Hydrocortisone is the pharmaceutical term for cortisol used in oral administration, intravenous injection, or topical application. It is used as an
immunosuppressive drug, given by injection in the treatment of severe allergic reactions such as
anaphylaxis and
angioedema, in place of
prednisolone in patients needing steroid treatment but unable to take oral medication, and perioperatively in patients on long-term steroid treatment to prevent an
adrenal crisis. It may also be injected into inflamed joints resulting from diseases such as
gout.
It may be used topically for allergic rashes,
eczema,
psoriasis,
itching and other inflammatory skin conditions.
Topical hydrocortisone creams and ointments are available in most countries without prescription in strengths ranging from 0.05% to 2.5% (depending on local regulations) with stronger forms available by prescription only.[citation needed]
It may also be used rectally in suppositories to relieve the swelling, itch, and irritation in
haemorrhoids.[7]
It may be used as an acetate form (
hydrocortisone acetate), which has slightly different pharmacokinetics and pharmacodynamics.[7][22]
Hydrocortisone has low
potency relative to
synthetic corticosteroids.[13] Compared to hydrocortisone,
prednisolone is about 4times as
potent and
dexamethasone about 40times as potent in terms of
anti-inflammatory effect.[23] Prednisolone can also be used as cortisol replacement, and at replacement dose levels (rather than anti-inflammatory levels), prednisolone is about 8times more potent than cortisol.[24] The equivalent doses and relative potencies of hydrocortisone compared to various other synthetic corticosteroids have also been reviewed and summarized.[13]
The
endogenousproduction rate of cortisol is approximately 5.7 to 9.9mg/m2 per day, which corresponds to an oral hydrocortisone dose of approximately 15 to 20mg/day (for a 70-kg person).[25][26] One review described daily cortisol production of 10mg in healthy volunteers and reported that daily cortisol production could increase up to 400mg in conditions of severe
stress (e.g.,
surgery).[11]
The total and/or free concentrations of cortisol/hydrocortisone required for various glucocorticoid effects have been determined.[11]
The
topicalpercutaneousabsorption of hydrocortisone varies widely depending on experimental circumstances and has been reported to range from 0.5 to 14.9% in different studies.[27] Some skin application sites, like the
scrotum and
vulva, absorb hydrocortisone much more efficiently than other application sites, like the
forearm.[27][28][29] In one study, the amount of hydrocortisone absorbed ranged from 0.2% to 36.2% depending on the application site, with the ball of the foot having the lowest absorption and the scrotum having the highest absorption.[29] The absorption of hydrocortisone by the vulva has ranged from 4.4 to 8.1%, relative to 1.3 to 2.8% for the arm, in different studies and subjects.[29][30][31]
In March 2021, the
Committee for Medicinal Products for Human Use (CHMP) of the
European Medicines Agency (EMA) adopted a positive opinion, recommending the granting of a marketing authorization for the medicinal product Efmody, intended for the treatment of congenital adrenal hyperplasia (CAH) in people aged twelve years and older.[37] The applicant for this medicinal product is Diurnal Europe BV.[37] Hydrocortisone (Efmody) was approved for medical use in the European Union, in May 2021, for the treatment of
congenital adrenal hyperplasia (CAH) in people aged twelve years and older.[9]
Anti-competitive practices
In the UK, the
Competition and Markets Authority (CMA) concluded an investigation into the supply of hydrocortisone tablets, finding that from October 2008 onwards, drug suppliers Auden McKenzie and
Actavis plc had charged "excessive and unfair prices" for 10mg and 20mg tablets and entered into agreements with potential competitors, paying companies who agreed not to enter the hydrocortisone market and enabling Auden McKenzie and Actavis to supply the drugs as "
generic" rather than branded products and thereby escape price controls until eventually other companies entered the market. Auden and Actavis overcharged the UK's
National Health Service for over ten years. Fines totalling over £255m were levied against the companies involved in this breach of
competition law.[38]
Research
COVID-19
Hydrocortisone was found to be effective in reducing mortality rate of critically ill COVID-19 patients when compared to other usual care or a placebo.[39]
References
^
abcdefgh"Hydrocortisone". Drugs.com. American Society of Health-System Pharmacists. 9 February 2015.
Archived from the original on 20 September 2016. Retrieved 30 August 2016.
^World Health Organization (2019). World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization.
hdl:10665/325771. WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
^Britz MB, Maibach HI, Anjo DM (1980). "Human percutaneous penetration of hydrocortisone: the vulva". Archives of Dermatological Research. 267 (3): 313–316.
doi:
10.1007/BF00403852.
PMID7406539.
S2CID33367289.
^Oriba HA, Bucks DA, Maibach HI (February 1996). "Percutaneous absorption of hydrocortisone and testosterone on the vulva and forearm: effect of the menopause and site". The British Journal of Dermatology. 134 (2): 229–233.
doi:
10.1111/j.1365-2133.1996.tb07606.x.
PMID8746334.
S2CID30076779.
^Boron WF, Boulpaep EL (2011). Medical Physiology (2nd ed.). Philadelphia: Saunders.
ISBN978-1-4377-1753-2.
^Nikolaou N, Hodson L, Tomlinson JW (March 2021). "The role of 5-reduction in physiology and metabolic disease: evidence from cellular, pre-clinical and human studies". The Journal of Steroid Biochemistry and Molecular Biology. 207: 105808.
doi:
10.1016/j.jsbmb.2021.105808.
PMID33418075.
S2CID230716310.