Hydrocortisone

Hydrocortisone: Uses, Dosage and Side Effects

Overview

• Alters the transcription of DNA, leading to alterations in cellular metabolism.
• It has both glucocorticoid and mineralocorticoid activity

Uses of Hydrocortisone

• Topical anti-inflammatory drug.
• Early management of acute hypoadrenocorticism.
• Treatment of critical illness-related corticosteroid insufficiency (CIRCI) has been described in dogs and cats with fluid-loaded, vasopressor-resistant septic shock.

Dose of Hydrocortisone in Dogs and Cats

Dogs:

• Topically: apply a thin layer of cream to the affected area q6–12h.
• Hypoadrenocorticism: 0.5 mg/kg/h i.v. by constant rate infusion, in acute Addisonian crisis and 0.125 mg/kg p.o. q12h for maintenance.
• Anti-inflammatory: 0.5 mg/kg p.o. q12h.

Cats:

• Topical use as for dogs.
• Its use in feline hypoadrenocorticism has not been documented.

Side Effects of Hydrocortisone in Dogs and Cats

• Prolonged use of glucocorticoids suppresses the hypothalamic-pituitary axis and causes adrenal atrophy.
• Excessively rapid correction of hyponatraemia in cases of acute hypoadrenocorticism may cause brain damage and so, in severely hyponatremic animals, initial
  doses should be reduced by 50% or postponed until the rate of correction using saline has been established.
• Catabolic effects of glucocorticoids lead to weight loss and cutaneous atrophy.
• Iatrogenic hyperadrenocorticism may develop (PU/PD, elevated liver enzymes).
• Vomiting and diarrhoea, or GI ulceration may develop.
• Glucocorticoids may increase urine glucose levels and decrease serum T3 and T4 values.
• Impaired wound healing and delayed recovery from infections may be seen.

Contraindications of Hydrocortisone in Dogs and Cats

• Do not use in pregnant animals.
• Contraindicated in patients with renal disease and diabetes mellitus

Some Notes:

• Increased risk of GI ulceration if used concurrently with NSAIDs.
• Glucocorticoids antagonize the effect of insulin.
• Antiepileptic drugs (phenobarbital) may accelerate the metabolism of corticosteroids
• Antifungals (e.g. itraconazole) may decrease the metabolism of corticosteroids.
• There is an increased risk of hypokalaemia when corticosteroids are used with acetazolamide, amphotericin and potassium-depleting diuretics (furosemide, thiazides).