⚡ Quick Answer — What is Cort-S Injection?
Cort-S Injection is een hydrocortisone sodium succinate 100 mg vial gedurende intravenous or intramuscular administration. It is the injectable short-acting glucocorticoid used in acute medical situations — anaphylaxis, acute severe asthma, adrenal crisis, severe allergic reactions, and peri-operative stress cover for patients on long-term steroids. Clinically equivalent to the more widely known Hydrocort and Solu-Cortef brands. Standard adult dose is 100 mg IV/IM every 6 hours in acute settings.
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Cort-S Injection is a reconstituted injectable preparation of hydrocortisone sodium succinate — the water-soluble ester of hydrocortisone (cortisol) that permits rapid IV or IM administration. The 100 mg vial strength is the standard adult dose in emergency and inpatient settings.
Hydrocortisone is the parenteral glucocorticoid of choice when rapid, short-acting systemic corticosteroid effect is required. It is less potent than dexamethasone per milligram but has a significant mineralocorticoid (salt-retaining) effect that makes it particularly useful in adrenal crisis, where both glucocorticoid en mineralocorticoid action are needed.
What Is Cort-S Injection Used For?
- Acute adrenal insufficiency (Addisonian crisis) — life-threatening emergency
- Anaphylaxis — as adjunct to IM adrenaline
- Acute severe asthma — when oral prednisolone is not tolerated
- Severe allergic drug reactions, transfusion reactions
- Autoimmune flares — SLE, vasculitis, inflammatory bowel disease
- Septic shock with suspected relative adrenal insufficiency
- Thyrotoxic crisis — adjunct therapy
- Peri-operative “stress cover” for patients on chronic oral glucocorticoids
- Severe reactions to contrast media or chemotherapy
How Does Cort-S Work?
Cort-S Injection delivers hydrocortisone to the systemic circulation, where it binds intracellular glucocorticoid receptors. The activated receptor enters the nucleus and modulates transcription of inflammatory, immune, and metabolic genes. Clinical effects include suppression of leukocyte trafficking, reduction of cytokine production, stabilisation of vascular permeability, and restoration of physiological cortisol activity in adrenal insufficiency.
Cort-S Injection Dosing
- Adult acute inflammatory or allergic condition: 100–200 mg IV/IM, repeated every 2–6 hours
- Adrenal crisis: 100 mg IV bolus, then 100 mg every 6 hours until stable
- Stress cover: 100 mg IV pre-op, then every 6 hours for 24–48 hours
- Paediatric: 2–4 mg/kg per dose IV/IM (specialist supervision)
Reconstitute immediately before use. IV push of 100 mg should be given over at least 30 seconds; larger doses over several minutes or as an 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.
| Corticosteroid | Glucocorticoid potency | Equivalent dose | Mineralocorticoid | Duur |
|---|---|---|---|---|
| Hydrocortisone | 1 (reference) | 20 mg | Substantial | 8–12 h |
| Prednisolone | 4 | 5 mg | Low | 12–36 h |
| Methylprednisolone | 5 | 4 mg | Minimal | 12–36 h |
| Dexamethasone | 25–30 | 0.75 mg | None | 36–54 h |
| Betamethasone | 25–30 | 0.75 mg | None | 36–54 h |
Who Should Not Take Cort-S 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.
Never stop corticosteroids abruptly after a prolonged course. Any course longer than 2–3 weeks, or any dose above a physiological replacement level (approximately 7.5 mg prednisolone or 40 mg hydrocortisone per day) suppresses the hypothalamic-pituitary-adrenal axis. Stopping suddenly can trigger a life-threatening adrenal crisis — nausea, vomiting, low blood pressure, shock. Courses longer than 3 weeks must be tapered down, typically over 1–4 weeks depending on duration and dose. Carry a steroid warning card during prolonged treatment and inform any doctor, dentist, or surgeon you see about your steroid use.
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Medisch disclaimer. De informatie op deze pagina is alleen bedoeld voor algemene educatie. Het is geen vervanging voor advies van uw eigen arts of apotheker. Overleg met een gekwalificeerde zorgprofessional voordat u een therapie start, stopt of wijzigt.
Veelgestelde vragen
What is Cort-S Injection used for?
Cort-S (hydrocortisone sodium succinate 100 mg) is used for acute allergic reactions, anaphylaxis, acute severe asthma, adrenal crisis, autoimmune flares, septic shock, and peri-operative stress cover for patients on long-term steroids.
Is Cort-S the same as Hydrocort 100?
Yes — both are hydrocortisone sodium succinate 100 mg per vial. Clinically equivalent; different manufacturers and brand names.
Is Cort-S the same as Solu-Cortef?
Yes — same molecule, same strength, same indications. Solu-Cortef is the Pfizer brand; Cort-S is a generic alternative.
How quickly does Cort-S work?
Genomic (anti-inflammatory) effects begin within 30–60 minutes after IV administration; membrane-mediated non-genomic effects occur within minutes.
Can Cort-S be given at home?
Only by a trained healthcare professional or, in the specific case of known adrenal insufficiency, by a patient or family member who has been trained on the emergency hydrocortisone kit.
Can I use Cort-S during pregnancy?
Short courses for acute medical indications are generally considered acceptable. For chronic therapy, use the lowest effective dose under specialist supervision.
Does Cort-S affect blood sugar?
Yes — hydrocortisone raises blood glucose. Diabetic patients need closer glucose monitoring and may require insulin dose adjustment while on therapy.
Can Cort-S cause insomnia?
Yes — particularly at higher doses or when given late in the day. This is a common and usually mild side effect that resolves on stopping.
Can I stop Cort-S abruptly after a short course?
Courses under 2 weeks in previously steroid-naive patients can usually be stopped without a taper. Longer courses, or any course in a patient with prior HPA-axis suppression, require a formal taper to avoid adrenal crisis.
Why is hydrocortisone preferred in adrenal crisis over dexamethasone?
Hydrocortisone has significant mineralocorticoid activity (salt retention) that helps restore blood pressure in adrenal crisis. Dexamethasone has essentially no mineralocorticoid activity. For acute adrenal replacement, hydrocortisone is the first choice.
Can Cort-S be used in children?
Yes, at weight-based doses (typically 2–4 mg/kg per dose every 6 hours) under paediatric specialist care.
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