Hydrocortisone Ι.Φ.Ε.Τ. (Hydrocortisone)

Hydrocortisone Ι.Φ.Ε.Τ. is employed in clinical practice for several endocrine and inflammatory conditions where glucocorticoid replacement or anti‑inflammatory effects are required, and for short‑term systemic therapy in selected patients.

• Primary adrenal insufficiency (Addison’s disease) requiring cortisol replacement.
• Congenital adrenal hyperplasia with cortisol deficiency.
• Acute adrenal crisis management.
• Inflammatory or allergic disorders such as severe asthma, dermatitis, or rheumatoid arthritis when systemic therapy is indicated.
• Certain autoimmune conditions where immunosuppression is needed.
• Post‑operative adrenal support after bilateral adrenalectomy.
• Replacement therapy during glucocorticoid tapering after high‑dose steroid courses.

• Hydrocortisone acts as an agonist at intracellular glucocorticoid receptors. After crossing cell membranes, it binds to the receptor complex, translocates to the nucleus, and modulates gene transcription. This results in up‑regulation of anti‑inflammatory proteins and down‑regulation of pro‑inflammatory cytokines, while also influencing carbohydrate, protein, and lipid metabolism and suppressing immune cell activation. Additionally, hydrocortisone reduces vascular permeability and stabilizes lysosomal membranes, contributing to its overall anti‑inflammatory profile.

Oral hydrocortisone may be associated with a range of adverse reactions, which vary in frequency and severity.

Common

• Increased appetite or weight gain.
• Mild gastrointestinal discomfort such as nausea or dyspepsia.
• Fluid retention leading to mild edema.
• Mood changes including irritability or mild anxiety.

Serious

• Severe hyperglycemia or new‑onset diabetes.
• Significant hypertension or cardiovascular events.
• Opportunistic infections due to immunosuppression.
• Adrenal suppression with risk of adrenal crisis upon abrupt discontinuation.

Before initiating Hydrocortisone Ι.Φ.Ε.Τ., clinicians should evaluate several precautionary factors to minimize risks.

• Assess baseline blood glucose and blood pressure, especially in patients with diabetes or hypertension.
• Evaluate for active infections; treat before starting systemic glucocorticoid therapy.
• Consider bone health; long‑term use may increase risk of osteoporosis.
• Review concomitant medications that may potentiate immunosuppression or fluid retention.
• Use the lowest effective dose for the shortest duration required.
• Monitor for signs of adrenal insufficiency during dose tapering or after abrupt cessation.

Hydrocortisone can interact with other agents, affecting its efficacy or safety profile.

Avoid

• Concurrent use of potent CYP3A4 inducers (e.g., rifampin, phenytoin) that may reduce hydrocortisone plasma levels.
• High‑dose non‑steroidal anti‑inflammatory drugs (NSAIDs) that increase the risk of gastrointestinal bleeding.

Use with caution

• Anticoagulants such as warfarin, where glucocorticoids may enhance anticoagulant effect.
• Diabetic medications, as hydrocortisone can raise blood glucose and require dose adjustments.
• Vaccines, particularly live attenuated vaccines, due to possible reduced immune response.
• Other systemic steroids, which may increase the risk of cumulative glucocorticoid toxicity.