Hydrocortisone Sodium Succinate
Corticosteroid, Systemic · Glucocorticoid
Indications
Adrenal failure; overwhelming infections (with chemotherapy).
Dosage
Dose should be based on severity of disease and patient response. Adults: Adrenal insufficiency (acute): 100 mg IV bolus, then 300 mg/day in divided doses every 8 hr or as a continuous infusion for 48 hr; once patient is stable change to oral, 50 mg every 8 hr for 6 doses, then taper to 30-50 mg/day in divided doses. Adrenal insufficiency (chronic): Oral: 15-25 mg/day in 2-3 divided doses. One-half to two-thirds of the daily dose in the morning in order to mimic the physiological cortisol secretion pattern. If the twice-daily regimen is utilized, the sec dose should be administered 6-8 hr following the first dose. Anti-inflammatory or immunosuppressive: Oral/IM/IV: 15-240 mg every 12 hr. Status asthmaticus: IV: 1-2 mg/kg/dose every 6 hr for 24 hr, then maintenance of 0.5-1 mg/kg every 6 hr. Stress dosing (surgery) in patients known to be adrenally-suppressed or on chronic systemic…
Administration
Hydrocortisone sodium succinate may be administered by IM or IV. IV bolus: Dilute to 50 mg/mL and give over 30 seconds to several min. IV intermittent infusion: Dilute to 1 mg/mL and give over 20-30 min. Compatibility: Stable in NS, D5W, fat emulsion 10%, LR, 1/2NS. Y-site administration: Drug to Drug IV Incompatibility: Ciprofloxacin, diazepam, ergotamine, idarubicin, midazolam, phenytoin, sargramostim. In syringe: Incompatible with doxapram. When admixed: Incompatible with aminophylline with cephalothin, bleomycin, ephedrine, hydralazine, naphcillin, pentobarbital, phenobarbital, prochlorperazine edisylate, promethazine. Stability: Store unreconstituted product and solution at 20°C-25°C (68°F-77°F). Protect from light. Use solution only if it is clear. Unused solution should be discarded after 3 days.
Adverse Effects
Endocrine irregularities including menstrual problems, Cushingoid state, adrenal suppression, growth suppression in children. Increased susceptibility to infection, increased severity of infection. Fluid/electrolyte disturbance, hypertension, negative protein, nitrogen and calcium balance. Myopathy, tendon rupture, osteoporosis, osteonecrosis and fractures. Impaired wound healing, sweating, hirsutism, striae, telangiectasia, acne. GI disturbance, peptic ulceration, acute pancreatitis, candidiasis. Psychiatric effects, neurological effects, insomnia. Diabetes, impaired glucose tolerance, weight gain, increased appetite. Ocular disturbances including cataracts, raised intraocular pressure, optic nerve damage, corneal changes, glaucoma. Thromboembolism, leukocytosis.
Risk Factor (Pregnancy/Lactation)
Pregnancy: Risk cannot be ruled out. Lactation: Caution advised or effect undetermined. Contraindications: Systemic fungal infections unless specific anti-infective therapy is used. Head injury, stroke. Precautions: Active infections not controlled by antibiotics. Latent or active amoebiasis. History of TB, septicaemia, symptoms may be masked. Avoid or maintain extreme cautions in chickenpox, measles, psychiatric disorders, renal impairment, hepatic failure, cirrhosis, active peptic ulcer, Myasthaenia gravis, previous steroid myopathy, osteoporosis, epilepsy, hypothyroidism, diabetes, adrenal suppression, hypertension, recent MI, congestive heart failure, thromboembolic disorders, glaucoma, corneal perforation. WITHDRAWAL: Withdraw gradually. Withdrawal symptoms may include fever, myalgia, arthralgia, rhinitis, itchy skin nodules and weight loss.
Interactions
Live vaccines or other vaccines, anticoagulants, hypoglycaemia agents, antihypertensives, diuretics, erythromycin, rifamycin, amphotericin, azole antifungals, ritonavir, cyclosporin, cardiac glycosides. Oestrogens including oral contraceptives, somatropin. Carbamazepine, phenytoin, primidone, barbiturates. Muscle relaxants, NSAIDs, salicylates, sympathomimetics, mifepristone, methotrexate, theophylline, aprepitant.
Advice to Patient
Take oral form with meals. Contact prescriber if there are signs of infection (such as chills, fever, sore throat, injury), swelling of ankles/hands/feet, sudden weight gain (5 lb per week), abdominal pain, difficulty in breathing, dark red or black stools, severe vomiting, weakness, anorexia, nausea, dizziness, fatigue, unusual changes in mood. Avoid alcohol during therapy. Have regular eye examinations if you are on long-term therapy. Carry or wear medical identification if you are on long-term therapy. Avoid highly crowded places to prevent infections. Avoid people with infections especially chicken pox or measles.
Pharmacokinetics
Absorption: IM: Rapid. Metabolism: Hepatic. Half-life elimination: 8-12 hrs. Excretion: Urine.
Brands with this active ingredient
Compiled by Healify Pharmacy from published drug references. How we compile it →
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