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cortisol; hydrocortisone (Cortef, Solu-Cortef, Alphaderm, Cetacort, Cortenema, Nutracort)

Indications: 1) topical anti-inflammatory agent - dermatitis, seborrheic dermatitis, atopic dermatitis, dermatitis herpetiformis - hemorrhoids, proctitis, - skin irritation, superficial injury - pruritus, urticaria - discoid lupus - granuloma annulare - Tinea cruris, Tinea pedis, Tinea corporis - dandruff - rash - keratoderma - acne - lichen simplex chronicus 2) treatment of acute & chronic adrenal insufficiency - congenital adrenal hyperplasia - adrenoleukodystrophy - adrenogenital syndrome - hypopituitarism 3) anti-inflammatory agent for adjunctive treatment of: - hypersensitivity reactions - shock - status asthmaticus - oral disorders - periodontal disease, aphthous stomatitis - trichinosis - Loeffler's syndrome - respiratory distress syndrome - musculoskeletal inflammation - synovitis, tendonitis, tenosynovitis, bursitis, - osteoarthritis - gout [3] 4) malignancy - cutaneous T-cell lymphoma - mycosis fungoides-Sezary syndrome - Hodgkin's disease - non-Hodgkin's lymphoma - acute lymphoblastic leukemia [3] 5) autoimmune disease - sarcoidosis - immune thrombocytopenic purpura - rheumatic heart disease - organ transplantation rejection - ankylosing spondylitis - rheumatoid arthritis - systemic lupus erythematosus - autoimmune hemolytic anemia - dermatomyositis - psoriatic arthritis - thyroiditis - pemphigus - Crohn's disease, ulcerative colitis, ulcerative proctitis [3] 6) other conditions - bronchopulmonary dysplasia - Diamond-Blackfan syndrome - cerebral edema, laryngeal edema, angioneurotic edema - psoriasis - multiple sclerosis - erythema multiforme - erythroderma - berylliosis - aspiration pneumonitis - nephrotic syndrome [3] 7) ophthalmic agent for treatment of inflammatory eye disease Dosage: 1) acute adrenal insufficiency a) adults: (succinate, phosphate) - 15-240 mg IV/IM/SC every 12 hours b) older children - 1-2 mg/kg bolus IM/IV - 150-250 mg/day in divided doses c) infants & young children: - 1-2 mg/kg bolus IM/IV - 25-150 mg/day in divided doses 2) physiologic replacement: a) children - oral: 0.5-0.75 mg/kg/day or 20-25 mg/m2/day divided every 8 hours - IM: 0.25-0.35 mg/kg or 12-15 mg/m2 QD b) adults: 20 mg QD, divided BID 3) anti-inflammatory or immunosuppressive: a) adults: - 15-20 mg IM/SC/IV every 12 hours as phosphate - 5-60 mg PO QID b) infants & children - oral 2.5-10 mg/kg/day or 75-300 mg/m2/day divided every 6-12 hours - IM/IV (succinate): 1-5 mg/kg/day or 30-150 mg/m2/day divided every 6-12 hours 4) status asthmaticus: (children) a) load 1-2 mg/kg every 6 hours for 24 hours b) maintenance of 0.5-1 mg/kg every 6 hours 5) shock a) adults: 500-2000 mg every 2-6 hours IM/IV as succinate b) children: - 50 mg/kg IM/IV initial as succinate - repeat in 4 hours - then 50 mg/kg IM/IV QD PRN Tabs: 5, 10, 20 mg. Suspension: 10 mg/5 mL (120 mL). Injection: 1) phosphate 50 mg/mL (10 mL) 2) succinate 100 mg, 250 mg. 500 mg 3) succinate may be given IV or IM 4) acetate may only be given IM, not IV aerosol 0.5%. also see topical cortisol Pharmacokinetics: - 90% of circulating cortisol is bound to plasma proteins, primarily to corticosteroid-binding globulin - also weak binding to albumin - biological 1/2life: 8-12 hours Adverse effects: 1) common (> 10%) - increased appetite, insomnia, indigestion, nervousness 2) less common (1-10%) - cataracts, hyperglycemia, hirsutism, joint pain epistaxis 3) uncommon (< 1%) - seizures, mood swings, headache, skin atrophy, bruising, hyperpigmentation, acne, amenorrhea, Na+ & H2O retention, Cushing's syndrome, suppression of bone growth, abdominal distension, ulcerative esophagitis, pancreatitis, muscle wasting, hypersensitivity, delirium, hallucinations, euphoria, hypotension, peptic ulcer, immunosuppression 4) short-term - fluid & electrolyte disturbances - hyperglycemia - poor wound healing - GI disturbances - spread of infection 5) long term - osteoporosis - bone fractures - pituitary adrenal insufficiency - Cushing's syndrome - rapid withdrawal may cause acute adrenal insufficiency 6) topical - irritation - rash - skin atrophy - acne Drug interactions: 1) aminoglutethimide 2) anticholinesterases 3) barbiturates 4) carbamazepine 5) phenytoin 6) rifampin 7) live virus vaccines Laboratory: - cortisol in hair - cortisol in blood - cortisol in dried blood spot - cortisol in CSF - cortisol in saliva - cortisol in serum - free cortisol in serum - cortisol in urine - urinary free cortisol Mechanism of action: 1) short-acting glucocorticoid 2) some mineralocorticoid activity - mineralocorticoid/glucocorticoid activity (1/125) [4]

Interactions

molecular events drug interactions drug adverse effects (more general classes) monitor with drug (more general classes)

Related

cortisol in serum free cortisol in 24 hour urine

Specific

Cortisol Topical (Westcort, Locoid, Hytone, Lacticare HC, Pramosome)

General

11 hydroxycorticosteroid 17 hydroxycorticosteroid adrenal cortex hormone; corticosteroid glucocorticoid pregnenedione

Properties

SECRETED-BY: clear cell WITHIN: zona fasciculata dark cell WITHIN: zona reticularis MISC-INFO: elimination route LIVER pregnancy-category C safety in lactation ?

Database Correlations

PUBCHEM correlations

References

  1. The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
  2. Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
  3. Deprecated Reference
  4. Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015
  5. Department of Veterans Affairs, VA National Formulary

Substructure-of

tetrahydrocortisol

Substructures

corticosterone

Component-of

acetic acid/cortisol acetic acid/cortisol/propylene glycol acyclovir/cortisol (Lipsovir, Xerese) aloe vera/cortisol/iodoquinol bacitracin/colistin/cortisol bacitracin/cortisol/neomycin/polymixin b benzalkonium/chloroxylenol/cortisol/pramoxine benzethonium/cortisol/diphenhydramine benzocaine/chloroxylenol/cortisol benzocaine/cortisol benzoyl peroxide/cortisol chlorhexidine/cortisol chlorhexidine/cortisol/ketoconazole chloroxylenol/cortisol/pramoxine ciprofloxacin/cortisol (Cipro HC) clioquinol/cortisol clioquinol/cortisol/cortistatin colistin/cortisol/neomycin (Coly-Mycin S) colistin/cortisol/neomycin/thonzonium bromide cortisol/diphenhydramine cortisol/diphenhydramine/nystatin cortisol/diphenhydramine/nystatin/tetracycline cortisol/diphenhydramine/pramoxine cortisol/gentamicin/miconazole cortisol/hexachlorophene/menthol cortisol/iodoquinol (Vytone) cortisol/ketoconazole cortisol/lidocaine cortisol/lidocaine/polycarbophil/psyllium cortisol/lidocaine/pramoxine cortisol/lidocaine/psyllium cortisol/miconazole/nitrate cortisol/neomycin cortisol/neomycin/polymixin-B (Corticosporin, Cortisporin, Cortomycin) cortisol/neomycin/polymyxin B cortisol/oatmeal cortisol/oxytetracycline cortisol/phenol cortisol/polymixin b cortisol/pramoxine cortisol/salicylic acid/sulfur