Nordison (Hydrocortisone)

• Hydrocortisone acts systemically to replace deficient cortisol and to suppress inflammation in several disease groups.
• Adrenal insufficiency: restores physiologic cortisol levels in primary or secondary adrenal failure.
• Congenital adrenal hyperplasia: provides glucocorticoid replacement to control excess androgen production.
• Severe inflammatory disease: reduces systemic inflammation in conditions such as rheumatoid arthritis or severe asthma exacerbations.
• Adrenal crisis: offers rapid glucocorticoid support during acute adrenal decompensation.

• Hydrocortisone binds to intracellular glucocorticoid receptors, forming a complex that translocates to the nucleus and interacts with glucocorticoid response elements on DNA. This modulates transcription of anti‑inflammatory proteins and suppresses pro‑inflammatory cytokine genes, leading to decreased leukocyte migration, reduced capillary permeability, and inhibition of immune cell activation.

Hydrocortisone may cause a range of adverse reactions, from mild to severe, depending on dose and duration.

Common Side Effects

• Increased appetite and weight gain
• Insomnia or mood swings
• Elevated blood glucose levels
• Gastrointestinal discomfort or ulceration
• Skin thinning and easy bruising
• Fluid retention causing mild edema

Serious or Rare Side Effects

• Adrenal suppression with abrupt discontinuation
• Severe infections due to immunosuppression
• Cushingoid appearance with chronic high‑dose use
• Osteoporosis and increased fracture risk
• Psychosis or severe mood disturbances
• Hyperkalemia or severe electrolyte imbalance

• When prescribing hydrocortisone, clinicians should consider several safety measures.
• Assess adrenal function: confirm need for glucocorticoid replacement before initiation.
• Monitor blood glucose: especially in diabetic patients or those at risk of hyperglycemia.
• Evaluate for infection: avoid use in uncontrolled systemic infections.
• Use lowest effective dose: to minimise systemic side effects.
• Taper when stopping: gradually reduce dose to prevent adrenal crisis.
• Store at ambient temperature: keep in original container, protect from moisture and direct sunlight.

Hydrocortisone can alter the pharmacokinetics or pharmacodynamics of several medicines.

Major Interactions (Avoid)

• Strong CYP3A4 inhibitors (e.g., ketoconazole, itraconazole): may increase hydrocortisone exposure.
• Live vaccines: risk of attenuated pathogen proliferation due to immunosuppression.
• Anticoagulants (warfarin): glucocorticoids may enhance anticoagulant effect, increasing bleeding risk.

Moderate Interactions (Monitor Closely)

• CYP3A4 inducers (e.g., rifampin, phenytoin): may reduce hydrocortisone levels.
• Non‑steroidal anti‑inflammatory drugs (NSAIDs): combined use can raise ulcer risk.
• Diabetic agents: glucocorticoids may diminish glycaemic control, requiring dose adjustment.