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Drug dosage identifier

Hydrocortisone sodium succinate

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Dose and administration

  1. For adrenal crisis: 1mg/kg IM/IV q 4 hourly.
  2. For maintenance: 1mg/kg/day PO

Indications

Replacement therapy in acute and chronic adrenocortical insufficiency.

Contraindication and precautions

  1. Infection.
  2. Abrupt discontinuation in longterm therapy may result in withdrawal-like symptoms.
  3. CAUTION concurrent use with amphotericin, potassium depleting diuretics, indomethacin, theophyllines.

Clinical pharmacology

Hydrocortisone is the principle glucorticoid of the human adrenal cortex. The rate of secretion follows a characteristic diurnal rhythm. Secretion increases in the early hours of the morning and gradually declines toward late evening.

The three major effects of adrenal steroids are on metabolism, mineral metabolism and inflammation.

Hydrocortisone is about 25-30 times less potent than dexamethasone.

Possible adverse effects

  1. Increased susceptibility to and suppression of the usual symptoms and signs of infection.
  2. Hyperglycaemia, glycosuria.
  3. Sodium and water retention.
  4. Hypertension.
  5. Poor growth.
  6. Gastrointestinal disturbance, aggravation of peptic ulcers, bleeding.
  7. Hypokalaemia.
  8. Hypocalcaemia.
  9. Thrombocytopenia.
  10. Interferes with tissue granulation and repair, wound healing.
  11. Rash.
  12. Osteoporosis.
  13. Prolonged use may produce posterior subcapsular cataracts.

Special considerations

  1. The manufacturer recommends that Solu-Cortef is contraindicated in premature infants because it contains benzyl alcohol. Benzyl alcohol has been reported to be associated with the fatal gasping syndrome in premature infants. However, no other preparation is currently available.
  2. Dangerous to stop if using for adrenal crisis.
  3. Infants born to mothers receiving this drug need to be monitored for signs of hypoadrenalism.
  4. Phenobarbitone and phenytoin may increase the clearance of corticosteroids.
  5. Hydrocortisone may increase or decrease theophylline levels.

Management of Hydocortisone administration

Description

Solu-Cortef presents as an act-o-vial 100 mg per 2 ml. The act-o-vial contains one compartment of hydrocortisone sodium succinate white powder, and one compartment of diluent which contains benzyl alcohol 18.1 mg/2 ml.

The reconstituted solution has a pH of 7.28 and is clear and colourless.

Oral

No proprietary product available. Contact Pharmacy for a preparation.

Prescription

  • Stat doses are charted on the stat page of the prescription chart in mg/dose.
  • Maintenance doses are charted on the prescription chart in mg/dose.

Administration

Slow IV Infusion

  1. Press down on plastic activator to force diluent into the lower compartment. Gently agitate to mix solution.
  2. Dilute immediately prior to use to 1 mg/ml in NS or D5W.
  3. Administer by slow IV infusion over 30 minutes. Filter prior to administration through a Pall 0.2 micron filter.
  4. Is compatible with D5W and NS.
  5. Do NOT administer with other drugs, IV solutions, blood or blood products.

IM Injection

Further dilution not necessary.

Oral

  1. Follow instructions on bottle label.
  2. Administer at feed times.

Observation and Documentation

  1. Monitor for signs of adverse effects.
  2. 8 hourly urinalysis for glycosuria.
  3. Weigh daily.
  4. Monitor vital signs including blood pressure.
  5. Monitor fluid balance.
  6. Assess baby closely for signs of infection.

Storage

  • Store at room temperature 15-30°C.
  • Reconstituted solution may be stored for 24 hours at room temperature 15-30°C. Protect from light.
  • Oral preparation dependent on presentation. Follow instructions from pharmacist.

Selected references

  1. Pawlak RP, Herfert LAT. Drug administration in the NICU. 2nd ed 1991 Neonatal Network p124-125.
  2. Prescribing information (product disclosure). The Upjohn Company. December 1994.

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Document Control

  • Date last published: 28 August 1996
  • Document type: Drug Dosage Guideline
  • Services responsible: ADHB Pharmacy, Neonatology
  • Editor: Sarah Bellhouse
  • Review frequency: 2 years