Is Cortisone Cream Safe to Use?

Hydrocortisone is a synthetic and naturally occurring glucocorticoid, with an anti-inflammatory effect of 1.25 times that of cortisone, and also has immunosuppressive, antitoxic, anti-shock and certain mineralocorticoid activity, etc., and It has the effect of retaining water, sodium and potassium, and the plasma half-life is 8-12 hours. This medicine can cause allergic reactions, and two patients developed lethal anaphylactic shock including respiratory damage after intravenous injection. Patients with bronchial asthma may also cause anaphylactic shock by intranasal inhalation or intravenous injection of hydrocortisone acetate. .

Hydrocortisone is a synthetic and naturally occurring glucocorticoid, with an anti-inflammatory effect of 1.25 times that of cortisone, and also has immunosuppressive, antitoxic, anti-shock and certain mineralocorticoid activity, etc., and It has the effect of retaining water, sodium and potassium, and the plasma half-life is 8-12 hours. This medicine can cause allergic reactions, and two patients developed lethal anaphylactic shock including respiratory damage after intravenous injection. Patients with bronchial asthma may also cause anaphylactic shock by intranasal inhalation or intravenous injection of hydrocortisone acetate. .
Chinese name
Hydrocortisone
Foreign name
Hydrocortisone
Molecular weight
362.46
Molecular formula
C21H30O5
Chemical Name:
11, 17

Hydrocortisone compounds

Hydrocortisone Basic Information

Chinese name: Hydrocortisone
Chinese alias: corazole; hydrocortisone; hydrocortisone; cortisone; cortisol; hydrocortisone; cortisol; cortisone; hydrocortisone; cortisol
English name: cortisol
English alias: Alacort; Signef; H-Cort; Cleiton; Hycort; 11, 17, 21-Trihydroxypregn-4-ene-3,20-dione
CAS number: 50-23-7
Molecular formula: C 21 H 30 O 5
Structural formula:
Molecular weight: 362.46000
Exact mass: 362.20900
PSA: 94.83000
LogP: 1.78160

Hydrocortisone physicochemical properties

Appearance and properties: white or almost white crystalline powder; odorless. Initially tasteless, followed by a persistent bitter taste; easy to deteriorate when exposed to light. not soluble in water. Its acetate is white or almost white crystalline powder; odorless
Density: 1.28g / cm 3
Melting point: 211-214 ° C (lit.)
Boiling point: 566.4ºC at 760 mmHg
Flash point: 220 ° C
Refractive index: 1.594
Stability: stable, but photosensitive, and incompatible with strong oxidants
Storage conditions: -20ºC

Hydrocortisone Safety Information

Customs code: 2937210000
WGK Germany: 3
Danger category code: R62; R63
Safety instructions: S36 / 37-S45
RTECS number: GM8925000
Dangerous goods mark: Xn [1]

Hydrocortisone safety term

S36 / 37Wear suitable protective clothing and gloves.
Wear suitable protective clothing and gloves.
S45In case of accident or if you feel unwell, seek medical advice immediately (show the label whenever possible.)
In case of accident or if you feel unwell, seek medical advice immediately (show the label if possible).

Hydrocortisone risk terminology

R62Risk of impaired fertility.
There is a danger of impairing fertility.
R63Possible risk of harm to the unborn child.
There is a risk of harm to the fetus.

Hydrocortisone production method

It can be separated from the adrenal glands, and can also be prepared by a series of reactions using 17-hydroxyflavonoids as raw materials [1] .

Hydrocortisone uses

For diseases caused by adrenal insufficiency, rheumatoid arthritis, rheumatic fever, gout, bronchial asthma, etc. For allergic dermatitis, seborrheic dermatitis, pruritus, etc. [1] .

Hydrocortisone Pharmacopoeia Standard

Hydrocortisone source (name), content (potency)

This product is 11, 17, 21-trihydroxypregn-4-ene-3,20-dione. Calculated on dry basis, containing C 21 H 30 O 5 should be 97.0% to 103.0%.

Hydrocortisone traits

This product is a white or off-white crystalline powder; odorless, initially odorless, and then has a persistent bitter taste; gradually deteriorates when exposed to light.
This product is slightly soluble in ethanol or acetone, slightly soluble in chloroform, almost insoluble in ether, and insoluble in water.
Specific rotation
Take this product, weigh it accurately, add absolute ethanol to dissolve and quantitatively dilute it to make a solution containing about 10mg per 1ml, and measure it according to the law (Appendix VIE of Part Two of the Pharmacopoeia, 2010 Edition). The specific rotation is + 162 ° to + 169 ° .
Absorption coefficient
Take this product, weigh it accurately, add absolute ethanol to dissolve and quantitatively dilute it to make a solution containing about 10 g per 1 ml. According to UV-Vis spectrophotometry (Appendix IVA of Pharmacopoeia Part II of 2010 Edition), measure at a wavelength of 242 nm. Absorbance and absorption coefficient () are 422 448.

Hydrocortisone identification

(1) Take about 0.1mg of this product, add 1ml of ethanol to dissolve it, add 8ml of freshly prepared phenylhydrazine sulfate test solution, and heat it at 70 for 15 minutes, then it will be yellow.
(2) Take about 2mg of this product, add 2ml of sulfuric acid to dissolve, and leave it for 5 minutes, showing brownish yellow to red, and green fluorescence; pour this solution into 10ml of water, it will turn yellow to orange yellow, and slightly green Fluorescence while generating a small amount of flocculent precipitate.
(3) In the chromatogram recorded under the content determination item, the retention time of the main peak of the test solution should be consistent with the retention time of the main peak of the reference solution.
(4) The infrared absorption spectrum of this product should be consistent with the control spectrum ("Infrared Spectra of Drugs" 283).

Hydrocortisone check

relative substance
Take this product, weigh it accurately, add methanol to dissolve and quantitatively dilute to make a solution containing about 0.5mg per 1ml as the test solution; take 1ml precisely, place it in a 100ml measuring bottle, dilute to the mark with methanol, shake Use it as a control solution; take another prednisone reference product, weigh it accurately, add methanol to dissolve and quantitatively dilute to make a solution containing about 5 g per 1 ml, and use it as a reference solution. According to the chromatographic conditions under the content determination item, take 20 l of the reference solution and inject it into the liquid chromatograph, and adjust the detection sensitivity so that the peak height of the main component chromatographic peak is about 30% of the full scale. Then accurately measure 20 l each of the test solution, the control solution and the reference solution, and inject them into the liquid chromatograph respectively, and record the chromatogram to 3 times the peak retention time of the main component of the test solution. For the test product solution chromatogram, if there is a peak with the retention time of prednisone peak in the chromatogram of the reference solution, the peak area calculated according to the external standard method shall not exceed 0.5%; the peak area of other single impurities shall not be larger than the control solution. The main peak area is 0.5 times (0.5%), and the sum of the area of each impurity peak must not be greater than 1.5 times (1.5%) the main peak area of the control solution. Any peak less than 0.01 times the area of the main peak of the control solution in the chromatogram of the test solution can be ignored.
Loss on drying
Take this product and dry it at 105 to constant weight, and the weight loss shall not exceed 0.5% (Appendix L of Part Two of the Pharmacopoeia of 2010 Edition).

Determination of hydrocortisone content

It was determined by high performance liquid chromatography (Appendix VD of Part Two of the Pharmacopoeia, 2010 Edition).
Chromatographic conditions and system suitability tests
Octadecylsilane-bonded silica gel was used as the filler; acetonitrile-water (28:72) was used as the mobile phase; the detection wavelength was 245 nm. Take hydrocortisone and prednisolone, dissolve and dilute with methanol to make a solution containing about 5g per 1ml, take 20l into the liquid chromatograph, record the chromatogram, and the peak order is prednisolone and hydrogenated The resolution of the cortisone, prednisone and hydrocortisone peaks should meet the requirements.
Assay
Take an appropriate amount of this product, accurately weigh it, add methanol to dissolve and quantitatively dilute it to make a solution containing about 0.1mg per 1ml. Precisely measure 20l into the liquid chromatograph and record the chromatogram; take another hydrocortisone reference substance, Same method. Calculate the peak area according to the external standard method.

Hydrocortisone Categories

Adrenal corticosteroids.

Hydrocortisone storage

Shaded and sealed.

Hydrocortisone preparation

(1) Hydrocortisone tablets (2) Hydrocortisone cream (3) Hydrocortisone injection [2]

Hydrocortisone Drug Description

Hydrocortisone Classification

Endocrine System Drugs> Adrenal Corticosteroids

Hydrocortisone dosage form

1. Tablet: 10mg, 20mg;
2. Injection: dilute ethanol solution: 10mg (2ml), 25mg (5ml); 50mg (10ml); 100mg (20ml);
3. Hydrocortisone acetate injection: 125mg (5ml);
4. Hydrocortisone (powder) sodium succinate for injection: 135mg (equivalent to 100mg hydrocortisone);
5. Eye drops: 15mg (3ml);
6. Aerosol film: 0.25%;
7. Ointment: 1%.

Hydrocortisone pharmacological action

1. Anti-inflammatory effect: The anti-inflammatory effect of hydrocortisone is 1.25 times that of cortisone, and it has an inhibitory effect on infectious and non-infectious inflammation at the pharmacological dose. Hydrocortisone can increase the tension of blood vessels, reduce congestion, reduce the permeability of capillaries, and therefore reduce exudation and edema; by inhibiting the accumulation of inflammatory cells (including macrophages and leukocytes) at the site of inflammation and inhibiting phagocytosis The function of cells stabilizes the lysosomal membrane, prevents complement from participating in the inflammatory response and the synthesis and release of inflammatory chemical mediators (such as prostaglandins, thromboxane, leukotrienes), thereby alleviating the symptoms of redness, swelling, heat, and pain.
2. Immunosuppressive effects: including preventing or suppressing cell-mediated immune responses, delayed allergic reactions, reducing the number of T lymphocytes, monocytes, and eosinophils, and reducing the binding of immunoglobulins to cell surface receptors Ability, and inhibit the synthesis and release of interleukins, thereby reducing the conversion of T lymphocytes to lymphoblasts, and reducing the expansion of the primary immune response. Hydrocortisone and other glucocorticoids can also reduce the passage of immune complexes through the basement membrane and reduce the concentration of complement components and immunoglobulins; it can relieve the symptoms of many allergic diseases and inhibit the pathology caused by allergic reactions Changes, such as allergic hyperemia, edema, exudation, rash, smooth muscle spasm, and cell damage, can inhibit the rejection of transplantation of tissues and organs, and can also play a certain short-term effect on autoimmune diseases.
3. Anti-toxin effect: Hydrocortisone and other glucocorticoids can improve the body's ability to respond to harmful stimuli, reduce the damage caused by bacterial endotoxins, alleviate the symptoms of toxemia, and have antipyretic effects against the high fever of toxemia effect. The antipyretic mechanism may be related to its inhibition of the body temperature's response to the pyrogens, stabilization of the lysosomal membrane, and reduction of the release of endogenous pyrogens.
4. Anti-shock effect: Hydrocortisone and other glucocorticoids have an anti-shock effect on toxic shock, hypovolemic shock, and cardiogenic shock. The anti-shock effect is related to the following factors: (1) expansion of spasm and constricted blood vessels and excitement of the heart to strengthen the heart's contractile force; (2) inhibit the production of certain inflammatory factors, reduce systemic inflammatory response syndrome and tissue damage, Circulating hemodynamics returned to normal and improved shock status; (3) stabilized lysosomal membrane and reduced myocardial inhibitory factor formation: (4) increased the body's tolerance to bacterial endotoxin.
5. Impact on metabolism: (1) Increase liver glycogen and increase blood sugar by promoting glycogen engraftment, slowing glucose breakdown, and reducing the use of glucose in the body tissues: (2) increase protein breakdown Metabolism, increase serum amino acid and urine nitrogen excretion, resulting in negative nitrogen balance. Moreover, large doses can inhibit protein synthesis; (3) can increase plasma cholesterol, activate subcutaneous esterases in the extremities, promote subcutaneous fat breakdown, and redistribute it on the face, upper chest, neck back, abdomen and hips, forming concentric obesity: (4) Hydrocortisone has a certain mineralocorticoid effect, which can enhance sodium ion reabsorption and excretion of potassium, calcium and phosphorus.
6. Effect on blood and hematopoietic system: It can stimulate the hematopoietic function of the bone marrow, increase the content of red blood cells and hemoglobin, and large doses may increase platelets and increase the concentration of fibrinogen and shorten the clotting time. In addition, it can reduce eosinophils and lymphocytes in the blood.
7. Others: It can reduce the pathological proliferation of connective tissue, increase the excitability of the central nervous system, and promote the secretion of gastric acid and pepsin [3] .

Hydrocortisone Pharmacokinetics

Hydrocortisone is quickly and completely absorbed orally, with a tmax of 1 to 2 hours, which can be maintained for 8 to 12 hours with each dose. Phosphate or succinate phosphate has increased water solubility and is rapidly absorbed after intramuscular or subcutaneous injection, with tmax of 1 h. But hydrocortisone acetate hydrosol has poor solubility, and its suspension is generally used. Intramuscular injection is slow in absorption and can be maintained for 24 hours per injection. Such as intra-articular injection, each injection can be maintained for about 1 week. After hydrocortisone enters the blood, the protein-binding rate (BPCR) is about 90%, 80% of which binds to the corticosteroid transporter, and 10% of which binds to albumin. It is mainly metabolized in the liver, and finally in the form of glucuronic acid or sulfuric acid binding and Part of the unbound form is excreted by the urine. The half-life is 80-144min, and the half-life of biological effects is about 8-12h. Hydrocortisone can be quickly absorbed from the digestive tract, and it can also be absorbed through the skin, especially faster in the damaged areas of the skin [3] .

Hydrocortisone indications

1. Acute and chronic adrenal insufficiency (including adrenal crisis), hypohypophysis, and subtotal adrenalectomy are performed after replacement therapy.
2. Severe infection complicated by toxemia: such as toxic pneumonia, toxic dysentery, fulminant meningococcal meningococcal meningitis (epidemic meningococcal meningitis), fulminant hepatitis, severe typhoid fever, acute miliary tuberculosis , Scarlet fever, sepsis, etc. While effective antibiotics are used to control the infection, hydrocortisone can be used as an adjuvant treatment.
3. Allergic diseases: such as bronchial asthma, persistent asthma, serum disease, angioedema, etc. Hydrocortisone can be used to relieve symptoms.
4. Anti-shock treatment: Infective toxic shock, while applying antibiotics, hydrocortisone can be used as an early, short-term, large-dose surprise, and the drug can be discontinued after the effect is achieved. For anaphylactic shock, it can be used in combination with the preferred drug epinephrine. When hypovolemic shock occurs, fluid replacement, electrolyte supplementation, or blood transfusion should be performed first. Hydrocortisone can be used in combination when the effect is not good.
5. Prevent the sequelae of certain inflammation: such as tuberculous meningitis, pleurisy, pericarditis, rheumatic heart valvitis, irisitis, keratitis, retinitis, optic neuritis, burns, etc. Early application can prevent the occurrence of sequelae.
6. Others: Hydrocortisone can be used for thyroid crisis, acute rejection after organ transplantation, severe pemphigus, erythroderma (exfoliative dermatitis), etc. For arthritis, tenosynovitis, tendon strain, etc., it can be injected intrathecally or joint cavity. For contact dermatitis, eczema, psoriasis (psoriasis), etc. can be applied topically.
7. Anti-toxin effect: improve the body's tolerance to bacterial endotoxins, ease the body's response to endotoxins, reduce cell damage, and alleviate symptoms of toxins. And can inhibit the hypothalamus' response to pyrogens, inhibit the generation and release of leukocyte pyrogens, reduce the sensitivity of the thermoregulation center to pyrogens, and have antipyretic effects on hyperthermia.
8. Anti-shock effect: It can inhibit the vasoconstrictive effect of vasoconstrictive active substances, relieve arteriolar spasm, stabilize the lysosomal membrane, and reduce the formation of myocardial inhibitory factors. Prevent the release of proteolytic enzymes and weakened myocardial contraction caused by myocardial inhibitory factors, prevent circulatory disorders such as reduced cardiac output and visceral vasoconstriction, improve microcirculation, and respond to toxic shock, hypovolemic shock, and cardiogenic shock All have an antagonistic effect.
9. Effect on the digestive system: It can stimulate the secretory function of the digestive glands, promote the secretion of gastric acid and pepsin, increase appetite and promote digestion.
10. Reduce the pathological proliferation of connective tissue. It is used for contact dermatitis, seborrheic dermatitis, neurodermatitis, pruritus of the skin, and to a lesser extent psoriasis.
11.2.5% hydrocortisone acetate hydrocortisone suspension is used for intradermal injection, 0.5 to 1 ml each time, and mixed with 0.5 to 1% procaine 2 to 5 ml before use.
12.1% hydrocortisone hydrocortisone ointment is used for dermatitis and eczema, and dermatitis membrane is used for neurodermatitis. Topical for ophthalmology and skin allergic diseases [3] .

Hydrocortisone contraindications

1. Those who are allergic to adrenal corticosteroids.
2. Within 2 weeks before and after vaccination.
3. Patients with viral skin diseases.
4. Patients with corneal ulcer.
5. Patients with severe mental illness and epilepsy.
6. Patients with active gastric and duodenal ulcers.
7. Recent gastrointestinal anastomosis.
8. Wound repair period.
9. Patients with fractures.
10. Hyperadrenal function.
11. More severe osteoporosis.
12. Patients with apparent diabetes.
13. Patients with severe hypertension.
14. Viral, bacterial, and fungal infections that cannot be controlled with antimicrobials. People who are allergic to ethanol are prohibited [3] .

Hydrocortisone dosage usage

1. Hydrocortisone Acetate Tablets: Take 1 tablet each time (containing medicine 20mg), 1 or 2 times a day. Hydrocortisone acetate ointment, 1% ointment, for external use. Hydrocortisone acetate eye drops: 5mg (3ml) per bottle, 1 to 2 drops each time.
2. Dermatitis film (neurodermatitis aerosol film): aerosol is sprayed on the surface of the lesion, that is, a film can be formed, which can isolate various stimuli from the outside to the lesion, and keep the lesion stable for a long time Coupled with the anti-inflammatory effect of hydrocortisone, it has a good effect on neurodermatitis
Hydrocortisone
Certain effect. Generally, the itchiness is reduced or completely disappeared after use, the skin lesions are gradually improved, the short course of disease is quicker, and the recovery rate is higher, but there is relapse after recovery.
3. Shake for joint injection and intrathecal injection. Intra-articular injection, 1 to 2 ml (25 mg of drug per ml); intrathecal injection, 1 ml each. Alternative treatment: 20-25mg daily for adults, 2/3 in the morning and 1/3 after lunch.

Hydrocortisone adverse reactions

Glucocorticoids have no obvious adverse reactions when applying physiological dose replacement therapy. Adverse reactions mostly occur when applying pharmacological doses, and are closely related to the course of treatment, dose, type of medication, usage, and route of administration. The common adverse reactions are as follows.
(1) Systemic allergic reactions, including swelling of the face, nasal mucosa, eyelids, urticaria, shortness of breath, chest tightness, and wheezing, may occur with rapid intravenous administration of large doses. Long-term medication can cause the following side effects: Iatrogenic Cushing Syndrome face and body shape, weight gain, lower limb edema, purple streaks, tendency to bleed easily, poor wound healing, acne, menstrual disorders, ischemic necrosis of the humerus or femoral head, bone Osteoporosis or fracture (including
Hydrocortisone
Compression fractures of the spine, pathological fractures of long bones), muscle weakness, muscle atrophy, hypokalemia syndrome, gastrointestinal irritation (nausea, vomiting), pancreatitis, peptic ulcer or bowel perforation, growth inhibition in children, glaucoma, Cataracts, benign intracranial pressure syndrome, impaired glucose tolerance, and exacerbation of diabetes.
(2) Patients may experience mental symptoms: euphoria, agitation, restlessness, delirium, disorientation, or inhibition. Mental symptoms are particularly likely to occur in people with chronic wasting diseases and in those who have had mental disorders in the past. Prednisone 40mg or more can be used within a few days to two weeks. Concurrent infections are the main adverse reactions to glucocorticoids. Mainly fungi, tuberculosis, staphylococcus, proteus, Pseudomonas aeruginosa and various herpes virus infections. Occurs in the middle or long course of treatment, but can also occur after short-term use of large doses.
(3) The hypothalamus-pituitary-adrenal axis is inhibited, which is an important complication of hormone therapy, and its occurrence is related to factors such as preparation, dose, and course of treatment. When prednisone is used more than 20mg daily for more than 3 weeks, and when iatrogenic Cushing syndrome occurs, adrenal function should be considered to be suppressed.
(4) Syndrome after glucocorticoid withdrawal can have the following different situations. Hypothalamus-pituitary-adrenal insufficiency can be manifested as fatigue, weakness, loss of appetite, nausea, vomiting, low blood pressure, and the recovery of this axial function after long-term treatment generally takes 9 to 12 months. For: i. Hypothalamic adrenocorticotropin (CRF) secretion recovery and increase; ii. ACTH secretion recovered and was higher than normal, at this time the secretion of adrenocortical hormone was still low; iii. The basic secretion of hydrocortin has returned to normal, and the secretion of ACTH from the pituitary has returned to normal. IV. The hypothalamic-pituitary-adrenal cortex axis response to stress returned to normal. After stopping the medicine, the symptoms whose original disease had been controlled reappeared. In order to avoid the occurrence of adrenal insufficiency and the recurrence of the original disease symptoms, the dose should be gradually reduced gradually after long-term hormone treatment and taken from the original several times a day to the daily medication once in the morning or the next morning. once. glucocorticoid withdrawal syndrome. Sometimes patients have dizziness, fainting tendency, abdominal pain or back pain, low fever, loss of appetite, nausea, vomiting, muscle or joint pain, headache, fatigue, weakness after discontinuation of medication. Careful inspection can rule out adrenal insufficiency and the original disease. The re-ignition can be considered as glucocorticoid dependence syndrome.
Long-term use of large doses may have obesity, hirsutism, acne, blood sugar, elevated blood pressure and intraocular pressure, water and sodium retention, and edema. Can cause hypokalemia, muscle paralysis, excitement, gastrointestinal ulcers, and even gastrointestinal bleeding, perforation, osteoporosis, pathological fractures, difficult to heal wounds, cataracts, and blindness. Sudden withdrawal can cause withdrawal syndrome.

Hydrocortisone contraindications

(1) medication during pregnancy; glucocorticoids can pass through the placenta. Animal experiments have confirmed that administration during pregnancy can increase the incidence of fissures in the embryo, placental dysfunction, spontaneous abortion and intrauterine growth retardation. Human use of pharmacological doses of glucocorticoids can increase the incidence of placental insufficiency, neonatal weight loss, or stillbirth. Teratogenic effects have not been proven in humans. Those who have received a certain dose of glucocorticoids during pregnancy should pay attention to observe whether there are signs of adrenal insufficiency.
Structural formula of hydrocortisone
(2) For preterm infants, to avoid respiratory distress syndrome, dexamethasone was given to mothers before delivery to induce the formation of pulmonary surfactant proteins in preterm infants. Due to short-term application, there is no evidence of growth and development in young children. Adverse effects.
(3) Medication during lactation: Physiological dose or low pharmacological dose (25 mg of cortisone or 5 mg of prednisone per day, or less) generally has no adverse effects on infants. However, if a nursing mother receives a pharmacologically high dose of glucocorticoids, she should not breastfeed, because glucocorticoids can be excreted from milk and cause adverse effects on infants, such as inhibited growth and inhibited adrenal function.
(4) Pediatric use: If children use adrenocortical hormones for a long time, they must be very careful, because hormones can inhibit the growth and development of children. If it is really necessary to use them for a long time, short-acting (such as cortisone) or intermediate-effect preparations should be used. (Such as prednisone) and avoid long-acting preparations (such as dexamethasone).

Hydrocortisone Drug Interactions

1. Combined with chloramphenicol can enhance the efficacy of hydrocortisone and other glucocorticoids (inhibit drug enzymes).
2. Combined with choline-like drugs (such as neostigmine and pirostamine), it can enhance the efficacy of the latter.
3. Combined with vitamin E or vitamin K, it can enhance the anti-inflammatory effect of hydrocortisone and other glucocorticoids and reduce the rebound phenomenon after withdrawal; combined with vitamin C can prevent subcutaneous bleeding reactions caused by this class of drugs; Combination with vitamin A can eliminate the delayed healing of wounds caused by this class of drugs, but also affect the anti-inflammatory effects of this class of drugs. This class of drugs can also antagonize systemic reactions (nausea, vomiting, drowsiness, etc.) when vitamin A poisoning occurs.
4. Combined with Chansu and Chinese patent medicines (such as Xiaoyan Jiedu Pill, Liushen Pill, etc.), Asarum, Zu Shima, can enhance the anti-inflammatory effect.
5. Antelope horn can increase the secretion of adrenocorticotropic hormone (ACTH), improve the efficacy of this class of drugs and reduce adverse reactions.
6. Hydrocortisone may increase the aminophylline concentration of aminophylline.
7. Combined with non-steroidal anti-inflammatory drugs, it can increase the anti-inflammatory effect, but may exacerbate the effect of causing ulcers.
8. Contraceptives or estrogen preparations can enhance the therapeutic effects and adverse effects of hydrocortisone.
9. Combined with cardiac glycoside can improve cardiac effect, but also increase the occurrence of digitalis toxicity and arrhythmia, so potassium should be appropriately added when the two are combined.
10. Can enhance liver toxicity of acetaminophen.
11. Combined with protein assimilation hormone, it can increase the incidence of edema and make acne worse.
12. When combined with amphotericin B and carbonic anhydrase inhibitors and other potassium-releasing diuretics, it can cause severe hypokalemia. Attention should be paid to changes in blood potassium and cardiac function. Long-term combination with carbonic anhydrase inhibitors can cause hypocalcemia And osteoporosis; thiazide diuretics can eliminate edema caused by this class of drugs.
13. When combined with hypoglycemic agents such as insulin, the dose of hypoglycemic agents should be adjusted appropriately because it can increase blood sugar in patients with diabetes.
14. Long-term combination with anticholinergic drugs (such as atropine) can cause increased intraocular pressure.
15. Tricyclic antidepressants can aggravate the mental symptoms caused by hydrocortisone.
16. Can enhance the cardiotoxic effect of isoproterenol.
17. When combined with a monoamine oxidase inhibitor, it may induce hypertension crisis.
18. Hydrocortisone combined with immunosuppressants can increase the risk of infection.
19. Testosterone and Nandrolone phenylpropionate can reduce protein consumption caused by hydrocortisone and other glucocorticoids, and prevent blood urea nitrogen from rising.
20. Stanozolol can prevent adverse reactions such as inhibition of adrenal cortex function and leukopenia caused by this class of drugs.
21. Phenytoin sodium and phenobarbital can accelerate the metabolic inactivation (enzyme induction) of this class of drugs and reduce their efficacy.
22. Hydrocortisone can inhibit the growth promoting effect of growth hormone.
23. May reduce quinine's antimalarial efficacy.
24. Hydrocortisone and other glucocorticoids can reduce the effects of anticoagulants and neuromuscular blockers.
25. When combined with antiepileptic drugs, it is necessary to increase the dosage of the latter to control seizures.
26. It can reduce the formation of inactivated vaccine antibodies and reduce the immune titer.
27. Thyroid hormone, ephedrine, and rifampicin can increase the metabolic clearance of hydrocortisone, so when the two are combined, the dosage of the latter should be adjusted appropriately.
28. Hydrocortisone can promote the metabolism of isoniazid and mexiletine in the body and reduce the blood concentration and efficacy of the latter.
29. Combined with salicylate, it can reduce the concentration of salicylate in plasma.
30. Cholestyramine, colestipol, and ten ash powder can reduce the absorption of hydrocortisone [3] .

Hydrocortisone precautions

Medication for children
Oral medium-effect preparations can reduce the inhibitory effect on growth every other day. Long-term use of glucocorticoids in children or adolescents must be closely monitored. Children are at increased risk for osteoporosis, ischemic necrosis of the femoral head, glaucoma, and cataracts.
In addition to the general dose of hormones for children, it should be based on the severity of the disease and the response of the child to treatment. For the treatment of children with adrenal insufficiency, the dosage of hormones should be based on body surface area. If it is based on weight, it is prone to overdose, especially infants and small or obese children.
Geriatric medication
Elderly patients are prone to hypertension with glucocorticoids. Elderly patients, especially postmenopausal women, are prone to osteoporosis with glucocorticoids. Glucocorticoids and infections: Patients with adrenal insufficiency are prone to infection and are more serious. As an important cause of death, giving a physiological dose of adrenal corticosteroids can improve patients' resistance to infection.
Other patients
Non-adrenal insufficiency patients are prone to infection after receiving pharmacological doses of glucocorticoids. This is because patients 'original diseases often have weakened cellular and / or humoral immune functions. Long-term superphysiological doses of corticosteroids make patients' inflammation The sexual response, cellular immunity, and humoral immune function are weakened, and the pathogens invading from the skin and mucous membranes cannot be controlled.
Under the action of hormones, infections that have been controlled can become active. The most common is recurrence of tuberculosis infection. Patients receiving glucocorticoids are susceptible to missed diagnosis due to mild inflammatory reactions and insignificant clinical symptoms after infection. The above shows that non-physiological glucocorticoids are not good for fighting infections. On the other hand, the application of hormones in certain infections can reduce tissue damage, reduce exudation, and reduce symptoms of infection poisoning. However, it must be treated with effective antibiotics at the same time, and changes in the condition must be closely observed. After short-term medication, it should be quickly reduced. Volume, discontinuation.

Hydrocortisone Expert Reviews

Suitable for contact dermatitis, lichen planus, etc. It is currently the main drug for supplementing glucocorticoids. It has a wide range of functions and is widely used. It is an indispensable drug in clinical practice. It has played an important role in rescuing critical illnesses such as adrenal crisis, anaphylactic shock, and persistent asthma. It is an indispensable important therapeutic drug in the treatment of autoimmune diseases such as systemic lupus erythematosus, rheumatism and immune vasculitis. The advantage of this medicine is that its ethanol solution and hydrocortisone sodium succinate can be directly administered by intravenous drip and quickly play a role. It is suitable for the rescue of critically ill patients and the shock therapy of certain diseases, and generally does not cause peptic ulcer, purpura and mental Symptoms, but the retention of water and sodium and the role of potassium excretion. Hydrocortisone is a short-time super-dose (intravenous infusion of 2000 to 4000 mg for 24 hours, for 2 to 3 days), which is used to rescue some critically ill patients, such as rescue of septic shock and persistent asthma. , Adult respiratory distress syndrome, etc., short-term application, generally no adverse reactions [3] .

Hydrocortisone anti-inflammatory test

purpose
1.Experimental method of learning how to use egg white to cause acute inflammation and swelling of the plantar foot in rats
2. Observe the anti-inflammatory effect of hydrocortisone
principle
1. Common inflammation models:
(1) Acute inflammation model: rat foot carrageenan, alloprotein-induced swelling method, mouse ear xylene-induced inflammation method
(2) Subacute inflammation model: rat cotton ball granuloma method, rat subcutaneous balloon method
(3) Immune inflammation model: adjuvant arthritis in rats
2. Hydrocortisone's anti-inflammatory mechanism: After entering the cell, hydrocortisone activates cytoplasmic receptors and enters the nucleus after allosteric, which binds to DNA response elements, causing the inhibition or induction of gene transcription, and the inflammation-related proteins Expression changes.
material
1. Animals: rats, weighing 150-200g, half male and half male
2. Equipment: balance, squirrel cage, syringe (2ml, 0.25ml), soft ruler, marker
3. Drugs: 50% hydrocortisone solution, physiological saline, 10% fresh egg white solution, picric acid solution
method
1. Take experimental animals, weigh them and mark them.
2. Straighten the right hind foot of the rat, mark the ankle joint with a marker, and measure the perimeter twice at the joint mark with a soft ruler, and find the average value as the perimeter before administration.
3. The rats were given the following drugs: blank control group was given normal saline, and test group was given hydrocortisone. The administration method is intraperitoneal injection, and the administration dose is 0.5ml / 100g body weight.
4. After 30 min, the needle was inserted into the right palm of the right hind foot to the vicinity of the ankle joint, and 10% fresh egg white solution was injected subcutaneously at 0.1 ml / head, and the circumference of the ankle joint was measured every 15 min.
result
1. Calculate the degree of swelling.
Swelling = (perimeter after inflammation-perimeter before administration) / perimeter before administration × 100%
2. All results are summarized, the aging curve is plotted, and t test is performed.

Effects of Hydrocortisone on Memory

The formation of memory is due to the interaction between several parts of the brain, resulting in changes in synapses to form a record of something. Experiments have shown that hydrocortisone is a corticosteroid that exerts its effect in stress response and can increase short-term memory retention after injection. However, in the case of long-term stress, hydrocortisone can prevent the retention of short-term memory (this shows that there is a chemical balance between short-term memory and memory) [4] .

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