Also found in: Dictionary, Thesaurus, Encyclopedia.
hydrocortisone sodium succinate
Pharmacologic class: Short-acting corticosteroid
Therapeutic class: Anti-inflammatory (steroidal)
Pregnancy risk category C
Suppresses inflammatory and immune responses, mainly by inhibiting migration of leukocytes and phagocytes and decreasing inflammatory mediators
Cream, gel, lotion, ointment, solution: various strengths
Injection: 25 mg/ml, 50 mg/ml; 100 mg/vial, 250 mg/vial, 500 mg/vial, 1,000 mg/vial
Intrarectal aerosol foam: 90 mg
Oral suspension: 10 mg/5 ml
Retention enema: 100 mg/60 ml
Spray (topical): 1%
Tablets: 5 mg, 10 mg, 20 mg
Indications and dosages
➣ Replacement therapy in adrenocortical insufficiency; hypercalcemia due to cancer; arthritis; collagen diseases; dermatologic diseases; autoimmune and hematologic disorders; trichinosis; ulcerative colitis; multiple sclerosis; proctitis; nephrotic syndrome; aspiration pneumonia
hydrocortisone, hydrocortisone cypionate-
Adults and children: 20 to 240 mg/day P.O.
hydrocortisone acetate (suspension)-
Adults and children: 5 to 75 mg by intra-articular injection (depending on joint size) q 2 to 3 weeks
hydrocortisone acetate (intrarectal foam)-
Adults and children: One applicatorful of intrarectal foam daily or b.i.d. for 2 to 3 weeks; then one applicatorful every other day
hydrocortisone sodium phosphate-
Adults and children: 15 to 240 mg/day subcutaneously, I.M., or I.V., adjusted according to response
hydrocortisone sodium succinate-
Adults and children: 100 to 500 mg I.M. or I.V.; may repeat at 2-, 4-, or 6-hour intervals, depending on response and condition
hydrocortisone retention enema-
Adults and children: 100 mg P.R. at bedtime for 21 nights or until desired response; patient should retain enema for at least 1 hour.
➣ Itching and inflammation caused by skin conditions
Adults and children: Thin film of topical preparation applied to affected area one to four times daily, depending on drug form and severity of condition
• Hypersensitivity to drug, alcohol, bisulfites, or tartrazine (with some products)
• Systemic fungal infections
• Concurrent use of other immunosuppressant corticosteroids
• Concurrent administration of live-virus vaccines
Use cautiously in:
• hypertension, osteoporosis, glaucoma, renal or GI disease, hypothyroidism, cirrhosis, thromboembolic disorders, myasthenia gravis, heart failure
• pregnant or breastfeeding patients
• children ages 6 and younger (safety not established).
• Give oral form with food or milk to avoid GI upset.
• Give I.V. injection of sodium succinate form over 30 seconds to a few minutes.
• Know that drug may be given as intermittent or continuous I.V. infusion. Dilute in normal saline solution, dextrose 5% in water, or dextrose 5% in normal saline solution.
• Inject I.M. deep into gluteal muscle. Rotate injection sites to prevent muscle atrophy.
• Be aware that subcutaneous administration may cause muscle atrophy or sterile abscess.
☞ Never abruptly discontinue high-dose or long-term systemic therapy.
• Know that systemic forms typically are used for adrenal replacement rather than inflammation.
• Be aware that occlusive dressings, heat, hydration, inflammation, denuding, and thinning of skin increase topical drug absorption.
CNS: headache, nervousness, depression, euphoria, personality changes, psychoses, vertigo, paresthesia, insomnia, restlessness, conus medullaris syndrome, meningitis, increased intracranial pressure, seizures
CV: hypotension, hypertension, thrombophlebitis, heart failure, shock, fat embolism, thromboembolism, arrhythmias
EENT: cataracts, glaucoma, increased intraocular pressure, epistaxis, nasal congestion, perforated nasal septum, dysphonia, hoarseness, nasopharyngeal or oropharyngeal fungal infections
GI: nausea, vomiting, esophageal candidiasis or ulcer, abdominal distention, dry mouth, rectal bleeding, peptic ulceration, pancreatitis
Metabolic: sodium and fluid retention, hypokalemia, hypocalcemia, hyperglycemia, hypercholesterolemia, amenorrhea, growth retardation, diabetes mellitus, cushingoid appearance, hypothalamic-pituitary-adrenal suppression with secondary adrenal insufficiency (with abrupt withdrawal or high-dose, prolonged use)
Musculoskeletal: osteoporosis, aseptic joint necrosis, muscle pain or weakness, steroid myopathy, loss of muscle mass, tendon rupture, spontaneous fractures
Respiratory: cough, wheezing, rebound congestion, bronchospasm
Skin: rash, pruritus, urticaria, contact dermatitis, acne, bruising, hirsutism, petechiae, striae, acneiform lesions, skin fragility and thinness, angioedema
Other: altered taste; anosmia; appetite changes; weight gain; facial edema; increased susceptibility to infection; masking or aggravation of infection; adhesive arachnoiditis; injection site pain, burning, or atrophy; immunosuppression; hypersensitivity reactions including anaphylaxis
Drug-drug. Amphotericin B, loop and thiazide diuretics, mezlocillin, piperacillin, ticarcillin: additive hypokalemia
Fluoroquinolones: increased risk of tendon rupture
Hormonal contraceptives: prolonged half-life and increased effects of hydrocortisone
Insulin, oral hypoglycemics: increased requirements for these drugs
Live-virus vaccines: decreased antibody response to vaccine, increased risk of adverse reactions
Nonsteroidal anti-inflammatory drugs: increased risk of adverse GI reactions
Phenobarbital, phenytoin, rifampin: decreased hydrocortisone efficacy
Somatrem: inhibition of growth-promoting effect
Drug-diagnostic tests. Calcium, potassium, thyroxine, triiodothyronine: decreased levels
Cholesterol, glucose: increased levels
Digoxin assays: false elevation (with some test methods)
Nitroblue tetrazolium test: false-negative result
Drug-herbs. Echinacea: increased immunostimulation
Ginseng: potentiation of immunomodulation
Drug-behaviors. Alcohol use: increased risk of gastric irritation and GI ulcers
☞ In high-dose therapy (which should not exceed 48 hours), watch closely for signs and symptoms of depression or psychotic episodes.
• Monitor blood pressure, weight, and electrolyte levels regularly.
• Assess blood glucose levels in diabetic patients. Expect to increase insulin or oral hypoglycemic dosage.
☞ Monitor patient's response during weaning from drug. Watch for adrenal crisis, which may occur if drug is discontinued too quickly.
• Instruct patient to take daily P.O. dose with food by 8 A.M.
☞ Urge patient to immediately report unusual weight gain, face or leg swelling, epigastric burning, vomiting of blood, black tarry stools, irregular menstrual cycles, fever, prolonged sore throat, cold or other infection, or worsening of symptoms.
• Tell patient using topical form not to apply occlusive dressing unless instructed by prescriber.
• Advise patient to discontinue topical drug and notify prescriber if local irritation occurs.
• Instruct patient to eat small, frequent meals and to take antacids as needed to minimize GI upset.
• Tell patient that response to drug will be monitored regularly.
☞ Caution patient not to stop taking drug abruptly.
• In long-term use, instruct patient to have regular eye exams.
• Instruct patient to wear medical identification stating that he's taking this drug.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above.
ClassificationTherapeutic: anti inflammatories steroidal
- Autoimmune disorders,
- Septic shock.
Time/action profile (anti-inflammatory activity)
|PO||unknown||1–2 hr||1.25–1.5 days|
Adverse Reactions/Side EffectsAdverse reactions/side effects are much more common with high-dose/long-term therapy
Central nervous system
- depression (most frequent)
- euphoria (most frequent)
- ↑ intracranial pressure (children only)
- personality changes
Ear, Eye, Nose, Throat
- ↑ intraocular pressure
- hypertension (most frequent)
- peptic ulceration (life-threatening)
- anorexia (most frequent)
- nausea (most frequent)
- acne (most frequent)
- ↓ wound healing (most frequent)
- ecchymoses (most frequent)
- fragility (most frequent)
- hirsutism (most frequent)
- petechiae (most frequent)
- adrenal suppression (most frequent)
Fluid and Electrolyte
- fluid retention (long-term high doses)
- hypokalemic alkalosis
- thromboembolism (life-threatening)
- weight gain
- weight loss
- muscle wasting (most frequent)
- osteoporosis (most frequent)
- avascular necrosis of joints
- muscle pain
- hypersensitivity reactions including anaphylaxis (life-threatening)
- cushingoid appearance (moon face, buffalo hump) (most frequent)
- ↑ susceptibility to infection
Drug-Drug interactionAdditive hypokalemia with thiazide and loop diuretics, or amphotericin B.Hypokalemia may ↑ the risk of digoxin toxicity.May ↑ requirement for insulin or oral hypoglycemic agents.Phenytoin,phenobarbital, and rifampin ↑ metabolism; may ↓ effectiveness.Oral contraceptives may ↓ metabolism.↑ risk of adverse GI effects with NSAIDs (includingaspirin ).At chronic doses that suppress adrenal function, may ↓ antibody response to and ↑ risk of adverse reactions from live-virus vaccines.
Availability (generic available)
- Indicated for many conditions. Assess involved systems prior to and periodically during therapy.
- Assess patient for signs of adrenal insufficiency (hypotension, weight loss, weakness, nausea, vomiting, anorexia, lethargy, confusion, restlessness) prior to and periodically during therapy.
- Monitor intake and output ratios and daily weights. Observe patient for peripheral edema, steady weight gain, rales/crackles, or dyspnea. Notify health care professional should these occur.
- Children should have periodic evaluations of growth.
- Rectal: Assess symptoms of ulcerative colitis (diarrhea, bleeding, weight loss, anorexia, fever, leukocytosis) periodically during therapy.
- Lab Test Considerations: Systemic—Monitor serum electrolytes and glucose. May cause hyperglycemia, especially in persons with diabetes. May cause hypokalemia. Monitor hematologic values, serum electrolytes, and serum and urine glucose routinely in patients on prolonged therapy. May cause ↓ WBC counts. May cause ↓ serum potassium and calcium and ↑ serum sodium concentrations.
- Guaiac test stools. Promptly report presence of guaiac-positive stools.
- May cause elevated serum cholesterol and lipid values. May cause ↓ uptake of thyroid 123I or 131I.
- Suppresses reactions to allergy skin tests.
- Periodic adrenal function tests may be ordered to assess degree of hypothalamic-pituitary-adrenal axis suppression in systemic and chronic topical therapy.
Potential Nursing DiagnosesRisk for infection (Side Effects)
Disturbed body image (Side Effects)
- Do not confuse hydrocortisone with hydrocodone. Do not confuse Solu-Cortef with Solu-Medrol (methylprednisolone).
- If dose is ordered daily or every other day, administer in the morning to coincide with the body's normal secretion of cortisol.
- Periods of stress, such as surgery, may require supplemental systemic corticosteroids.
- Oral: Administer with meals to minimize GI irritation.
- Tablets may be crushed and administered with food or fluids for patients with difficulty swallowing.
- Intramuscular: IM doses should not be administered when rapid effect is desirable. Do not dilute with other solution or admix.
- pH: 7.0–8.0.
- Reconstitute with provided solution (i.e., Act-O-Vials) or 2 mL of bacteriostatic water or saline for injection.
- Rate: Administer each 100 mg over at least 30 sec. Doses ≥500 mg should be infused over at least 10 min.
- Intermittent Infusion: Diluent: May be added to 50–1000 mL of D5W or 0.9% NaCl. Concentration: Usual 1–5 mg/mL. Adults who are fluid restricted may received up to 60 mg/mL.
- Rate: Administer over 20–30 min
- Y-Site Compatibility: acyclovir, alemtuzumab, alfentanil, allopurinol, amifostine, amikacin, aminocaproic acid, aminophylline, amphotericin B cholesteryl, amphotericin B lipid complex, amphotericin B liposome, amsacrine, anidulafungin, argatroban, ascorbic acid, atracurium, atropine, aztreonam, benztropine, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, carboplatin, carmustine, caspofungin, cefazolin, cefepime, cefoperazone, cefotaxime, cefotetan, cefoxitin, ceftaroline, ceftazidime, ceftriaxone, cefuroxime, chloramphenicol, chlorpromazine, cisatracurium, cisplatin, cladribine, clindamycin, cyanocobalamin, cytarabine, clindamycin, cyanocobalamin, cyclophosphamide, cyclosporine, cytarabine, dactinomycin, daptomycin, dexamethasone, dexmedetomidine, digoxin, docetaxel, dopamine, doripenem, doxacurium, doxorubicin hydrochloride, doxorubicin liposome, droperidol, edrophonium, enalaprilat, ephedrine, epinephrine, epirubicin, epoetin alfa, eptifibitide, ertapenem, erythromycin, etoposide, famotidine, fenoldopam, fentanyl, filgrastim, fluconazole, fludarabine, fluorouracil, folic acid, foscarnet, furosemide, gemcitabine, glycopyrrolate, granisetron, heparin, hetastarch, hydromorphone, ifosfamide, imiepnem/cilastatin, indomethacin, insulin, irinotecan, isoproterenol, ketamine, ketorolac, levofloxacin, lidocaine, linezolid, lorazepam, mannitol, mechlorethamine, melphalan, metaraminol, methotrexate, methoxamine, methyldopate, methylergonovine, metoclopramide, metoprolol, metronidazole, milrinone, mitoxantrone, morphine, multivitamins, nafcillin, naloxone, neostigmine, nesiritide, nicardipine, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxacillin, oxaliplatin, oxytocin, paclitaxel, palonosetron, pamidronate, pancuronium, pantoprazole, pemetrexed, penicillin G, pentobarbital, phenobarbital, phentolamine, phenylephrine, phytonadione, piperacillin/tazobactam, potassium acetate, potassium chloride, procainamide, prochlorperazine, propofol, propranolol, pyridostigmine, ranitidine, remifentanil, rituximab, scopolamine, sodium acetate, sodium bicarbonate, streptokinase, succinylcholine, sufentanil, tacrolimus, telavancin, teniposide, theophylline, thiotepa, ticarcillin/clavulanate, tigecycline, tirofiban, trastuzumab, trimetaphan, vasopressin, vecuronium, verapamil, vincristine, vinorelbine, voriconazole, zoledronic acid
- Y-Site Incompatibility: amphotericin B colloidal, azathioprine, calcium chloride, ciprofloxacin, dacarbazine, dantrolene, diazepam, diazoxide, dobutamine, doxycycline, ganciclovir, haloperidol, idarubicin, labetalol, mycophenolate, nalbuphine, pentamidine, phenytoin, protamine, pyridoxime, quinapristin/dalfopristin, rocuronium, sargramostim, thiamine, trimethoprim/sulfamethoxazole
- Rectal: Position patient on left side and administer nightly for 21 days. Enema should be retained for at least 1 hr and preferrably all night. May use sedatives and antidiarrheals to facilitate retention.
- Instruct patient on correct technique of medication administration. Advise patient to take medication as directed. Take missed doses as soon as remembered unless almost time for next dose. Do not double doses. Stopping the medication suddenly may result in adrenal insufficiency (anorexia, nausea, weakness, fatigue, dyspnea, hypotension, hypoglycemia). If these signs appear, notify health care professional immediately. This can be life-threatening.
- Corticosteroids cause immunosuppression and may mask symptoms of infection. Instruct patient to avoid people with known contagious illnesses and to report possible infections immediately.
- Caution patient to avoid vaccinations without first consulting health care professional.
- Review side effects with patient. Instruct patient to inform health care professional promptly if severe abdominal pain or tarry stools occur. Patient should also report unusual swelling, weight gain, tiredness, bone pain, bruising, nonhealing sores, visual disturbances, or behavior changes.
- Advise patient to notify health care professional of medication regimen prior to treatment or surgery.
- Discuss possible effects on body image. Explore coping mechanisms.
- Instruct patient to inform health care professional if symptoms of underlying disease return or worsen.
- Advise patient to carry identification describing disease process and medication regimen in the event of emergency in which patient cannot relate medical history.
- Explain need for continued medical follow-up to assess effectiveness and possible side effects of medication. Periodic lab tests and eye exams may be needed.
- Long-term Therapy: Encourage patient to eat a diet high in protein, calcium, and potassium, and low in sodium and carbohydrates (see ). Alcohol should be avoided during therapy.
- If rectal dose used >21 days, decrease to every other night for 2–3 weeks to decrease gradually.
- Decrease in presenting symptoms with minimal systemic side effects.
- Suppression of the inflammatory and immune responses in autoimmune disorders, allergic reactions, and neoplasms.
- Management of symptoms in adrenal insufficiency.
- Improvement in symptoms of ulcerative colitis. Clinical symptoms usually improve in 3–5 days. Mucosal appearance may require 2–3 mo to improve.