hydrocortisone butyrate

hydrocortisone butyrate

Locoid

Pharmacologic class: Short-acting corticosteroid

Therapeutic class: Anti-inflammatory (steroidal)

Pregnancy risk category C

Action

Suppresses inflammatory and immune responses, mainly by inhibiting migration of leukocytes and phagocytes and decreasing inflammatory mediators

Availability

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

Off-label uses

• Phlebitis
• Stomatitis

Contraindications

• 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

Precautions

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).

Administration

• 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.

Route	Onset	Peak	Duration
P.O.	1-2 hr	1-2 hr	1-1.5 days
I.V.	Immediate	Unknown	1-1.5 days
I.M.	Rapid	4-8 hr	1-1.5 days
P.R.	Slow	3-5 days	4-6 days
Spray (topical), subcut.	Unknown	Unknown	Unknown

Adverse reactions

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

Hematologic: purpura

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

Interactions

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

Patient monitoring

☞ 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.

Patient teaching

• 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.