Nordisone 20 Mg Tablets (Hydrocortisone)

Hydrocortisone is a glucocorticoid that modulates inflammatory and immune pathways.

• Adrenal insufficiency: provides glucocorticoid replacement to restore cortisol levels and prevent adrenal crisis.
• Rheumatoid arthritis: reduces joint inflammation and pain, improving functional ability.
• Systemic lupus erythematosus: suppresses immune activity to control disease flares.
• Severe allergic reactions: diminishes systemic inflammation and edema during acute episodes.
• Asthma exacerbations: helps control airway inflammation when high‑dose oral steroids are required.

• Hydrocortisone binds to intracellular glucocorticoid receptors, forming a complex that translocates to the nucleus and regulates gene transcription. This interaction up‑regulates anti‑inflammatory proteins such as annexin‑1 and down‑regulates pro‑inflammatory cytokines (IL‑1, IL‑6, TNF‑α). The net effect is reduced synthesis of prostaglandins and leukotrienes, decreased vascular permeability, and suppression of immune cell activation, providing systemic anti‑inflammatory and immunosuppressive activity through multiple downstream pathways.

Hydrocortisone may cause a range of adverse reactions, varying from mild to serious.

Common Side Effects

• Increased appetite: may lead to weight gain.
• Fluid retention: can cause mild edema.
• Elevated blood pressure: occasional rise in systolic/diastolic values.
• Mood changes: irritability or mild euphoria.
• Gastrointestinal discomfort: nausea or dyspepsia.
• Skin thinning: easy bruising or stretch marks.
• Sleep disturbances: insomnia or altered sleep patterns.

Serious or Rare Side Effects

• Severe infection: immunosuppression may predispose to opportunistic infections.
• Hyperglycemia: significant rise in blood glucose, especially in diabetic patients.
• Osteoporosis: long‑term use can reduce bone mineral density.
• Adrenal suppression: abrupt discontinuation may precipitate adrenal crisis.
• Psychiatric disturbances: psychosis or severe mood swings.
• Cushingoid appearance: facial rounding and central obesity.
• Electrolyte imbalance: hypokalemia or sodium retention.

When prescribing Hydrocortisone tablets, clinicians should observe several precautionary measures to minimise risk.

• Assess adrenal function: confirm diagnosis before initiating therapy.
• Monitor blood glucose: especially in patients with diabetes or metabolic syndrome.
• Evaluate blood pressure: regular checks for hypertension development.
• Review infection risk: avoid use in active uncontrolled infections.
• Taper dose gradually: prevent adrenal insufficiency upon discontinuation.
• Store at ambient temperature: keep below 25°C in original packaging, protect from moisture.

Hydrocortisone can alter the pharmacokinetics or pharmacodynamics of several medicines; awareness of key interactions helps avoid adverse outcomes.

Major Interactions (Avoid)

• CYP3A4 inhibitors (e.g., ketoconazole): may increase systemic exposure and toxicity.
• Anticoagulants (warfarin): enhanced anticoagulant effect, risk of bleeding.
• Live vaccines: immunosuppression can reduce vaccine efficacy and increase infection risk.
• Antifungal azoles (e.g., itraconazole): potent CYP3A4 inhibition raising hydrocortisone levels.
• Antiretrovirals (protease inhibitors): may increase cortisol levels.

Moderate Interactions (Monitor Closely)

• Non‑steroidal anti‑inflammatory drugs (NSAIDs): additive risk of gastrointestinal ulceration.
• Diuretics (loop, thiazide): may exacerbate electrolyte disturbances, especially hypokalemia.
• Antidiabetic agents: glucocorticoid‑induced hyperglycemia may require dose adjustment.
• Thyroid hormones: glucocorticoids may decrease conversion of T4 to T3.
• Beta‑blockers: may mask tachycardia signs of adrenal insufficiency.