HYDROCORTISONE
(Cortef, Solu-Cortef)Standard Prescription
hydrocortisone mg PO/IV/IM/SC Q H ( mg/kg/day) or (mg/m2/day)
Dosages
Anti-inflammatory/immunosuppressive:
Infants and Children: Oral: 1-3 mg/kg/dose PO or 25-100 mg/m2/dose PO Q8H (2.5-10 mg/kg/day PO or 75-300 mg/m2/day PO divided Q6-8H)
IM/IV: 0.5-2.5 mg/kg/dose or 15-75 mg/m2/dose IM/IV Q12H (1-5 mg/kg/day or 30-150 mg/m2/day IM/IV divided Q12-24H)
Adolescents and Adults: Oral/IM/IV/SC: 15-240 mg/dose Q12H
Septic Shock or Acute Adrenal Insufficiency:
Emergency Loading Dose:
<3 years: 25 mg IV/IM/IO/SC
3 to <10 years: 50 mg IV/IM/IO/SC
10 years and older: 100 mg IV/IM/IO/SC
Followed by:
12.5 mg/ m2/dose IV Q6H (see comments for estimation if body surface area not available)
Physiologic Replacement:
Congenital adrenal hyperplasia:
Rectal:
Adolescents: 1 application daily-BID
Infants and Children: Oral: 1-3 mg/kg/dose PO or 25-100 mg/m2/dose PO Q8H (2.5-10 mg/kg/day PO or 75-300 mg/m2/day PO divided Q6-8H)
IM/IV: 0.5-2.5 mg/kg/dose or 15-75 mg/m2/dose IM/IV Q12H (1-5 mg/kg/day or 30-150 mg/m2/day IM/IV divided Q12-24H)
Adolescents and Adults: Oral/IM/IV/SC: 15-240 mg/dose Q12H
Emergency Loading Dose:
<3 years: 25 mg IV/IM/IO/SC
3 to <10 years: 50 mg IV/IM/IO/SC
10 years and older: 100 mg IV/IM/IO/SC
Followed by:
12.5 mg/ m2/dose IV Q6H (see comments for estimation if body surface area not available)
Physiologic Replacement:
2.6-4 mg/m2/dose PO Q8H (8-12 mg/m2/24 hr)
3.3-5 mg/m2/dose PO Q8H (10-15 mg/m2/24 hr)
Topical:
Apply 2-3 times daily.
Adolescents: 1 application daily-BID
Mechanism of Action
Corticosteroid
Forms Supplied
tablet: 5 mg, 10 mg, 20 mg (5 mg tablet is Special Access Programme release only)
injection (as sodium succinate): 100 mg/vial, 250 mg/vial, 500 mg/vial
cream: 0.5%, 1%, 2.5%
lotion: 1%
ointment: 0.5%, 1%, 2.5% (note that 2.5% ointment is compounded by the BCCH pharmacy)
rectal: 100 mg/60 mL
injection (as sodium succinate): 100 mg/vial, 250 mg/vial, 500 mg/vial
cream: 0.5%, 1%, 2.5%
lotion: 1%
ointment: 0.5%, 1%, 2.5% (note that 2.5% ointment is compounded by the BCCH pharmacy)
rectal: 100 mg/60 mL
Comments
A corticosteroid with less mineralocorticoid activity is recommended for prolonged use, unless it is being used for physiologic replacement.
Methylprednisolone is the preferred parenteral steroid for the treatment of asthma.
4 mg hydrocortisone = ~1 mg prednisone. (anti-inflammatory response).
For acute adrenal insufficiency, hydrocortisone is used at home (single IM dose which will last 6 hours).
See Body Surface Area Calculator in Supplementary Materials and References.
Dose Estimation:
The doses below are based on average body surface areas (BSA) for the age ranges:
For patients 0 to 5 kg: hydrocortisone 2.5 mg IV q6h (12.5 mg x 0.2 m2)
For patients greater than 5 kg to 10 kg: hydrocortisone 5 mg IV q6h (12.5 mg x 0.4 m2)
For patients greater than 10 kg to 20 kg: hydrocortisone 10 mg IV q6h (12.5 mg x 0.8 m2)
For patients greater than 20 kg to 40 kg: hydrocortisone 15 mg IV q6h (12.5 mg x 1.2 m2)
For patients greater than 40 kg: hydrocortisone 20 mg IV q6h (12.5 mg x 1.73 m2)
Methylprednisolone is the preferred parenteral steroid for the treatment of asthma.
4 mg hydrocortisone = ~1 mg prednisone. (anti-inflammatory response).
See Corticosteroid Equivalency Table in Supplementary Materials and References.
See Body Surface Area Calculator in Supplementary Materials and References.
The doses below are based on average body surface areas (BSA) for the age ranges:
For patients 0 to 5 kg: hydrocortisone 2.5 mg IV q6h (12.5 mg x 0.2 m2)
For patients greater than 5 kg to 10 kg: hydrocortisone 5 mg IV q6h (12.5 mg x 0.4 m2)
For patients greater than 10 kg to 20 kg: hydrocortisone 10 mg IV q6h (12.5 mg x 0.8 m2)
For patients greater than 20 kg to 40 kg: hydrocortisone 15 mg IV q6h (12.5 mg x 1.2 m2)
For patients greater than 40 kg: hydrocortisone 20 mg IV q6h (12.5 mg x 1.73 m2)
References
11, 44, 367, 368, 369
Last Edited
2022-01-04 08:02:09