Hydrocortisone, History, Action, Best Uses, Side effects, Dosage and 15 Brands.
- May 23, 2024
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Introduction
Hydrocortisone is a corticosteroid hormone (glucocorticoid) that plays a crucial role in the human body. The adrenal glands produce it and regulate various bodily functions, including metabolism, immune response, and stress management. When the body fails to produce sufficient cortisol, or if additional cortisol is needed to treat a medical condition, hydrocortisone is prescribed as a medication.
it is widely used to treat various health conditions, including allergic reactions, skin conditions, inflammatory conditions, and adrenal insufficiency. It is a synthetic version of the natural hormone cortisol, which is produced by the adrenal glands. It is available in different forms, including creams, ointments, tablets, oral solutions, injections, and suppositories.
History of Hydrocortisone
The history of hydrocortisone dates back to the early 20th century. In 1901, British chemist William Henry Perkin first synthesized cortisol (hydrocortisone) from adrenal glands. In the 1920s and 1930s, scientists like Edward Calvin Kendall and Tadeus Reichstein isolated and characterized cortisol from animal adrenal glands. By the 1930s, hydrocortisone was isolated and synthesized in the lab, and by the 1940s, it was being produced commercially and used to treat various conditions, including Addison’s disease. In the 1940s, hydrocortisone was first used to treat rheumatoid arthritis and other inflammatory conditions, and in the 1950s, its use expanded to include skin conditions, allergies, and asthma.
The development of topical preparations in the 1950s made it more accessible for skin conditions, and by the 1960s, hydrocortisone had become a widely used medication. Since the 1970s, research has focused on improving hydrocortisone formulations, dosing, and delivery methods, and today, it remains a vital medication for various conditions, with ongoing research exploring it.
In recent years, hydrocortisone has maintained its status as a widely used medication due to its effectiveness in treating a range of conditions. In 2021, hydrocortisone was the 192nd most commonly prescribed medication in the United States, with more than 2 million prescriptions issued. Hydrocortisone has also been studied for treating COVID-19, especially in hospitalized patients requiring supplemental oxygen.
Mechanism of Action
The mechanism of action of hydrocortisone, also known as cortisol, primarily involves its interaction with glucocorticoid receptors within cells. Here’s a breakdown of its mechanism of action:
1. Binding to Glucocorticoid Receptors
- Hydrocortisone enters cells and binds to glucocorticoid receptors (GRs), which are present in almost every cell in the body.
- GRs are typically located in the cytoplasm, bound to heat shock proteins. Upon binding with hydrocortisone, the heat shock proteins dissociate, allowing the GR-hydrocortisone complex to translocate into the cell nucleus.
2. Regulation of Gene Expression
- In the nucleus, the hydrocortisone-GR complex acts as a transcription factor, binding to specific DNA sequences known as glucocorticoid response elements (GREs) within the regulatory regions of target genes.
- This binding either promotes or inhibits the transcription of these target genes, leading to changes in mRNA synthesis.
3. Anti-inflammatory Effects
- Hydrocortisone exerts potent anti-inflammatory effects by inhibiting the transcription of pro-inflammatory genes, such as those encoding cytokines (e.g., interleukins, tumour necrosis factor-alpha) and inflammatory enzymes (e.g., cyclooxygenase-2).
- By downregulating the expression of these inflammatory mediators, hydrocortisone reduces inflammation, swelling, and immune responses.
4. Immunosuppressive Effects
- Hydrocortisone suppresses various aspects of the immune response by inhibiting the function and proliferation of immune cells, including T cells, B cells, macrophages, and dendritic cells.
- It reduces the production of cytokines involved in immune activation and inflammation, thereby dampening the immune response in autoimmune diseases and organ transplant rejection.
5. Metabolic Effects
- Hydrocortisone influences glucose metabolism by promoting gluconeogenesis (the synthesis of glucose from non-carbohydrate sources) and reducing glucose uptake in peripheral tissues, leading to increased blood glucose levels (hyperglycemia).
- It also affects lipid metabolism, promoting lipolysis (breakdown of fats) and redistribution of fat stores, contributing to features such as central obesity and thinning of the skin seen with chronic glucocorticoid use.
Hydrocortisone Uses
The detailed uses of hydrocortisone in various conditions include:
1. Skin Problems
- Eczema: Hydrocortisone cream, ointment, or lotion helps reduce inflammation, itching, and redness associated with eczema.
- Contact Dermatitis: It treats skin reactions caused by contact with irritants or allergens.
- Heat Rash: Its cream or lotion relieves prickly heat and reduces inflammation.
- Insect Bites and Stings: Its cream or lotion reduces swelling, itching, and inflammation caused by insect bites and stings.
- Psoriasis: this cream or ointment helps reduce inflammation, scaling, and itching associated with psoriasis.
- Nappy Rash: It’s cream or ointment treats and prevents nappy rash in babies.
2. Piles and Itchy Bottom
- Piles (Haemorrhoids): Its cream, ointment, spray, or suppositories reduce swelling, itching, and inflammation associated with piles.
- Itchy Bottom: Its cream, ointment, spray, or suppositories relieve itching and inflammation around the anus.
3. Mouth Ulcers
- Mouth Ulcer Pain Relief: Hydrocortisone buccal tablets stick to the inside of the mouth and release hydrocortisone as they dissolve, relieving pain and inflammation.
4. Painful JointsTennis Elbow
- Hydrocortisone injections reduce pain and inflammation in the elbow joint.
- Painful Tendons: Its injections relieve pain and inflammation in tendons.
- Bursitis: His injections reduce pain and inflammation in the fluid-filled sacs (bursae) that cushion joints.
5. Adrenal Gland Conditions
- Addison’s Disease: Hydrocortisone tablets replace natural cortisol production in people with Addison’s disease.
- Hypopituitarism: Its tablets replace natural cortisol production in people with hypopituitarism, a rare condition affecting the pituitary gland.
- Adrenal Gland Removal: Its tablets replace natural cortisol production in people who have had their adrenal glands removed.
Side effects
Hydrocortisone, like other corticosteroids, can produce a range of side effects, particularly with long-term or high-dose use. It’s essential to be aware of these potential side effects, although not everyone will experience them. Here’s a detailed overview:
Common Side Effects
- Weight Gain: Corticosteroids can lead to fluid retention and increased appetite, resulting in weight gain, particularly around the face, abdomen, and trunk.
- Increased Blood Sugar Levels: It can raise blood glucose levels, leading to hyperglycemia, which may exacerbate or unmask diabetes in susceptible individuals.
- Mood Changes: Some people experience mood swings, irritability, anxiety, or depression while taking It.
- Insomnia: Corticosteroids can disrupt sleep patterns, leading to difficulty falling asleep or staying asleep.
- Gastrointestinal Issues: Long-term use of it increases the risk of gastrointestinal problems, including stomach ulcers, gastritis, and gastrointestinal bleeding.
- Fluid Retention and Edema: Corticosteroids can cause fluid retention, leading to swelling (edema) in the face, hands, feet, or ankles.
- Increased Risk of Infections: It suppresses the immune system, making individuals more susceptible to infections such as bacterial, viral, fungal, or parasitic infections.
Less Common Side Effects
- Osteoporosis: Long-term use of It lead to bone loss (osteoporosis), increasing the risk of fractures.
- Hypertension: Corticosteroids can elevate blood pressure, particularly with prolonged use or in individuals predisposed to hypertension.
- Cataracts and Glaucoma: Long-term use of corticosteroids may increase the risk of developing cataracts or glaucoma.
- Skin Changes: Thinning of the skin, easy bruising, stretch marks (striae), acne, and delayed wound healing may occur with prolonged corticosteroid use.
- Adrenal Suppression: Chronic use of hydrocortisone can suppress the body’s natural production of cortisol, leading to adrenal insufficiency when the medication is discontinued abruptly.
- Muscle Weakness: Prolonged corticosteroid use may lead to muscle weakness and loss of muscle mass (muscle atrophy).
- Menstrual Irregularities: Corticosteroids can disrupt menstrual cycles and may lead to irregularities in menstruation.
Serious Side Effects
- Adrenal Crisis: Abrupt discontinuation of Its or insufficient replacement therapy in individuals with adrenal insufficiency can precipitate an adrenal crisis, a life-threatening condition characterized by severe fatigue, dehydration, hypotension, and electrolyte imbalances.
- Severe Infections: It suppresses inflammation, it also impairs the body’s ability to fight infections, increasing the risk of severe or opportunistic infections.
- Allergic Reactions: Rarely, individuals experience allergic reactions to hydrocortisone, manifesting as rash, itching, swelling, or difficulty breathing.
Dosage
The general guidelines for different forms and uses of hydrocortisone:
1. Topical Hydrocortisone (Cream, Ointment, Lotion)
- Conditions Treated: Skin conditions such as eczema, dermatitis, psoriasis, insect bites, and heat rash.
- Dosage: Apply a thin layer to the affected area 1-4 times daily, depending on the severity and as directed by a healthcare provider. Avoid prolonged use on large skin areas, especially in children.
2. Rectal Hydrocortisone (Cream, Ointment, Suppositories)
- Conditions Treated: Piles (hemorrhoids), anal itching.
Dosage: - Cream/Ointment: Apply to the affected area 2-4 times daily, particularly after bowel movements.
Suppositories: Insert one suppository into the rectum 1-2 times daily, as directed by your doctor.
3. Buccal Tablets (Hydrocortisone for Mouth Ulcers)
- Conditions Treated: Mouth ulcers.
- Dosage: Apply one buccal tablet to the inside of the mouth where the ulcer is located, up to four times daily. Allow it to dissolve in place.
4. Injectable Hydrocortisone
- Conditions Treated: Severe allergic reactions, acute asthma attacks, adrenal crisis, joint inflammation (bursitis, tendinitis).
Dosage: - Intravenous (IV): The dosage can vary, but for severe allergic reactions or adrenal crises, an initial dose might be 100 mg, followed by doses every 6-8 hours as needed.
- Intra-articular (Joint Injection): Dosages vary based on joint size and condition but typically range from 5-50 mg per injection.
5. Oral Hydrocortisone Tablets
- Conditions Treated: Adrenal insufficiency (Addison’s disease), hypopituitarism.
Dosage: - Typical replacement dosage for adrenal insufficiency is 15-30 mg per day, divided into 2-3 doses (e.g., 10 mg in the morning, 5 mg at midday, and 5 mg in the evening).
- Dosages for other conditions, like inflammation, can be higher and vary widely based on medical advice.
Hydrocortisone Brands
Here are the manufacturers and brands of hydrocortisone available in Pakistan:
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