Hidrocortizon Hf (Hydrocortisone)

Hidrocortizon Hf is indicated for several acute and chronic conditions that benefit from systemic glucocorticoid activity.

• Adrenal insufficiency, including primary and secondary forms.
• Acute inflammatory conditions such as severe asthma exacerbations, allergic reactions, and rheumatic flares.
• Management of shock states where cortisol deficiency contributes to hemodynamic instability.
• Replacement therapy in patients undergoing long‑term corticosteroid tapering.
• Adjunctive treatment for certain hematologic or oncologic emergencies requiring rapid anti‑inflammatory effect.
• Control of severe dermatologic eruptions such as Stevens‑Johnson syndrome when systemic therapy is required.
• Supportive therapy in postoperative patients at risk of adrenal crisis due to stress.

• Hydrocortisone acts as an agonist at intracellular glucocorticoid receptors. After crossing cell membranes, it binds to the receptor complex, inducing conformational changes that allow translocation to the nucleus. The activated complex interacts with glucocorticoid response elements on DNA, modulating transcription of anti‑inflammatory proteins and suppressing pro‑inflammatory cytokines. This genomic effect reduces leukocyte migration, capillary permeability, and immune activation, producing systemic anti‑inflammatory and immunosuppressive actions.

Like all systemic corticosteroids, hydrocortisone may cause a range of adverse reactions that vary in frequency and severity.

Common

• Transient increase in blood glucose levels.
• Mild electrolyte disturbances, such as sodium retention or potassium loss.
• Local irritation or pain at the injection site.
• Headache or dizziness.
• Gastrointestinal discomfort, including nausea.
• Mild insomnia or sleep disturbances.
• Weight gain due to fluid retention.

Serious

• Severe hyperglycemia or new‑onset diabetes mellitus.
• Significant hypertension or fluid overload.
• Acute adrenal insufficiency after abrupt discontinuation.
• Infections that become more severe or difficult to treat.
• Allergic reactions ranging from rash to anaphylaxis.
• Psychiatric manifestations such as mood swings, depression, or psychosis.
• Osteoporosis or increased risk of fractures with prolonged use.

When prescribing Hidrocortizon Hf, clinicians should evaluate patient history and monitor for conditions that may be aggravated by systemic glucocorticoids.

• Existing uncontrolled diabetes mellitus or marked hyperglycemia, which may worsen with glucocorticoid therapy.
• Active or latent infections, especially tuberculosis, fungal disease, or viral hepatitis, which can be exacerbated.
• Known hypersensitivity to hydrocortisone or any formulation excipients; an allergic reaction may manifest as rash or anaphylaxis.
• History of peptic ulcer disease or gastrointestinal bleeding, as glucocorticoids can increase ulcer risk.
• Severe hypertension, cardiac failure, or fluid overload, which may be aggravated by sodium retention.

Hydrocortisone can alter the pharmacokinetics or pharmacodynamics of several co‑administered agents; clinicians should review concomitant medications.

Avoid

• Combined use with potent CYP3A4 inducers such as rifampin, which may reduce hydrocortisone exposure.
• Concurrent administration of other systemic glucocorticoids, increasing risk of adrenal suppression and systemic toxicity.
• Live vaccines while on systemic corticosteroid therapy, due to impaired immune response.

Use with caution

• Non‑steroidal anti‑inflammatory drugs (NSAIDs), which may increase gastrointestinal bleeding risk.
• Anticoagulants (e.g., warfarin), as glucocorticoids can enhance anticoagulant effect.
• Diabetic agents, because hydrocortisone may raise blood glucose and require dose adjustment.
• Antihypertensive medications, as fluid retention may blunt their efficacy.