Hydrocortisone Focus Pharmaceuticals Limited (Hydrocortisone)

Hydrocortisone is used when the body requires additional glucocorticoid activity to replace deficient hormone levels or to control excessive inflammation.

• Replacement therapy for primary or secondary adrenal insufficiency.
• Management of acute adrenal crisis.
• Treatment of inflammatory skin conditions such as eczema or dermatitis when systemic therapy is indicated.
• Adjunct therapy for autoimmune diseases including rheumatoid arthritis and systemic lupus erythematosus.
• Short‑term control of severe allergic reactions or asthma exacerbations.

• 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 decreased synthesis of pro‑inflammatory cytokines, inhibition of phospholipase A2, and reduced expression of adhesion molecules, collectively producing anti‑inflammatory and immunosuppressive effects that mimic endogenous cortisol and helps maintain metabolic homeostasis especially during stress.

Like other systemic corticosteroids, hydrocortisone may cause a range of adverse reactions that vary with dose and duration of therapy.

Common

• Increased appetite or weight gain.
• Fluid retention leading to mild edema.
• Elevated blood glucose levels, especially in diabetic patients.
• Mood changes such as irritability or insomnia.

Serious

• Severe hypertension or cardiovascular complications.
• Suppression of the hypothalamic‑pituitary‑adrenal (HPA) axis.
• Opportunistic infections due to immunosuppression.

Healthcare providers should evaluate several factors before initiating hydrocortisone therapy to minimize risks.

• Assess for active infections; avoid use in uncontrolled bacterial, viral, or fungal infections.
• Screen for diabetes mellitus or glucose intolerance, as corticosteroids can worsen glycemic control.
• Evaluate cardiovascular status, particularly hypertension or heart failure, before long‑term use.
• Consider bone health; prolonged therapy may increase risk of osteoporosis.
• Use the lowest effective dose for the shortest duration required.
• Monitor for signs of adrenal suppression during tapering.
• Counsel patients on potential pregnancy and lactation considerations, as safety data are limited.

Hydrocortisone can alter the pharmacokinetics or pharmacodynamics of several other medicines.

Avoid

• Concurrent use with potent CYP3A4 inducers such as rifampin, which may reduce hydrocortisone exposure.
• Co‑administration with systemic immunosuppressants (e.g., cyclosporine) that markedly increase infection risk.

Use with caution

• Non‑steroidal anti‑inflammatory drugs (NSAIDs) because of additive gastrointestinal ulcer risk.
• Anticoagulants (e.g., warfarin) as corticosteroids may affect coagulation parameters.
• Vaccines, especially live attenuated vaccines, due to possible reduced immune response.
• Diuretics, which may exacerbate fluid and electrolyte imbalances.