Hydrocortisone

Brand Names: Claritin Skin Itch Relief Cortef Tablets Cortenema Cortoderm Emo-Cort Hycort Hydrosone Prevex HC Sarna HC Westcort Preparations

Prescription Needed: Yes in some cases

What is this drug used for?

Hydrocortisone belongs to a class of drugs called "corticosteroids" and is used most commonly for medical conditions that involve inflammation. Some examples are arthritis asthma allergic reactions Crohn's disease colitis and other inflammatory conditions of the skin blood kidney eye and thyroid.

Hydrocortisone and other corticosteroids are similar to the body's natural hormone cortisone and works in many parts of the body to decrease inflammation. These medications are often needed when the body is not producing enough of its own hormone cortisone to keep things in balance.

This medication is available in many different forms in combination with other medications and can be used for many different conditions as above:

  • topical preparations (e.g. cream ointment lotion) - to treat itchiness inflammation of the skin rectal area
  • suppositories enemas - used to treat symptoms of ulcerative colitis hemorrhoids
  • eye drops ear drops
  • oral tablets
  • injection

Is there any reason not to take this drug?

You should not take this drug if you are allergic to hydrocortisone or if you have a fungal infection in some place other than on your skin. Tell your doctor if you have or have ever had:

  • problems with your kidney or liver
  • problems with stomach ulcers bleeding of the stomach or heartburn
  • diabetes
  • congestive heart failure
  • problems with swelling of your feet or ankles
  • high blood pressure
  • osteoporosis
  • problems with frequent infections
  • low thyroid hormone (hypothyroidism)
  • problems with depression hallucinations or other mental illness
  • myasthenia gravis
  • herpes eye infection or shingles (herpes zoster infection)
  • tuberculosis
  • glaucoma or cataracts
  • problems with low potassium or calcium in the blood
  • side effects to other corticosteroid medications

What about possible side effects?

Side effects to this medication will depend on the type of dosage form you are taking. For example side effects will be more common with the tablets and injection to the veins and less so with the lotion or eye drops. Some of the side effects will only be at the site of where the drug is being given (e.g. injection to the joint).

The most common side effects are:

  • upset stomach vomiting heartburn
  • increase in appetite with possible weight gain
  • swelling of the feet and ankles
  • swelling of the face
  • dizziness
  • difficulty falling or staying asleep nightmares
  • feeling depressed anxious or restless
  • feeling "high" or euphoric[D1]
  • acne
  • changes in the skin (easy bruising skin thinning increased hair growth over body presence of small blood vessels)
  • changes or absence of menstrual periods
  • decrease in bone strength and osteoporosis

Some of these side effects are more likely with higher doses and some are more likely with long-term use. Talk to your doctor or pharmacist.

Less common and sometimes severe side effects include:

  • high blood pressure
  • increase in blood sugars
  • feeling weak in the muscles
  • stopping your body's own ability to produce its natural hormone cortisone (with high doses and long-term use)
  • a condition called avascular necrosis of bone
  • changes in vision (call you doctor)
  • increased chance of infection or slow recovery from an infection (call your doctor)
  • decrease growth rate in children

Specific to topical preparation:

Side effects are usually uncommon.

Contact our doctor if these symptoms are severe or do not go away:

  • drying or cracking of the skin
  • itching burning
  • acne
  • change in skin colour

If you experience any of the following symptoms call your doctor right away:

  • severe skin rash
  • skin infection (redness swelling or oozing of pus)
  • skin thinning

This is not a complete list of side effects. If you are concerned about these or other unusual symptoms while taking this medication ask your doctor and/or pharmacist for more information and advice.

What if I am taking other drugs?

Always provide your doctor with a list of all other drugs you are taking (including over-the-counter medications and herbal/natural products) as they may interact with and/or may change the safety or effectiveness of either drug. Tell your doctor specifically if you are taking any of these drugs as these are the most common interactions and he/she may need to make changes or monitor you more closely:

  • Other pain medications that include ASA & other anti-inflammatories (e.g. ibuprofen naproxen voltaren diclofenac) - can increase your chances of having side effects especially those in the stomach.
  • If you are taking medications to treat high blood pressure this medication may interfere with how well your blood pressure medication can work and your blood pressure may increase. Your doctor will likely check your blood pressure periodically while you are taking this medication.
  • Water pills (e.g. hydrochlorothiazide furosemide) - this medication may cause swelling of the ankles and feet and may interfere with how well the water pills can work. As well there is an increase chance for side effects like low potassium in the blood.
  • If you are taking medications for congestive heart failure this medication may make your symptoms of congestive heart failure worse and interfere with how well your medications can work. Call your doctor immediately if you notice that your symptoms of heart failure are getting worse.
  • If you are taking medications for diabetes this medication may increase your blood sugars and interfere with how well your medications can work.
  • Digoxin - potassium levels in the blood may need to be monitored.
  • Cyclosporine - may change the amount of hydrocortisone or cyclosporine in the blood.
  • Ketoconazole itraconazole - may increase chances for hydrocortisone side effects.
  • Birth control pills - may increase chances for hydrocortisone side effects.
  • Carbamazepine phenobarbital phenytoin rifampin - may decrease the amount of hydrocortisone in the body.
  • Live vaccines
  • Warfarin

This is not a complete list of drug interactions. Ask your doctor or pharmacist to review your list of medications.

Other information

Special instructions:

  • This drug makes you more susceptible to illnesses including chicken pox measles and tuberculosis. If you are exposed to any of these infections talk to your doctor.
  • Do not have a vaccination other immunization or any skin test while you are taking hydrocortisone without first talking to your doctor.
  • You may need to take extra doses of hydrocortisone during periods of stress (injuries infections and severe asthma attacks) especially if you have recently stopped taking the medication.
  • If you are scheduled for surgery including dental surgery tell your healthcare provider(s) that you are taking hydrocortisone.
  • If you need to take this medication for a long period of time you may be at risk for osteoporosis. Talk to your doctor or pharmacist about taking calcium (1000mg-1500mg/day) and vitamin D (400-800 IU/day). As well your doctor may prescribe a different medication to prevent this side effect from happening.
  • It is extremely important that you do not stop taking this medication without talking to your doctor first. Since this medication can cause your body to stop producing its own natural hormone after long-term use stopping the medication could cause severe side effects (feeling weak tired dizzy nauseous low blood pressure muscle pains).
  • If you are using topical or enema hydrocortisone preparations follow your doctor or pharmacist's specific instructions. Avoid prolonged use on the face in the genital and rectal area and in skin creases and armpits unless directed by the doctor. Do not bandage or wrap the affected area unless directed by your doctor.

Lab and Other Tests:

  • Your doctor may send you for periodic bone mineral density scans to check your bones while taking this medication.
  • You may need to check your blood sugar more often while taking this medication since this medication can increase your blood sugar.

Children: Can be used. The lowest effective dose is used to decrease the chances for long-term side effects.

Seniors: Lower doses may be necessary to decrease the chances for side effects.

Pregnant women: Topical preparations (cream ointment lotion) can generally be used. While harm to the unborn child is not likely at low doses you should always discuss this with your doctor.

Women who are nursing: Talk to your doctor.

People who drive or operate machinery: Should have no problems associated with taking this drug.

Alcohol: May increase the risk of stomach irritation and side effects to hydrocortisone. Try to limit alcohol consumption.

Overdose: If you experience any unusual reactions or if you seriously exceed the recommended dosage call your doctor or 911.

Stopping the drug: Do not stop taking this drug until you have discussed it with your doctor. He/she may need to decrease the dose slowly over time.

If you miss a dose: Take it as soon as you remember. However if your next dose is almost due do not take the missed dose. Instead wait and take the next scheduled dose. Do not take a double dose.

Storage conditions: Closed container; cool dry location away from excess moisture (not in the bathroom); always out of reach of children.

Dietary precautions: If you are taking hydrocortisone for an extended period of time your doctor may advise you to follow a low-sodium high-potassium and high-calcium diet. You may want to take this medication with food to decrease the feeling of upset stomach.