Hydrocortisone - instructions for use, dose, side effects, contraindications

By inhibition of phospholipase A activity₂ and reducing the release of arachidonic acid from the phospholipids of cell membranes reduces the production of leukotrienes and prostaglandins. Due to this suppresses the development of inflammatory manifestations: pain, swelling, fever and redness in the area of inflammation. It inhibits the expression of the cyclooxygenase-2 gene, which also leads to inhibition of prostaglandin synthesis.

Reduces the main substance of the connective tissue, weakening the exudative and proliferative processes in the skin. Inhibits cellular kinins, which have proteolytic activity. Prevents the access of macrophages and T-sensitized lymphocytes to the foci of inflammation.

It has anti-inflammatory, anti-edematous and anti-allergic effect.

Pharmacokinetics:

After intravenous administration the maximum concentration in the blood plasma is reached after 1 hour. With intramuscular injection, absorption takes place within 24-48 hours. When intraarticular administration is absorbed slowly, within 6-24 hours. The connection with plasma proteins is 90%.

Therapeutic effect develops in 6-24 hours. Penetrates through the blood-brain and placental barrier. Metabolism in the liver.

The half-life is 6-7 days. Elimination by the kidneys.

When using ophthalmic ointment systemic action on the body does not have.

Indications:

It is used for relief of acute allergic reactions, treatment of shock and coma of various genesis, acute leukemia in children, nephrotic syndrome, tuberculous meningitis, acute manifestations of multiple sclerosis.

It is used to treat osteoarthritis, monoarthrosis, rheumatoid arthritis, bronchial asthma, bursitis, epicondylitis, tendovaginitis. Used for contractures, before surgical treatment of ankylosed joints, as well as in the tuberculostatic therapy.

In ophthalmology it is used for the treatment of blepharitis, keratitis, iritis, iridocyclitis, in conditions after the operation.

ICD-10

I.A15-A19.A15 Tuberculosis of respiratory organs, confirmed bacteriologically and histologically

I.A15-A19.A17.0 Tuberculous meningitis (G01 *)

I.A15-A19.A18 Tuberculosis of other organs

I.B65-B83.B75 Trichinosis

II.C81-C96.C84.0 Mushroom mycosis

II.C81-C96.C91.0 Acute lymphoblastic leukemia

II.C81-C96.C92.0 Acute myeloid leukemia

III.D55-D59.D59 Acquired hemolytic anemia

III.D60-D64.D60 Acquired pure red cell aplasia (erythroblastopenia)

III.D65-D69.D69.3 Idiopathic thrombocytopenic purpura

III.D80-D89.D86 Sarcoidosis

IV.E00-E07.E06 Thyroiditis

IV.E20-E35.E27.4 Other and unspecified adrenocortical insufficiency

VII.H10-H13.H10.1 Acute atopic conjunctivitis

VII.H10-H13.H10.2 Other acute conjunctivitis

VII.H10-H13.H10.4 Chronic conjunctivitis

VII.H10-H13.H10.5 Blepharoconjunctivitis

VII.H15-H22.H16 Keratite

VII.H15-H22.H16.2 Keratoconjunctivitis

VII.H15-H22.H20.0 Acute and subacute iridocyclitis

VII.H15-H22.H20.1 Chronic iridocyclitis

X.J40-J47.J45 Asthma

X.J40-J47.J46 Asthmatic status [status asthmaticus]

X.J60-J70.J69 Pneumonitis caused by solids and liquids

X.J80-J84.J82 Pulmonary eosinophilia, not elsewhere classified

XI.K50-K52.K50 Crohn's disease [regional enteritis]

XI.K50-K52.K51 Ulcerative colitis

XII.L10-L14.L10 Pemphigus [pemphigus]

XII.L10-L14.L13.0 Dermatitis herpetiformis

XII.L20-L30.L20.8 Other atopic dermatitis

XII.L20-L30.L21 Seborrheic dermatitis

XII.L20-L30.L26 Exfoliative dermatitis

XII.L20-L30.L28.0 Simple chronic lichen

XII.L20-L30.L28.1 Scabby nodosum

XII.L20-L30.L30.0 Coin-like eczema

XII.L40-L45.L40 Psoriasis

XII.L40-L45.L43 Lichen red flat

XII.L50-L54.L51.1 Bullous erythema multiforme

XIII.M30-M36.M30 Nodular polyarteritis and related conditions

XIII.M30-M36.M32 Systemic lupus erythematosus

XIII.M30-M36.M33 Dermatopolymiositis

XIII.M30-M36.M34 Systemic sclerosis

XIV.N00-N08.N04 Nephrotic syndrome

XVIII.R50-R69.R57.0 Cardiogenic shock

XVIII.R50-R69.R57.1 Hypovolemic shock

XVIII.R50-R69.R57.8 Other types of shock

XIX.S00-S09.S05 Injury of the eye and orbit

XIX.T66-T78.T78.2 Anaphylactic shock, unspecified

XIX.T66-T78.T78.3 Angioedema

XIX.T79.T79.4 Traumatic shock

XXI.Z40-Z54.Z51.5 Palliative Care

Contraindications:

At rendering of the help under vital indications - hypersensitivity.

Syndrome Itenko-Cushing, thrombophilia, Achilles tendon lesions, systemic infection, individual intolerance.

With intraarticular administration: intraarticular fracture of bones, infectious arthritis, infectious osteoporosis, severe deformation and destruction of the joint, aseptic necrosis of the epiphyses of bones.

Children up to 12 months.

Carefully:

Chronic heart failure, osteoporosis, gastric and duodenal ulcer, diabetes mellitus, arterial hypertension, herpetic infection, glaucoma, measles, epilepsy, steroid myelopathy, hypersensitivity.

Pregnancy and lactation:

Recommendations for FDA - Category C. Contraindicated in pregnancy and lactation.

Dosing and Administration:

Use in children

In acute, life threatening conditions: intravenously or intramuscularly 1-2 mg / kg every 4 hours. The daily dose is 6-9 mg / kg.

Periarticular, single dose:

2-6 years: 25-50 mg;

7-14 years: 50-75 mg.

Adults

Intramuscularly deep, from 50-300 mg to 1-1,5 g per day. In diseases of the respiratory system no more than 3 days. In rheumatology - no more than 6 days.

According to vital indications: intravenously or deeply intramuscularly, 100-15 mg every 4 hours for 48 hours, then - every 8-12 hours.

Periarticular, single dose is from 5 to 25 mg.

The highest daily dose: 1-1.5 g.

The highest single dose: 300 mg.

Side effects:

Central and peripheral nervous system: agitation, headache, dizziness, anxiety, insomnia, irritability, depression, paranoia, hallucinations, pseudotumor cerebellum,edema of the nipple of the optic nerve due to increased intracranial pressure.

Hemopoietic system: leukocytosis, leukocyturia.

The cardiovascular system: arterial hypertension, arrhythmia, peripheral vasodilation, cardiac insufficiency, thromboembolism.

Digestive system: nausea, vomiting, peptic ulcer, pancreatitis, esophagitis, increased appetite, hiccups, flatulence.

Musculoskeletal system: osteoporosis, rarely - pathological bone fractures, aseptic necrosis of the head of the femoral and humerus, steroid myopathy, arthralgia, decrease in muscle mass, rupture of the tendons of muscles.

Dermatological reactions: hyperhidrosis, folliculitis, telangiectasia, striae, steroid acne, petechiae, ecchymosis, hypopigmentation.

Sense organs: glaucoma, exophthalmos, optic nerve damage, posterior capsular cataract, secondary eye infections, trophic corneal changes.

Endocrine system: a decrease in glucose tolerance, diabetes mellitus, Itenko-Cushing syndrome, suppression of adrenal cortex function, growth retardation in children and adolescents.

The immune system: exacerbation of chronic infections, exacerbation of tuberculosis, pyoderma and candidiasis.

Allergic reactions.

Overdose:

Arterial hypertension, arthralgia, hypokalemia.

Treatment is symptomatic.

Interaction:

Enhances the effect of anticoagulants.

Increases the toxicity of cardiac glycosides, barbiturates.

Enhances the hepatotoxic effect of paracetamol.

Reduces the effect of somatotropin, oral hypoglycemic drugs, praziquantel.

Mifepristone, thyroid hormones, estrogens, inhibitors of the adrenal cortex reduce the effect of hydrocortisone.

When used simultaneously with loop diuretics, carbonic anhydrase inhibitors, amphotericin B, theophylline, the risk of hypokalemia is increased.

With simultaneous application with salicylates, the risk of developing gastric and duodenal ulcers increases, as well as hemorrhage.

When used simultaneously with carbonic anhydrase inhibitors, the risk of developing osteoporosis increases.

The use of tricyclic antidepressants for the treatment of hydrocortisone-induced depression exacerbates mental disorder.

Special instructions:

Control of blood pressure, coagulation and the composition of peripheral blood, the concentration of glucose in the blood plasma.

It is recommended to postpone vaccination for the duration of treatment.

When treating joints, it is not recommended to administer the drug more than 3 times a year.

In the treatment it is not recommended to drive vehicles and work with moving mechanisms.

Instructions

Hydrocortisone (Hydrocortisonum)