Hydrocort 100 Injection

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Hydrocort 100 Injection is a sterile powder containing hydrocortisone sodium succinate, the water-soluble ester of hydrocortisone that can be reconstituted for rapid intravenous or intramuscular administration. Hydrocortisone is the synthetic form of cortisol, the natural glucocorticoid produced by the adrenal cortex.

Because parenteral hydrocortisone acts within minutes when given IV, it is the default glucocorticoid of choice in emergency settings where rapid glucocorticoid effect is required — anaphylaxis, acute severe asthma, shock in adrenal insufficiency, and severe inflammatory or allergic reactions. The 100 mg vial strength is the most commonly used in adults.

What Is Hydrocort 100 Injection Used For?

• Acute adrenal crisis (Addisonian crisis) — life-threatening cortisol deficiency
• Anaphylaxis — as second-line to adrenaline; reduces the late-phase response
• Acute severe asthma — when oral prednisolone is not possible (patient too unwell, vomiting)
• Acute exacerbations of chronic inflammatory disease — inflammatory bowel disease, autoimmune rheumatic disease
• Severe allergic reactions — drug allergy, angioedema, serum sickness
• Septic shock with suspected adrenal insufficiency (specialist use in ICU)
• Stress-dose cover for patients on long-term oral steroids undergoing surgery or severe illness
• Thyrotoxic crisis — as adjunct
• Cerebral oedema — though dexamethasone is usually preferred
• Transfusion reactions, severe reactions to chemotherapy or contrast media

How Does Hydrocortisone Work?

Hydrocortisone binds to intracellular glucocorticoid receptors, translocates to the nucleus, and modulates transcription of hundreds of genes. The net effect is broad:

• Ontstekingsremmend — reduces cytokine production, leukocyte trafficking, and vascular permeability
• Immunosuppressive — suppresses T-cell activation, antibody production, and inflammatory cell function
• Metabolic — raises blood glucose, promotes protein catabolism, shifts fat distribution
• Mineralocorticoid activity — hydrocortisone has substantial salt-retaining action (unlike dexamethasone), which is useful in adrenal insufficiency but can cause fluid retention and hypertension at high doses

Hydrocort 100 Injection Dosing

• Adult acute inflammatory / anaphylactic / asthma: 100–200 mg IV/IM, repeated at 2–6 hour intervals as required
• Acute adrenal crisis: 100 mg IV bolus, then 100 mg every 6 hours by slow IV infusion until oral therapy tolerated
• Peri-operative stress cover for patients on long-term steroids: 100 mg IV pre-induction, then 100 mg every 6 hours for the first 24–48 hours
• Kinderen: weight- and age-based; typically 2–4 mg/kg per dose IV/IM, every 6 hours (specialist paediatric care)

Reconstitute the vial immediately before use with 2 mL of water for injection; inspect for particulate matter before administration. IV push should be given over at least 30 seconds for the 100 mg dose; larger doses should be given over 10 minutes or diluted for infusion.

Corticosteroid Potency and Equivalence

Different corticosteroids differ mainly in potency, duration of action, and mineralocorticoid (salt-retaining) activity. The table below gives the clinically useful equivalence — it lets you translate a dose of one steroid into the equivalent dose of another.

Who Should Not Take Hydrocort 100 Injection?

• Systemic fungal infection (other than as replacement therapy in adrenal insufficiency)
• Live vaccines during immunosuppressive doses (see specialist before BCG, MMR, yellow fever, varicella, oral typhoid)
• Active untreated bacterial infection (start antibiotics first)
• Active tuberculosis without anti-TB cover
• Known hypersensitivity to the active molecule or any excipient
• Use with caution in: diabetes mellitus, congestive heart failure, hypertension, osteoporosis, peptic ulcer, psychiatric disorders, glaucoma, herpes simplex ophthalmicus
• Pregnancy: use only if clearly needed — prednisolone and hydrocortisone cross the placenta less than dexamethasone/betamethasone, which are preferred when a fetal effect is intended (e.g. lung maturation)

Side Effects of Corticosteroids

Corticosteroid side effects are dose- and duration-dependent. Short courses (< 2 weeks) at moderate doses are usually well tolerated. Longer or higher-dose therapy produces the classic “Cushingoid” profile.

Short-term (first 1–2 weeks):

• Insomnia, anxiety, euphoria, irritability — particularly at doses > 20 mg prednisolone-equivalent
• Increased appetite, weight gain
• Raised blood glucose (especially in diabetes)
• Fluid retention, mild ankle swelling
• Heartburn, dyspepsia
• Hypertension — especially with higher mineralocorticoid activity (hydrocortisone, fludrocortisone)

Longer-term (weeks to months):

• Osteoporosis and vertebral fractures
• Muscle wasting and proximal myopathy
• Skin thinning, easy bruising, striae, impaired wound healing
• Cushingoid appearance — moon face, central obesity, buffalo hump
• Cataracts, glaucoma
• Infection susceptibility (bacterial, viral, fungal, parasitic)
• Avascular necrosis of the femoral head
• HPA-axis suppression — risk of adrenal crisis on abrupt withdrawal
• Psychiatric effects — depression, mania, psychosis
• Peptic ulcer, especially when combined with NSAIDs

Zeldzaam maar ernstig: steroid psychosis, pancreatitis, posterior subcapsular cataract, severe osteonecrosis.

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Veelgestelde vragen

What is Hydrocort 100 Injection used for?

Hydrocort 100 (hydrocortisone sodium succinate 100 mg) is used in emergency or hospital settings for acute allergic reactions, anaphylaxis, acute severe asthma, adrenal crisis, severe inflammatory or autoimmune flares, septic shock, and as stress-dose cover for patients on long-term steroids undergoing surgery.

How is Hydrocort different from dexamethasone or prednisolone?

All three are glucocorticoids. Hydrocortisone is the natural cortisol-equivalent and has the fastest IV onset but also the most mineralocorticoid activity (salt retention). Dexamethasone is ~25–30 times more potent, has zero mineralocorticoid activity, and is longer-acting. Prednisolone sits between the two and is the usual oral maintenance steroid.

How fast does IV hydrocortisone work?

Genomic (anti-inflammatory) effects begin within 30–60 minutes after IV administration; some non-genomic effects (membrane-mediated) occur within minutes. Onset is faster IV than IM.

Why is Hydrocort used in anaphylaxis rather than an oral steroid?

Because patients in anaphylaxis may be vomiting, hypotensive, or unable to swallow, and the late-phase response needs to be prevented quickly. IV hydrocortisone delivers rapid, reliable systemic corticosteroid coverage — but it is always adjunctive: adrenaline IM is the first-line emergency drug in anaphylaxis.

Can Hydrocort be given at home?

Hydrocort 100 Injection is designed for administration by a qualified healthcare professional in a hospital, clinic, or ambulance. Patients with known adrenal insufficiency are sometimes issued a hydrocortisone emergency injection kit for self- or family-administration during acute illness — only with specific medical training.

What is the difference between Hydrocort 100 and Cort-S Injection?

Both are hydrocortisone sodium succinate 100 mg vials. They are clinically equivalent — different brand names for the same active molecule and strength.

Does hydrocortisone cause weight gain?

Short courses rarely cause meaningful weight change. Longer courses or repeated high doses cause fluid retention, increased appetite, and the characteristic Cushingoid fat redistribution. Short IV courses for acute illness do not typically cause weight gain.

Can I take hydrocortisone during pregnancy?

Short-course use for acute medical indications is usually considered acceptable — hydrocortisone is less efficiently crossing the placenta than dexamethasone. For chronic therapy, use the lowest effective dose under specialist supervision.

What is an adrenal crisis?

A life-threatening state of acute cortisol deficiency — usually triggered by illness, surgery, or abrupt withdrawal of long-term steroids. Symptoms include severe nausea, vomiting, abdominal pain, low blood pressure, shock, and low blood sugar. Treatment is immediate IV hydrocortisone and fluid resuscitation.

Can hydrocortisone be used in diabetes?

Yes, but with monitoring. It raises blood glucose — diabetic patients may need insulin dose adjustment during and after a course.

How long can I stay on hydrocortisone?

In adrenal insufficiency, lifelong replacement is necessary. For acute illness, duration depends on the underlying disease — anything beyond 2–3 weeks requires a formal taper before stopping.

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