Hydrocortisone
Hydrocortisone resembles endogenous cortisol and provides both glucocorticoid and mineralocorticoid activity; soluble sodium succinate is used in acute adrenal insufficiency.
Group
Glucocorticoid
Mechanism of Action
Activates intracellular glucocorticoid receptors, changing gene expression to suppress inflammatory and immune responses.
Dose Rates
Dogs
| Use / stage | Dose | Route | Schedule | Instructions |
|---|---|---|---|---|
| Adrenal replacement | 1–2 mg/kg | PO | Every 12 h | |
| Anti-inflammatory treatment | 2.5–5 mg/kg | PO | Every 12 h | |
| Adrenal crisis | 0.625 mg/kg/hour | IV | Continuous | Hydrocortisone sodium succinate; monitor sodium, potassium, glucose and circulation. |
| Anti-inflammatory treatment | 5 mg/kg | IV | Every 12 h | Sodium succinate formulation. |
| Historical shock regimen | Reference only | IV | Not a recommended use: sodium succinate 50-150 mg/kg for two doses 8 hours apart. Retained for clinical context, not routine shock treatment. | |
| Adrenal replacement | 1 mg/kg | PO | Every 24 h | Separate general starting daily replacement recommendation; the detailed oral dosage section gives a higher every-12-hour alternative. Titrate according to endocrine assessment. |
| Adrenal crisis | 0.5 mg/kg/hour | IV | Continuous | Sodium succinate; continue until oral intake and GI function permit oral replacement. |
| Adrenal crisis intermittent treatment | 2 mg/kg | IV | Every 6 h | Sodium succinate alternative. |
| Adrenal crisis intermittent treatment | 2–4 mg/kg | IV | Every 8 h | Separate sodium succinate alternative. |
| Low-dose septic-shock adjunct | 0.08 mg/kg/hour | IV | Continuous | Low-dose adjunct protocol, distinct from historical high-dose shock treatment. |
Cats
| Use / stage | Dose | Route | Schedule | Instructions |
|---|---|---|---|---|
| Adrenal replacement | 1–2 mg/kg | PO | Every 12 h | |
| Anti-inflammatory treatment | 2.5–5 mg/kg | PO | Every 12 h | |
| Adrenal crisis | 0.625 mg/kg/hour | IV | Continuous | Hydrocortisone sodium succinate; monitor sodium, potassium, glucose and circulation. |
| Anti-inflammatory treatment | 5 mg/kg | IV | Every 12 h | Sodium succinate formulation. |
| Historical shock regimen | Reference only | IV | Not a recommended use: sodium succinate 50-150 mg/kg for two doses 8 hours apart. Retained for clinical context, not routine shock treatment. | |
| Adrenal replacement | 1 mg/kg | PO | Every 24 h | Separate general starting daily replacement recommendation; the detailed oral dosage section gives a higher every-12-hour alternative. Titrate according to endocrine assessment. |
| Low-dose septic-shock adjunct | 0.08 mg/kg/hour | IV | Continuous | Low-dose adjunct protocol, distinct from historical high-dose shock treatment. |
Horses
| Use / stage | Dose | Route | Schedule | Instructions |
|---|---|---|---|---|
| Anti-inflammatory treatment | 5 mg/kg | IV | Every 12 h | Sodium succinate formulation. |
| Critical-illness adrenal replacement | 1–3 mg/kg | IV | Every 24 h | Foals only; total daily amount, with delivery individualized. |
| Glucocorticoid therapy | 1–4 mg/kg | IV | Sodium succinate by infusion; duration and repeat schedule are not specified. |
Cattle
| Use / stage | Dose | Route | Schedule | Instructions |
|---|---|---|---|---|
| Photosensitization adjunct | Reference only | IV | 100-600 mg/animal in 1 L of 10% dextrose-saline; salt is not specified, so concentration conversion is not assigned. | |
| Photosensitization adjunct | Reference only | SC | 100-600 mg/animal in 1 L of 10% dextrose-saline; salt unspecified. |
Indications
- Inflammatory and immune-mediated disorders
- Localized inflammatory or pruritic skin disease using an appropriate topical product.
Contraindications
- Use cautiously with diabetes, active infection, gastrointestinal ulceration, impaired wound healing or pregnancy.
Interactions
- NSAIDs increase gastrointestinal ulceration and bleeding.
- May antagonize insulin and impair glycaemic control.
Adverse effects
- Polyphagia, polydipsia and polyuria
- Adrenal suppression, hyperglycaemia, hepatopathy and secondary infection
- Delayed wound healing
Toxicity
Excessive exposure causes iatrogenic hyperadrenocorticism and immunosuppression; abrupt withdrawal after prolonged treatment may cause adrenal insufficiency.
Preparations
| Preparation | Form | Strength | Route |
|---|---|---|---|
| Hydrocortisone 5 mg tablet | Tablet | 5 mg / tablet | PO |
| Hydrocortisone 10 mg tablet | Tablet | 10 mg / tablet | PO |
| Hydrocortisone 20 mg tablet | Tablet | 20 mg / tablet | PO |
| Hydrocortisone sodium succinate 100 mg vial Vial presentation; no unverified final mL concentration. Check the labelled hydrocortisone-equivalent basis before substitution. | Injection | 100 mg / vial | IV, IM |
| Hydrocortisone sodium succinate 250 mg vial Vial presentation; no unverified final mL concentration. Check the labelled hydrocortisone-equivalent basis before substitution. | Injection | 250 mg / vial | IV, IM |
| Hydrocortisone sodium succinate 500 mg vial Vial presentation; no unverified final mL concentration. Check the labelled hydrocortisone-equivalent basis before substitution. | Injection | 500 mg / vial | IV, IM |
| Hydrocortisone sodium succinate 1000 mg vial Vial presentation; no unverified final mL concentration. Check the labelled hydrocortisone-equivalent basis before substitution. | Injection | 1000 mg / vial | IV, IM |
Monitoring and Administration
Monitor glucose, hepatic and renal parameters, infection and adrenal function when indicated.
Taper sustained systemic treatment according to response rather than stopping abruptly; depot injections cannot be withdrawn after administration.
A separate general replacement statement gives 1 mg/kg/day, whereas the oral dosage section gives 1-2 mg/kg every 12 hours. These are distinct reported guidance recommendations; choose replacement intensity from the clinical endocrine assessment.
Hydrocortisone degrades at alkaline pH above approximately 7-9. Specific compounded suspensions, ointments and lotions were stable for 30 days; this does not establish stability of every vehicle.
The 0.3 mg/kg acute-crisis CRI statement omits a time denominator and cannot establish an infusion rate. Reconstituted sodium-succinate solutions must be clear, protected from light and used within the particular product’s stated period; a three-day period is described for the listed presentations. Do not autoclave.
Topical hydrocortisone is applied sparingly 1-4 times daily initially, then tapered to the smallest area and shortest course needed; focal courses are generally under 2 months. Shampoo contact is at least 10 minutes before rinsing. Prevent licking for 20-30 minutes; prolonged frequent use can cause skin atrophy and HPA suppression. A two-week interruption before allergy testing is described. Cream/ointment strengths 0.5%, 1% and 2.5%, plus multi-active veterinary products, require the actual product concentration basis before mass conversion.