loss of hydrocortisone occurred in 18 hours at room temperature.
      ReferencesAnon. Manufacturer's information and labeling. (Package insert).
      ReferencesMcEvoy GK (ed). AHFS Drug Information (current edition). Bethesda, MD: American Society of Health-System Pharmacists.
      ReferencesSimmons A, Allwood MC. Sorption to plastic syringes of drugs administered by syringe pump. J Clin Hosp Pharm. 1981; 6
      pH Effects
      Hydrocortisone solutions at pH 9.1 oxidized to 21-dehydrocortisone at a rate of 1.6 to 2.8% per hour at room temperature, which is 4 to 5 times higher than the oxidation rate at pH 6.9 to 7.9.
      ReferencesKleinberg ML, Stauffer GL, Latiolais CJ. Stability of five liquid drug products after unit dose repackaging. Am J Hosp Pharm. 1980; 37
      Freezing
      Hydrocortisone sodium phosphate injection should be protected from freezing.
      ReferencesAnon. Manufacturer's information and labeling. (Package insert).
      Sorption Leaching
      Hydrocortisone sodium phosphate has not been found to undergo substantial sorption to polypropylene syringes and polypropylene-polystyrene syringes. In addition, Xu et al. reported no sorption occurred to a polyurethane central catheter from Arrow International as well as no leaching of the chlorhexidine antimicrobial in it.
      ReferencesSimmons A, Allwood MC. Sorption to plastic syringes of drugs administered by syringe pump. J Clin Hosp Pharm. 1981; 6
      ReferencesXu QA, Zhang Y, Trissel LA, et al. Adequacy of a new chlorhexidine-bearing polyurethane central catheter for administration of 82 selected parenteral drugs. Ann Pharmacother. 2000; 34
      Other Information
      Dacarbazine: Hydrocortisone sodium phosphate and dacarbazine were physically compatible when mixed.
      ReferencesDorr RT. Incompatibilities with parenteral anticancer drugs. Am J IV Ther. 1979; 6

      Hydrocortisone sodium succinate

      pH Range
      pH 7 to 8
      ReferencesAnon. Manufacturer's information and labeling. (Package insert).
      ReferencesSolu-Cortef (hydrocortisone sodium succinate) injection package insert. New York, NY. Pfizer Injectables. 2024; Jun
      Sodium Content
      Hydrocortisone sodium succinate provides 2.066 mEq of sodium per gram of drug.
      ReferencesRaymond G, Day P, Rabb M. Sodium content of commonly administered intravenous drugs. Hosp Pharm. 1982; 17
      ReferencesSolu-Cortef (hydrocortisone sodium succinate) injection package insert. New York, NY. Pfizer Injectables. 2024; Jun
      Osmolality/Osmolarity
      Abbott hydrocortisone sodium succinate 50 mg/mL was isotonic having an osmolality of 292 mOsm/kg.
      ReferencesErnst JA, Williams JM, Glick MR, et al. Osmolality of substances used in the intensive care nursery. Pediatrics. 1983; 72
      ReferencesSolu-Cortef (hydrocortisone sodium succinate) injection package insert. New York, NY. Pfizer Injectables. 2024; Jun
      Stability
      Hydrocortisone sodium succinate injection in intact containers stored as directed by the manufacturer is stable until the labeled expiration date. Reconstituted hydrocortisone sodium succinate is stable at or below controlled room temperature if protected from exposure to light. Hydrocortisone sodium succinate is heat labile and should not be autoclaved to sterilize the vial exterior. Use only clear solutions. Infusion Solutions: The manufacturer indicates that hydrocortisone sodium succinate is stable for at least 4 hours at concentrations of 2 to 60 mg/mL is dextrose 5%, sodium chloride 0.9%, and in dextrose 5% in sodium chloride 0.9%. Rigge et al. evaluated the stability of Pharmacia hydrocortisone sodium succinate 1 mg/mL in sodium chloride 0.9% packaged in polyvinyl chloride (PVC) bags and polyolefin bags. Calculated shelf life periods were about 7 days at room temperature in both containers and 41 days and 48 days in PVC and polyolefin bags, respectively. Dixon and Weshalek and Parker reported that hydrocortisone sodium succinate in dextrose 5% and in sodium chloride 0.9% was stable for 24 to 48 hours, respectively. Cradock et al. reported that hydrocortisone sodium succinate 1 mg/mL in sodium chloride 0.9%, lactated Ringer's injection, and Elliott's B solution was stable with no loss in 24 hours and about 10% loss in 7 days at room temperature exposed to fluorescent light. Packaged in Syringes: Rigge et al. evaluated the stability of Pharmacia hydrocortisone sodium succinate 50 mg/mL in sterile water for injection packaged in Omnifix (Braun) polypropylene syringes sealed with Baxa Luer lock tip caps. Calculated shelf life periods were about 6.8 days at room temperature and 81 days refrigerated. Gupta and Ling evaluated the stability of hydrocortisone sodium succinate 10 mg/mL in sodium chloride 0.9% packaged in Becton Dickinson polypropylene syringes. The solution remained clear. HPLC analysis found losses of 5% and 10% in 3 days and 7 days, respectively, stored at room temperature. About 2% loss occurred in 21 days under refrigeration. Zhang and Trissel reported that hydrocortisone sodium succinate 2 mg/mL in Elliott's B solution packaged in Becton Dickinson polypropylene syringes sealed with Red Cap tip caps was physically stable with no increase in particulates or turbidity by electronic measurement. HPLC analysis found not more than 9% loss in 24 hours at room temperature and 7% loss in 48 hours under refrigeration. Intrathecal Injection Mixtures: Cradock et al. and Cheung et al. reported that hydrocortisone sodium succinate alone and mixed with methotrexate and/or cytarabine for intrathecal injection in sodium chloride 0.9% and lactated Ringer's injection is stable for up to 7 days at room temperature. However, the drug is less stable in Elliott's B solution with reported drug losses ranging from 7 to 13% in 24 hours and a precipitate developing after several days. Zhang and Trissel reported a similar result for hydrocortisone sodium succinate 2 mg/mL in Elliott's B solution in both glass vials and polypropylene syringes. The solution was physically stable, and HPLC analysis found about 9% loss in 24 hours at room temperature and 7% loss in 48 hours under refrigeration.
      ReferencesAnon. Manufacturer's information and labeling. (Package insert).
      ReferencesCheung YW, Vishnuvajjala BR, Flora KP. Stability of cytarabine, methotrexate sodium, and hydrocortisone sodium succinate admixtures. Am J Hosp Pharm. 1984; 41
      ReferencesCradock JC, Kleinman LM, Rahman A. Evaluation of some pharmaceutical aspectes of intrathecal methotrexate sodium, cytarabine and hydrocortisone sodium succinate. Am J Hosp Pharm. 1978; 35
      ReferencesDixon FW, Weshalek J. Physical compatibility of nine drugs in various intravenous solutions. Am J Hosp Pharm. 1972; 29
      ReferencesGupta VD, Ling J. Stability of hydrocortisone sodium succinate after reconstitution in 0.9% sodium chloride injection and storage in polypropylene syringes for pediatric use. Int J Pharmaceut Compound. 2000; 4
      ReferencesMcEvoy GK (ed). AHFS Drug Information (current edition). Bethesda, MD: American Society of Health-System Pharmacists.
      ReferencesParker EA. Solution additive chemical incompatibility study. Am J Hosp Pharm. 1967; 24
      ReferencesRigge DC, Jones MF. Shelf lives of aseptically prepared medicines - stability of hydrocortisone sodium succinate in PVC an non-PVC bags and in polypropylene syringes. J Pharm Biomed Anal. 2005; 38
      ReferencesZhang Y, Xu QA, Trissel LA, et al. Physical and chemical stability of methotrexate sodium, cytarabine, and hydrocortisone sodium succinate. Hosp Pharm. 1996; 31
      ReferencesSolu-Cortef (hydrocortisone sodium succinate) injection package insert. New York, NY. Pfizer Injectables. 2024; Jun
      pH Effects
      Hydrocortisone sodium succinate exhibits maximum stability in the pH range of 7 to 8. At pH 6 it is stable for 72 hours while at pH 5 it is stable for only 12 hours. It is also reported to be less stable at alkaline pH above 8. Hydrocortisone solutions at pH 9.1 oxidized to 21-dehydrocortisone at a rate of 1.6 to 2.8% per hour at room temperature, which is 4 to 5 times higher than the oxidation rate at pH 6.9 to 7.9.
      ReferencesEdward M. pH - an important factor in the compatibility of additives in intravenous therapy. Am J Hosp Pharm. 1967; 24
      ReferencesMonder C. Stability of corticosteroids in aqueous solutions. Endocrinology. 1968; 84
      ReferencesStoberski P, Zakrzewski Z, Siedlecka E. Studies on the stability of hydrocortisone sodium succinate in the presence of aminophylline in some intravenous solutions. Farm Pol. 1985; 41
      ReferencesSolu-Cortef (hydrocortisone sodium succinate) injection package insert. New York, NY. Pfizer Injectables. 2024; Jun
      Light Exposure
      Hydrocortisone sodium succinate vials should be protected from exposure to light during long-term storage.
      ReferencesAnon. Manufacturer's information and labeling. (Package insert).
      ReferencesSolu-Cortef (hydrocortisone sodium succinate) injection package insert. New York, NY. Pfizer Injectables. 2024; Jun
      Freezing
      Ho and Goeman reported no loss of concentration from Upjohn hydrocortisone sodium succinate 125 mg/mL stored frozen for 4 weeks.
      ReferencesHo NFH, Goeman JA. Prediction of pharmaceutical stability of parenteral solutions. Drug Intell Clin Pharm. 1970; 4
      ReferencesSolu-Cortef (hydrocortisone sodium succinate) injection package insert. New York, NY. Pfizer Injectables. 2024; Jun
      Filtration
      Hydrocortisone sodium succinate did not undergo substantial binding to an Abbott S-A-I-F 0.45-micron cellulose membrane filter from a 10-mcg/mL solution.
      ReferencesStiles ML, Allen LV Jr. Retention of drugs during inline filtration of parenteral solutions. Infusion. 1979; 3
      ReferencesSolu-Cortef (hydrocortisone sodium succinate) injection package insert. New York, NY. Pfizer Injectables. 2024; Jun
      Sorption Leaching
      Hydrocortisone sodium succinate has been shown not to undergo sorption to polyvinyl chloride (PVC) plastic bags and PVC administration tubing, polyethylene tubing, Silastic tubing, cellulose propionate burettes, polyolefin plastic bags, and polypropylene and polypropylene/polyethylene plastic syringes, glass containers, and elastomeric pump reservoirs. In addition, Xu et al. reported no sorption occurred to a polyurethane central catheter from Arrow International as well as no leaching of the chlorhexidine antimicrobial in it.
      ReferencesGupta VD, Ling J. Stability of hydrocortisone sodium succinate after reconstitution in 0.9% sodium chloride injection and storage in polypropylene syringes for pediatric use. Int J Pharmaceut Compound. 2000; 4
      ReferencesKowaluk EA, Roberts MA, Blackburn HD, et al. Interactions between drugs and polyvinyl chloride infusion bags. Am J Hosp Pharm. 1981; 38
      ReferencesKowaluk EA, Roberts MS, Polack AE. Interactions between drugs and intravenous delivery systems. Am J Hosp Pharm. 1982; 39
      ReferencesMoorhatch P, Chiou WL. Interactions between drugs and plastic intravenous fluid bags, part I: sorption studies on 17 drugs. Am J Hosp Pharm. 1974; 31
      ReferencesRigge DC, Jones MF. Shelf lives of aseptically prepared medicines - stability of hydrocortisone sodium succinate in PVC an non-PVC bags and in polypropylene syringes. J Pharm Biomed Anal. 2005; 38
      ReferencesThur MP (Travenol Laboratories). Personal communication. Data on file. 1976; 9
      ReferencesXu QA, Zhang Y, Trissel LA, et al. Adequacy of a new chlorhexidine-bearing polyurethane central catheter for administration of 82 selected parenteral drugs. Ann Pharmacother. 2000; 34
      ReferencesZhang Y, Xu QA, Trissel LA, et al. Physical and chemical stability of methotrexate sodium, cytarabine, and hydrocortisone sodium succinate. Hosp Pharm. 1996; 31
      ReferencesSolu-Cortef (hydrocortisone sodium succinate) injection package insert. New York, NY. Pfizer Injectables. 2024; Jun
      Other Information
      Amphotericin B: Amphotericin B appears to be compatible with limited amounts of hydrocortisone sodium succinate. Dacarbazine: Dorr reported that a pink precipitate appeared upon mixing dacarbazine with hydrocortisone sodium succinate. Magnesium Sulfate: Fraser reported a white precipitate possibly of magnesium phosphate may form if magnesium sulfate and hydrocortisone sodium succinate are mixed. The phosphate buffers in the hydrocortisone sodium succinate formulation may react with the magnesium forming insoluble magnesium phosphate.
      ReferencesDorr RT. Incompatibilities with parenteral anticancer drugs. Am J IV Ther. 1979; 6
      ReferencesFraser GL. Incompatibility of magnesium sulfate and hydrocortisone sodium succinate. Am J Hosp Pharm. 1978; 35
      ReferencesMcEvoy GK (ed). AHFS Drug Information (current edition). Bethesda, MD: American Society of Health-System Pharmacists.
      ReferencesSolu-Cortef (hydrocortisone sodium succinate) injection package insert. New York, NY. Pfizer Injectables. 2024; Jun
      Stability Max
      Maximum reported stability periods: In D5W- 48 hours at room temperature. In NS- 7 days at room temperature and 41 days refrigerated in PVC and 48 days refrigerated in polyolefin. See Stability.
      ReferencesGupta VD, Ling J. Stability of hydrocortisone sodium succinate after reconstitution in 0.9% sodium chloride injection and storage in polypropylene syringes for pediatric use. Int J Pharmaceut Compound. 2000; 4
      ReferencesParker EA. Solution additive chemical incompatibility study. Am J Hosp Pharm. 1967; 24
      ReferencesRigge DC, Jones MF. Shelf lives of aseptically prepared medicines - stability of hydrocortisone sodium succinate in PVC an non-PVC bags and in polypropylene syringes. J Pharm Biomed Anal. 2005; 38
      ReferencesSolu-Cortef (hydrocortisone sodium succinate) injection package insert. New York, NY. Pfizer Injectables. 2024; Jun
      Revision Date: 06/12/2024, 01:59:00 AMCopyright 2004-2024 by Lawrence A. Trissel. All Rights Reserved.

      References

      54049 - Solu-cortef (hydrocortisone sodium succinate) injection package insert. New York, NY: Pharmacia & Upjohn Co.; 2023 Dec.54060 - Anusol HC (hydrocortisone acetate) suppository package insert. Bridgewater, NJ: Valeant Pharmaceuticals North America LLC; 2017 OCt.54123 - Speiser PW, Azziz R, Baskin LS, et al. Congenital adrenal hyperplasia due to steroid 21-hydroxylase deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2010;95:4133-60.54448 - Fawcett JP, Bpulton DW, Jiang R, et al. Stability of hydrocortisone oral suspensions prepared from tablets and powder. Ann Pharmacother 1995;29:987-90.54462 - Merke DP, Cho D, Calis KA, et al. Hydrocortisone suspension and hydrocortisone tablets are not bioequivalent in the treatment of children with congenital adrenal hyperplasia. J Clin Endocrinol Metab 2001;86(1):441-445.60551 - Cortifoam (hydrocortisone acetate 10% aerosol, foam) package label. Somerset, NJ: Meda Pharmaceuticals, Inc.; 2024 March.62343 - Cortenema (hydrocortisone retention enema) package insert. Baltimore, MD. ANI Pharmaceuticals, Inc.; 2007 Sept.66033 - Alkindi sprinkle oral granules (hydrocortisone) package insert. Baden-Wuerttemberg, Germany: Glatt Pharmaceutical Services GmbH & Co.; 2022 Dec.66174 - American Society of Health-System Pharmacists. Standardize 4 Safety Initiative, compounded oral liquid standards. Retrieved December 15th, 2020. Available at: https://www.ashp.org/Pharmacy-Practice/Standardize-4-Safety-Initiative?utm_source=112320generalnewslink&utm_medium=email&loginreturnUrl=SSOCheckOnly67306 - Manchanda A, Laracy M, Savji T, Bogner RH, et al. Stability of an alcohol-free, dye-free hydrocortisone (2 mg/mL) compounded oral suspension. International Journal of Pharmaceutical Compounding 2018;22:66-75.

      Adverse Reactions

      Moderate

      • adrenocortical insufficiency
      • amnesia
      • anemia
      • angina
      • blurred vision
      • candidiasis
      • cataracts
      • conjunctivitis
      • constipation
      • contact dermatitis
      • Cushing's syndrome
      • delirium
      • depression
      • diabetes mellitus
      • edema
      • EEG changes
      • elevated hepatic enzymes
      • erythema
      • euphoria
      • exophthalmos
      • fluid retention
      • gastritis
      • glossitis
      • glycosuria
      • growth inhibition
      • hallucinations
      • hepatomegaly
      • hypercholesterolemia
      • hyperglycemia
      • hypernatremia
      • hypertension
      • hypocalcemia
      • hypokalemia
      • hypotension
      • hypothalamic-pituitary-adrenal (HPA) suppression
      • immunosuppression
      • impaired cognition
      • impaired wound healing
      • mania
      • memory impairment
      • metabolic alkalosis
      • myopathy
      • neuritis
      • ocular infection
      • osteopenia
      • osteoporosis
      • palpitations
      • peripheral neuropathy
      • phlebitis
      • physiological dependence
      • pseudotumor cerebri
      • psychosis
      • sinus tachycardia
      • skin ulcer
      • sodium retention
      • tolerance
      • withdrawal

      Mild

      • abdominal pain
      • acne vulgaris
      • acneiform rash
      • alopecia
      • anorexia
      • anxiety
      • appetite stimulation
      • arthralgia
      • arthropathy
      • dental caries
      • diaphoresis
      • dizziness
      • ecchymosis
      • emotional lability
      • fever
      • folliculitis
      • headache
      • hiccups
      • hirsutism
      • hypertrichosis
      • infection
      • injection site reaction
      • insomnia
      • irritability
      • lethargy
      • leukocytosis
      • maculopapular rash
      • malaise
      • menstrual irregularity
      • miliaria
      • myalgia
      • nausea
      • paresthesias
      • perineal pain
      • petechiae
      • pharyngitis
      • pruritus
      • purpura
      • rash
      • restlessness
      • rhinitis
      • skin hyperpigmentation
      • skin hypopigmentation
      • skin irritation
      • striae
      • syncope
      • telangiectasia
      • urticaria
      • vertigo
      • vomiting
      • weakness
      • weight gain
      • weight loss
      • xerosis

      Severe

      • anaphylactoid reactions
      • angioedema
      • arrhythmia exacerbation
      • avascular necrosis
      • bone fractures
      • bradycardia
      • cardiac arrest
      • cardiomyopathy
      • esophageal ulceration
      • exfoliative dermatitis
      • GI bleeding
      • GI perforation
      • heart failure
      • increased intracranial pressure
      • lupus-like symptoms
      • myocardial infarction
      • ocular hypertension
      • optic neuritis
      • pancreatitis
      • papilledema
      • peptic ulcer
      • pulmonary edema
      • retinopathy
      • seizures
      • skin atrophy
      • stroke
      • tendon rupture
      • thromboembolism
      • thrombosis
      • tumor lysis syndrome (TLS)
      • vasculitis
      • visual impairment

      0

      • diarrhea

      Pharmacologic doses of systemic corticosteroids administered for prolonged periods can result in physiological dependence due to hypothalamic-pituitary-adrenal (HPA) suppression. Pediatric patients may absorb proportionally larger amounts of topical corticosteroids compared to adults due to a larger skin surface to body mass ratio and, therefore, may be at increased risk of systemic adverse reactions, especially if applied to a large surface area and/or if occlusive dressings are used. HPA axis suppression and increased intracranial pressure have been reported in pediatric patients receiving topical corticosteroids. Increased intracranial pressure with papilledema (i.e., pseudotumor cerebri) has also been reported with withdrawal of glucocorticoid therapy.[54049] [54074] Systemic absorption of topical hydrocortisone is minimal in adults, but theoretically could cause systemic adverse reactions, especially if applied to a large surface area and/or if occlusive dressings are used. Exogenously administered corticosteroids exert a negative feedback effect on the pituitary, inhibiting the secretion of adrenocorticotropin (ACTH). This results in a decrease in ACTH-mediated synthesis of endogenous corticosteroids and androgens by the adrenal cortex. The severity of secondary adrenocortical insufficiency varies among individuals and is dependent on the dose, frequency, time of administration, and duration of therapy. Systemic administration of drug on alternate days may help to alleviate this adverse effect. Patients with HPA suppression will require increased doses of corticosteroid therapy during periods of physiologic stress or infectious conditions, even after the drug has been discontinued. Acute adrenal insufficiency and even death can occur with abrupt discontinuation of therapy. Gradual discontinuation of prolonged oral corticosteroid therapy is recommended, since HPA suppression can last for up to 12 months after cessation of therapy. Patients may continue to need supplemental corticosteroid treatment during periods of physiologic stress or infectious conditions, even after the drug has been discontinued.[54049] [54138] A withdrawal syndrome unrelated to adrenocortical insufficiency can occur after sudden discontinuance of corticosteroid therapy. This syndrome includes symptoms such as loss of appetite, lethargy, stomach upset, pyrexia, muscle and joint pain, exfoliative dermatitis, loss of weight, and hypotension. These effects are believed to be due to the sudden change in corticosteroid concentration rather than to low corticosteroid concentrations.

      Prolonged systemic hydrocortisone therapy can adversely affect the endocrine system, resulting in hypercorticism (Cushing's syndrome including fat abnormalities such as buffalo hump and moon face), acne vulgaris, hirsutism, menstrual irregularity, and a decrease in carbohydrate and glucose tolerance.[32057] [54049] In some patients, systemic absorption of rectal or topical corticosteroids can produce these effects, but these are uncommon when the duration of use is limited. Percutaneous absorption of hydrocortisone is dependent on many factors including the vehicle, the integrity of the epidermal barrier, duration of use, and use of an occlusive dressing. Children may be more susceptible to systemic toxicity from equivalent doses due to their larger skin surface to body mass ratios.

      Glucocorticoids, such as hydrocortisone, are responsible for protein metabolism, and prolonged therapy can result in various musculoskeletal manifestations, including: myopathy (myalgia, muscle wasting, muscle weakness, and quadriplegia), arthralgia, tendon rupture, bone matrix atrophy (osteoporosis and osteopenia), bone fractures such as vertebral compression fractures or fractures of long bones, and avascular necrosis of femoral or humoral heads. These effects are more likely to occur in older or debilitated patients. Of note, abrupt cessation of corticosteroids can cause arthralgia and myalgia. Glucocorticoids interact with calcium metabolism at many sites, including decreasing the synthesis by osteoblasts of the principle proteins of bone matrix, malabsorption of calcium in both the nephron and the gut, and reduction of sex hormone concentrations. Although all of these actions probably contribute to glucocorticoid-induced osteoporosis, the actions on osteoblasts are the most important. Glucocorticoids do not modify vitamin D metabolism.[24837] Postmenopausal women, in particular, should be monitored for signs of osteoporosis during corticosteroid therapy. Intra-articular injections of corticosteroids can cause Charcot-like arthropathy and postinjection flare. Atrophy at the site of injection has been reported after administration of soluble glucocorticoids.

      Adverse GI effects associated with long-term oral corticosteroid administration, such as hydrocortisone, include nausea, vomiting, and anorexia with subsequent weight loss. Appetite stimulation with weight gain, diarrhea, constipation, abdominal pain and/or distention, hiccups, esophageal ulceration, gastritis, and pancreatitis have also been reported with systemic therapy. Peptic ulcers with possible subsequent GI bleeding and GI perforation have been reported. Although it was once believed that corticosteroids contributed to the development of peptic ulcer disease, in a published review of 93 studies of corticosteroid use, the incidence of peptic ulcer disease was not found to be higher in steroid recipients compared to control groups.[24362] While most of these studies did not utilize endoscopy, it is unlikely that corticosteroids contribute to the development of peptic ulcer disease. Gastroenteritis (50%), vomiting (39%), and diarrhea (11%) were reported in pediatric patients receiving oral granules for up to 29 months during an open-label trial (n = 18).[66033]

      The following adverse reactions (listed in decreasing order of occurrence) are reported with topical corticosteroids such as hydrocortisone and may occur more often when used with an occlusive dressing: skin irritation (including burning), pruritus, xerosis (dry skin), folliculitis, hypertrichosis, acneiform rash/eruptions, skin hypopigmentation, perioral dermatitis, maceration of the skin, secondary infection, skin atrophy, striae, and miliaria. Erythema, telangiectasia, purpura, and maculopapular rash may also occur. Although skin atrophy usually occurs after prolonged use of topical corticosteroids, this effect may occur even with short-term use on intertriginous or flexor areas, or on the face. If irritation develops, discontinue topical corticosteroids and institute appropriate therapy. The anti-inflammatory activity of topical corticosteroids may also mask manifestations of infection. In the presence of dermatological infections, institute the use of an appropriate antifungal or antibacterial agent. If a favorable response does not promptly occur, discontinue the corticosteroid until the infection has been adequately controlled. Various adverse dermatologic effects reported during systemic corticosteroid therapy include skin atrophy, diaphoresis or sweating, striae, acneiform rash, alopecia, xerosis, lupus-like symptoms, perineal pain and irritation, purpura, rash, telangiectasia, facial erythema, petechiae, ecchymosis, and easy bruising. Hypersensitivity reactions may manifest as allergic dermatitis, urticaria, anaphylactoid reactions, and/or angioedema. Parenteral corticosteroid therapy has also produced skin hypopigmentation, skin hyperpigmentation, scarring, and other types of injection site reaction (e.g., induration, delayed pain or soreness, subcutaneous and cutaneous atrophy, and sterile abscesses). Burning or tingling in the perineal area may occur after IV injection of corticosteroids.

      In general, excessive use of systemic or topical corticosteroids can lead to impaired wound healing. Hydrocortisone should not be applied directly on or near healing wounds. Skin ulcer may develop in patients with markedly impaired circulation who use topical corticosteroids.

      Corticosteroid therapy (systemic or topical) can mask the symptoms of infection and may result in secondary systemic or localized infections. Avoid systemic use of corticosteroids, such as hydrocortisone, in patients with an active infection unless adequately controlled by anti-infective agents. Leukocytosis is a common physiologic effect of systemic corticosteroid therapy and may need to be differentiated from the leukocytosis that occurs with inflammatory or infectious processes.[30943] [65096] [65097] Immunosuppression is most likely to occur in patients receiving high-dose systemic corticosteroid therapy for any period of time, particularly in conjunction with corticosteroid-sparing drugs (e.g., troleandomycin) and/or concomitant immunosuppressant agents; however, patients receiving moderate dosages of systemic corticosteroids for short periods or low dosages for prolonged periods also may be at risk. Corticosteroids can reactivate tuberculosis and should not be used in patients with a history of active tuberculosis except when chemoprophylaxis is instituted concomitantly. Patients receiving immunosuppressive doses of corticosteroids should be advised to avoid exposure to measles or varicella (chickenpox) and, if exposed to these diseases, to seek medical advice immediately. Additionally, health care providers should monitor steroid recipients for signs of an opportunistic fungal infection as cases of candidiasis have been reported with the use of corticosteroids. The development of Kaposi's sarcoma has been associated with prolonged administration of corticosteroids.[54049] [54074] Fever (56%), viral upper respiratory tract infection (44%), viral infection (33%), otitis media viral (17%), increased body temperature (11%), bronchitis (11%), pharyngitis (11%), respiratory tract infection (11%), and rhinitis (11%) were reported in pediatric patients receiving oral granules for up to 29 months during an open-label trial (n = 18).[66033]

      Corticosteroids are divided into 2 classes: mineralocorticoids and glucocorticoids. Mineralocorticoids alter electrolyte and fluid balance by facilitating sodium retention and hydrogen and potassium excretion at the level of the distal renal tubule, resulting in edema and hypertension. Mineralocorticoids can cause fluid retention; electrolyte disturbances (hypokalemia, hypokalemic metabolic alkalosis, hypernatremia, hypocalcemia); edema; and hypertension. Prolonged administration of glucocorticoids, such as hydrocortisone, also can result in edema and hypertension. In a review of 93 studies of corticosteroid use, hypertension was found to develop 4 times as often in steroid recipients compared to control groups.[24362] Congestive heart failure can occur in susceptible patients. In a study, an increased risk of heart failure was observed for medium-dose glucocorticoid use as compared with nonuse. At the beginning of the study, patients were at least 40 years of age and had not been hospitalized for cardiovascular disease. Medium exposure was defined as less than 7.5 mg daily of prednisolone or the equivalent given orally, rectally, or parenterally.[30697]

      Adverse neurologic effects have been reported during prolonged corticosteroid therapy, such as hydrocortisone, including headache, insomnia, amnesia and memory impairment, increased motor activity, impaired cognition, neuritis, paresthesias, ischemic peripheral neuropathy, malaise, vertigo, restlessness, ischemic peripheral neuropathy, seizures, and EEG changes. Increased intracranial pressure with papilledema (pseudotumor cerebri) usually follows discontinuation of treatment. Mental status changes including depression, anxiety, euphoria, personality changes, emotional lability, delirium, dementia, hallucinations, irritability, mania, mood swings, schizophrenic reactions, withdrawn behavior, and psychosis also have been reported. Emotional lability and psychotic problems can be exacerbated by corticosteroid therapy.

      Conjunctivitis was reported in 28% of pediatric patients receiving hydrocortisone oral granules for up to 29 months during an open-label trial (n = 18).[66033] Ocular effects, such as corneal perforation, exophthalmos, posterior subcapsular cataracts, retinopathy, central serous chorioretinopathy (CSCR), or ocular hypertension, can result from prolonged use of glucocorticoids and could result in glaucoma, or ocular nerve damage including optic neuritis.[32057] [60551]Temporary or permanent visual impairment, including blurred vision and blindness, has been reported with corticosteroid administration by several routes of administration. If systemic steroid therapy is continued for more than 6 weeks, monitor intraocular pressure; evaluate any patient who develops changes in vision for ocular hypertension. Ocular hypertension and cataracts leading to visual impairment have also been reported after prolonged application of corticosteroids to the skin around the eye. Case reports describe visual impairment patients using topical corticosteroids for eczema of the face; although, use of hydrocortisone has been reported to be safer for short-term use around eye area. The visual impairment was secondary to the onset of ocular hypertension. Such adverse effects, if they occur, could lead to blindness. Cataracts have also been reported with topical corticosteroids, but usually with large doses or longer durations of therapy (more than 6 months). The mechanism of corticosteroid-induced cataract formation is uncertain but may involve disruption of sodium-potassium pumps in the lens epithelium leading to accumulation of water in lens fibers and agglutination of lens proteins.[24813] Hydrocortisone can reduce host resistance to infection. Secondary fungal and viral infections of the eye (ocular infection) can be masked or exacerbated by corticosteroid therapy. Investigate the possibility of fungal infection if patients have persistent corneal ulceration.

      Systemic corticosteroids are a common cause of drug-induced hyperglycemia. In the hospital setting, there is evidence that more than 50% of the patients receiving high-dose systemic steroids develop hyperglycemia, with many more having at least 1 episode of hyperglycemia or a mean blood glucose of 140 mg/dL or greater. Long-term use produces metabolic and endocrine effects that include insulin resistance that may lead to new diagnoses of diabetes mellitus (DM) in patients without a history of hyperglycemia or DM prior to corticosteroid use. Glucosuria (glycosuria) and aggravation of existing diabetes mellitus may also occur.[68700] Rectal and topical corticosteroids have also been reported to cause hyperglycemia and glucosuria in some patients, but these are relatively uncommon when used for limited durations. Percutaneous absorption of hydrocortisone is dependent on many factors including the vehicle, duration of use, the integrity of the epidermal barrier, and use of an occlusive dressing. Children may be more susceptible to systemic absorption with topical use due to their larger skin surface to body mass ratios.

      Hypercholesterolemia, atherosclerosis, fat embolism, sinus tachycardia, palpitations, bradycardia, syncope, vasculitis, necrotizing angiitis, thrombosis, thromboembolism, and phlebitis have been associated with systemic corticosteroid therapy, such as hydrocortisone. Glucocorticoid use appears to increase the risk of cardiovascular events such as myocardial infarction, left ventricular rupture (in persons who recently experienced a myocardial infarction), angina, angioplasty, coronary revascularization, stroke, transient ischemic attack, cardiomegaly, arrhythmia exacerbation and ECG changes, hypertrophic cardiomyopathy (in premature infants), congestive heart failure and pulmonary edema, cardiac arrest or cardiovascular death. As determined from observational data, the rate of cardiovascular events was 17 per 1,000 person-years among 82,202 non-users of glucocorticoids. In contrast, the rate was 23.9 per 1,000 person-years among 68,781 glucocorticoid users. Furthermore, the rate of cardiovascular events was 76.5 per 1,000 person-years for high exposure patients. After adjustment for known covariates by multivariate analysis, high-dose glucocorticoid use was associated with a 2.56-fold increased risk of cardiovascular events as compared with nonuse. At the beginning of the study, patients were at least 40 years of age and had not been hospitalized for cardiovascular disease. High glucocorticoid exposure was defined as at least 7.5 mg daily of prednisolone or the equivalent given orally, rectally, or parenterally whereas medium exposure was defined as less than the above dosage by any of the 3 routes. Low-dose exposure was defined as inhaled, topical, or nasal usage only.[30697]

      Tolerance may occur with the prolonged use of topical corticosteroids. Tolerance is usually described as a decreased acute vasoconstrictive response to the agent after a period of days to weeks. This may explain the dramatic responses noted initially by patients early in topical corticosteroid treatment and an apparent diminished response with time. Tolerance is reversible and may be attenuated by interrupted or cyclic schedules of application (e.g., hydrocortisone is given for 2 to 3 weeks, followed by a 1-week intermission).

      Because of retardation of bone growth, children receiving prolonged systemic corticosteroid therapy (e.g., hydrocortisone) may have growth inhibition. Growth inhibition has been observed in the absence of laboratory evidence of hypothalamic-pituitary-adrenal (HPA) suppression, suggesting that growth velocity is a more sensitive indicator of systemic corticosteroid exposure in pediatric patients. Topically applied corticosteroids can be absorbed in sufficient amounts to produce systemic effects, especially if used in excessive dosage, over large body surface areas, or with occlusive dressings.

      Cases of elevated hepatic enzymes (usually reversible upon discontinuation) and hepatomegaly have been associated with corticosteroid receipt such as hydrocortisone.

      Allergic contact dermatitis with topical corticosteroids such as hydrocortisone is usually diagnosed by observing a failure to heal. Appropriate diagnostic patch testing may help with the diagnosis.

      Dizziness and anemia have been reported with corticosteroid use such as hydrocortisone. Corticosteroids may decrease serum concentrations of vitamin C (ascorbic acid) and vitamin A, which may rarely produce symptoms of vitamin A deficiency or vitamin C deficiency. Some loss of folic acid may also be caused by corticosteroid use; glossitis may be noted. Dental caries (11%) and genitourinary operation (11%) were reported in pediatric patients receiving oral granules for up to 29 months during an open-label trial (n = 18).[66033]

      Tumor lysis syndrome (TLS) has been reported during postmarketing surveillance of systemic corticosteroids alone or in combination with other chemotherapeutic agents in patients with malignancies, including hematological malignancies and solid tumors. Patients at high risk of TLS, such as patients with tumors that have a high proliferative rate, high tumor burden and high sensitivity to cytotoxic agents, should be monitored closely and appropriate precautions should be taken.[32057] [54049]

      Revision Date: 06/12/2024, 01:59:00 AM

      References

      24362 - Conn HO, Poynard T. Corticosteroids and peptic ulcer: meta-analysis of adverse events during steroid therapy. J Intern Med 1994;236:619-32.24813 - Cumming RG, Mitchell P, Leeder SR, et al. Use of inhaled corticosteroids and the risk of cataracts. N Engl J Med 1997;337:8-14.24837 - Reid IR. Preventing glucocorticoid-induced osteoporosis. N Engl J Med 1997;337:420-1.30697 - Wei L, MacDonald TM, Walker BR. Taking glucocorticoids by prescription is associated with subsequent cardiovascular disease. Ann Intern Med 2004;141:764-70.30943 - Schimmer B, Parker K. Adrenocorticotropic hormone; adrenocortical steroids and their synthetic analogs; inhibitors of the synthesis and actions of adrenocortical hormones. In: Hardman JG, Limbird LE, Molinoff PB, et al., eds. Goodman and Gilman's the Pharmacological Basis of Therapeutics, 10th edition. New York: McGraw Hill, 2001;1649-1674.32057 - Cortef (hydrocortisone tablets, USP) package insert. New York, NY: Pharmacia & Upjohn Co., Inc.; 2024 June54049 - Solu-cortef (hydrocortisone sodium succinate) injection package insert. New York, NY: Pharmacia & Upjohn Co.; 2023 Dec.54074 - Hydrocortisone 2.5% cream and ointment package insert. Bronx, NY: Perrigo; 2012 Dec.54138 - Shulman DI, Palmert MR, Kemp SF. Adrenal insufficiency: still a cause of morbidity and death in childhood. Pediatrics 2007;119(2):e484-494.60551 - Cortifoam (hydrocortisone acetate 10% aerosol, foam) package label. Somerset, NJ: Meda Pharmaceuticals, Inc.; 2024 March.65096 - Abramson N, Melton B. Leukocytosis: basic of clinical assessment. Am Fam Physician 2000;62:2053-60.65097 - Shoenfeld Y, Gurewich Y, Gallant LA, et al. Prednisone-induced leukocytosis. Influenced of dosage, method and duration of administration on the degree of leukocytosis. Am J Med 1981;71:773-8.66033 - Alkindi sprinkle oral granules (hydrocortisone) package insert. Baden-Wuerttemberg, Germany: Glatt Pharmaceutical Services GmbH & Co.; 2022 Dec.68700 - Tamez-Perez HE, Quintanilla-Flores DL, Rodriguez-Gutierrez R, et al. Steroid hyperglycemia: Prevalence, early detection and therapeutic recommendations: A narrative review. World J Diabetes. 2015;6:1073-1081.

      Contraindications/Precautions

      Absolute contraindications are italicized.

      • fungal infection
      • intrathecal administration
      • abrupt discontinuation
      • acne rosacea
      • acne vulgaris
      • asthma
      • benzyl alcohol hypersensitivity
      • breast-feeding
      • cardiomyopathy
      • cataracts
      • coagulopathy
      • corticosteroid hypersensitivity
      • Cushing's syndrome
      • diabetes mellitus
      • diverticulitis
      • epidural administration
      • geriatric
      • GI disease
      • GI perforation
      • glaucoma
      • growth inhibition
      • heart failure
      • helminth infection
      • hemophilia
      • hepatic disease
      • herpes infection
      • hypertension
      • hypothalamic-pituitary-adrenal (HPA) suppression
      • hypothyroidism
      • immunosuppression
      • increased intracranial pressure
      • infection
      • inflammatory bowel disease
      • measles
      • myasthenia gravis
      • myocardial infarction
      • neonates
      • neoplastic disease
      • ocular exposure
      • ocular infection
      • ophthalmic administration
      • osteoporosis
      • peptic ulcer disease
      • perioral dermatitis
      • peripheral vascular disease
      • pheochromocytoma
      • pregnancy
      • premature neonates
      • psychosis
      • renal disease
      • seizure disorder
      • skin abrasion
      • skin atrophy
      • sulfite hypersensitivity
      • surgery
      • thromboembolic disease
      • tuberculosis
      • tumor lysis syndrome (TLS)
      • ulcerative colitis
      • vaccination
      • varicella
      • viral infection
      • visual disturbance

      Systemic corticosteroids can aggravate Cushing's syndrome and should be avoided in patients with Cushing's syndrome. Prolonged administration of pharmacological doses of systemic corticosteroids or topical preparations (resulting in systemic absorption) may result in hypothalamic-pituitary-adrenal (HPA) suppression and/or manifestations of Cushing's syndrome in some patients. Adrenocortical insufficiency, adrenal crisis, and death may occur after abrupt discontinuation of prolonged systemic therapy. Adrenal crisis may also be induced by stressful events such as infections or surgery; patients may require higher doses of corticosteroids. Symptoms of adrenocortical insufficiency include poor feeding, fatigue, low muscle tone, joint pain, nausea, vomiting, hypoglycemia, low blood pressure, and electrolyte disturbances. Switch patients unable to take oral medications (i.e., severely ill or vomiting) to parenteral corticosteroid formulations until recovered. Once oral medications are tolerated, gradually reduce the steroid dosage during the acute event. A withdrawal syndrome unrelated to adrenocortical insufficiency may occur after sudden discontinuation of corticosteroid therapy. These effects are thought to be due to the sudden change in glucocorticoid concentration rather than to low corticosteroid concentrations. Withdrawal from prolonged systemic corticosteroid therapy should be gradual. HPA suppression can last for up to 12 months following cessation of systemic therapy. Recovery of HPA axis function is generally prompt and complete upon discontinuation of the topical corticosteroid. HPA-suppressed patients may need supplemental corticosteroid treatment during periods of physiologic stress, such as surgical procedures, acute blood loss, or infection, even after the corticosteroid has been discontinued. Encourage patients currently receiving chronic corticosteroid therapy or who have had corticosteroids discontinued within the last 12 months to carry identification advising the need for administration of hydrocortisone in situations of increased stress. Conditions that increase systemic absorption of topical corticosteroids include use over large surface areas, prolonged use, use in areas where the epidermal barrier is disrupted (i.e., skin abrasion), and the use of an occlusive dressing. Patients receiving large doses of hydrocortisone applied to a large surface area should be evaluated periodically for evidence of HPA axis suppression and/or manifestations of Cushing's syndrome. If these effects are noted, an attempt should be made to withdraw the drug, to reduce the frequency of application, or to substitute a less potent corticosteroid.[43359] [54049] [54074] [54137] [54138] [66033]

      Chronic corticosteroid therapy in pediatric patients may interfere with growth and development. Chronic use of systemic or topical corticosteroids may cause growth inhibition (including linear growth retardation and delayed weight gain) in pediatric patients. Children and infants may absorb proportionally larger amounts of topical corticosteroids due to a larger skin surface area to body weight ratio, and therefore are more susceptible to developing systemic toxicity, especially with very-high-potency topical products. Hypothalamic-pituitary-adrenal (HPA) axis suppression, Cushing's syndrome, and increased intracranial pressure have been reported in children receiving corticosteroids. Administration of corticosteroids to pediatric patients should be limited to the least amount compatible with an effective therapeutic regimen. If children are being treated topically in the diaper area, tight-fitting diapers or plastic pants should be avoided as these garments may act as an occlusive dressing and increase systemic absorption of the drug.[43359] [54278]

      Patients receiving high-dose (e.g., equivalent to 1 mg/kg or more of prednisone daily) systemic corticosteroid therapy, such as hydrocortisone, for any period of time, particularly in conjunction with corticosteroid sparing drugs (e.g., troleandomycin) are at risk to develop immunosuppression; patients receiving moderate doses of systemic corticosteroids, such as hydrocortisone, for short periods or low doses for prolonged periods may also be at risk. When given in combination with other immunosuppressive agents, there is a risk of over-immunosuppression.[54049] [54074]

      Systemic corticosteroid therapy, such as hydrocortisone, can mask the symptoms of infection and should not be used in patients with a fungal, bacterial, protozoan, helminth infection that are not adequately controlled with antiinfective agents. Although the manufacturers state that systemic hydrocortisone is contraindicated in patients with a systemic fungal infection, in clinical use systemic corticosteroids can be administered to these patients as long as appropriate antiinfective therapy is administered simultaneously. Activation of latent disease or exacerbation of intercurrent infection due to pathogens such as Amoeba, Candida, Cryptococcus, Mycobacterium, Nocardia, Pneumocystis, or Toxoplasma can occur in patients receiving systemic corticosteroids. Rule out infection with latent or active amebiasis before initiating corticosteroid therapy in patients who have spent time in the tropics or who have unexplained diarrhea. Use corticosteroids with caution in patients with known or suspected Strongyloides (threadworm) infestation as the immunosuppressive effects may lead to disseminated infection, severe enterocolitis, and sepsis. Cases of severe and disseminated strongyloidiasis have been reported following use of corticosteroids in combination with tocilizumab to treat patients with coronavirus disease 2019 (COVID-19). Before giving these drugs together to patients from strongyloidiasis endemic areas, consider administering ivermectin as prophylactic treatment.[54049] [54074] [65314]

      Reactivation of tuberculosis may occur in patients with latent tuberculosis or tuberculin reactivity; close observation for disease reactivation is needed if corticosteroids are indicated in such patients. Further, chemoprophylaxis is advised if prolonged corticosteroid therapy is needed. Patients receiving immunosuppressive doses of systemic corticosteroids should be advised to avoid exposure to viral infections (i.e., measles or varicella) because these diseases may be more serious or even fatal in immunosuppressed patients. If exposed to chicken pox, prophylaxis with varicella zoster immune globulin may be indicated. Pediatric patients dependent on systemic corticosteroids should undergo anti-varicella-zoster virus antibody testing. If exposed to measles, prophylaxis with pooled intramuscular immunoglobulin may be indicated. Instruct patients to avoid exposure to chicken pox and measles and to get immediate medical advice if exposure occurs. Application of topical corticosteroids to areas of infection, including tuberculosis of the skin, dermatologic fungal infection, and cutaneous or systemic viral infection (e.g., herpes infection, measles, varicella), should be initiated or continued only if the appropriate antiinfective treatment is instituted. If the infection does not respond to the antimicrobial therapy, the concurrent use of the topical corticosteroid should be discontinued until the infection is controlled. Topical corticosteroids should not be used to treat acne vulgaris, acne rosacea, or perioral dermatitis as they may exacerbate these conditions. Topical corticosteroids may delay the healing of non-infected wounds, such as venous stasis ulcers. Use topical hydrocortisone preparations with caution in patients with markedly impaired circulation or peripheral vascular disease; skin ulceration has been reported in these patients following topical corticosteroid use.

      Corticosteroid therapy, such as hydrocortisone, has been associated with left ventricular free-wall rupture in patients with recent myocardial infarction, and should therefore be used cautiously in these patients.

      Systemic corticosteroids, such as hydrocortisone, can cause edema and weight gain. Use with caution in patients with congestive heart failure or hypertension as this can cause an exacerbation of their condition.

      Prolonged systemic corticosteroid therapy can lead to osteoporosis, vertebral compression fractures, aseptic necrosis of femoral and humoral heads, and pathologic fractures of long bones secondary to decreased bone formation, increased bone resorption, and protein catabolism.[54049] [54074] Use cautiously in older (65 years and older), debilitated, or postmenopausal patients because they are especially susceptible to these adverse effects. A high-protein diet may alleviate or prevent the adverse effects associated with protein catabolism.

      Systemic corticosteroids, such as hydrocortisone, may decrease glucose tolerance, produce hyperglycemia, and aggravate or precipitate diabetes mellitus. This may especially occur in patients predisposed to diabetes mellitus. When corticosteroid therapy is necessary in patients with diabetes mellitus, changes in insulin, oral antidiabetic agent dosage, and/or diet may be required. Topical corticosteroids should be used with caution in patients with diabetes mellitus. Exacerbation of diabetes may occur with systemic absorption of the topical corticosteroid. Use of topical corticosteroids may further delay healing of skin ulcers in diabetic patients.

      Oral corticosteroids, such as hydrocortisone, can cause gastrointestinal irritation. The drugs should be used with caution in patients with GI disease, diverticulitis, nonspecific ulcerative colitis, or intestinal anastomosis (because of the possibility of perforation). While used for the short-term treatment of acute exacerbations of chronic inflammatory bowel disease such as ulcerative colitis and Crohn's disease, corticosteroids should not be used in patients where there is a possibility of impending GI perforation, abscess, or pyogenic infection. Some patients may require long-term corticosteroid therapy to suppress disease activity, but generally this practice is not recommended. Corticosteroids should not be used in patients with peptic ulcer disease except under life-threatening circumstances.

      Systemic corticosteroids should be used with extreme caution in patients with psychosis, emotional instability, renal disease, and seizure disorder because the drugs can exacerbate these conditions. Patients with hepatic disease, such as cirrhosis, or hypothyroidism can have an exaggerated response to systemic corticosteroids. Use systemic corticosteroids, such as hydrocortisone, with caution in these patients.

      Systemic glucocorticoids, such as hydrocortisone, should be used with caution in patients with myasthenia gravis who are being treated with anticholinesterase agents (see Drug Interactions).

      Systemic corticosteroids rarely may increase blood coagulability, causing intravascular thrombosis, thrombophlebitis, and thromboembolism. Therefore, systemic corticosteroids, such as hydrocortisone, should be used with caution in patients with preexisting coagulopathy (e.g., hemophilia) or thromboembolic disease.

      Systemic and rectal preparations of hydrocortisone must be used with caution during human pregnancy. Corticosteroids are generally teratogenic in laboratory animals when administered systemically at relatively low dosage levels. Complications, including cleft palate, stillbirth, and premature abortion, have been reported during animal studies. If hydrocortisone must be used during pregnancy, the potential risks should be discussed with the patient. However, insufficient treatment of an underlying condition (e.g., Addison's disease) during pregnancy is also associated with fetal and maternal risks and the mother may require additional monitoring to ensure adequate replacement during pregnancy and in the post-partum period as requirements return to pre-pregnancy levels. Infants born to mothers who have taken substantial doses of corticosteroids during pregnancy should be monitored for signs of hypoadrenalism.[54278] [32057] [54049] [54060] [62343] Topical application of hydrocortisone warrants caution during pregnancy as there are no adequate and well-controlled studies. Topical corticosteroids should not be used in large amounts, on large areas, or for prolonged periods of time in pregnant women. Guidelines recommend mild to moderate potency agents, such as topical hydrocortisone, over potent topical corticosteroids, which should be used in short durations. Fetal growth restriction and a significantly increased risk of low birthweight has been reported with use of potent or very potent topical corticosteroids during the third trimester, particularly when using more than 300 grams. Corticosteroids are generally teratogenic in laboratory animals when administered systemically at relatively low dosage levels. The more potent corticosteroids have been shown to be teratogenic after dermal application in laboratory animals.[42474] [62348] [62792] Systemic corticosteroids have been shown to impair fertility in male rats; the impact to human male fertility is not certain.[54278] [54049]

      The use of systemic and rectal hydrocortisone has not been studied during breast-feeding; however cortisol is a normal component of breast milk.[32057] [54278] [54049] [54060] [62343] Other corticosteroids (prednisone and prednisolone) are usually considered compatible with breast-feeding.[27500] It is not known whether topical administration of desonide could result in sufficient systemic absorption to produce detectable quantities in breast milk.[42474] [62348] However, most dermatologists stress that topical corticosteroids can be safely used during lactation and breast-feeding.[62791] If applied topically, care should be used to ensure the infant will not come into direct contact with the area of application, such as the breast. Increased blood pressure has been reported in an infant whose mother applied a high potency topical corticosteroid ointment directly to the nipples. Consider the benefits of breast-feeding, the risk of potential infant drug exposure, and the risk of an untreated or inadequately treated condition. If a breast-feeding infant experiences an adverse effect related to a maternally ingested drug, healthcare providers are encouraged to report the adverse effect to the FDA.

      Corticosteroid therapy, such as hydrocortisone, usually does not contraindicate vaccination with live-virus vaccines when such therapy is of short-term (< 2 weeks); low to moderate dose; long-term alternate day treatment with short-acting preparations; maintenance physiologic doses (replacement therapy); or administration topically (skin or eye), by aerosol, or by intra-articular, bursal or tendon injection. The immunosuppressive effects of steroid treatment differ, but many clinicians consider a dose equivalent to either 2 mg/kg/day or 20 mg/day of prednisone as sufficiently immunosuppressive to raise concern about the safety of immunization with live-virus vaccines. In general, patients with severe immunosuppression due to large doses of corticosteroids should not receive vaccination with live-virus vaccines. When cancer chemotherapy or immunosuppressive therapy is being considered (e.g., for patients with Hodgkin's disease or organ transplantation), vaccination should precede the initiation of chemotherapy or immunotherapy by >= 2 weeks. Patients vaccinated while on immunosuppressive therapy or in the 2 weeks prior to starting therapy should be considered unimmunized and should be revaccinated at least 3 months after discontinuation of therapy. In patients who have received high-dose, systemic corticosteroids for >= 2 weeks, it is recommended to wait at least 3 months after discontinuation of therapy before administering a live-virus vaccine.

      Some commercially available formulations of hydrocortisone may contain sulfites. Sulfites may cause allergic reactions in some people. They should be used with caution in patients with known sulfite hypersensitivity. Patients with asthma are more likely to experience this sensitivity reaction than non-asthmatic patients.

      Hypertrophic cardiomyopathy may develop after parenteral administration of hydrocortisone to premature neonates, therefore appropriate diagnostic evaluation and monitoring of cardiac function and structure should be performed. Several commercial formulations of hydrocortisone injection are contraindicated in premature neonates because these products contain benzyl alcohol. Use these formulations of hydrocortisone with caution in neonates. Administration of benzyl alcohol to neonates can result in a 'gasping syndrome', which is a potentially fatal condition characterized by metabolic acidosis and CNS, respiratory, circulatory, and renal dysfunction; it is also characterized by high concentrations of benzyl alcohol and its metabolites in the blood and urine. While the minimum amount of benzyl alcohol at which toxicity may occur is not known, 'gasping syndrome' has been associated with benzyl alcohol dosages more than 99 mg/kg/day in neonates and low-birth-weight neonates. Additional symptoms may include gradual neurological deterioration, seizures, intracranial hemorrhage, hematologic abnormalities, skin breakdown, hepatic failure, renal failure, hypotension, bradycardia, and cardiovascular collapse. Rare cases of death, primarily in premature neonates, have been reported. Further, an increased incidence of kernicterus, especially in small, premature neonates has been reported. Practitioners administering this and other medications containing benzyl alcohol should consider the combined daily metabolic load of benzyl alcohol from all sources. Premature neonates, neonates with a low birth weight, and patients who receive a high dose may be more likely to develop toxicity. Hypertrophic cardiomyopathy may develop after administration of hydrocortisone to premature neonates, therefore appropriate diagnostic evaluation and monitoring of cardiac function and structure should be performed.[54278]

      True corticosteroid hypersensitivity reactions are rare. While a hypersensitivity reaction could be to a specific salt of the corticosteroid (i.e., hydrocortisone sodium succinate), patients who have demonstrated a prior hypersensitivity reaction to hydrocortisone should receive any form of hydrocortisone with extreme caution. It is possible, though also rare, that such patients will display cross-hypersensitivity to other corticosteroids; there have been reports that a cross-sensitivity between hydrocortisone and methylprednisolone may exist.[27642] Rare instances of anaphylactoid reactions have occurred in patients receiving corticosteroid therapy. It is advisable that patients who have a hypersensitivity reaction to any corticosteroid undergo skin testing, which, although not a conclusive predictor, may help to determine if hypersensitivity to another corticosteroid exists. Such patients should be carefully monitored during and following the administration of any corticosteroid.[27616] Some injectable formulations of hydrocortisone contain benzyl alcohol and should be used with caution in those patients with benzyl alcohol hypersensitivity.[54278] [54246]

      Corticosteroids should be used cautiously in patients with glaucoma or any other visual disturbance. Corticosteroids are well known to cause cataracts and can exacerbate glaucoma during long-term administration. Patients receiving corticosteroids chronically should be periodically assessed for cataract formation. There is also an increase in the propensity for secondary ocular infection caused by fungal or viral infections. Care should be taken to avoid ocular exposure; ophthalmic administration of topical hydrocortisone preparations should be avoided. Visual impairment, ocular hypertension and worsened cataracts have been reported with ocular exposure to other high potency topical corticosteroids. Preexisting glaucoma may be aggravated if hydrocortisone is applied in the periorbital area. Consider an ophthalmologist referral for patients who present with symptoms of blurred vision or other visual disturbances.[54074][60551] 

      Injection of hydrocortisone may result in dermal and/or subdermal changes forming depressions in the skin at the injection site. In order to minimize the incidence of subdermal and dermal atrophy, care must be exercised not to exceed recommended doses in injections. Injection into the deltoid muscle should be avoided because of a high incidence of subcutaneous atrophy.[54278] Topical corticosteroids, such as hydrocortisone, should be used for brief periods, or under close medical supervision in patients with evidence of pre-existing skin atrophy. Use of lower potency topical corticosteroids may be necessary in some patients, such as the elderly adult. Prolonged use of a topical corticosteroid, and the application of the steroid to thin areas of skin appear to increase the risk for atrophy.[54074]

      Use systemic corticosteroids with caution in the geriatric adult; the risks and benefits of therapy should be considered for any individual patient, particularly with chronic use.[54278] [32057] Prolonged systemic corticosteroid therapy, such as hydrocortisone, can lead to osteoporosis and fracture risk. A high-protein diet may alleviate or prevent the adverse effects associated with protein catabolism. Additionally, topical corticosteroids, such as hydrocortisone, should be used for brief periods, or under close medical supervision in patients with evidence of pre-existing skin atrophy; older adults may be more likely to have preexisting skin atrophy secondary to aging.[43359] [62348] According to the Beers Criteria, systemic corticosteroids are considered potentially inappropriate medications (PIMs) for use in geriatric patients with delirium or at high risk for delirium; avoid when possible in these patient populations due to the possibility of new-onset delirium or exacerbation of the current condition. Oral and parenteral corticosteroids may be required for conditions such as exacerbation of chronic obstructive pulmonary disease (COPD) but should be prescribed in the lowest effective dose and for the shortest possible duration.[63923]

      Intrathecal administration of hydrocortisone sodium succinate injection is contraindicated. Severe medical events, including arachnoiditis, meningitis, paraparesis, paraplegia, and sensory disturbances, have been reported after intrathecal administration. Epidural lipomatosis has been reported with hydrocortisone sodium succinate injection.[54049] Epidural administration of corticosteroids should be used with great caution. Rare, but serious adverse reactions, including cortical blindness, stroke, spinal cord infarction, paralysis, seizures, nerve injury, brain edema, and death have been associated with epidural administration of injectable corticosteroids. These events have been reported with and without the use of fluoroscopy. Many cases were temporally associated with the corticosteroid injection; reactions occurred within minutes to 48 hours after injection. Some cases of neurologic events were confirmed through magnetic resonance imaging (MRI) or computed tomography (CT) scan. Many patients did not recover from the reported adverse effects. Discuss the benefits and risks of epidural corticosteroid injections with the patient before treatment. If a decision is made to proceed with corticosteroid epidural administration, counsel patients to seek emergency medical attention if they experience symptoms after injection such as vision changes, tingling in the arms or legs, dizziness, severe headache, seizures, or sudden weakness or numbness of face, arm, or leg.[57053]

      Use hydrocortisone with caution in patients with diagnosed or suspected pheochromocytoma. Pheochromocytoma crisis, which can be fatal, has been reported after administration of systemic corticosteroids. Consider the risk of pheochromocytoma crisis prior to administering corticosteroids in any patients with suspected pheochromocytoma.[32057]

      Tumor lysis syndrome (TLS) has been reported in patients with neoplastic disease, including hematological malignancies and solid tumors, following the use of systemic corticosteroids alone or in combination with other chemotherapeutic agents. Patients at high risk of TLS, such as patients with tumors that have a high proliferative rate, high tumor burden and high sensitivity to cytotoxic agents, should be monitored closely and appropriate precautions should be taken.[32057] [54049]

      Revision Date: 06/12/2024, 01:59:00 AM

      References

      27500 - American Academy of Pediatrics (AAP) Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics 2001;108(3):776-789.27616 - Butani L. Corticosteroid-induced hypersensitivity reactions. Ann Allergy Asthma Immunol 2002;89(5):439-445.27642 - Kamm GL, Hagmeyer KO. Allergic-type reactions to corticosteroids. Ann Pharmacother 1999;33(4):451-460.32057 - Cortef (hydrocortisone tablets, USP) package insert. New York, NY: Pharmacia & Upjohn Co., Inc.; 2024 June42474 - Hydrocortisone 1% cream package insert. Melville, NY: E. Fougera & Co.; 2006 Jun.43359 - Locoid (hydrocortisone butyrate lotion) package insert. Bridgewater, NJ: Bausch Health US, LLC; 2023 Oct.54049 - Solu-cortef (hydrocortisone sodium succinate) injection package insert. New York, NY: Pharmacia & Upjohn Co.; 2023 Dec.54060 - Anusol HC (hydrocortisone acetate) suppository package insert. Bridgewater, NJ: Valeant Pharmaceuticals North America LLC; 2017 OCt.54074 - Hydrocortisone 2.5% cream and ointment package insert. Bronx, NY: Perrigo; 2012 Dec.54137 - Gupta P, Bhatia V. Corticosteroid physiology and principles of therapy. Indian J Pediatr 2008;75:1039-44.54138 - Shulman DI, Palmert MR, Kemp SF. Adrenal insufficiency: still a cause of morbidity and death in childhood. Pediatrics 2007;119(2):e484-494.54246 - Hydrocortone (hydrocortisone sodium phosphate) injection package insert. Whitehouse Station, NJ: Merck & Co., Inc.; 2001 Nov.54278 - Solu-Cortef (hydrocortisone sodium succinate) injection package insert. New York, NY: Pharmacia and Upjohn Co.; 2023 Dec.57053 - Food and Drug Administration (US FDA) Drug Medwatch-FDA requires label changes to warn of rare but serious neurologic problems after epidural corticosteroid injections for pain. Retrieved April 23, 2014. Available on the World Wide Web at http://www.fda.gov/downloads/Drugs/DrugSafety/UCM394286.pdf.60551 - Cortifoam (hydrocortisone acetate 10% aerosol, foam) package label. Somerset, NJ: Meda Pharmaceuticals, Inc.; 2024 March.62343 - Cortenema (hydrocortisone retention enema) package insert. Baltimore, MD. ANI Pharmaceuticals, Inc.; 2007 Sept.62348 - Hydrocortisone valerate 0.2% cream and ointment package insert. Haethorne, NY: Taro Pharmaceuticals USA, Inc; 2015 Oct.62791 - Butler DC, Heller MM, Murase JE. Safety of dermatologic medications in pregnancy and lactation: Part II. Lactation. J Am Acad Dermatol. 2014;70:417.e1-10. Review.62792 - Murase JE, Heller MM, Butler DC. Safety of dermatologic medications in pregnancy and lactation: Part I. Pregnancy. J Am Acad Dermatol. 2014;70:401.e1-14. Review.63923 - 2023 American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023;71:2052-208165314 - COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. Accessed March 1, 2024. Available at https://www.covid19treatmentguidelines.nih.gov/66033 - Alkindi sprinkle oral granules (hydrocortisone) package insert. Baden-Wuerttemberg, Germany: Glatt Pharmaceutical Services GmbH & Co.; 2022 Dec.

      Mechanism of Action

      Endogenous corticosteroids are secreted by the adrenal cortex, and their effects are believed to be due to enzyme modification rather than to a direct hormone-induced action. Corticosteroids are loosely classified into two categories, mineralocorticoids and glucocorticoids, depending on their primary pharmacological activity. Mineralocorticoids alter electrolyte and fluid balance by facilitating sodium resorption and hydrogen and potassium excretion at the level of the distal renal tubule, resulting in edema and hypertension. Glucocorticoids exert some mineralocorticoid effects but are also involved in a number of other metabolic pathways including gluconeogenesis, fat redistribution, protein metabolism, and calcium balance. Hydrocortisone possesses both mineralocorticoid actions and glucocorticoid actions.

       

      Corticosteroids exhibit anti-inflammatory, antipruritic, and vasoconstrictive properties. At the cellular level, corticosteroids induce peptides called lipocortins. Lipocortins antagonize phospholipase A2, an enzyme which causes the breakdown of leukocyte lysosomal membranes to release arachidonic acid. This action decreases the subsequent formation and release of endogenous inflammatory mediators including prostaglandins, kinins, histamine, liposomal enzymes and the complement system.

       

      Early anti-inflammatory effects of topical corticosteroids include the inhibition of macrophage and leukocyte movement and activity in the inflamed area by reversing vascular dilation and permeability. Later inflammatory processes such as capillary production, collagen deposition, keloid (scar) formation also are inhibited by corticosteroids. Clinically, these actions correspond to decreased edema, erythema, pruritus, plaque formation and scaling of the affected skin.

       

      In the treatment of asthma, corticosteroids block the late phase allergic response to allergens. Mediators involved in the pathogenesis of asthma include histamine, leukotrienes (slow releasing substance of anaphylaxis, SRS-A), eosinophil chemotactic factor of anaphylaxis (ECF-A), neutrophil chemotactic factor (NCF), cytokines, hydroxyeicosatetraenoic acids, prostaglandin-generating factor of anaphylaxis (PGF-A), prostaglandins, major basic protein, bradykinin, adenosine, peroxides, and superoxide anions. Different cell types are responsible for release of these mediators including airway epithelium, eosinophils, basophils, lung parenchyma, lymphocytes, macrophages, mast cells, neutrophils, and platelets. Corticosteroids inhibit the release of these mediators as well as inhibit IgE synthesis, attenuate mucous secretion and eicosanoid generation, up-regulate beta-receptors, promote vasoconstriction, and suppress inflammatory cell influx and inflammatory processes. Clinical effects in asthma include a reduction in bronchial hyperresponsiveness to allergens, a decreased number of asthma exacerbations, and an improvement in FEV1, peak-flow rate, and respiratory symptoms. Since corticosteroid effects take several hours to days to become clinically noticeable, they are ineffective for primary treatment of severe acute bronchospastic attacks or for status asthmaticus. Inhaled corticosteroids have no bronchodilatory properties.

      Revision Date: 06/12/2024, 01:59:00 AM

      References

      Pharmacokinetics

      Hydrocortisone is administered via oral, parenteral, topical, and rectal routes. Circulating drug binds extensively to plasma proteins, and only the unbound portion of a dose is active. Systemic hydrocortisone is quickly distributed into the kidneys, intestines, skin, liver, and muscle. Corticosteroids distribute into breast milk and cross the placenta. Systemic hydrocortisone is metabolized by the liver to inactive metabolites. These inactive metabolites, as well as a small portion of unchanged drug, are excreted in the urine. The biological half-life of hydrocortisone is 8 to 12 hours.

       

      Affected cytochrome P450 (CYP450) isoenzymes and drug transporters: None

      Route-Specific Pharmacokinetics

      Oral Route

      Hydrocortisone is rapidly absorbed after an oral dose; peak effects occur within 1 to 2 hours.

      Intravenous Route

      Peak effects of hydrocortisone after intravenous administration occur within 1 to 2 hours.

      Intramuscular Route

      After intramuscular administration of hydrocortisone, the onset and duration of action depend on the type of injection and the extent of the local blood supply.

      Topical Route

      Systemic absorption after topical application of hydrocortisone is dependant on the vehicle, the state of the skin at the application site, the use of occlusive dressings, and the age of the patient. Absorption is increased in areas that have skin damage, inflammation, or occlusion, or where the stratum corneum is thin such as the eyelids, genitalia, and face. Factors that can increase systemic absorption of topical hydrocortisone include occlusive dressings, large surface area, frequent application, longer duration of treatment, increased humidity or temperature, and younger age.[51799] Topical preparations distribute throughout the area of application but are only minimally absorbed into the circulation. Topical preparations of hydrocortisone are metabolized in the skin.

      Other Route(s)

      Rectal Route

      When a suppository containing hydrocortisone acetate is administered rectally, about 26% of a dose is absorbed in normal subjects; absorption may vary across abraded or inflamed surfaces.[54060] Hydrocortisone rectal suspension is partially absorbed after rectal administration. In patients with ulcerative colitis, up to 50% of hydrocortisone was absorbed when administered as the rectal suspension.[45274]

       

      Intra-articular Route

      The onset and duration of action depend on type of hydrocortisone injection and the extent of the local blood supply.

      Special Populations

      Hepatic Impairment

      Hydrocortisone is a synthetic preparation of the steroid hormone cortisol and does not undergo bioconversion in the liver to active form. There is an enhanced effect due to decreased metabolism of corticosteroids in patients with cirrhosis.[54049][68680]

      Pediatrics

      Children and Adolescents

      During an open-label trial of pediatric patients (n = 24) with adrenocortical insufficiency, hydrocortisone oral granules (1 to 4 mg based on body surface area) increased median cortisol concentrations from baseline to 19.4 mcg/dL (range 12.5 to 52.4 mcg/dL) at Cmax (60 minutes post-dose).[66033] Cortisol clearance was significantly increased in pubertal patients (n = 20, age 10.6 to 16.8 years) compared to prepubertal (n = 14, age 6.1 to 11 years) and postpubertal patients (n = 6, age 17.2 to 20.3 years) with congenital adrenal hyperplasia. Volume of distribution was higher in pubertal patients compared to prepubertal and postpubertal patients; however, only the difference between pubertal and prepubertal patients reached statistical significance. The mean clearance and volume distribution of free cortisol after a single dose of hydrocortisone 15 mg/m2 IV were 4,787.7 mL/minute and 540.7 L, respectively, in the pubertal group. Mean clearance in the prepubertal and postpubertal groups was 2,477.4 mL/minute and 3,001.8 mL/minute, respectively; mean volume of distribution in these 2 groups was 237 L and 276.6 L, respectively. There were no significant differences in half-life between the 3 groups (mean half-life 67.2 minutes, 77.1 minutes, and 62.5 minutes in the prepubertal, pubertal, and postpubertal groups, respectively).[54065]

       

      Neonates

      The half-life of hydrocortisone is prolonged in premature (8 to 12 hours) and term (4 hours) neonates compared to adults (1.7 to 2.1 hours).[54041][54046]

      Revision Date: 06/12/2024, 01:59:00 AM

      References

      45274 - Hydrocortisone rectal suspension. Baltimore, MD. BayPharma, Inc.; 2008 Jun.51799 - Morley KW, Dinulos JG. Update on topical glucocorticoid use in children. Curr Opin Pediatr 2012;24(1):121-12854041 - Watterberg K. Evidence-based neonatal pharmacotherapy: postnatal corticosteroids. Clin Perinatol 2012;39:47-59.54046 - Czock D, Keller F, Rasche FM, et al. Pharmacokinetics and pharmacodynamics of systemically administered glucocorticoids. Clin Pharmacokinet 2005;44:61-98.54049 - Solu-cortef (hydrocortisone sodium succinate) injection package insert. New York, NY: Pharmacia & Upjohn Co.; 2023 Dec.54060 - Anusol HC (hydrocortisone acetate) suppository package insert. Bridgewater, NJ: Valeant Pharmaceuticals North America LLC; 2017 OCt.54065 - Charmandari E, Hindmarsh PC, Johnston A. Congenital adrenal hyperplasia due to 21-hydroxylase deficiency: alterations in cortisol pharmacokinetics at puberty. J Clin Endocrinol Metab 2001;86:2701-8.66033 - Alkindi sprinkle oral granules (hydrocortisone) package insert. Baden-Wuerttemberg, Germany: Glatt Pharmaceutical Services GmbH & Co.; 2022 Dec.68680 - Williams DM. Clinical Pharmacology of Corticosteroids. Respir Care. 2018;63:655-670.

      Pregnancy/Breast-feeding

      pregnancy

      Systemic and rectal preparations of hydrocortisone must be used with caution during human pregnancy. Corticosteroids are generally teratogenic in laboratory animals when administered systemically at relatively low dosage levels. Complications, including cleft palate, stillbirth, and premature abortion, have been reported during animal studies. If hydrocortisone must be used during pregnancy, the potential risks should be discussed with the patient. However, insufficient treatment of an underlying condition (e.g., Addison's disease) during pregnancy is also associated with fetal and maternal risks and the mother may require additional monitoring to ensure adequate replacement during pregnancy and in the post-partum period as requirements return to pre-pregnancy levels. Infants born to mothers who have taken substantial doses of corticosteroids during pregnancy should be monitored for signs of hypoadrenalism.[54278] [32057] [54049] [54060] [62343] Topical application of hydrocortisone warrants caution during pregnancy as there are no adequate and well-controlled studies. Topical corticosteroids should not be used in large amounts, on large areas, or for prolonged periods of time in pregnant women. Guidelines recommend mild to moderate potency agents, such as topical hydrocortisone, over potent topical corticosteroids, which should be used in short durations. Fetal growth restriction and a significantly increased risk of low birthweight has been reported with use of potent or very potent topical corticosteroids during the third trimester, particularly when using more than 300 grams. Corticosteroids are generally teratogenic in laboratory animals when administered systemically at relatively low dosage levels. The more potent corticosteroids have been shown to be teratogenic after dermal application in laboratory animals.[42474] [62348] [62792] Systemic corticosteroids have been shown to impair fertility in male rats; the impact to human male fertility is not certain.[54278] [54049]

      breast-feeding

      The use of systemic and rectal hydrocortisone has not been studied during breast-feeding; however cortisol is a normal component of breast milk.[32057] [54278] [54049] [54060] [62343] Other corticosteroids (prednisone and prednisolone) are usually considered compatible with breast-feeding.[27500] It is not known whether topical administration of desonide could result in sufficient systemic absorption to produce detectable quantities in breast milk.[42474] [62348] However, most dermatologists stress that topical corticosteroids can be safely used during lactation and breast-feeding.[62791] If applied topically, care should be used to ensure the infant will not come into direct contact with the area of application, such as the breast. Increased blood pressure has been reported in an infant whose mother applied a high potency topical corticosteroid ointment directly to the nipples. Consider the benefits of breast-feeding, the risk of potential infant drug exposure, and the risk of an untreated or inadequately treated condition. If a breast-feeding infant experiences an adverse effect related to a maternally ingested drug, healthcare providers are encouraged to report the adverse effect to the FDA.

      Revision Date: 06/12/2024, 01:59:00 AM

      References

      27500 - American Academy of Pediatrics (AAP) Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics 2001;108(3):776-789.32057 - Cortef (hydrocortisone tablets, USP) package insert. New York, NY: Pharmacia & Upjohn Co., Inc.; 2024 June42474 - Hydrocortisone 1% cream package insert. Melville, NY: E. Fougera & Co.; 2006 Jun.54049 - Solu-cortef (hydrocortisone sodium succinate) injection package insert. New York, NY: Pharmacia & Upjohn Co.; 2023 Dec.54060 - Anusol HC (hydrocortisone acetate) suppository package insert. Bridgewater, NJ: Valeant Pharmaceuticals North America LLC; 2017 OCt.54278 - Solu-Cortef (hydrocortisone sodium succinate) injection package insert. New York, NY: Pharmacia and Upjohn Co.; 2023 Dec.62343 - Cortenema (hydrocortisone retention enema) package insert. Baltimore, MD. ANI Pharmaceuticals, Inc.; 2007 Sept.62348 - Hydrocortisone valerate 0.2% cream and ointment package insert. Haethorne, NY: Taro Pharmaceuticals USA, Inc; 2015 Oct.62791 - Butler DC, Heller MM, Murase JE. Safety of dermatologic medications in pregnancy and lactation: Part II. Lactation. J Am Acad Dermatol. 2014;70:417.e1-10. Review.62792 - Murase JE, Heller MM, Butler DC. Safety of dermatologic medications in pregnancy and lactation: Part I. Pregnancy. J Am Acad Dermatol. 2014;70:401.e1-14. Review.

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      • Aspirin, ASA
      • Aspirin, ASA; Butalbital; Caffeine
      • Aspirin, ASA; Caffeine
      • Aspirin, ASA; Caffeine; Orphenadrine
      • Aspirin, ASA; Carisoprodol; Codeine
      • Aspirin, ASA; Citric Acid; Sodium Bicarbonate
      • Aspirin, ASA; Dipyridamole
      • Aspirin, ASA; Omeprazole
      • Aspirin, ASA; Oxycodone
      • Atenolol; Chlorthalidone
      • Atracurium
      • Azilsartan; Chlorthalidone
      • Benazepril; Hydrochlorothiazide, HCTZ
      • Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
      • Bexagliflozin
      • Bismuth Subsalicylate
      • Bismuth Subsalicylate; Metronidazole; Tetracycline
      • Bisoprolol; Hydrochlorothiazide, HCTZ
      • Brompheniramine; Dextromethorphan; Phenylephrine
      • Brompheniramine; Phenylephrine
      • Bumetanide
      • Bupivacaine; Epinephrine
      • Bupivacaine; Meloxicam
      • Bupropion
      • Bupropion; Naltrexone
      • Butalbital; Aspirin; Caffeine; Codeine
      • Caffeine; Sodium Benzoate
      • Canagliflozin
      • Canagliflozin; Metformin
      • Candesartan; Hydrochlorothiazide, HCTZ
      • Captopril; Hydrochlorothiazide, HCTZ
      • Celecoxib
      • Celecoxib; Tramadol
      • Chlorothiazide
      • Chlorpheniramine; Dextromethorphan; Phenylephrine
      • Chlorpheniramine; Ibuprofen; Pseudoephedrine
      • Chlorpheniramine; Phenylephrine
      • Chlorthalidone
      • Cholera Vaccine
      • Cholestyramine
      • Choline Salicylate; Magnesium Salicylate
      • Ciprofloxacin
      • Cisatracurium
      • Clarithromycin
      • Codeine; Phenylephrine; Promethazine
      • Colestipol
      • Conjugated Estrogens
      • Conjugated Estrogens; Bazedoxifene
      • Conjugated Estrogens; Medroxyprogesterone
      • Dapagliflozin
      • Dapagliflozin; Metformin
      • Dapagliflozin; Saxagliptin
      • Delafloxacin
      • Dengue Tetravalent Vaccine, Live
      • Denosumab
      • Desogestrel; Ethinyl Estradiol
      • Dexbrompheniramine; Dextromethorphan; Phenylephrine
      • Dextromethorphan; Bupropion
      • Dextromethorphan; Diphenhydramine; Phenylephrine
      • Dextromethorphan; Guaifenesin; Phenylephrine
      • Diclofenac
      • Diclofenac; Misoprostol
      • Dienogest; Estradiol valerate
      • Diflunisal
      • Dipeptidyl Peptidase-4 Inhibitors
      • Diphenhydramine; Ibuprofen
      • Diphenhydramine; Naproxen
      • Diphenhydramine; Phenylephrine
      • Diphtheria Toxoid, Tetanus Toxoid, Acellular Pertussis Vaccine, DTaP; Haemophilus influenzae type b Conjugate Vaccine; Hepatitis B Vaccine, Recombinant; Inactivated Poliovirus Vaccine, IPV
      • Diphtheria Toxoid, Tetanus Toxoid, Acellular Pertussis Vaccine, DTaP; Haemophilus influenzae type b Conjugate Vaccine; Inactivated Poliovirus Vaccine, IPV
      • Diphtheria Toxoid, Tetanus Toxoid, Acellular Pertussis Vaccine, DTaP; Hepatitis B Vaccine, Recombinant; Inactivated Poliovirus Vaccine, IPV
      • Diphtheria Toxoid, Tetanus Toxoid, Acellular Pertussis Vaccine, DTaP; Inactivated Poliovirus Vaccine, IPV
      • Diphtheria Toxoid; Tetanus Toxoid Adsorbed, DT, Td
      • Diphtheria/Tetanus Toxoids; Pertussis Vaccine
      • Droperidol
      • Drospirenone; Estetrol
      • Drospirenone; Estradiol
      • Drospirenone; Ethinyl Estradiol
      • Drospirenone; Ethinyl Estradiol; Levomefolate
      • Dulaglutide
      • Echinacea
      • Elagolix; Estradiol; Norethindrone acetate
      • Empagliflozin
      • Empagliflozin; Linagliptin
      • Empagliflozin; Linagliptin; Metformin
      • Empagliflozin; Metformin
      • Enalapril; Hydrochlorothiazide, HCTZ
      • Encorafenib
      • Ephedrine
      • Ephedrine; Guaifenesin
      • Epinephrine
      • Eprosartan; Hydrochlorothiazide, HCTZ
      • Erlotinib
      • Ertugliflozin
      • Ertugliflozin; Metformin
      • Ertugliflozin; Sitagliptin
      • Erythromycin
      • Eslicarbazepine
      • Esterified Estrogens
      • Esterified Estrogens; Methyltestosterone
      • Estradiol
      • Estradiol; Levonorgestrel
      • Estradiol; Norethindrone
      • Estradiol; Norgestimate
      • Estradiol; Progesterone
      • Estrogens
      • Estropipate
      • Ethacrynic Acid
      • Ethinyl Estradiol; Norelgestromin
      • Ethinyl Estradiol; Norethindrone Acetate
      • Ethinyl Estradiol; Norgestrel
      • Ethynodiol Diacetate; Ethinyl Estradiol
      • Etodolac
      • Etonogestrel; Ethinyl Estradiol
      • Exenatide
      • Fenoprofen
      • Flurbiprofen
      • Fosinopril; Hydrochlorothiazide, HCTZ
      • Furosemide
      • Gallium Ga 68 Dotatate
      • Gemifloxacin
      • Glimepiride
      • Glipizide
      • Glipizide; Metformin
      • Glyburide
      • Glyburide; Metformin
      • Glycerol Phenylbutyrate
      • Guaifenesin; Phenylephrine
      • Haemophilus influenzae type b Conjugate Vaccine
      • Haloperidol
      • Hemin
      • Hepatitis A Vaccine, Inactivated
      • Hepatitis A Vaccine, Inactivated; Hepatitis B Vaccine, Recombinant
      • Hepatitis B Vaccine, Recombinant
      • Human Papillomavirus 9-Valent Vaccine
      • Hydrochlorothiazide, HCTZ
      • Hydrochlorothiazide, HCTZ; Moexipril
      • Hydrocodone; Ibuprofen
      • Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
      • Ibuprofen
      • Ibuprofen; Famotidine
      • Ibuprofen; Oxycodone
      • Ibuprofen; Pseudoephedrine
      • Incretin Mimetics
      • Indapamide
      • Indomethacin
      • Inebilizumab
      • Influenza Virus Vaccine
      • Insulin Aspart
      • Insulin Aspart; Insulin Aspart Protamine
      • Insulin Degludec
      • Insulin Degludec; Liraglutide
      • Insulin Detemir
      • Insulin Glargine
      • Insulin Glargine; Lixisenatide
      • Insulin Glulisine
      • Insulin Lispro
      • Insulin Lispro; Insulin Lispro Protamine
      • Insulin, Inhaled
      • Insulins
      • Irbesartan; Hydrochlorothiazide, HCTZ
      • Isophane Insulin (NPH)
      • Isoproterenol
      • Japanese Encephalitis Virus Vaccine
      • Ketoprofen
      • Ketorolac
      • Lansoprazole; Amoxicillin; Clarithromycin
      • Lenacapavir
      • Levofloxacin
      • Levonorgestrel; Ethinyl Estradiol
      • Levonorgestrel; Ethinyl Estradiol; Ferrous Bisglycinate
      • Levonorgestrel; Ethinyl Estradiol; Ferrous Fumarate
      • Lidocaine; Epinephrine
      • Linagliptin
      • Linagliptin; Metformin
      • Liraglutide
      • Lisinopril; Hydrochlorothiazide, HCTZ
      • Lixisenatide
      • Lonapegsomatropin
      • Loop diuretics
      • Losartan; Hydrochlorothiazide, HCTZ
      • Magnesium Salicylate
      • Mannitol
      • Mecasermin, Recombinant, rh-IGF-1
      • Meclofenamate Sodium
      • Mefenamic Acid
      • Meglitinides
      • Meloxicam
      • Meningococcal Group B Vaccine (3 strain)
      • Meningococcal Group B Vaccine (4 strain)
      • Meningococcal Groups A, B, C, W, and Y Vaccine (5 valent)
      • Meningococcal Groups A, C, W, and Y Vaccine (4 valent)
      • Metformin
      • Metformin; Repaglinide
      • Metformin; Saxagliptin
      • Metformin; Sitagliptin
      • Methazolamide
      • Methenamine; Sodium Salicylate
      • Metolazone
      • Metoprolol; Hydrochlorothiazide, HCTZ
      • Micafungin
      • Miglitol
      • Moxifloxacin
      • Nabumetone
      • Naproxen
      • Naproxen; Esomeprazole
      • Naproxen; Pseudoephedrine
      • Nateglinide
      • Neostigmine
      • Neostigmine; Glycopyrrolate
      • Neuromuscular blockers
      • Non-Live Vaccines
      • Nonsteroidal antiinflammatory drugs
      • Norethindrone Acetate; Ethinyl Estradiol; Ferrous fumarate
      • Norethindrone; Ethinyl Estradiol
      • Norethindrone; Ethinyl Estradiol; Ferrous fumarate
      • Norgestimate; Ethinyl Estradiol
      • Ocrelizumab
      • Ofatumumab
      • Ofloxacin
      • Olmesartan; Amlodipine; Hydrochlorothiazide, HCTZ
      • Olmesartan; Hydrochlorothiazide, HCTZ
      • Oxaprozin
      • Oxymetholone
      • Ozanimod
      • Pancuronium
      • Pegaspargase
      • Phenylephrine
      • Physostigmine
      • Pimozide
      • Pioglitazone
      • Pioglitazone; Glimepiride
      • Pioglitazone; Metformin
      • Piroxicam
      • Pneumococcal Vaccine, Polyvalent
      • Ponesimod
      • Pramlintide
      • Prasterone, Dehydroepiandrosterone, DHEA (Dietary Supplements)
      • Prasterone, Dehydroepiandrosterone, DHEA (FDA-approved)
      • Prilocaine; Epinephrine
      • Promethazine; Phenylephrine
      • Propranolol
      • Pyridostigmine
      • Quinapril; Hydrochlorothiazide, HCTZ
      • Quinolones
      • Rabies Vaccine
      • Regular Insulin
      • Regular Insulin; Isophane Insulin (NPH)
      • Relugolix; Estradiol; Norethindrone acetate
      • Repaglinide
      • Respiratory Syncytial Virus Vaccine
      • Rituximab
      • Rituximab; Hyaluronidase
      • Rocuronium
      • Rosiglitazone
      • Salicylates
      • Salsalate
      • SARS-CoV-2 (COVID-19) vaccines
      • SARS-CoV-2 Virus (COVID-19) Adenovirus Vector Vaccine
      • SARS-CoV-2 Virus (COVID-19) mRNA Vaccine
      • SARS-CoV-2 Virus (COVID-19) Recombinant Spike Protein Nanoparticle Vaccine
      • Saxagliptin
      • Segesterone Acetate; Ethinyl Estradiol
      • Semaglutide
      • SGLT2 Inhibitors
      • Siponimod
      • Sitagliptin
      • Sodium Benzoate; Sodium Phenylacetate
      • Sodium Phenylbutyrate
      • Sodium Phenylbutyrate; Taurursodiol
      • Somapacitan
      • Somatrogon
      • Somatropin, rh-GH
      • Sotagliflozin
      • Spironolactone; Hydrochlorothiazide, HCTZ
      • Succinylcholine
      • Sulfonylureas
      • Sulindac
      • Sumatriptan; Naproxen
      • Telmisartan; Hydrochlorothiazide, HCTZ
      • Testosterone
      • Thiazide diuretics
      • Thiazolidinediones
      • Tick-Borne Encephalitis Vaccine
      • Tirzepatide
      • Tocilizumab
      • Tolmetin
      • Torsemide
      • Triamterene; Hydrochlorothiazide, HCTZ
      • Tuberculin Purified Protein Derivative, PPD
      • Valsartan; Hydrochlorothiazide, HCTZ
      • Vecuronium
      • Vonoprazan; Amoxicillin; Clarithromycin
      • Voriconazole
      • Vorinostat
      • Warfarin

      Level 4 (Minor)

      • Amiloride
      • Aminolevulinic Acid
      • Azathioprine
      • Basiliximab
      • Bortezomib
      • Carmustine, BCNU
      • Chlorambucil
      • Cladribine
      • Clofarabine
      • Econazole
      • Estramustine
      • Fludarabine
      • Hydroxyurea
      • Ibritumomab Tiuxetan
      • Interferon Alfa-2b
      • Isotretinoin
      • Lomustine, CCNU
      • Mercaptopurine, 6-MP
      • Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine
      • Methoxsalen
      • Mitoxantrone
      • Nelarabine
      • Pentostatin
      • Photosensitizing agents (topical)
      • Potassium Phosphate; Sodium Phosphate
      • Potassium-sparing diuretics
      • Purine analogs
      • Sodium Phosphate Monobasic Monohydrate; Sodium Phosphate Dibasic Anhydrous
      • Spironolactone
      • Thioguanine, 6-TG
      • Tretinoin, ATRA
      • Triamterene
      • Vincristine Liposomal
      • Zafirlukast
      Abatacept: (Moderate) Concomitant use of immunosuppressives, as well as long-term corticosteroids, may potentially increase the risk of serious infection in abatacept treated patients. Advise patients taking abatacept to seek immediate medical advice if they develop signs and symptoms suggestive of infection. [8565] Acarbose: (Moderate) Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Systemic and inhaled corticosteroids are known to increase blood glucose and worsen glycemic control in patients taking antidiabetic agents. The main risk factors for impaired glucose tolerance due to corticosteroids are the dose of steroid and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [62853] Acetaminophen; Aspirin, ASA; Caffeine: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Concomitant use increases the risk of GI bleeding. In patients receiving concomitant corticosteroids and chronic use of salicylates, withdrawal of corticosteroids may result in salicylism because corticosteroids enhance renal clearance of salicylates and their withdrawal is followed by return to normal rates of renal clearance. [24574] [28502] Acetaminophen; Aspirin: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Concomitant use increases the risk of GI bleeding. In patients receiving concomitant corticosteroids and chronic use of salicylates, withdrawal of corticosteroids may result in salicylism because corticosteroids enhance renal clearance of salicylates and their withdrawal is followed by return to normal rates of renal clearance. [24574] [28502] Acetaminophen; Aspirin; diphenhydrAMINE: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Concomitant use increases the risk of GI bleeding. In patients receiving concomitant corticosteroids and chronic use of salicylates, withdrawal of corticosteroids may result in salicylism because corticosteroids enhance renal clearance of salicylates and their withdrawal is followed by return to normal rates of renal clearance. [24574] [28502] Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine: (Moderate) The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Monitor patients for increased pressor effect if these agents are administered concomitantly. [54374] [57578] Acetaminophen; Chlorpheniramine; Phenylephrine : (Moderate) The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Monitor patients for increased pressor effect if these agents are administered concomitantly. [54374] [57578] Acetaminophen; Dextromethorphan; guaiFENesin; Phenylephrine: (Moderate) The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Monitor patients for increased pressor effect if these agents are administered concomitantly. [54374] [57578] Acetaminophen; Dextromethorphan; Phenylephrine: (Moderate) The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Monitor patients for increased pressor effect if these agents are administered concomitantly. [54374] [57578] Acetaminophen; guaiFENesin; Phenylephrine: (Moderate) The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Monitor patients for increased pressor effect if these agents are administered concomitantly. [54374] [57578] Acetaminophen; Ibuprofen: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and nonsteroidal antiinflammatory drug (NSAID) use. Concomitant use increases the risk of GI bleeding. [24574] [29611] [35893] Acetaminophen; Phenylephrine: (Moderate) The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Monitor patients for increased pressor effect if these agents are administered concomitantly. [54374] [57578] acetaZOLAMIDE: (Moderate) Corticosteroids may increase the risk of hypokalemia if used concurrently with acetazolamide. Hypokalemia may be especially severe with prolonged use of corticotropin, ACTH. Monitor serum potassium levels to determine the need for potassium supplementation and/or alteration in drug therapy. [26417] [28267] Aldesleukin, IL-2: (Major) Avoid coadministration of corticosteroids with aldesleukin. Corticosteroids can be immunosuppressive. Aldesleukin is an interleukin-2 lymphocyte growth factor which induces lymphokine-activated killer (LAK) cells, natural killer (NK) cells, and interferon gamma production. Concomitant use may reduce the efficacy of aldesleukin. [41853] Alemtuzumab: (Moderate) Concomitant use of alemtuzumab with immunosuppressant doses of corticosteroids may increase the risk of immunosuppression. Monitor patients carefully for signs and symptoms of infection. [58461] Aliskiren; hydroCHLOROthiazide, HCTZ: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] Alogliptin: (Moderate) Monitor blood glucose during concomitant corticosteroid and dipeptidyl peptidase-4 (DPP-4) inhibitor use; a DPP-4 dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Alogliptin; metFORMIN: (Moderate) Monitor blood glucose during concomitant corticosteroid and dipeptidyl peptidase-4 (DPP-4) inhibitor use; a DPP-4 dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] (Moderate) Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [28550] [30585] [51002] [51324] [62853] Alogliptin; Pioglitazone: (Moderate) Monitor blood glucose during concomitant corticosteroid and dipeptidyl peptidase-4 (DPP-4) inhibitor use; a DPP-4 dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] (Moderate) Monitor blood glucose during concomitant corticosteroid and thiazolidinedione use; a thiazolidinedione dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Alpha-glucosidase Inhibitors: (Moderate) Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Systemic and inhaled corticosteroids are known to increase blood glucose and worsen glycemic control in patients taking antidiabetic agents. The main risk factors for impaired glucose tolerance due to corticosteroids are the dose of steroid and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [62853] Amifampridine: (Moderate) Carefully consider the need for concomitant treatment with systemic corticosteroids and amifampridine, as coadministration may increase the risk of seizures. If coadministration occurs, closely monitor patients for seizure activity. Seizures have been observed in patients without a history of seizures taking amifampridine at recommended doses. Systemic corticosteroids may increase the risk of seizures in some patients. [45339] [63790] aMILoride: (Minor) The manufacturer of spironolactone lists corticosteroids as a potential drug that interacts with spironolactone. Intensified electrolyte depletion, particularly hypokalemia, may occur. However, potassium-sparing diuretics such as spironolactone do not induce hypokalemia. In fact, hypokalemia is one of the indications for potassium-sparing diuretic therapy. Therefore, drugs that induce potassium loss, such as corticosteroids, could counter the hyperkalemic effects of potassium-sparing diuretics. [26417] [29016] [30011] aMILoride; hydroCHLOROthiazide, HCTZ: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] (Minor) The manufacturer of spironolactone lists corticosteroids as a potential drug that interacts with spironolactone. Intensified electrolyte depletion, particularly hypokalemia, may occur. However, potassium-sparing diuretics such as spironolactone do not induce hypokalemia. In fact, hypokalemia is one of the indications for potassium-sparing diuretic therapy. Therefore, drugs that induce potassium loss, such as corticosteroids, could counter the hyperkalemic effects of potassium-sparing diuretics. [26417] [29016] [30011] Aminolevulinic Acid: (Minor) Corticosteroids administered prior to or concomitantly with photosensitizing agents used in photodynamic therapy may decrease the efficacy of the treatment. [6625] Aminosalicylate sodium, Aminosalicylic acid: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Concomitant use increases the risk of GI bleeding. In patients receiving concomitant corticosteroids and chronic use of salicylates, withdrawal of corticosteroids may result in salicylism because corticosteroids enhance renal clearance of salicylates and their withdrawal is followed by return to normal rates of renal clearance. [24574] [28502] amLODIPine; Celecoxib: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and nonsteroidal antiinflammatory drug (NSAID) use. Concomitant use increases the risk of GI bleeding. [24574] [29611] [35893] amLODIPine; Valsartan; hydroCHLOROthiazide, HCTZ: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] Amoxicillin; Clarithromycin; Omeprazole: (Moderate) Clarithromycin inhibits CYP3A4 and has the potential to result in increased plasma concentrations of corticosteroids. Therefore, the dose of corticosteroid should be titrated to avoid steroid toxicity. [28001] Amphotericin B lipid complex (ABLC): (Moderate) Monitor serum electrolytes and cardiac function during concomitant use. Corticosteroids have potassium-wasting effects and may potentiate hypokalemia during amphotericin B therapy and increase the risk for cardiac dysfunction. There have been cases reported in which concomitant use of amphotericin B and systemic corticosteroids was followed by cardiac enlargement and congestive heart failure. [26417] [35434] [35435] [45579] [54049] Amphotericin B liposomal (LAmB): (Moderate) Monitor serum electrolytes and cardiac function during concomitant use. Corticosteroids have potassium-wasting effects and may potentiate hypokalemia during amphotericin B therapy and increase the risk for cardiac dysfunction. There have been cases reported in which concomitant use of amphotericin B and systemic corticosteroids was followed by cardiac enlargement and congestive heart failure. [26417] [35434] [35435] [45579] [54049] Amphotericin B: (Moderate) Monitor serum electrolytes and cardiac function during concomitant use. Corticosteroids have potassium-wasting effects and may potentiate hypokalemia during amphotericin B therapy and increase the risk for cardiac dysfunction. There have been cases reported in which concomitant use of amphotericin B and systemic corticosteroids was followed by cardiac enlargement and congestive heart failure. [26417] [35434] [35435] [45579] [54049] Anthrax Vaccine: (Moderate) Patients receiving high-dose corticosteroid therapy may have a diminished response to vaccines. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 2 weeks after discontinuation. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving high-dose corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine. [60092] [65107] Antithymocyte Globulin: (Moderate) Because systemically administered corticosteroids exhibit immunosuppressive effects when given in high doses and/or for extended periods, additive effects may be seen with other immunosuppressives or antineoplastic agents. [6303] [7714] Arsenic Trioxide: (Moderate) Caution is advisable during concurrent use of arsenic trioxide and corticosteroids as electrolyte imbalance caused by corticosteroids may increase the risk of QT prolongation with arsenic trioxide. [26417] [59438] Articaine; EPINEPHrine: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and epinephrine use due to risk for additive hypokalemia; potassium supplementation may be necessary. Corticosteroids may potentiate the hypokalemic effects of epinephrine. [26417] [56575] Asparaginase Erwinia chrysanthemi: (Moderate) Concomitant use of L-asparaginase with corticosteroids can result in additive hyperglycemia. L-Asparaginase transiently inhibits insulin production contributing to hyperglycemia seen during concurrent corticosteroid therapy. Insulin therapy may be required in some cases. Administration of L-asparaginase after rather than before corticosteroids reportedly has produced fewer hypersensitivity reactions. [55362] Aspirin, ASA: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Concomitant use increases the risk of GI bleeding. In patients receiving concomitant corticosteroids and chronic use of salicylates, withdrawal of corticosteroids may result in salicylism because corticosteroids enhance renal clearance of salicylates and their withdrawal is followed by return to normal rates of renal clearance. [24574] [28502] Aspirin, ASA; Butalbital; Caffeine: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Concomitant use increases the risk of GI bleeding. In patients receiving concomitant corticosteroids and chronic use of salicylates, withdrawal of corticosteroids may result in salicylism because corticosteroids enhance renal clearance of salicylates and their withdrawal is followed by return to normal rates of renal clearance. [24574] [28502] Aspirin, ASA; Caffeine: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Concomitant use increases the risk of GI bleeding. In patients receiving concomitant corticosteroids and chronic use of salicylates, withdrawal of corticosteroids may result in salicylism because corticosteroids enhance renal clearance of salicylates and their withdrawal is followed by return to normal rates of renal clearance. [24574] [28502] Aspirin, ASA; Caffeine; Orphenadrine: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Concomitant use increases the risk of GI bleeding. In patients receiving concomitant corticosteroids and chronic use of salicylates, withdrawal of corticosteroids may result in salicylism because corticosteroids enhance renal clearance of salicylates and their withdrawal is followed by return to normal rates of renal clearance. [24574] [28502] Aspirin, ASA; Carisoprodol; Codeine: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Concomitant use increases the risk of GI bleeding. In patients receiving concomitant corticosteroids and chronic use of salicylates, withdrawal of corticosteroids may result in salicylism because corticosteroids enhance renal clearance of salicylates and their withdrawal is followed by return to normal rates of renal clearance. [24574] [28502] Aspirin, ASA; Citric Acid; Sodium Bicarbonate: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Concomitant use increases the risk of GI bleeding. In patients receiving concomitant corticosteroids and chronic use of salicylates, withdrawal of corticosteroids may result in salicylism because corticosteroids enhance renal clearance of salicylates and their withdrawal is followed by return to normal rates of renal clearance. [24574] [28502] Aspirin, ASA; Dipyridamole: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Concomitant use increases the risk of GI bleeding. In patients receiving concomitant corticosteroids and chronic use of salicylates, withdrawal of corticosteroids may result in salicylism because corticosteroids enhance renal clearance of salicylates and their withdrawal is followed by return to normal rates of renal clearance. [24574] [28502] Aspirin, ASA; Omeprazole: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Concomitant use increases the risk of GI bleeding. In patients receiving concomitant corticosteroids and chronic use of salicylates, withdrawal of corticosteroids may result in salicylism because corticosteroids enhance renal clearance of salicylates and their withdrawal is followed by return to normal rates of renal clearance. [24574] [28502] Aspirin, ASA; oxyCODONE: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Concomitant use increases the risk of GI bleeding. In patients receiving concomitant corticosteroids and chronic use of salicylates, withdrawal of corticosteroids may result in salicylism because corticosteroids enhance renal clearance of salicylates and their withdrawal is followed by return to normal rates of renal clearance. [24574] [28502] Atenolol; Chlorthalidone: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] Atracurium: (Moderate) Limit the period of use of neuromuscular blockers and corticosteroids and only use when the specific advantages of the drugs outweigh the risks for acute myopathy. An acute myopathy has been observed with the use of high doses of corticosteroids in patients receiving concomitant long-term therapy with neuromuscular blockers. Clinical improvement or recovery after stopping therapy may require weeks to years. [41361] [41961] [42031] [43319] [54278] [60760] [61750] [61937] azaTHIOprine: (Minor) Because systemically administered corticosteroids exhibit immunosuppressive effects when given in high doses and/or for extended periods, additive effects may be seen with other immunosuppressives or antineoplastic agents. [4710] [7714] Azilsartan; Chlorthalidone: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] Bacillus Calmette-Guerin Vaccine, BCG: (Contraindicated) Avoid the administration of live virus vaccines with high-dose corticosteroid therapy and for at least 1 month following treatment. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated live virus vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 1 month after discontinuation. Patients with altered immunocompetence may be at increased risk for severe adverse reactions due to uninhibited growth of the attenuated live virus. Additionally, vaccine efficacy may be diminished in patients receiving any supraphysiologic dose of corticosteroid. [60092] [65107] Basiliximab: (Minor) Because systemically administered corticosteroids have immunosuppressive effects when given in high doses and/or for extended periods, additive effects may be seen with other immunosuppressives. [4746] Benazepril; hydroCHLOROthiazide, HCTZ: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Concomitant use increases the risk of GI bleeding. In patients receiving concomitant corticosteroids and chronic use of salicylates, withdrawal of corticosteroids may result in salicylism because corticosteroids enhance renal clearance of salicylates and their withdrawal is followed by return to normal rates of renal clearance. [24574] [28502] Bexagliflozin: (Moderate) Monitor blood glucose during concomitant corticosteroid and SGLT2 inhibitor use; a SGLT2 inhibitor dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Bismuth Subsalicylate: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Concomitant use increases the risk of GI bleeding. In patients receiving concomitant corticosteroids and chronic use of salicylates, withdrawal of corticosteroids may result in salicylism because corticosteroids enhance renal clearance of salicylates and their withdrawal is followed by return to normal rates of renal clearance. [24574] [28502] Bismuth Subsalicylate; metroNIDAZOLE; Tetracycline: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Concomitant use increases the risk of GI bleeding. In patients receiving concomitant corticosteroids and chronic use of salicylates, withdrawal of corticosteroids may result in salicylism because corticosteroids enhance renal clearance of salicylates and their withdrawal is followed by return to normal rates of renal clearance. [24574] [28502] Bisoprolol; hydroCHLOROthiazide, HCTZ: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] Bortezomib: (Minor) Because systemically administered corticosteroids exhibit immunosuppressive effects when given in high doses and/or for extended periods, additive effects may be seen with other immunosuppressives or antineoplastic agents. [7714] Brompheniramine; Dextromethorphan; Phenylephrine: (Moderate) The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Monitor patients for increased pressor effect if these agents are administered concomitantly. [54374] [57578] Brompheniramine; Phenylephrine: (Moderate) The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Monitor patients for increased pressor effect if these agents are administered concomitantly. [54374] [57578] Bumetanide: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and loop diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and loop diuretics cause increased renal potassium loss. [26417] [28429] [29779] BUPivacaine; EPINEPHrine: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and epinephrine use due to risk for additive hypokalemia; potassium supplementation may be necessary. Corticosteroids may potentiate the hypokalemic effects of epinephrine. [26417] [56575] BUPivacaine; Meloxicam: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and nonsteroidal antiinflammatory drug (NSAID) use. Concomitant use increases the risk of GI bleeding. [24574] [29611] [35893] buPROPion: (Moderate) Monitor for seizure activity during concomitant bupropion and corticosteroid use. Bupropion is associated with a dose-related seizure risk; concomitant use of other medications that lower the seizure threshold, such as systemic corticosteroids, increases the seizure risk. [44094] buPROPion; Naltrexone: (Moderate) Monitor for seizure activity during concomitant bupropion and corticosteroid use. Bupropion is associated with a dose-related seizure risk; concomitant use of other medications that lower the seizure threshold, such as systemic corticosteroids, increases the seizure risk. [44094] Butalbital; Aspirin; Caffeine; Codeine: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Concomitant use increases the risk of GI bleeding. In patients receiving concomitant corticosteroids and chronic use of salicylates, withdrawal of corticosteroids may result in salicylism because corticosteroids enhance renal clearance of salicylates and their withdrawal is followed by return to normal rates of renal clearance. [24574] [28502] Caffeine; Sodium Benzoate: (Moderate) Corticosteroids may cause protein breakdown, which could lead to elevated blood ammonia concentrations, especially in patients with an impaired ability to form urea. Corticosteroids should be used with caution in patients receiving treatment for hyperammonemia. [8083] Canagliflozin: (Moderate) Monitor blood glucose during concomitant corticosteroid and SGLT2 inhibitor use; a SGLT2 inhibitor dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Canagliflozin; metFORMIN: (Moderate) Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [28550] [30585] [51002] [51324] [62853] (Moderate) Monitor blood glucose during concomitant corticosteroid and SGLT2 inhibitor use; a SGLT2 inhibitor dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Candesartan; hydroCHLOROthiazide, HCTZ: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] Captopril; hydroCHLOROthiazide, HCTZ: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] Carmustine, BCNU: (Minor) Because systemically administered corticosteroids exhibit immunosuppressive effects when given in high doses and/or for extended periods, additive effects may be seen with other immunosuppressives or antineoplastic agents. [5946] [7714] [7944] Celecoxib: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and nonsteroidal antiinflammatory drug (NSAID) use. Concomitant use increases the risk of GI bleeding. [24574] [29611] [35893] Celecoxib; Tramadol: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and nonsteroidal antiinflammatory drug (NSAID) use. Concomitant use increases the risk of GI bleeding. [24574] [29611] [35893] Chikungunya Vaccine, Live: (Contraindicated) Avoid the administration of live virus vaccines with high-dose corticosteroid therapy and for at least 1 month following treatment. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated live virus vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 1 month after discontinuation. Patients with altered immunocompetence may be at increased risk for severe adverse reactions due to uninhibited growth of the attenuated live virus. Additionally, vaccine efficacy may be diminished in patients receiving any supraphysiologic dose of corticosteroid. [60092] [65107] Chlorambucil: (Minor) Because systemically administered corticosteroids exhibit immunosuppressive effects when given in high doses and/or for extended periods, additive effects may be seen with other immunosuppressives or antineoplastic agents. [4757] [7714] Chlorothiazide: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] Chlorpheniramine; Dextromethorphan; Phenylephrine: (Moderate) The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Monitor patients for increased pressor effect if these agents are administered concomitantly. [54374] [57578] Chlorpheniramine; Ibuprofen; Pseudoephedrine: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and nonsteroidal antiinflammatory drug (NSAID) use. Concomitant use increases the risk of GI bleeding. [24574] [29611] [35893] Chlorpheniramine; Phenylephrine: (Moderate) The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Monitor patients for increased pressor effect if these agents are administered concomitantly. [54374] [57578] Chlorthalidone: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] Cholera Vaccine: (Moderate) Patients receiving immunosuppressant medications may have a diminished response to the live cholera vaccine. When feasible, administer indicated vaccines prior to initiating immunosuppressant medications. Counsel patients receiving immunosuppressant medications about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure to cholera bacteria after receiving the vaccine. High-dose corticosteroid therapy may impair immune function and is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. [60092] [60871] [65107] Cholestyramine: (Moderate) Cholestyramine has been shown to bind to hydrocortisone. To minimize drug interactions, the manufacturer recommends to administer other drugs at least 1 hour before or at least 4 to 6 hours after the administration of cholestyramine. [28070] [30288] Choline Salicylate; Magnesium Salicylate: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Concomitant use increases the risk of GI bleeding. In patients receiving concomitant corticosteroids and chronic use of salicylates, withdrawal of corticosteroids may result in salicylism because corticosteroids enhance renal clearance of salicylates and their withdrawal is followed by return to normal rates of renal clearance. [24574] [28502] Ciprofloxacin: (Moderate) Quinolones have been associated with an increased risk of tendon rupture requiring surgical repair or resulting in prolonged disability; this risk is further increased in those receiving concomitant corticosteroids. Discontinue quinolone therapy at the first sign of tendon inflammation or tendon pain, as these are symptoms that may precede rupture of the tendon. [28423] [28424] [28764] [29818] [30738] [62028] [65562] Cisatracurium: (Moderate) Limit the period of use of neuromuscular blockers and corticosteroids and only use when the specific advantages of the drugs outweigh the risks for acute myopathy. An acute myopathy has been observed with the use of high doses of corticosteroids in patients receiving concomitant long-term therapy with neuromuscular blockers. Clinical improvement or recovery after stopping therapy may require weeks to years. [41361] [41961] [42031] [43319] [54278] [60760] [61750] [61937] Cladribine: (Minor) Concurrent use of purine analogs with other agents which cause bone marrow or immune suppression such as other antineoplastic agents or immunosuppressives may result in additive effects. [5504] Clarithromycin: (Moderate) Clarithromycin inhibits CYP3A4 and has the potential to result in increased plasma concentrations of corticosteroids. Therefore, the dose of corticosteroid should be titrated to avoid steroid toxicity. [28001] Clofarabine: (Minor) Because systemically administered corticosteroids exhibit immunosuppressive effects when given in high doses and/or for extended periods, additive effects may be seen with other immunosuppressives or antineoplastic agents. [7557] [7714] Codeine; Phenylephrine; Promethazine: (Moderate) The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Monitor patients for increased pressor effect if these agents are administered concomitantly. [54374] [57578] Colestipol: (Moderate) The bile-acid sequestrant colestipol is well-known to cause drug interactions by binding and decreasing the oral administration of many drugs. Colestipol can bind with and possibly decrease the oral absorption of hydrocortisone. According to the manufacturer, administer other drugs at least 1 hour before or at least 4 to 6 hours after the administration of colestipol. [4794] [7038] Conjugated Estrogens: (Moderate) Monitor for corticosteroid-related adverse events if corticosteroids are used with estrogens. Concurrent use may increase the exposure of corticosteroids. Estrogens may decrease the hepatic clearance of corticosteroids thereby increasing their effect. [29779] [54049] Conjugated Estrogens; Bazedoxifene: (Moderate) Monitor for corticosteroid-related adverse events if corticosteroids are used with estrogens. Concurrent use may increase the exposure of corticosteroids. Estrogens may decrease the hepatic clearance of corticosteroids thereby increasing their effect. [29779] [54049] Conjugated Estrogens; medroxyPROGESTERone: (Moderate) Monitor for corticosteroid-related adverse events if corticosteroids are used with estrogens. Concurrent use may increase the exposure of corticosteroids. Estrogens may decrease the hepatic clearance of corticosteroids thereby increasing their effect. [29779] [54049] Cosyntropin: (Major) Patients receiving hydrocortisone should omit their pre-test doses on the day selected for testing. Patients taking inadvertent doses of hydrocortisone may exhibit abnormally high basal plasma cortisol concentrations and a decreased response to the test. A paradoxical decrease in plasma cortisol concentrations may be seen in patients receiving hydrocortisone following a stimulating dose of cosyntropin injection. [43709] Dapagliflozin: (Moderate) Monitor blood glucose during concomitant corticosteroid and SGLT2 inhibitor use; a SGLT2 inhibitor dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Dapagliflozin; metFORMIN: (Moderate) Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [28550] [30585] [51002] [51324] [62853] (Moderate) Monitor blood glucose during concomitant corticosteroid and SGLT2 inhibitor use; a SGLT2 inhibitor dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Dapagliflozin; sAXagliptin: (Moderate) Monitor blood glucose during concomitant corticosteroid and dipeptidyl peptidase-4 (DPP-4) inhibitor use; a DPP-4 dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] (Moderate) Monitor blood glucose during concomitant corticosteroid and SGLT2 inhibitor use; a SGLT2 inhibitor dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Delafloxacin: (Moderate) Quinolones have been associated with an increased risk of tendon rupture requiring surgical repair or resulting in prolonged disability; this risk is further increased in those receiving concomitant corticosteroids. Discontinue quinolone therapy at the first sign of tendon inflammation or tendon pain, as these are symptoms that may precede rupture of the tendon. [28423] [28424] [28764] [29818] [30738] [62028] [65562] Dengue Tetravalent Vaccine, Live: (Moderate) Patients receiving high-dose corticosteroid therapy may have a diminished response to the dengue virus vaccine. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 1 month after discontinuation. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving high-dose corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine. [60092] [64100] [65107] Denosumab: (Moderate) The safety and efficacy of denosumab use in patients with immunosuppression have not been evaluated. Patients receiving immunosuppressives along with denosumab may be at a greater risk of developing an infection. [40862] Desmopressin: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer. [42295] [61806] Desogestrel; Ethinyl Estradiol: (Moderate) Monitor for corticosteroid-related adverse events if corticosteroids are used with estrogens. Concurrent use may increase the exposure of corticosteroids. Estrogens may decrease the hepatic clearance of corticosteroids thereby increasing their effect. [29779] [54049] Dexbrompheniramine; Dextromethorphan; Phenylephrine: (Moderate) The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Monitor patients for increased pressor effect if these agents are administered concomitantly. [54374] [57578] Dextromethorphan; buPROPion: (Moderate) Monitor for seizure activity during concomitant bupropion and corticosteroid use. Bupropion is associated with a dose-related seizure risk; concomitant use of other medications that lower the seizure threshold, such as systemic corticosteroids, increases the seizure risk. [44094] Dextromethorphan; diphenhydrAMINE; Phenylephrine: (Moderate) The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Monitor patients for increased pressor effect if these agents are administered concomitantly. [54374] [57578] Dextromethorphan; guaiFENesin; Phenylephrine: (Moderate) The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Monitor patients for increased pressor effect if these agents are administered concomitantly. [54374] [57578] Diclofenac: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and nonsteroidal antiinflammatory drug (NSAID) use. Concomitant use increases the risk of GI bleeding. [24574] [29611] [35893] Diclofenac; miSOPROStol: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and nonsteroidal antiinflammatory drug (NSAID) use. Concomitant use increases the risk of GI bleeding. [24574] [29611] [35893] Dienogest; Estradiol valerate: (Moderate) Monitor for corticosteroid-related adverse events if corticosteroids are used with estrogens. Concurrent use may increase the exposure of corticosteroids. Estrogens may decrease the hepatic clearance of corticosteroids thereby increasing their effect. [29779] [54049] Diflunisal: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and nonsteroidal antiinflammatory drug (NSAID) use. Concomitant use increases the risk of GI bleeding. [24574] [29611] [35893] Dipeptidyl Peptidase-4 Inhibitors: (Moderate) Monitor blood glucose during concomitant corticosteroid and dipeptidyl peptidase-4 (DPP-4) inhibitor use; a DPP-4 dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] diphenhydrAMINE; Ibuprofen: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and nonsteroidal antiinflammatory drug (NSAID) use. Concomitant use increases the risk of GI bleeding. [24574] [29611] [35893] diphenhydrAMINE; Naproxen: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and nonsteroidal antiinflammatory drug (NSAID) use. Concomitant use increases the risk of GI bleeding. [24574] [29611] [35893] diphenhydrAMINE; Phenylephrine: (Moderate) The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Monitor patients for increased pressor effect if these agents are administered concomitantly. [54374] [57578] Diphtheria Toxoid, Tetanus Toxoid, Acellular Pertussis Vaccine, DTaP; Haemophilus influenzae type b Conjugate Vaccine; Hepatitis B Vaccine, Recombinant; Inactivated Poliovirus Vaccine, IPV: (Moderate) Patients receiving high-dose corticosteroid therapy may have a diminished response to vaccines. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 2 weeks after discontinuation. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving high-dose corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine. [60092] [65107] Diphtheria Toxoid, Tetanus Toxoid, Acellular Pertussis Vaccine, DTaP; Haemophilus influenzae type b Conjugate Vaccine; Inactivated Poliovirus Vaccine, IPV: (Moderate) Patients receiving high-dose corticosteroid therapy may have a diminished response to vaccines. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 2 weeks after discontinuation. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving high-dose corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine. [60092] [65107] Diphtheria Toxoid, Tetanus Toxoid, Acellular Pertussis Vaccine, DTaP; Hepatitis B Vaccine, Recombinant; Inactivated Poliovirus Vaccine, IPV : (Moderate) Patients receiving high-dose corticosteroid therapy may have a diminished response to vaccines. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 2 weeks after discontinuation. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving high-dose corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine. [60092] [65107] Diphtheria Toxoid, Tetanus Toxoid, Acellular Pertussis Vaccine, DTaP; Inactivated Poliovirus Vaccine, IPV: (Moderate) Patients receiving high-dose corticosteroid therapy may have a diminished response to vaccines. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 2 weeks after discontinuation. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving high-dose corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine. [60092] [65107] Diphtheria Toxoid; Tetanus Toxoid Adsorbed, DT, Td: (Moderate) Patients receiving high-dose corticosteroid therapy may have a diminished response to vaccines. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 2 weeks after discontinuation. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving high-dose corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine. [60092] [65107] Diphtheria/Tetanus Toxoids; Pertussis Vaccine: (Moderate) Patients receiving high-dose corticosteroid therapy may have a diminished response to vaccines. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 2 weeks after discontinuation. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving high-dose corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine. [60092] [65107] Dofetilide: (Major) Corticosteroids can cause increases in blood pressure, sodium and water retention, and hypokalemia, predisposing patients to interactions with certain other medications. Corticosteroid-induced hypokalemia could also enhance the proarrhythmic effects of dofetilide. [49489] droPERidol: (Moderate) Caution is advised when using droperidol in combination with corticosteroids which may lead to electrolyte abnormalities, especially hypokalemia or hypomagnesemia, as such abnormalities may increase the risk for QT prolongation or cardiac arrhythmias. [5468] Drospirenone; Estetrol: (Moderate) Monitor for corticosteroid-related adverse events if corticosteroids are used with estrogens. Concurrent use may increase the exposure of corticosteroids. Estrogens may decrease the hepatic clearance of corticosteroids thereby increasing their effect. [29779] [54049] Drospirenone; Estradiol: (Moderate) Monitor for corticosteroid-related adverse events if corticosteroids are used with estrogens. Concurrent use may increase the exposure of corticosteroids. Estrogens may decrease the hepatic clearance of corticosteroids thereby increasing their effect. [29779] [54049] Drospirenone; Ethinyl Estradiol: (Moderate) Monitor for corticosteroid-related adverse events if corticosteroids are used with estrogens. Concurrent use may increase the exposure of corticosteroids. Estrogens may decrease the hepatic clearance of corticosteroids thereby increasing their effect. [29779] [54049] Drospirenone; Ethinyl Estradiol; Levomefolate: (Moderate) Monitor for corticosteroid-related adverse events if corticosteroids are used with estrogens. Concurrent use may increase the exposure of corticosteroids. Estrogens may decrease the hepatic clearance of corticosteroids thereby increasing their effect. [29779] [54049] Dulaglutide: (Moderate) Monitor blood glucose during concomitant corticosteroid and incretin mimetic use; an incretin mimetic dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Echinacea: (Moderate) Echinacea possesses immunostimulatory activity and may theoretically reduce the response to immunosuppressant drugs like corticosteroids. For some patients who are using corticosteroids for serious illness, such as cancer or organ transplant, this potential interaction may result in the preferable avoidance of Echinacea. Although documentation is lacking, coadministration of echinacea with immunosuppressants is not recommended by some resources. [25398] [32073] [61902] [61905] Econazole: (Minor) In vitro studies indicate that corticosteroids inhibit the antifungal activity of econazole against C. albicans in a concentration-dependent manner. When the concentration of the corticosteroid was equal to or greater than that of econazole on a weight basis, the antifungal activity of econazole was substantially inhibited. When the corticosteroid concentration was one-tenth that of econazole, no inhibition of antifungal activity was observed. [6968] Elagolix; Estradiol; Norethindrone acetate: (Moderate) Monitor for corticosteroid-related adverse events if corticosteroids are used with estrogens. Concurrent use may increase the exposure of corticosteroids. Estrogens may decrease the hepatic clearance of corticosteroids thereby increasing their effect. [29779] [54049] Empagliflozin: (Moderate) Monitor blood glucose during concomitant corticosteroid and SGLT2 inhibitor use; a SGLT2 inhibitor dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Empagliflozin; Linagliptin: (Moderate) Monitor blood glucose during concomitant corticosteroid and dipeptidyl peptidase-4 (DPP-4) inhibitor use; a DPP-4 dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] (Moderate) Monitor blood glucose during concomitant corticosteroid and SGLT2 inhibitor use; a SGLT2 inhibitor dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Empagliflozin; Linagliptin; metFORMIN: (Moderate) Monitor blood glucose during concomitant corticosteroid and dipeptidyl peptidase-4 (DPP-4) inhibitor use; a DPP-4 dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] (Moderate) Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [28550] [30585] [51002] [51324] [62853] (Moderate) Monitor blood glucose during concomitant corticosteroid and SGLT2 inhibitor use; a SGLT2 inhibitor dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Empagliflozin; metFORMIN: (Moderate) Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [28550] [30585] [51002] [51324] [62853] (Moderate) Monitor blood glucose during concomitant corticosteroid and SGLT2 inhibitor use; a SGLT2 inhibitor dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Enalapril; hydroCHLOROthiazide, HCTZ: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] Encorafenib: (Moderate) Monitor for decreased corticosteroid efficacy if hydrocortisone is used with encorafenib; a dosage increase may be necessary. Concurrent use may decrease hydrocortisone exposure. Hydrocortisone is a CYP3A substrate and encorafenib is a strong CYP3A inducer. [54049] [63317] ePHEDrine: (Moderate) Ephedrine may enhance the metabolic clearance of corticosteroids. Decreased blood concentrations and lessened physiologic activity may necessitate an increase in corticosteroid dosage. [8844] ePHEDrine; guaiFENesin: (Moderate) Ephedrine may enhance the metabolic clearance of corticosteroids. Decreased blood concentrations and lessened physiologic activity may necessitate an increase in corticosteroid dosage. [8844] EPINEPHrine: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and epinephrine use due to risk for additive hypokalemia; potassium supplementation may be necessary. Corticosteroids may potentiate the hypokalemic effects of epinephrine. [26417] [56575] Eprosartan; hydroCHLOROthiazide, HCTZ: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] Erlotinib: (Moderate) Monitor for symptoms of gastrointestinal (GI) perforation (e.g., severe abdominal pain, fever, nausea, and vomiting) if coadministration of erlotinib with hydrocortisone is necessary. Permanently discontinue erlotinib in patients who develop GI perforation. The pooled incidence of GI perforation clinical trials of erlotinib ranged from 0.1% to 0.4%, including fatal cases; patients receiving concomitant hydrocortisone may be at increased risk. [30555] Ertugliflozin: (Moderate) Monitor blood glucose during concomitant corticosteroid and SGLT2 inhibitor use; a SGLT2 inhibitor dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Ertugliflozin; metFORMIN: (Moderate) Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [28550] [30585] [51002] [51324] [62853] (Moderate) Monitor blood glucose during concomitant corticosteroid and SGLT2 inhibitor use; a SGLT2 inhibitor dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Ertugliflozin; SITagliptin: (Moderate) Monitor blood glucose during concomitant corticosteroid and dipeptidyl peptidase-4 (DPP-4) inhibitor use; a DPP-4 dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] (Moderate) Monitor blood glucose during concomitant corticosteroid and SGLT2 inhibitor use; a SGLT2 inhibitor dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Erythromycin: (Moderate) Monitor for corticosteroid-related adverse events if hydrocortisone is used with erythromycin. Concurrent use may increase hydrocortisone exposure. Hydrocortisone is a CYP3A substrate and erythromycin is a CYP3A inhibitor. [54049] Eslicarbazepine: (Moderate) In vivo studies suggest eslicarbazepine is an inducer of CYP3A4. Hydrocodone is metabolized by CYP3A4. Coadministration may cause increased clearance of hydrocodone, which could result in lack of efficacy or the development of an abstinence syndrome in a patient who had developed physical dependence to hydrocodone. Monitor the patient for reduced efficacy of hydrocodone. A higher hydrocodone dose may be needed if used with eslicarbazepine. [56303] [56436] Esterified Estrogens: (Moderate) Monitor for corticosteroid-related adverse events if corticosteroids are used with estrogens. Concurrent use may increase the exposure of corticosteroids. Estrogens may decrease the hepatic clearance of corticosteroids thereby increasing their effect. [29779] [54049] Esterified Estrogens; methylTESTOSTERone: (Moderate) Monitor for corticosteroid-related adverse events if corticosteroids are used with estrogens. Concurrent use may increase the exposure of corticosteroids. Estrogens may decrease the hepatic clearance of corticosteroids thereby increasing their effect. [29779] [54049] Estradiol: (Moderate) Monitor for corticosteroid-related adverse events if corticosteroids are used with estrogens. Concurrent use may increase the exposure of corticosteroids. Estrogens may decrease the hepatic clearance of corticosteroids thereby increasing their effect. [29779] [54049] Estradiol; Levonorgestrel: (Moderate) Monitor for corticosteroid-related adverse events if corticosteroids are used with estrogens. Concurrent use may increase the exposure of corticosteroids. Estrogens may decrease the hepatic clearance of corticosteroids thereby increasing their effect. [29779] [54049] Estradiol; Norethindrone: (Moderate) Monitor for corticosteroid-related adverse events if corticosteroids are used with estrogens. Concurrent use may increase the exposure of corticosteroids. Estrogens may decrease the hepatic clearance of corticosteroids thereby increasing their effect. [29779] [54049] Estradiol; Norgestimate: (Moderate) Monitor for corticosteroid-related adverse events if corticosteroids are used with estrogens. Concurrent use may increase the exposure of corticosteroids. Estrogens may decrease the hepatic clearance of corticosteroids thereby increasing their effect. [29779] [54049] Estradiol; Progesterone: (Moderate) Monitor for corticosteroid-related adverse events if corticosteroids are used with estrogens. Concurrent use may increase the exposure of corticosteroids. Estrogens may decrease the hepatic clearance of corticosteroids thereby increasing their effect. [29779] [54049] Estramustine: (Minor) Because systemically administered corticosteroids exhibit immunosuppressive effects when given in high doses and/or for extended periods, additive effects may be seen with other immunosuppressives or antineoplastic agents. [4744] [7714] Estrogens: (Moderate) Monitor for corticosteroid-related adverse events if corticosteroids are used with estrogens. Concurrent use may increase the exposure of corticosteroids. Estrogens may decrease the hepatic clearance of corticosteroids thereby increasing their effect. [29779] [54049] Estropipate: (Moderate) Monitor for corticosteroid-related adverse events if corticosteroids are used with estrogens. Concurrent use may increase the exposure of corticosteroids. Estrogens may decrease the hepatic clearance of corticosteroids thereby increasing their effect. [29779] [54049] Ethacrynic Acid: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and loop diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and loop diuretics cause increased renal potassium loss. [26417] [28429] [29779] Ethinyl Estradiol; Norelgestromin: (Moderate) Monitor for corticosteroid-related adverse events if corticosteroids are used with estrogens. Concurrent use may increase the exposure of corticosteroids. Estrogens may decrease the hepatic clearance of corticosteroids thereby increasing their effect. [29779] [54049] Ethinyl Estradiol; Norethindrone Acetate: (Moderate) Monitor for corticosteroid-related adverse events if corticosteroids are used with estrogens. Concurrent use may increase the exposure of corticosteroids. Estrogens may decrease the hepatic clearance of corticosteroids thereby increasing their effect. [29779] [54049] Ethinyl Estradiol; Norgestrel: (Moderate) Monitor for corticosteroid-related adverse events if corticosteroids are used with estrogens. Concurrent use may increase the exposure of corticosteroids. Estrogens may decrease the hepatic clearance of corticosteroids thereby increasing their effect. [29779] [54049] Ethynodiol Diacetate; Ethinyl Estradiol: (Moderate) Monitor for corticosteroid-related adverse events if corticosteroids are used with estrogens. Concurrent use may increase the exposure of corticosteroids. Estrogens may decrease the hepatic clearance of corticosteroids thereby increasing their effect. [29779] [54049] Etodolac: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and nonsteroidal antiinflammatory drug (NSAID) use. Concomitant use increases the risk of GI bleeding. [24574] [29611] [35893] Etonogestrel; Ethinyl Estradiol: (Moderate) Monitor for corticosteroid-related adverse events if corticosteroids are used with estrogens. Concurrent use may increase the exposure of corticosteroids. Estrogens may decrease the hepatic clearance of corticosteroids thereby increasing their effect. [29779] [54049] Exenatide: (Moderate) Monitor blood glucose during concomitant corticosteroid and incretin mimetic use; an incretin mimetic dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Fenoprofen: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and nonsteroidal antiinflammatory drug (NSAID) use. Concomitant use increases the risk of GI bleeding. [24574] [29611] [35893] Fludarabine: (Minor) Concurrent use of purine analogs with other agents which cause bone marrow or immune suppression such as other antineoplastic agents or immunosuppressives may result in additive effects. [5504] Flurbiprofen: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and nonsteroidal antiinflammatory drug (NSAID) use. Concomitant use increases the risk of GI bleeding. [24574] [29611] [35893] Fosinopril; hydroCHLOROthiazide, HCTZ: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] Furosemide: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and loop diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and loop diuretics cause increased renal potassium loss. [26417] [28429] [29779] Gallium Ga 68 Dotatate: (Moderate) Repeated administration of high corticosteroid doses prior to gallium Ga 68 dotatate may result in false negative imaging. High-dose corticosteroid therapy is generally defined as at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. Corticosteroids can down-regulate somatostatin subtype 2 receptors: thereby, interfering with binding of gallium Ga 68 dotatate to malignant cells that overexpress these receptors. [60852] Gemifloxacin: (Moderate) Quinolones have been associated with an increased risk of tendon rupture requiring surgical repair or resulting in prolonged disability; this risk is further increased in those receiving concomitant corticosteroids. Discontinue quinolone therapy at the first sign of tendon inflammation or tendon pain, as these are symptoms that may precede rupture of the tendon. [28423] [28424] [28764] [29818] [30738] [62028] [65562] Glimepiride: (Moderate) Monitor blood glucose during concomitant corticosteroid and sulfonylurea use; a sulfonylurea dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] glipiZIDE: (Moderate) Monitor blood glucose during concomitant corticosteroid and sulfonylurea use; a sulfonylurea dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] glipiZIDE; metFORMIN: (Moderate) Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [28550] [30585] [51002] [51324] [62853] (Moderate) Monitor blood glucose during concomitant corticosteroid and sulfonylurea use; a sulfonylurea dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] glyBURIDE: (Moderate) Monitor blood glucose during concomitant corticosteroid and sulfonylurea use; a sulfonylurea dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] glyBURIDE; metFORMIN: (Moderate) Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [28550] [30585] [51002] [51324] [62853] (Moderate) Monitor blood glucose during concomitant corticosteroid and sulfonylurea use; a sulfonylurea dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Glycerol Phenylbutyrate: (Moderate) Corticosteroids may induce elevated blood ammonia concentrations. Corticosteroids should be used with caution in patients receiving glycerol phenylbutyrate. Monitor ammonia concentrations closely. [53022] guaiFENesin; Phenylephrine: (Moderate) The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Monitor patients for increased pressor effect if these agents are administered concomitantly. [54374] [57578] Haemophilus influenzae type b Conjugate Vaccine: (Moderate) Patients receiving high-dose corticosteroid therapy may have a diminished response to vaccines. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 2 weeks after discontinuation. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving high-dose corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine. [60092] [65107] Haloperidol: (Moderate) Caution is advisable during concurrent use of haloperidol and corticosteroids as electrolyte imbalance caused by corticosteroids may increase the risk of QT prolongation with haloperidol. [28307] Hemin: (Moderate) Hemin works by inhibiting aminolevulinic acid synthetase. Corticosteroids increase the activity of this enzyme should not be used with hemin. [6702] Hepatitis A Vaccine, Inactivated: (Moderate) Patients receiving high-dose corticosteroid therapy may have a diminished response to vaccines. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 2 weeks after discontinuation. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving high-dose corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine. [60092] [65107] Hepatitis A Vaccine, Inactivated; Hepatitis B Vaccine, Recombinant: (Moderate) Patients receiving high-dose corticosteroid therapy may have a diminished response to vaccines. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 2 weeks after discontinuation. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving high-dose corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine. [60092] [65107] Hepatitis B Vaccine, Recombinant: (Moderate) Patients receiving high-dose corticosteroid therapy may have a diminished response to vaccines. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 2 weeks after discontinuation. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving high-dose corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine. [60092] [65107] Human Papillomavirus 9-Valent Vaccine: (Moderate) Patients receiving high-dose corticosteroid therapy may have a diminished response to vaccines. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 2 weeks after discontinuation. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving high-dose corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine. [60092] [65107] hydroCHLOROthiazide, HCTZ: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] hydroCHLOROthiazide, HCTZ; Moexipril: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] HYDROcodone; Ibuprofen: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and nonsteroidal antiinflammatory drug (NSAID) use. Concomitant use increases the risk of GI bleeding. [24574] [29611] [35893] Hydroxyurea: (Minor) Because systemically administered corticosteroids exhibit immunosuppressive effects when given in high doses and/or for extended periods, additive effects may be seen with other immunosuppressives or antineoplastic agents. [7714] Hylan G-F 20: (Major) The safety and efficacy of hylan G-F 20 given concomitantly with other intra-articular injectables have not been established. Other intra-articular injections may include intra-articular steroids (betamethasone, dexamethasone, hydrocortisone, prednisolone, methylprednisolone, and triamcinolone). [45238] [45239] Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Concomitant use increases the risk of GI bleeding. In patients receiving concomitant corticosteroids and chronic use of salicylates, withdrawal of corticosteroids may result in salicylism because corticosteroids enhance renal clearance of salicylates and their withdrawal is followed by return to normal rates of renal clearance. [24574] [28502] (Minor) Use sodium phosphate cautiously with mineralocorticoids as concurrent use can cause hypernatremia in some patients. [57713] [57714] [57715] Ibritumomab Tiuxetan: (Minor) Because systemically administered corticosteroids exhibit immunosuppressive effects when given in high doses and/or for extended periods, additive effects may be seen with other immunosuppressives or antineoplastic agents. [7714] (Minor) Use sodium phosphate cautiously with mineralocorticoids as concurrent use can cause hypernatremia in some patients. [57713] [57714] [57715] Ibuprofen: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and nonsteroidal antiinflammatory drug (NSAID) use. Concomitant use increases the risk of GI bleeding. [24574] [29611] [35893] Ibuprofen; Famotidine: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and nonsteroidal antiinflammatory drug (NSAID) use. Concomitant use increases the risk of GI bleeding. [24574] [29611] [35893] Ibuprofen; oxyCODONE: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and nonsteroidal antiinflammatory drug (NSAID) use. Concomitant use increases the risk of GI bleeding. [24574] [29611] [35893] Ibuprofen; Pseudoephedrine: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and nonsteroidal antiinflammatory drug (NSAID) use. Concomitant use increases the risk of GI bleeding. [24574] [29611] [35893] Incretin Mimetics: (Moderate) Monitor blood glucose during concomitant corticosteroid and incretin mimetic use; an incretin mimetic dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Indapamide: (Moderate) Additive hypokalemia may occur when indapamide is coadministered with other drugs with a significant risk of hypokalemia such as systemic corticosteroids. Coadminister with caution and careful monitoring. [26417] Indomethacin: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and nonsteroidal antiinflammatory drug (NSAID) use. Concomitant use increases the risk of GI bleeding. [24574] [29611] [35893] Inebilizumab: (Moderate) Concomitant usage of inebilizumab with immunosuppressant drugs, including systemic corticosteroids, may increase the risk of infection. Consider the risk of additive immune system effects when coadministering therapies that cause immunosuppression with inebilizumab. [65576] Influenza Virus Vaccine: (Moderate) Patients receiving high-dose corticosteroid therapy may have a diminished response to vaccines. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 2 weeks after discontinuation. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving high-dose corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine. [60092] [65107] Insulin Aspart: (Moderate) Monitor blood glucose during concomitant corticosteroid and insulin use; an insulin dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Insulin Aspart; Insulin Aspart Protamine: (Moderate) Monitor blood glucose during concomitant corticosteroid and insulin use; an insulin dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Insulin Degludec: (Moderate) Monitor blood glucose during concomitant corticosteroid and insulin use; an insulin dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Insulin Degludec; Liraglutide: (Moderate) Monitor blood glucose during concomitant corticosteroid and incretin mimetic use; an incretin mimetic dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] (Moderate) Monitor blood glucose during concomitant corticosteroid and insulin use; an insulin dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Insulin Detemir: (Moderate) Monitor blood glucose during concomitant corticosteroid and insulin use; an insulin dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Insulin Glargine: (Moderate) Monitor blood glucose during concomitant corticosteroid and insulin use; an insulin dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Insulin Glargine; Lixisenatide: (Moderate) Monitor blood glucose during concomitant corticosteroid and incretin mimetic use; an incretin mimetic dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] (Moderate) Monitor blood glucose during concomitant corticosteroid and insulin use; an insulin dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Insulin Glulisine: (Moderate) Monitor blood glucose during concomitant corticosteroid and insulin use; an insulin dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Insulin Lispro: (Moderate) Monitor blood glucose during concomitant corticosteroid and insulin use; an insulin dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Insulin Lispro; Insulin Lispro Protamine: (Moderate) Monitor blood glucose during concomitant corticosteroid and insulin use; an insulin dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Insulin, Inhaled: (Moderate) Monitor blood glucose during concomitant corticosteroid and insulin use; an insulin dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Insulins: (Moderate) Monitor blood glucose during concomitant corticosteroid and insulin use; an insulin dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Interferon Alfa-2b: (Minor) Because systemically administered corticosteroids exhibit immunosuppressive effects when given in high doses and/or for extended periods, additive effects may be seen with other immunosuppressives or antineoplastic agents. [7714] Intranasal Influenza Vaccine: (Contraindicated) Avoid the administration of live virus vaccines with high-dose corticosteroid therapy and for at least 1 month following treatment. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated live virus vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 1 month after discontinuation. Patients with altered immunocompetence may be at increased risk for severe adverse reactions due to uninhibited growth of the attenuated live virus. Additionally, vaccine efficacy may be diminished in patients receiving any supraphysiologic dose of corticosteroid. [60092] [65107] (Moderate) Patients receiving high-dose corticosteroid therapy may have a diminished response to vaccines. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 2 weeks after discontinuation. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving high-dose corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine. [60092] [65107] Iohexol: (Major) Serious adverse events, including death, have been observed during intrathecal administration of both corticosteroids (i.e., hydrocortisone) and radiopaque contrast agents (i.e., iohexol); therefore, concurrent use of these medications via the intrathecal route is contraindicated. Cases of cortical blindness, stroke, spinal cord infarction, paralysis, seizures, nerve injury, brain edema, and death have been temporally associated (i.e., within minutes to 48 hours after injection) with epidural administration of injectable corticosteroids. In addition, patients inadvertently administered iohexol formulations not indicated for intrathecal use have experienced seizures, convulsions, cerebral hemorrhages, brain edema, and death. Administering these medications together via the intrathecal route may increase the risk for serious adverse events. [28963] [57053] Iopamidol: (Contraindicated) Because both intrathecal corticosteroids (i.e., hydrocortisone) and intrathecal radiopaque contrast agents (i.e., iopamidoll) can increase the risk of seizures, the intrathecal administration of corticosteroids with intrathecal radiopaque contrast agents is contraindicated. [5442] Irbesartan; hydroCHLOROthiazide, HCTZ: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] Isophane Insulin (NPH): (Moderate) Monitor blood glucose during concomitant corticosteroid and insulin use; an insulin dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Isoproterenol: (Moderate) The risk of cardiac toxicity with isoproterenol in asthma patients appears to be increased with the coadministration of corticosteroids. Intravenous infusions of isoproterenol in refractory asthmatic children at rates of 0.05 to 2.7 mcg/kg/min have caused clinical deterioration, myocardial infarction (necrosis), congestive heart failure and death. [28004] ISOtretinoin: (Minor) Both isotretinoin and corticosteroids can cause osteoporosis during chronic use. Patients receiving systemic corticosteroids should receive isotretinoin therapy with caution. [5283] Japanese Encephalitis Virus Vaccine: (Moderate) Patients receiving high-dose corticosteroid therapy may have a diminished response to vaccines. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 2 weeks after discontinuation. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving high-dose corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine. [60092] [65107] Ketoprofen: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and nonsteroidal antiinflammatory drug (NSAID) use. Concomitant use increases the risk of GI bleeding. [24574] [29611] [35893] Ketorolac: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and nonsteroidal antiinflammatory drug (NSAID) use. Concomitant use increases the risk of GI bleeding. [24574] [29611] [35893] Lansoprazole; Amoxicillin; Clarithromycin: (Moderate) Clarithromycin inhibits CYP3A4 and has the potential to result in increased plasma concentrations of corticosteroids. Therefore, the dose of corticosteroid should be titrated to avoid steroid toxicity. [28001] Lenacapavir: (Moderate) Monitor for corticosteroid-related adverse effects if hydrocortisone is used with lenacapavir. Concurrent use may increase the exposure of hydrocortisone. Hydrocortisone is a CYP3A substrate and lenacapavir is a moderate CYP3A inhibitor. [68383] levoFLOXacin: (Moderate) Quinolones have been associated with an increased risk of tendon rupture requiring surgical repair or resulting in prolonged disability; this risk is further increased in those receiving concomitant corticosteroids. Discontinue quinolone therapy at the first sign of tendon inflammation or tendon pain, as these are symptoms that may precede rupture of the tendon. [28423] [28424] [28764] [29818] [30738] [62028] [65562] Levonorgestrel; Ethinyl Estradiol: (Moderate) Monitor for corticosteroid-related adverse events if corticosteroids are used with estrogens. Concurrent use may increase the exposure of corticosteroids. Estrogens may decrease the hepatic clearance of corticosteroids thereby increasing their effect. [29779] [54049] Levonorgestrel; Ethinyl Estradiol; Ferrous Bisglycinate: (Moderate) Monitor for corticosteroid-related adverse events if corticosteroids are used with estrogens. Concurrent use may increase the exposure of corticosteroids. Estrogens may decrease the hepatic clearance of corticosteroids thereby increasing their effect. [29779] [54049] Levonorgestrel; Ethinyl Estradiol; Ferrous Fumarate: (Moderate) Monitor for corticosteroid-related adverse events if corticosteroids are used with estrogens. Concurrent use may increase the exposure of corticosteroids. Estrogens may decrease the hepatic clearance of corticosteroids thereby increasing their effect. [29779] [54049] Lidocaine; EPINEPHrine: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and epinephrine use due to risk for additive hypokalemia; potassium supplementation may be necessary. Corticosteroids may potentiate the hypokalemic effects of epinephrine. [26417] [56575] Linagliptin: (Moderate) Monitor blood glucose during concomitant corticosteroid and dipeptidyl peptidase-4 (DPP-4) inhibitor use; a DPP-4 dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Linagliptin; metFORMIN: (Moderate) Monitor blood glucose during concomitant corticosteroid and dipeptidyl peptidase-4 (DPP-4) inhibitor use; a DPP-4 dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] (Moderate) Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [28550] [30585] [51002] [51324] [62853] Liraglutide: (Moderate) Monitor blood glucose during concomitant corticosteroid and incretin mimetic use; an incretin mimetic dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Lisinopril; hydroCHLOROthiazide, HCTZ: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] Live Vaccines: (Contraindicated) Avoid the administration of live virus vaccines with high-dose corticosteroid therapy and for at least 1 month following treatment. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated live virus vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 1 month after discontinuation. Patients with altered immunocompetence may be at increased risk for severe adverse reactions due to uninhibited growth of the attenuated live virus. Additionally, vaccine efficacy may be diminished in patients receiving any supraphysiologic dose of corticosteroid. [60092] [65107] Lixisenatide: (Moderate) Monitor blood glucose during concomitant corticosteroid and incretin mimetic use; an incretin mimetic dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Lomustine, CCNU: (Minor) Because systemically administered corticosteroids exhibit immunosuppressive effects when given in high doses and/or for extended periods, additive effects may be seen with other immunosuppressives or antineoplastic agents. [5946] [7714] [7944] Lonapegsomatropin: (Moderate) Corticosteroids can retard bone growth and therefore, can inhibit the growth-promoting effects of somatropin. If corticosteroid therapy is required, the corticosteroid dose should be carefully adjusted. [6807] Loop diuretics: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and loop diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and loop diuretics cause increased renal potassium loss. [26417] [28429] [29779] Losartan; hydroCHLOROthiazide, HCTZ: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] Lutetium Lu 177 dotatate: (Major) Avoid repeated administration of high doses of glucocorticoids during treatment with lutetium Lu 177 dotatate due to the risk of decreased efficacy of lutetium Lu 177 dotatate. Lutetium Lu 177 dotatate binds to somatostatin receptors, with the highest affinity for subtype 2 somatostatin receptors (SSTR2); glucocorticoids can induce down-regulation of SSTR2. [62824] Macimorelin: (Major) Avoid use of macimorelin with drugs that directly affect pituitary growth hormone secretion, such as corticosteroids. Healthcare providers are advised to discontinue corticosteroid therapy and observe a sufficient washout period before administering macimorelin. Use of these medications together may impact the accuracy of the macimorelin growth hormone test. [62723] Magnesium Salicylate: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Concomitant use increases the risk of GI bleeding. In patients receiving concomitant corticosteroids and chronic use of salicylates, withdrawal of corticosteroids may result in salicylism because corticosteroids enhance renal clearance of salicylates and their withdrawal is followed by return to normal rates of renal clearance. [24574] [28502] Mannitol: (Moderate) Corticosteroids may accentuate the electrolyte loss associated with diuretic therapy resulting in hypokalemia. Also, corticotropin may cause calcium loss and sodium and fluid retention. Mannitol itself can cause hypernatremia. Close monitoring of electrolytes should occur in patients receiving these drugs concomitantly. [6524] Measles Virus; Mumps Virus; Rubella Virus; Varicella Virus Vaccine, Live: (Contraindicated) Avoid the administration of live virus vaccines with high-dose corticosteroid therapy and for at least 1 month following treatment. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated live virus vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 1 month after discontinuation. Patients with altered immunocompetence may be at increased risk for severe adverse reactions due to uninhibited growth of the attenuated live virus. Additionally, vaccine efficacy may be diminished in patients receiving any supraphysiologic dose of corticosteroid. [60092] [65107] Measles/Mumps/Rubella Vaccines, MMR: (Contraindicated) Avoid the administration of live virus vaccines with high-dose corticosteroid therapy and for at least 1 month following treatment. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated live virus vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 1 month after discontinuation. Patients with altered immunocompetence may be at increased risk for severe adverse reactions due to uninhibited growth of the attenuated live virus. Additionally, vaccine efficacy may be diminished in patients receiving any supraphysiologic dose of corticosteroid. [60092] [65107] Mecasermin, Recombinant, rh-IGF-1: (Moderate) Additional monitoring may be required when coadministering systemic or inhaled corticosteroids and mecasermin, recombinant, rh-IGF-1. In animal studies, corticosteroids impair the growth-stimulating effects of growth hormone (GH) through interference with the physiological stimulation of epiphyseal chondrocyte proliferation exerted by GH and IGF-1. Dexamethasone administration on long bone tissue in vitro resulted in a decrease of local synthesis of IGF-1. Similar counteractive effects are expected in humans. If systemic or inhaled glucocorticoid therapy is required, the steroid dose should be carefully adjusted and growth rate monitored. [8314] [8315] Meclofenamate Sodium: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and nonsteroidal antiinflammatory drug (NSAID) use. Concomitant use increases the risk of GI bleeding. [24574] [29611] [35893] Mefenamic Acid: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and nonsteroidal antiinflammatory drug (NSAID) use. Concomitant use increases the risk of GI bleeding. [24574] [29611] [35893] Meglitinides: (Moderate) Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Systemic and inhaled corticosteroids are known to increase blood glucose and worsen glycemic control in patients taking antidiabetic agents. The main risk factors for impaired glucose tolerance due to corticosteroids are the dose of steroid and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [62853] Meloxicam: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and nonsteroidal antiinflammatory drug (NSAID) use. Concomitant use increases the risk of GI bleeding. [24574] [29611] [35893] Meningococcal Group B Vaccine (3 strain): (Moderate) Patients receiving high-dose corticosteroid therapy may have a diminished response to vaccines. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 2 weeks after discontinuation. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving high-dose corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine. [60092] [65107] Meningococcal Group B Vaccine (4 strain): (Moderate) Patients receiving high-dose corticosteroid therapy may have a diminished response to vaccines. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 2 weeks after discontinuation. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving high-dose corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine. [60092] [65107] Meningococcal Groups A, B, C, W, and Y Vaccine (5 valent): (Moderate) Patients receiving high-dose corticosteroid therapy may have a diminished response to vaccines. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 2 weeks after discontinuation. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving high-dose corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine. [60092] [65107] Meningococcal Groups A, C, W, and Y Vaccine (4 valent): (Moderate) Patients receiving high-dose corticosteroid therapy may have a diminished response to vaccines. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 2 weeks after discontinuation. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving high-dose corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine. [60092] [65107] Mercaptopurine, 6-MP: (Minor) Concurrent use of purine analogs with other agents which cause bone marrow or immune suppression such as other antineoplastic agents or immunosuppressives may result in additive effects. [5504] metFORMIN: (Moderate) Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [28550] [30585] [51002] [51324] [62853] metFORMIN; Repaglinide: (Moderate) Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [28550] [30585] [51002] [51324] [62853] (Moderate) Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Systemic and inhaled corticosteroids are known to increase blood glucose and worsen glycemic control in patients taking antidiabetic agents. The main risk factors for impaired glucose tolerance due to corticosteroids are the dose of steroid and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [62853] metFORMIN; sAXagliptin: (Moderate) Monitor blood glucose during concomitant corticosteroid and dipeptidyl peptidase-4 (DPP-4) inhibitor use; a DPP-4 dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] (Moderate) Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [28550] [30585] [51002] [51324] [62853] metFORMIN; SITagliptin: (Moderate) Monitor blood glucose during concomitant corticosteroid and dipeptidyl peptidase-4 (DPP-4) inhibitor use; a DPP-4 dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] (Moderate) Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [28550] [30585] [51002] [51324] [62853] methazolAMIDE: (Moderate) Corticosteroids may increase the risk of hypokalemia if used concurrently with methazolamide. Hypokalemia may be especially severe with prolonged use of corticotropin, ACTH. Monitor serum potassium levels to determine the need for potassium supplementation and/or alteration in drug therapy. The chronic use of corticosteroids may augment calcium excretion with methazolamide leading to increased risk for hypocalcemia and/or osteoporosis. [5023] Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine: (Minor) Use sodium phosphate cautiously with mineralocorticoids as concurrent use can cause hypernatremia in some patients. [57713] [57714] [57715] Methenamine; Sodium Salicylate: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Concomitant use increases the risk of GI bleeding. In patients receiving concomitant corticosteroids and chronic use of salicylates, withdrawal of corticosteroids may result in salicylism because corticosteroids enhance renal clearance of salicylates and their withdrawal is followed by return to normal rates of renal clearance. [24574] [28502] Methoxsalen: (Minor) Because systemically administered corticosteroids exhibit immunosuppressive effects when given in high doses and/or for extended periods, additive effects may be seen with other immunosuppressives or antineoplastic agents. [7714] metOLazone: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] Metoprolol; hydroCHLOROthiazide, HCTZ: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] metyraPONE: (Contraindicated) Medications which affect pituitary or adrenocortical function, including all corticosteroid therapy, should be discontinued prior to and during testing with metyrapone. Patients taking inadvertent doses of corticosteroids on the test day may exhibit abnormally high basal plasma cortisol levels and a decreased response to the test. Although systemic absorption of topical corticosteroids is minimal, temporary discontinuation of these products should be considered if possible to reduce the potential for interference with the test results. [33528] Micafungin: (Moderate) Leukopenia, neutropenia, anemia, and thrombocytopenia have been associated with micafungin. Patients who are taking immunosuppressives such as the corticosteroids with micafungin concomitantly may have additive risks for infection or other side effects. In a pharmacokinetic trial, micafungin had no effect on the pharmacokinetics of prednisolone. Acute intravascular hemolysis and hemoglobinuria was seen in a healthy volunteer during infusion of micafungin (200 mg) and oral prednisolone (20 mg). This reaction was transient, and the subject did not develop significant anemia. [44913] miFEPRIStone: (Major) Mifepristone for termination of pregnancy is contraindicated in patients on long-term corticosteroid therapy and mifepristone for Cushing's disease or other chronic conditions is contraindicated in patients who require concomitant treatment with systemic corticosteroids for life-saving purposes, such as serious medical conditions or illnesses (e.g., immunosuppression after organ transplantation). For other situations where corticosteroids are used for treating non-life threatening conditions, mifepristone may lead to reduced corticosteroid efficacy and exacerbation or deterioration of such conditions. This is because mifepristone exhibits antiglucocorticoid activity that may antagonize corticosteroid therapy and the stabilization of the underlying corticosteroid-treated illness. Mifepristone may also cause adrenal insufficiency, so patients receiving corticosteroids for non life-threatening illness require close monitoring. Because serum cortisol levels remain elevated and may even increase during treatment with mifepristone, serum cortisol levels do not provide an accurate assessment of hypoadrenalism. Patients should be closely monitored for signs and symptoms of adrenal insufficiency, If adrenal insufficiency occurs, stop mifepristone treatment and administer systemic glucocorticoids without delay; high doses may be needed to treat these events. Factors considered in deciding on the duration of glucocorticoid treatment should include the long half-life of mifepristone (85 hours). [28003] [48697] Miglitol: (Moderate) Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Systemic and inhaled corticosteroids are known to increase blood glucose and worsen glycemic control in patients taking antidiabetic agents. The main risk factors for impaired glucose tolerance due to corticosteroids are the dose of steroid and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [62853] Mitotane: (Major) Because of increased glucocorticoid clearance, a higher dose of hydrocortisone (50 mg/day or more) may be needed for the treatment of adrenal insufficiency in patients treated with mitotane; some may require additional fludrocortisone. [41934] [60651] mitoXANTRONE: (Minor) Because systemically administered corticosteroids exhibit immunosuppressive effects when given in high doses and/or for extended periods, additive effects may be seen with other immunosuppressives or antineoplastic agents. [7714] Moxifloxacin: (Moderate) Quinolones have been associated with an increased risk of tendon rupture requiring surgical repair or resulting in prolonged disability; this risk is further increased in those receiving concomitant corticosteroids. Discontinue quinolone therapy at the first sign of tendon inflammation or tendon pain, as these are symptoms that may precede rupture of the tendon. [28423] [28424] [28764] [29818] [30738] [62028] [65562] Nabumetone: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and nonsteroidal antiinflammatory drug (NSAID) use. Concomitant use increases the risk of GI bleeding. [24574] [29611] [35893] Naproxen: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and nonsteroidal antiinflammatory drug (NSAID) use. Concomitant use increases the risk of GI bleeding. [24574] [29611] [35893] Naproxen; Esomeprazole: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and nonsteroidal antiinflammatory drug (NSAID) use. Concomitant use increases the risk of GI bleeding. [24574] [29611] [35893] Naproxen; Pseudoephedrine: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and nonsteroidal antiinflammatory drug (NSAID) use. Concomitant use increases the risk of GI bleeding. [24574] [29611] [35893] Natalizumab: (Major) Ordinarily, patients receiving chronic immunosuppressant therapy should not be treated with natalizumab. Treatment recommendations for combined corticosteroid therapy are dependent on the underlying indication for natalizumab therapy. Corticosteroids should be tapered in those patients with Crohn's disease who are on chronic corticosteroids when they start natalizumab therapy, as soon as a therapeutic benefit has occurred. If the patient cannot discontinue systemic corticosteroids within 6 months, discontinue natalizumab. The concomitant use of natalizumab and corticosteroids may further increase the risk of serious infections, including progressive multifocal leukoencephalopathy, over the risk observed with use of natalizumab alone. In multiple sclerosis (MS) clinical trials, an increase in infections was seen in patients concurrently receiving short courses of corticosteroids. However, the increase in infections in natalizumab-treated patients who received steroids was similar to the increase in placebo-treated patients who received steroids. Short courses of steroid use during natalizumab, such as when they are needed for MS relapse treatment, appear to be acceptable for use concurrently. [30470] [62264] Nateglinide: (Moderate) Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Systemic and inhaled corticosteroids are known to increase blood glucose and worsen glycemic control in patients taking antidiabetic agents. The main risk factors for impaired glucose tolerance due to corticosteroids are the dose of steroid and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [62853] Nelarabine: (Minor) Because systemically administered corticosteroids exhibit immunosuppressive effects when given in high doses and/or for extended periods, additive effects may be seen with other immunosuppressives or antineoplastic agents. [7714] Neostigmine: (Moderate) Concomitant use of anticholinesterase agents, such as neostigmine, and systemic corticosteroids may produce severe weakness in patients with myasthenia gravis. If possible, anticholinesterase agents should be withdrawn at least 24 hours before initiating systemic corticosteroid therapy. [29779] [30015] [30028] [31123] [54891] [56146] [64165] Neostigmine; Glycopyrrolate: (Moderate) Concomitant use of anticholinesterase agents, such as neostigmine, and systemic corticosteroids may produce severe weakness in patients with myasthenia gravis. If possible, anticholinesterase agents should be withdrawn at least 24 hours before initiating systemic corticosteroid therapy. [29779] [30015] [30028] [31123] [54891] [56146] [64165] Neuromuscular blockers: (Moderate) Limit the period of use of neuromuscular blockers and corticosteroids and only use when the specific advantages of the drugs outweigh the risks for acute myopathy. An acute myopathy has been observed with the use of high doses of corticosteroids in patients receiving concomitant long-term therapy with neuromuscular blockers. Clinical improvement or recovery after stopping therapy may require weeks to years. [41361] [41961] [42031] [43319] [54278] [60760] [61750] [61937] Non-Live Vaccines: (Moderate) Patients receiving high-dose corticosteroid therapy may have a diminished response to vaccines. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 2 weeks after discontinuation. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving high-dose corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine. [60092] [65107] Nonsteroidal antiinflammatory drugs: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and nonsteroidal antiinflammatory drug (NSAID) use. Concomitant use increases the risk of GI bleeding. [24574] [29611] [35893] Norethindrone Acetate; Ethinyl Estradiol; Ferrous fumarate: (Moderate) Monitor for corticosteroid-related adverse events if corticosteroids are used with estrogens. Concurrent use may increase the exposure of corticosteroids. Estrogens may decrease the hepatic clearance of corticosteroids thereby increasing their effect. [29779] [54049] Norethindrone; Ethinyl Estradiol: (Moderate) Monitor for corticosteroid-related adverse events if corticosteroids are used with estrogens. Concurrent use may increase the exposure of corticosteroids. Estrogens may decrease the hepatic clearance of corticosteroids thereby increasing their effect. [29779] [54049] Norethindrone; Ethinyl Estradiol; Ferrous fumarate: (Moderate) Monitor for corticosteroid-related adverse events if corticosteroids are used with estrogens. Concurrent use may increase the exposure of corticosteroids. Estrogens may decrease the hepatic clearance of corticosteroids thereby increasing their effect. [29779] [54049] Norgestimate; Ethinyl Estradiol: (Moderate) Monitor for corticosteroid-related adverse events if corticosteroids are used with estrogens. Concurrent use may increase the exposure of corticosteroids. Estrogens may decrease the hepatic clearance of corticosteroids thereby increasing their effect. [29779] [54049] Ocrelizumab: (Moderate) Ocrelizumab has not been studied in combination with other immunosuppressive or immune modulating therapies used for the treatment of multiple sclerosis, including immunosuppressant doses of corticosteroids. Concomitant use of ocrelizumab with any of these therapies may increase the risk of immunosuppression. Monitor patients carefully for signs and symptoms of infection. [61838] Ofatumumab: (Moderate) Concomitant use of ofatumumab with corticosteroids may increase the risk of immunosuppression. Monitor patients carefully for signs and symptoms of infection. Ofatumumab has not been studied in combination with other immunosuppressive or immune modulating therapies used for the treatment of multiple sclerosis, including immunosuppressant doses of corticosteroids. [65850] Ofloxacin: (Moderate) Quinolones have been associated with an increased risk of tendon rupture requiring surgical repair or resulting in prolonged disability; this risk is further increased in those receiving concomitant corticosteroids. Discontinue quinolone therapy at the first sign of tendon inflammation or tendon pain, as these are symptoms that may precede rupture of the tendon. [28423] [28424] [28764] [29818] [30738] [62028] [65562] Olmesartan; amLODIPine; hydroCHLOROthiazide, HCTZ: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] Olmesartan; hydroCHLOROthiazide, HCTZ: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] Oxaprozin: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and nonsteroidal antiinflammatory drug (NSAID) use. Concomitant use increases the risk of GI bleeding. [24574] [29611] [35893] Oxymetholone: (Moderate) Concomitant use of oxymetholone with corticosteroids or corticotropin, ACTH may cause increased edema. Manage edema with diuretic and/or digitalis therapy. [48342] Ozanimod: (Moderate) Concomitant use of ozanimod with systemic hydrocortisone may increase the risk of immunosuppression. Monitor patients carefully for signs and symptoms of infection. In clinical studies for ulcerative colitis, the use of systemic corticosteroids did not appear to influence safety or efficacy of ozanimod. [65169] Pancuronium: (Moderate) Limit the period of use of neuromuscular blockers and corticosteroids and only use when the specific advantages of the drugs outweigh the risks for acute myopathy. An acute myopathy has been observed with the use of high doses of corticosteroids in patients receiving concomitant long-term therapy with neuromuscular blockers. Clinical improvement or recovery after stopping therapy may require weeks to years. [41361] [41961] [42031] [43319] [54278] [60760] [61750] [61937] Pegaspargase: (Moderate) Monitor for an increase in glucocorticoid-related adverse reactions such as hyperglycemia and osteonecrosis during concomitant use of pegaspargase and glucocorticoids. [61310] penicillAMINE: (Major) Agents such as immunosuppressives have adverse reactions similar to those of penicillamine. Concomitant use of penicillamine with these agents is contraindicated because of the increased risk of developing severe hematologic and renal toxicity. [5567] Pentostatin: (Minor) Concurrent use of purine analogs with other agents which cause bone marrow or immune suppression such as other antineoplastic agents or immunosuppressives may result in additive effects. [5504] Phenylephrine: (Moderate) The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Monitor patients for increased pressor effect if these agents are administered concomitantly. [54374] [57578] Photosensitizing agents (topical): (Minor) Corticosteroids administered prior to or concomitantly with photosensitizing agents used in photodynamic therapy may decrease the efficacy of the treatment. [6625] PHYSostigmine: (Moderate) Concomitant use of anticholinesterase agents, such as physostigmine, and systemic corticosteroids may produce severe weakness in patients with myasthenia gravis. If possible, withdraw anticholinesterase inhibitors at least 24 hours before initiating corticosteroid therapy. [29779] [30015] [30028] [31123] [56146] [64165] Pimozide: (Moderate) According to the manufacturer of pimozide, the drug should not be coadministered with drugs known to cause electrolyte imbalances, such as high-dose, systemic corticosteroid therapy. Pimozide is associated with a well-established risk of QT prolongation and torsade de pointes (TdP), and electrolyte imbalances (e.g., hypokalemia, hypocalcemia, hypomagnesemia) may increase the risk of life-threatening arrhythmias. Pimozide is contraindicated in patients with known hypokalemia or hypomagnesemia. Topical corticosteroids are less likely to interact. [28225] [43463] Pioglitazone: (Moderate) Monitor blood glucose during concomitant corticosteroid and thiazolidinedione use; a thiazolidinedione dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Pioglitazone; Glimepiride: (Moderate) Monitor blood glucose during concomitant corticosteroid and sulfonylurea use; a sulfonylurea dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] (Moderate) Monitor blood glucose during concomitant corticosteroid and thiazolidinedione use; a thiazolidinedione dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Pioglitazone; metFORMIN: (Moderate) Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [28550] [30585] [51002] [51324] [62853] (Moderate) Monitor blood glucose during concomitant corticosteroid and thiazolidinedione use; a thiazolidinedione dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Piroxicam: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and nonsteroidal antiinflammatory drug (NSAID) use. Concomitant use increases the risk of GI bleeding. [24574] [29611] [35893] Pneumococcal Vaccine, Polyvalent: (Moderate) Patients receiving high-dose corticosteroid therapy may have a diminished response to vaccines. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 2 weeks after discontinuation. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving high-dose corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine. [60092] [65107] Ponesimod: (Moderate) Monitor for signs and symptoms of infection. Additive immune suppression may result from concomitant use of ponesimod and high-dose corticosteroid therapy which may extend the duration or severity of immune suppression. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. [66527] Potassium Phosphate; Sodium Phosphate: (Minor) Use sodium phosphate cautiously with mineralocorticoids as concurrent use can cause hypernatremia in some patients. [57713] [57714] [57715] Potassium-sparing diuretics: (Minor) The manufacturer of spironolactone lists corticosteroids as a potential drug that interacts with spironolactone. Intensified electrolyte depletion, particularly hypokalemia, may occur. However, potassium-sparing diuretics such as spironolactone do not induce hypokalemia. In fact, hypokalemia is one of the indications for potassium-sparing diuretic therapy. Therefore, drugs that induce potassium loss, such as corticosteroids, could counter the hyperkalemic effects of potassium-sparing diuretics. [26417] [29016] [30011] Pramlintide: (Moderate) Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Systemic and inhaled corticosteroids are known to increase blood glucose and worsen glycemic control in patients taking antidiabetic agents. The main risk factors for impaired glucose tolerance due to corticosteroids are the dose of steroid and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [62853] Prasterone, Dehydroepiandrosterone, DHEA (Dietary Supplements): (Moderate) Corticosteroids blunt the adrenal secretion of endogenous DHEA and DHEAS, resulting in reduced DHEA and DHEAS serum concentrations. [2460] Prasterone, Dehydroepiandrosterone, DHEA (FDA-approved): (Moderate) Corticosteroids blunt the adrenal secretion of endogenous DHEA and DHEAS, resulting in reduced DHEA and DHEAS serum concentrations. [2460] Prilocaine; EPINEPHrine: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and epinephrine use due to risk for additive hypokalemia; potassium supplementation may be necessary. Corticosteroids may potentiate the hypokalemic effects of epinephrine. [26417] [56575] Promethazine; Phenylephrine: (Moderate) The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Monitor patients for increased pressor effect if these agents are administered concomitantly. [54374] [57578] Propranolol: (Moderate) Monitor blood sugar during concomitant corticosteroid and propranolol use due to risk for hypoglycemia. Concurrent use may increase risk of hypoglycemia because of loss of the counter-regulatory cortisol response. [56853] Purine analogs: (Minor) Concurrent use of purine analogs with other agents which cause bone marrow or immune suppression such as other antineoplastic agents or immunosuppressives may result in additive effects. [5504] pyRIDostigmine: (Moderate) Concomitant use of anticholinesterase agents, such as pyridostigmine, and corticosteroids may produce severe weakness in patients with myasthenia gravis. If possible, anticholinesterase agents should be withdrawn at least 24 hours before initiating corticosteroid therapy. [29779] [30015] [30028] [31123] [34253] [56146] [64002] [64165] Quinapril; hydroCHLOROthiazide, HCTZ: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] Quinolones: (Moderate) Quinolones have been associated with an increased risk of tendon rupture requiring surgical repair or resulting in prolonged disability; this risk is further increased in those receiving concomitant corticosteroids. Discontinue quinolone therapy at the first sign of tendon inflammation or tendon pain, as these are symptoms that may precede rupture of the tendon. [28423] [28424] [28764] [29818] [30738] [62028] [65562] Rabies Vaccine: (Moderate) Patients receiving high-dose corticosteroid therapy may have a diminished response to vaccines. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 2 weeks after discontinuation. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving high-dose corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine. [60092] [65107] Regular Insulin: (Moderate) Monitor blood glucose during concomitant corticosteroid and insulin use; an insulin dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Regular Insulin; Isophane Insulin (NPH): (Moderate) Monitor blood glucose during concomitant corticosteroid and insulin use; an insulin dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Relugolix; Estradiol; Norethindrone acetate: (Moderate) Monitor for corticosteroid-related adverse events if corticosteroids are used with estrogens. Concurrent use may increase the exposure of corticosteroids. Estrogens may decrease the hepatic clearance of corticosteroids thereby increasing their effect. [29779] [54049] Repaglinide: (Moderate) Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Systemic and inhaled corticosteroids are known to increase blood glucose and worsen glycemic control in patients taking antidiabetic agents. The main risk factors for impaired glucose tolerance due to corticosteroids are the dose of steroid and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [62853] Respiratory Syncytial Virus Vaccine: (Moderate) Patients receiving high-dose corticosteroid therapy may have a diminished response to vaccines. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 2 weeks after discontinuation. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving high-dose corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine. [60092] [65107] riTUXimab: (Moderate) Rituximab and corticosteroids are commonly used together; however, monitor the patient for immunosuppression and signs and symptoms of infection during combined chronic therapy. [30943] [49773] [56233] riTUXimab; Hyaluronidase: (Moderate) Rituximab and corticosteroids are commonly used together; however, monitor the patient for immunosuppression and signs and symptoms of infection during combined chronic therapy. [30943] [49773] [56233] Rocuronium: (Moderate) Limit the period of use of neuromuscular blockers and corticosteroids and only use when the specific advantages of the drugs outweigh the risks for acute myopathy. An acute myopathy has been observed with the use of high doses of corticosteroids in patients receiving concomitant long-term therapy with neuromuscular blockers. Clinical improvement or recovery after stopping therapy may require weeks to years. [41361] [41961] [42031] [43319] [54278] [60760] [61750] [61937] Rosiglitazone: (Moderate) Monitor blood glucose during concomitant corticosteroid and thiazolidinedione use; a thiazolidinedione dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Rotavirus Vaccine: (Contraindicated) Avoid the administration of live virus vaccines with high-dose corticosteroid therapy and for at least 1 month following treatment. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated live virus vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 1 month after discontinuation. Patients with altered immunocompetence may be at increased risk for severe adverse reactions due to uninhibited growth of the attenuated live virus. Additionally, vaccine efficacy may be diminished in patients receiving any supraphysiologic dose of corticosteroid. [60092] [65107] Salicylates: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Concomitant use increases the risk of GI bleeding. In patients receiving concomitant corticosteroids and chronic use of salicylates, withdrawal of corticosteroids may result in salicylism because corticosteroids enhance renal clearance of salicylates and their withdrawal is followed by return to normal rates of renal clearance. [24574] [28502] Salsalate: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Concomitant use increases the risk of GI bleeding. In patients receiving concomitant corticosteroids and chronic use of salicylates, withdrawal of corticosteroids may result in salicylism because corticosteroids enhance renal clearance of salicylates and their withdrawal is followed by return to normal rates of renal clearance. [24574] [28502] Sargramostim, GM-CSF: (Major) Avoid the concomitant use of sargramostim and systemic corticosteroid agents due to the risk of additive myeloproliferative effects. If coadministration of these drugs is required, frequently monitor patients for clinical and laboratory signs of excess myeloproliferative effects (e.g., leukocytosis). Sargramostim is a recombinant human granulocyte-macrophage colony-stimulating factor that works by promoting proliferation and differentiation of hematopoietic progenitor cells. [61087] SARS-CoV-2 (COVID-19) vaccines: (Moderate) Patients receiving corticosteroids in greater than physiologic doses may have a diminished response to the SARS-CoV-2 virus vaccine. Counsel patients receiving corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure to SARS-CoV-2 virus after receiving the vaccine. [65107] [66080] SARS-CoV-2 Virus (COVID-19) Adenovirus Vector Vaccine: (Moderate) Patients receiving corticosteroids in greater than physiologic doses may have a diminished response to the SARS-CoV-2 virus vaccine. Counsel patients receiving corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure to SARS-CoV-2 virus after receiving the vaccine. [65107] [66080] SARS-CoV-2 Virus (COVID-19) mRNA Vaccine: (Moderate) Patients receiving corticosteroids in greater than physiologic doses may have a diminished response to the SARS-CoV-2 virus vaccine. Counsel patients receiving corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure to SARS-CoV-2 virus after receiving the vaccine. [65107] [66080] SARS-CoV-2 Virus (COVID-19) Recombinant Spike Protein Nanoparticle Vaccine: (Moderate) Patients receiving corticosteroids in greater than physiologic doses may have a diminished response to the SARS-CoV-2 virus vaccine. Counsel patients receiving corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure to SARS-CoV-2 virus after receiving the vaccine. [65107] [66080] sAXagliptin: (Moderate) Monitor blood glucose during concomitant corticosteroid and dipeptidyl peptidase-4 (DPP-4) inhibitor use; a DPP-4 dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Segesterone Acetate; Ethinyl Estradiol: (Moderate) Monitor for corticosteroid-related adverse events if corticosteroids are used with estrogens. Concurrent use may increase the exposure of corticosteroids. Estrogens may decrease the hepatic clearance of corticosteroids thereby increasing their effect. [29779] [54049] Semaglutide: (Moderate) Monitor blood glucose during concomitant corticosteroid and incretin mimetic use; an incretin mimetic dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] SGLT2 Inhibitors: (Moderate) Monitor blood glucose during concomitant corticosteroid and SGLT2 inhibitor use; a SGLT2 inhibitor dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Siponimod: (Moderate) Monitor patients carefully for signs and symptoms of infection during coadministration of siponimod and hydrocortisone. Concomitant use may increase the risk of immunosuppression. Siponimod has not been studied in combination with other immunosuppressive therapies used for the treatment of multiple sclerosis, including immunosuppressant doses of corticosteroids. [64031] SITagliptin: (Moderate) Monitor blood glucose during concomitant corticosteroid and dipeptidyl peptidase-4 (DPP-4) inhibitor use; a DPP-4 dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Smallpox and Monkeypox Vaccine, Live, Nonreplicating: (Contraindicated) Avoid the administration of live virus vaccines with high-dose corticosteroid therapy and for at least 1 month following treatment. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated live virus vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 1 month after discontinuation. Patients with altered immunocompetence may be at increased risk for severe adverse reactions due to uninhibited growth of the attenuated live virus. Additionally, vaccine efficacy may be diminished in patients receiving any supraphysiologic dose of corticosteroid. [60092] [65107] Smallpox Vaccine, Vaccinia Vaccine: (Contraindicated) Avoid the administration of live virus vaccines with high-dose corticosteroid therapy and for at least 1 month following treatment. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated live virus vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 1 month after discontinuation. Patients with altered immunocompetence may be at increased risk for severe adverse reactions due to uninhibited growth of the attenuated live virus. Additionally, vaccine efficacy may be diminished in patients receiving any supraphysiologic dose of corticosteroid. [60092] [65107] Sodium Benzoate; Sodium Phenylacetate: (Moderate) Corticosteroids may cause protein breakdown, which could lead to elevated blood ammonia concentrations, especially in patients with an impaired ability to form urea. Corticosteroids should be used with caution in patients receiving treatment for hyperammonemia. [8083] Sodium Phenylbutyrate: (Moderate) The concurrent use of corticosteroids with sodium phenylbutyrate may increase plasma ammonia levels (hyperammonemia) by causing the breakdown of body protein. Patients with urea cycle disorders being treated with sodium phenylbutyrate usually should not receive regular treatment with corticosteroids. [57685] Sodium Phenylbutyrate; Taurursodiol: (Moderate) The concurrent use of corticosteroids with sodium phenylbutyrate may increase plasma ammonia levels (hyperammonemia) by causing the breakdown of body protein. Patients with urea cycle disorders being treated with sodium phenylbutyrate usually should not receive regular treatment with corticosteroids. [57685] Sodium Phosphate Monobasic Monohydrate; Sodium Phosphate Dibasic Anhydrous: (Minor) Use sodium phosphate cautiously with mineralocorticoids as concurrent use can cause hypernatremia in some patients. [57713] [57714] [57715] Somapacitan: (Moderate) Patients treated with glucocorticoid replacement for hypoadrenalism may require an increase in their maintenance or stress steroid doses following initiation of somapacitan. Monitor for signs/symptoms of reduced serum cortisol concentrations. Growth hormone (GH) inhibits 11betaHSD-1. Consequently, patients with untreated GH deficiency have relative increases in 11betaHSD-1 and serum cortisol. The initiation of somapacitan may result in inhibition of 11betaHSD-1 and reduced serum cortisol concentrations. [65878] Somatrogon: (Moderate) Monitor for a decrease in serum cortisol concentrations and corticosteroid efficacy during concurrent use of corticosteroids and somatrogon. Patients treated with glucocorticoid replacement for hypoadrenalism may require an increase in their maintenance or stress steroid doses following initiation of somatrogon. Additionally, supraphysiologic glucocorticoid treatment may attenuate the growth promoting effects of somatrogon. Carefully adjust glucocorticoid replacement dosing to avoid hypoadrenalism and an inhibitory effect on growth. [69144] Somatropin, rh-GH: (Moderate) Corticosteroids can retard bone growth and therefore, can inhibit the growth-promoting effects of somatropin. If corticosteroid therapy is required, the corticosteroid dose should be carefully adjusted. [6807] Sotagliflozin: (Moderate) Monitor blood glucose during concomitant corticosteroid and SGLT2 inhibitor use; a SGLT2 inhibitor dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Spironolactone: (Minor) The manufacturer of spironolactone lists corticosteroids as a potential drug that interacts with spironolactone. Intensified electrolyte depletion, particularly hypokalemia, may occur. However, potassium-sparing diuretics such as spironolactone do not induce hypokalemia. In fact, hypokalemia is one of the indications for potassium-sparing diuretic therapy. Therefore, drugs that induce potassium loss, such as corticosteroids, could counter the hyperkalemic effects of potassium-sparing diuretics. [26417] [29016] [30011] Spironolactone; hydroCHLOROthiazide, HCTZ: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] (Minor) The manufacturer of spironolactone lists corticosteroids as a potential drug that interacts with spironolactone. Intensified electrolyte depletion, particularly hypokalemia, may occur. However, potassium-sparing diuretics such as spironolactone do not induce hypokalemia. In fact, hypokalemia is one of the indications for potassium-sparing diuretic therapy. Therefore, drugs that induce potassium loss, such as corticosteroids, could counter the hyperkalemic effects of potassium-sparing diuretics. [26417] [29016] [30011] Succinylcholine: (Moderate) Limit the period of use of neuromuscular blockers and corticosteroids and only use when the specific advantages of the drugs outweigh the risks for acute myopathy. An acute myopathy has been observed with the use of high doses of corticosteroids in patients receiving concomitant long-term therapy with neuromuscular blockers. Clinical improvement or recovery after stopping therapy may require weeks to years. [41361] [41961] [42031] [43319] [54278] [60760] [61750] [61937] Sulfonylureas: (Moderate) Monitor blood glucose during concomitant corticosteroid and sulfonylurea use; a sulfonylurea dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Sulindac: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and nonsteroidal antiinflammatory drug (NSAID) use. Concomitant use increases the risk of GI bleeding. [24574] [29611] [35893] SUMAtriptan; Naproxen: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and nonsteroidal antiinflammatory drug (NSAID) use. Concomitant use increases the risk of GI bleeding. [24574] [29611] [35893] Telmisartan; hydroCHLOROthiazide, HCTZ: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] Testosterone: (Moderate) Monitor for fluid retention during concurrent corticosteroid and testosterone use. Concurrent use may result in increased fluid retention. [33698] Thiazide diuretics: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] Thiazolidinediones: (Moderate) Monitor blood glucose during concomitant corticosteroid and thiazolidinedione use; a thiazolidinedione dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Thioguanine, 6-TG: (Minor) Concurrent use of purine analogs with other agents which cause bone marrow or immune suppression such as other antineoplastic agents or immunosuppressives may result in additive effects. [5504] Tick-Borne Encephalitis Vaccine: (Moderate) Patients receiving high-dose corticosteroid therapy may have a diminished response to vaccines. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 2 weeks after discontinuation. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving high-dose corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine. [60092] [65107] Tirzepatide: (Moderate) Monitor blood glucose during concomitant corticosteroid and incretin mimetic use; an incretin mimetic dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. [28032] [30585] [51002] [51324] [62853] Tocilizumab: (Moderate) Closely observe patients for signs of infection. Most patients taking tocilizumab who developed serious infections were taking concomitant immunosuppressives such as systemic corticosteroids. [38283] Tolmetin: (Moderate) Monitor for gastrointestinal toxicity during concurrent corticosteroid and nonsteroidal antiinflammatory drug (NSAID) use. Concomitant use increases the risk of GI bleeding. [24574] [29611] [35893] Torsemide: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and loop diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and loop diuretics cause increased renal potassium loss. [26417] [28429] [29779] Tretinoin, ATRA: (Minor) Because systemically administered corticosteroids exhibit immunosuppressive effects when given in high doses and/or for extended periods, additive effects may be seen with other immunosuppressives or antineoplastic agents. [7714] Triamterene: (Minor) The manufacturer of spironolactone lists corticosteroids as a potential drug that interacts with spironolactone. Intensified electrolyte depletion, particularly hypokalemia, may occur. However, potassium-sparing diuretics such as spironolactone do not induce hypokalemia. In fact, hypokalemia is one of the indications for potassium-sparing diuretic therapy. Therefore, drugs that induce potassium loss, such as corticosteroids, could counter the hyperkalemic effects of potassium-sparing diuretics. [26417] [29016] [30011] Triamterene; hydroCHLOROthiazide, HCTZ: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] (Minor) The manufacturer of spironolactone lists corticosteroids as a potential drug that interacts with spironolactone. Intensified electrolyte depletion, particularly hypokalemia, may occur. However, potassium-sparing diuretics such as spironolactone do not induce hypokalemia. In fact, hypokalemia is one of the indications for potassium-sparing diuretic therapy. Therefore, drugs that induce potassium loss, such as corticosteroids, could counter the hyperkalemic effects of potassium-sparing diuretics. [26417] [29016] [30011] Tuberculin Purified Protein Derivative, PPD: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy. [43298] [43299] Typhoid Vaccine: (Contraindicated) Avoid the administration of live virus vaccines with high-dose corticosteroid therapy and for at least 1 month following treatment. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated live virus vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 1 month after discontinuation. Patients with altered immunocompetence may be at increased risk for severe adverse reactions due to uninhibited growth of the attenuated live virus. Additionally, vaccine efficacy may be diminished in patients receiving any supraphysiologic dose of corticosteroid. [60092] [65107] Valsartan; hydroCHLOROthiazide, HCTZ: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. [26417] [29779] Varicella-Zoster Virus Vaccine, Live: (Contraindicated) Avoid the administration of live virus vaccines with high-dose corticosteroid therapy and for at least 1 month following treatment. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated live virus vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 1 month after discontinuation. Patients with altered immunocompetence may be at increased risk for severe adverse reactions due to uninhibited growth of the attenuated live virus. Additionally, vaccine efficacy may be diminished in patients receiving any supraphysiologic dose of corticosteroid. [60092] [65107] Vecuronium: (Moderate) Limit the period of use of neuromuscular blockers and corticosteroids and only use when the specific advantages of the drugs outweigh the risks for acute myopathy. An acute myopathy has been observed with the use of high doses of corticosteroids in patients receiving concomitant long-term therapy with neuromuscular blockers. Clinical improvement or recovery after stopping therapy may require weeks to years. [41361] [41961] [42031] [43319] [54278] [60760] [61750] [61937] Vigabatrin: (Major) Vigabatrin should not be used with corticosteroids, which are associated with serious ophthalmic effects (e.g., retinopathy or glaucoma) unless the benefit of treatment clearly outweighs the risks. [36250] vinCRIStine Liposomal: (Minor) Use sodium phosphate cautiously with mineralocorticoids as concurrent use can cause hypernatremia in some patients. [57713] [57714] [57715] Vonoprazan; Amoxicillin; Clarithromycin: (Moderate) Clarithromycin inhibits CYP3A4 and has the potential to result in increased plasma concentrations of corticosteroids. Therefore, the dose of corticosteroid should be titrated to avoid steroid toxicity. [28001] Voriconazole: (Moderate) Monitor for potential adrenal dysfunction with concomitant use of voriconazole and hydrocortisone. In patients taking corticosteroids, voriconazole-associated CYP3A4 inhibition of their metabolism may lead to corticosteroid excess and adrenal suppression. Corticosteroid exposure is likely to be increased. Voriconazole is a strong CYP3A4 inhibitor, and hydrocortisone is a CYP3A4 substrate. [28158] [34447] Vorinostat: (Moderate) Use vorinostat and corticosteroids together with caution; the risk of QT prolongation and arrhythmias may be increased if electrolyte abnormalities occur. Corticosteroids may cause electrolyte imbalances; hypomagnesemia, hypokalemia, or hypocalcemia and may increase the risk of QT prolongation with vorinostat. Frequently monitor serum electrolytes if concomitant use of these drugs is necessary. [26417] [32789] Warfarin: (Moderate) Monitor the INR if warfarin is administered with corticosteroids. The effect of corticosteroids on warfarin is variable. There are reports of enhanced as well as diminished effects of anticoagulants when given concurrently with corticosteroids; however, limited published data exist, and the mechanism of the interaction is not well described. High-dose corticosteroids appear to pose a greater risk for increased anticoagulant effect. In addition, corticosteroids have been associated with a risk of peptic ulcer and gastrointestinal bleeding. [28549] [29779] Yellow Fever Vaccine, Live: (Contraindicated) Avoid the administration of live virus vaccines with high-dose corticosteroid therapy and for at least 1 month following treatment. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated live virus vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 1 month after discontinuation. Patients with altered immunocompetence may be at increased risk for severe adverse reactions due to uninhibited growth of the attenuated live virus. Additionally, vaccine efficacy may be diminished in patients receiving any supraphysiologic dose of corticosteroid. [60092] [65107] Zafirlukast: (Minor) Zafirlukast inhibits the CYP3A4 isoenzymes and should be used cautiously in patients stabilized on drugs metabolized by CYP3A4, such as corticosteroids. [4718] [4948]
      Revision Date: 06/12/2024, 01:59:00 AM

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      Monitoring Parameters

      • blood glucose
      • blood pressure
      • growth rate
      • serum cortisol
      • serum potassium
      • weight

      US Drug Names

      • A-Hydrocort
      • Ala-Cort
      • Ala-Scalp
      • Alkindi
      • Anucort-HC
      • Anumed-HC
      • Anusol HC
      • Aqua Glycolic HC
      • Aquaphor Children's Itch Relief
      • Aquaphor Itch Relief
      • Aveeno
      • Balneol for Her
      • Caldecort
      • Cetacort
      • Colocort
      • Cortaid
      • Cortaid Advanced
      • Cortaid Intensive Therapy
      • Cortaid Sensitive Skin
      • CortAlo
      • Cortef
      • Cortenema
      • Corticaine
      • Corticool
      • Cortifoam
      • Cortizone-10
      • Cortizone-10 Cooling Relief
      • Cortizone-10 External Itch Relief
      • Cortizone-10 Intensive Healing
      • Cortizone-10 Plus
      • Cortizone-10 Quick Shot
      • Cortizone-5
      • DermacinRx Hydroxate
      • Dermarest Dricort
      • Dermarest Eczema
      • Dermarest Itch Relief
      • Encort
      • First - Hydrocortisone
      • Gly-Cort
      • GRx HiCort
      • Hemmorex-HC
      • Hemorrhoidal-HC
      • Hemril
      • Hycort
      • Hydro Skin
      • Hydrocort
      • Hydrocortisone in Absorbase
      • Hydrocortone
      • Hydroskin
      • Hydroxym
      • Hytone
      • Instacort
      • Lacticare HC
      • Locoid
      • Locoid Lipocream
      • MiCort-HC
      • Monistat Complete Care Instant Itch Relief Cream
      • Neosporin Eczema
      • NuCort
      • Nutracort
      • NuZon
      • Pandel
      • Penecort
      • Preparation H Hydrocortisone
      • Proctocort
      • Proctocream-HC
      • Procto-Kit
      • Procto-Med HC
      • Procto-Pak
      • Proctosert HC
      • Proctosol-HC
      • Proctozone-HC
      • Rectacort HC
      • Rectasol-HC
      • Rederm
      • Sarnol-HC
      • Scalacort
      • Scalpicin Anti-Itch
      • Solu-Cortef
      • Texacort
      • Tucks HC
      • Vagisil Anti-Itch
      • VANICREAM HC
      • Walgreens Intensive Healing
      • Westcort
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