Locoid


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hydrocortisone

Ala-Cort, Ala-Scalp, Cetacort, Colocort, Cortef, Cortenema, Hi-Cor, Hycort (CA), Hytone, Stie-Cort, Synacort, Texacort

hydrocortisone acetate

Cortifoam, Hydrocortistab (UK)

hydrocortisone butyrate

Locoid

hydrocortisone sodium succinate

A-hydroCort, Solu-Cortef

hydrocortisone valerate

Westcort

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.

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.

hydrocortisone (topical)

(hye-droe-kor-ti-sone) ,

Ala-Cort

(trade name),

Ala-Scalp

(trade name),

Anusol HC

(trade name),

Barriere-HC

(trade name),

CaldeCORT Anti-Itch

(trade name),

Carmol HC

(trade name),

Cortaid

(trade name),

Cortate

(trade name),

Corticaine

(trade name),

Cortifoam

(trade name),

Cortizone

(trade name),

Cortoderm

(trade name),

Emo-Cort

(trade name),

Hyderm

(trade name),

Hydroval

(trade name),

Lanacort 9-1-1

(trade name),

Locoid

(trade name),

Nutracort

(trade name),

Pandel

(trade name),

Prevex HC

(trade name),

Sarna HC

(trade name),

Synacort

(trade name),

Texacort

(trade name),

Topiderm HC

(trade name),

Uremol HC

(trade name)

Classification

Therapeutic: anti inflammatories steroidal
Pharmacologic: corticosteroids
Pregnancy Category: C

Indications

Management of inflammation and pruritis associated with various allergic/immunologic skin problems.

Action

Suppress normal immune response and inflammation.

Therapeutic effects

Suppression of dermatologic inflammation and immune processes.

Pharmacokinetics

Absorption: Minimal. Prolonged use on large surface areas, application of large amounts, or use of occlusive dressings may ↑ systemic absorption.
Distribution: Remain primarily at site of action.
Metabolism and Excretion: Usually metabolized in skin; some have been modified to resist local metabolism and have a prolonged local effect.
Half-life: 1.5–2 hr (plasma), 8–12 hr (tissue).

Time/action profile (response depends on condition being treated)

ROUTEONSETPEAKDURATION
Topicalmins–hrshrs–dayshrs–days

Contraindications/Precautions

Contraindicated in: Hypersensitivity or known intolerance to glucocorticoid or components of vehicles (ointment or cream base, preservative, alcohol); Untreated bacterial or viral infections.
Use Cautiously in: Hepatic dysfunction; Diabetes mellitus, cataracts, glaucoma, or tuberculosis (use of large amounts of high-potency agents may worsen condition); Patients with pre-existing skin atrophy; Obstetric / Lactation / Pediatric: Chronic high-dose usage may result in adrenal suppression in mother, growth suppression in children; children may be more susceptible to adrenal and growth suppression.

Adverse Reactions/Side Effects

Dermatologic

  • allergic contact dermatitis
  • atrophy
  • burning
  • dryness
  • edema
  • folliculitis
  • hypersensitivity reactions
  • hypertrichosis
  • hypopigmentation
  • irritation
  • maceration
  • miliaria
  • perioral dermatitis
  • secondary infection
  • striae

Miscellaneous

  • adrenal suppression (use of occlusive dressings, long-term therapy)

Interactions

Drug-Drug interaction

None significant.

Route/Dosage

Topical (Adults and Children) Apply to affected area(s) 1–4 times daily (depends on product, preparation, and condition being treated).
Rectal (Adults) Aerosol foam—90 mg 1–2 times/day for 2–3 wk; then adjusted.

Availability (generic available)

Cream: 0.5%Rx, OTC, 1%Rx, OTC, 2.5%
Gel: 0.5%Rx, OTC, 1%Rx, OTC
Ointment: 0.5%Rx, OTC, 1%Rx, OTC
Lotion: 0.25%, 0.5%Rx, OTC, 1%Rx, OTC, 2%, 2.5%
Solution: 1%
Spray: 0.5%Rx, OTC, 1%Rx, OTC
Rectal cream: 1%
Rectal aerosol: 10%
In combination with: acetic acid, antifungals, anti-infectives, antihistamines, urea, and benzoyl peroxide in various otic and topical preparations; acyclovir (Lipsovir cream). See combination drugs.

Nursing implications

Nursing assessment

  • Assess affected skin before and daily during therapy. Note degree of inflammation and pruritus. Notify health care professional if symptoms of infection (increased pain, erythema, purulent exudate) develop.
  • Lab Test Considerations: Periodic adrenal function tests may be ordered to assess degree of hypothalamic-pituitary-adrenal (HPA) axis suppression in chronic topical therapy if suspected. Children and patients with dose applied to a large area, using an occlusive dressing, or using high-potency products are at highest risk for HPA suppression.
    • May cause increased serum and urine glucose concentrations if significant absorption occurs.

Potential Nursing Diagnoses

Risk for impaired skin integrity (Indications)
Risk for infection (Side Effects)
Deficient knowledge, related to medication regimen (Patient/Family Teaching)

Implementation

  • Choice of vehicle depends on site and type of lesion. Ointments are more occlusive and preferred for dry, scaly lesions. Creams should be used on oozing or intertriginous areas, where the occlusive action of ointments might cause folliculitis or maceration. Creams may be preferred for aesthetic reasons even though they may be more drying to skin than ointments. Gels, aerosols, lotions, and solutions are useful in hairy areas.
  • Apply ointments, creams, or gels sparingly as a thin film to clean, slightly moist skin. Wash hands immediately after application. Apply occlusive dressing only if specified by physician or other health care professional.
    • Apply lotion, solution, or gel to hair by parting hair and applying a small amount to affected area. Rub in gently. Protect area from washing, clothing, or rubbing until medication has dried. Hair may be washed as usual but not right after applying medication.
    • Use aerosols by shaking well and spraying on affected area, holding container 3–6 in. away. Spray for about 2 sec to cover an area the size of a hand. Do not inhale. If spraying near face, cover eyes.

Patient/Family Teaching

  • Instruct patient on correct technique of medication administration. Emphasize importance of avoiding the eyes. If a dose is missed, it should be applied as soon as remembered unless almost time for next dose.
  • Caution patient to use only as directed. Avoid using cosmetics, bandages, dressings, or other skin products over the treated area unless directed by health care professional.
  • Advise parents of pediatric patients not to apply tight-fitting diapers or plastic pants on a child treated in the diaper area; these garments work like an occlusive dressing and may cause more of the drug to be absorbed.
  • Advise patient to consult health care professional before using medicine for conditions other than indicated.
  • Instruct patient to inform health care professional if symptoms of underlying disease return or worsen or if symptoms of infection develop.

Evaluation/Desired Outcomes

  • Resolution of skin inflammation, pruritus, or other dermatologic conditions.

Locoid

A brand name for HYDROCORTISONE.
References in periodicals archive ?
Lupin signed a co-promotion agreement with Onset Dermatologics LLC that grants Lupin exclusive rights to promote Onset's Locoid lotion (hydrocortisone butyrate 0.
Triax markets the mid-potency topical steroid called Locoid and the acne treatment products Minocin and Tretin X.
Ferndale Healthcare has a 116-year history of success in the fields of dermatology and colorectal disease, with such products as Locoid (divested in 2007) and Analpram.
Hydrocortisone butyrate Taro Pharmaceutical Locoid solution