cortisol; hydrocortisone (Cortef, Solu-Cortef, Alphaderm, Cetacort, Cortenema, Nutracort)

Indications

• topical anti-inflammatory agent
  • dermatitis, seborrheic dermatitis, atopic dermatitis, dermatitis herpetiformis
  • hemorrhoids, proctitis,
  • skin irritation, superficial injury
  • pruritus, urticaria
  • discoid lupus
  • granuloma annulare
  • Tinea cruris, Tinea pedis, Tinea corporis
  • dandruff
  • rash
  • keratoderma
  • acne
  • lichen simplex chronicus
• treatment of acute & chronic adrenal insufficiency
  • congenital adrenal hyperplasia
  • adrenoleukodystrophy
  • adrenogenital syndrome
  • hypopituitarism
• anti-inflammatory agent for adjunctive treatment of:
  • hypersensitivity reactions
  • shock
  • status asthmaticus
  • oral disorders
    • periodontal disease, aphthous stomatitis
  • trichinosis
  • Loeffler's syndrome
  • respiratory distress syndrome
  • musculoskeletal inflammation
    • synovitis, tendonitis, tenosynovitis, bursitis,
    • osteoarthritis
  • gout
• malignancy
  • cutaneous T-cell lymphoma
  • mycosis fungoides-Sezary syndrome
  • Hodgkin's disease
  • non-Hodgkin's lymphoma
  • acute lymphoblastic leukemia
• autoimmune disease
  • sarcoidosis
  • immune thrombocytopenic purpura
  • rheumatic heart disease
  • organ transplantation rejection
  • ankylosing spondylitis
  • rheumatoid arthritis
  • systemic lupus erythematosus
  • autoimmune hemolytic anemia
  • dermatomyositis
  • psoriatic arthritis
  • thyroiditis
  • pemphigus
  • Crohn's disease, ulcerative colitis, ulcerative proctitis
• other conditions
  • bronchopulmonary dysplasia
  • Diamond-Blackfan syndrome
  • cerebral edema, laryngeal edema, angioneurotic edema
  • psoriasis
  • multiple sclerosis
  • erythema multiforme
  • erythroderma
  • berylliosis
  • aspiration pneumonitis
  • nephrotic syndrome
• ophthalmic agent for treatment of inflammatory eye disease

Dosage

• acute adrenal insufficiency
  • adults: (succinate, phosphate)
    • 15-240 mg IV/IM/SC every 12 hours
  • older children
    • 1-2 mg/kg bolus IM/IV
    • 150-250 mg/day in divided doses
  • infants & young children:
    • 1-2 mg/kg bolus IM/IV
    • 25-150 mg/day in divided doses
• physiologic replacement:
  • children
    • oral: 0.5-0.75 mg/kg/day or 20-25 mg/m2/day divided every 8 hours
    • IM: 0.25-0.35 mg/kg or 12-15 mg/m2 QD
  • adults: 20 mg QD, divided BID
• anti-inflammatory or immunosuppressive:
  • adults:
    • 15-20 mg IM/SC/IV every 12 hours as phosphate
    • 5-60 mg PO QID
  • infants & children
    • oral 2.5-10 mg/kg/day or 75-300 mg/m2/day divided every 6-12 hours
    • IM/IV (succinate): 1-5 mg/kg/day or 30-150 mg/m2/day divided every 6-12 hours
• status asthmaticus: (children)
  • load 1-2 mg/kg every 6 hours for 24 hours
  • maintenance of 0.5-1 mg/kg every 6 hours
• shock
  • adults: 500-2000 mg every 2-6 hours IM/IV as succinate
  • children:
    • 50 mg/kg IM/IV initial as succinate
    • repeat in 4 hours
    • then 50 mg/kg IM/IV QD PRN

Tabs: 5, 10, 20 mg.

Suspension: 10 mg/5 mL (120 mL).

Injection:

• phosphate 50 mg/mL (10 mL)
• succinate 100 mg, 250 mg. 500 mg
• succinate may be given IV or IM
• acetate may only be given IM, not IV

aerosol 0.5%.

also see topical cortisol

Pharmacokinetics

• 90% of circulating cortisol is bound to plasma proteins, primarily to corticosteroid-binding globulin
• also weak binding to albumin
• biological 1/2life: 8-12 hours

elimination via liver

Adverse effects

• common (> 10%)
  • increased appetite, insomnia, indigestion, nervousness
• less common (1-10%)
  • cataracts, hyperglycemia, hirsutism, joint pain epistaxis
• uncommon (< 1%)
  • seizures, mood swings, headache, skin atrophy, bruising, hyperpigmentation, acne, amenorrhea, Na+ & H2O retention, Cushing's syndrome, suppression of bone growth, abdominal distension, ulcerative esophagitis, pancreatitis, muscle wasting, hypersensitivity, delirium, hallucinations, euphoria, hypotension, peptic ulcer, immunosuppression
• short-term
  • fluid & electrolyte disturbances
  • hyperglycemia
  • poor wound healing
  • GI disturbances
  • spread of infection
• long term
  • osteoporosis
  • bone fractures
  • pituitary adrenal insufficiency
  • Cushing's syndrome
  • rapid withdrawal may cause acute adrenal insufficiency
• topical
  • irritation
  • rash
  • skin atrophy
  • acne

• drug adverse effects of glucocorticoids
• drug adverse effects of immunosuppressive agents

Drug interactions

• aminoglutethimide
• anticholinesterases
• barbiturates
• carbamazepine
• phenytoin
• rifampin
• live virus vaccines

• drug interaction(s) of methotrexate with biological response modifier
• drug interaction(s) of glucocorticoids with warfarin
• drug interaction(s) of NSAIDs with glucocorticoid

Laboratory

• cortisol in hair
• cortisol in blood
  • cortisol in dried blood spot
• cortisol in CSF
• cortisol in saliva
• cortisol in serum
  • free cortisol in serum
• cortisol in urine
  • urinary free cortisol

Mechanism of action

• short-acting glucocorticoid
• some mineralocorticoid activity
  • mineralocorticoid/glucocorticoid activity (1/125)

More general terms

• pregnenedione
• 11 hydroxycorticosteroid
• 17 hydroxycorticosteroid
• adrenal cortex hormone; corticosteroid
• glucocorticoid

More specific terms

• Cortisol Topical (Westcort, Locoid, Hytone, Lacticare HC, Pramosome)

Additional terms

• cortisol in serum
• free cortisol in 24 hour urine

Component of

• cortisol/tolnaftate
• cortisol/salicylic acid/shampoo/sulfur
• cortisol/lidocaine/pramoxine/shampoo
• cortisol/ketoconazole/shampoo
• cortisol/emollient/pramoxine
• chlorhexidine/cortisol/shampoo
• chlorhexidine/cortisol/ketoconazole/shampoo
• all trans retinoic acid/cortisol
• bacitracin/colistin/cortisol
• cortisol/polymixin b
• cortisol/phenol
• cortisol/oxytetracycline
• cortisol/oatmeal
• cortisol/neomycin
• cortisol/miconazole/nitrate
• cortisol/lidocaine/psyllium
• cortisol/hexachlorophene/menthol
• cortisol/gentamicin/miconazole
• cortisol/diphenhydramine/nystatin/tetracycline
• cortisol/diphenhydramine/nystatin
• cortisol/lidocaine/polycarbophil/psyllium
• benzalkonium/chloroxylenol/cortisol/pramoxine
• chloroxylenol/cortisol/pramoxine
• benzocaine/chloroxylenol/cortisol
• aloe vera/cortisol/iodoquinol
• cortisol/ketoconazole
• cortisol/salicylic acid/sulfur
• cortisol/lidocaine
• cortisol/diphenhydramine
• colistin/cortisol/neomycin (Coly-Mycin S)
• clioquinol/cortisol/cortistatin
• clioquinol/cortisol
• benzoyl peroxide/cortisol
• benzocaine/cortisol
• bacitracin/cortisol/neomycin/polymixin b
• acetic acid/cortisol
• acetic acid/cortisol/propylene glycol
• cortisol/neomycin/polymyxin B
• cortisol/iodoquinol (Vytone)
• ciprofloxacin/cortisol (Cipro HC)
• cortisol/neomycin/polymixin-B (Corticosporin, Cortisporin, Cortomycin)
• cortisol/neomycin/polymyxin B otic (Corticosporin otic, Cortisporin otic)
• acetic acid/cortisol/propylene glycol otic (VoSol otic)
• cortisol/pramoxine
• colistin/cortisol/neomycin otic (Coly-Mycin S otic)
• cortisol/pramoxine rectal (Anusol HC, Pramosone, Proctofoam-HC)
• acyclovir/cortisol (Lipsovir, Xerese)

Database

• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=5754
• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=3640
• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=657311