Hydrocortisone 

Cortef

Cortef, or hydrocortisone, is an artificial version of a natural substance (cortisol) formed by the adrenal glands. This medication is used to treat various conditions, including arthritis, breathing problems, cancer, skin, and eye conditions, along with blood/hormone/immune system disorders. Available in various forms like tablets and an injection, its dosage varies depending on the patient’s needs and treatment. Like other medications, it can also have different side effects in people. Therefore, it is essential to follow your medical professional’s guidelines for effective results and to avoid any complications. For detailed information, talk to your healthcare provider.

Product Overview

Cortef, primarily composed of hydrocortisone, is a glucocorticoid, a steroid that can be both naturally occurring and synthetic. These steroids are used for their anti-inflammatory and immunosuppressive properties. Cortef is suitable for patients suffering from conditions like allergic disorders, skin problems, arthritis, lupus, psoriasis, breathing problems, and ulcerative colitis. These medications are easily absorbed by the body when taken orally.

Available in strengths of 5, 10, and 20 mg per tablet, Cortef should be taken orally with food or milk to prevent stomach upset, as directed by a healthcare provider. It is suitable for people diagnosed with conditions that require corticosteroid treatment. The dosing regimen varies based on the condition being treated and the patient’s response to therapy. Hydrocortisone works by mimicking the effects of cortisol, a naturally occurring hormone produced by the adrenal glands, which helps to reduce inflammation and modify the body’s immune response.

Side effects of Cortef can include mood changes, increased appetite, indigestion, and high blood pressure. Patients should consult their healthcare provider if they experience severe or persistent side effects. Important precautions include monitoring for signs of infection, as Cortef can mask typical symptoms. If a dose is missed, take it when you remember unless it is almost time for the next dose. In the case of an overdose, immediate medical attention is necessary. Store Cortef at room temperature, away from moisture and heat. Patients are advised to consult their healthcare provider for comprehensive guidance and to ensure the medication is used safely and effectively.

Uses of Cortef

It is used to treat: 

• Endocrine Disorders: Occurred from the improper functioning of the endocrine system. It includes addison’s diseases, adrenal fatigue, diabetes, cushing’s syndrome etc.
• Rheumatic Disorders: Comprises arthritis and conditions that affect joints, tendons, muscles, ligaments, and bones. It includes acute and subacute bursitis, synovitis of osteoarthritis, epicondylitis, etc.
• Collagen Diseases: These are autoimmune diseases that occur when the body’s immune system attacks its skin, tissues, and organs. It includes systemic lupus erythematosus, systemic dermatomyositis (polymyositis), and acute rheumatic carditis.
• Dermatologic Diseases: Conditions that affect a person’s skin. It includes exfoliative dermatitis, mycosis fungicides, severe psoriasis, etc.
• Allergic States: These include serum sickness, bronchial asthma, contact dermatitis, atopic dermatitis, and drug hypersensitivity reactions.
• Ophthalmic Diseases: Develop from acute or severe chronic allergic processes in the eye and its adnexa. It includes allergic conjunctivitis, keratitis, corneal marginal ulcers, herpes zoster ophthalmics, iritis, and iridocyclitis. 
• Respiratory Diseases: These disorders or conditions affect the lungs and other parts of the respiratory system. They include aspiration pneumonitis, symptomatic sarcoidosis, and berylliosis.
• Gastrointestinal Diseases: It affects a person’s gastrointestinal tract, from mouth to anus. It includes ulcerative colitis and regional enteritis.

How to Use Cortef?

Dosage

Strengths and Forms

• Tablets: 5, 10, and 20 mg
• Powder for Injection: 100, 250, 500 mg/vial and 1g/vial

Recommended Dosage for Different Patients

• For Adults (18 Years & Above): The typical starting dose of Cortef is 20-240 mg per day, but it depends on the patient’s condition and severity. After the starting dose, the doctor might increase the dosage if the body does not show good results. If it responds well to the medication, the doctor may gradually start to reduce the dosage.
• For Children (0 to 17 Years): Your medical professional will decide the dose based on factors like condition and severity. However, the usual dose is 0.5 to 1 mg, divided into 3 doses and given to the child 3 times a day.

[Note: Remember these recommendations may vary depending on person to person. Discuss it with your doctor, and they’ll customize your dosage accordingly.]

How to Take It?

• Take the medication orally with food or milk to prevent any stomach issues, as the doctor prescribes. You can also take it with a glass of water unless your doctor says otherwise.
• Follow the dosing instructions carefully. Your doctor may direct you to take the medication 1 to 4 times once a day.
• Do not alter your medication without consulting with a medical professional, as it can create future problems. 
• If you suddenly stop taking Cortef, you may experience withdrawal symptoms like weakness, nausea, muscle pain, headache, weight loss, tiredness, and dizziness.
• Do not crush or chew your medication unless directed to do so.
• Swallow the tablet as a whole to release its drug gradually in the body.

[Note: Your doctor will decide the right amount for you based on your condition, following guidelines and studies on the drug. They’ll adjust it as needed over time.]

How Does Cortef Work?

Cortef contains hydrocortisone, which belongs to a class of drugs known as glucocorticoids. These A class of drugs comprise a group of medications that function in a similar way. Hydrocortisone, a steroid hormone, works by restricting specific proteins in your body. This effectively reduces swelling and prevents the immune system from overreacting to various triggers. Additionally, it influences how your body processes and stores carbohydrates, proteins, and fats. It also plays a role in regulating the balance of water and electrolytes in your body.

Important Safety Information

Side Effects

Common side effects of Cortef may include:

• Headaches
• Muscle pain
• Skin problems 
• Feeling hungry
• Skin thinning
• Stomach bloating
• Trouble in sleeping
• Changes in menstrual cycle

Serious side effects of Cortef may include:

• Skin rash
• Hives
• Swelling around the face, lips, or tongue
• Breathing problems
• Fever
• Sore throat 
• Unhealed wound
• Pain while urinating
• Depression
• Mood swings
• Vomiting
• Stomach pain
• Distorted vision
• Fatty deposits on the back
• High blood pressure
• Excessive sweating
• Tremors
• High blood sugar
• Seizures
• Pale face
• Rapid heartbeat

[Note: This list may not cover all possible side effects. Always consult with your healthcare provider for medical advice about side effects.]

Warnings

• Infection Risk: The usage of Cortef can impair your body’s response to infection due to weakened immune systems. Besides, patients might face difficulty in knowing whether they have an infection or not. Therefore, it is advised to talk with your healthcare provider before making a decision.
• Vaccine Warning: Due to a weakened immune system, you will not be able to take vaccines like chicken vaccine while you are on high doses of hydrocortisone or if you have taken this medication for a long time. Instead, you will be given inactivated vaccines that might not work as well.
• Drug Usage: If you have been taking hydrocortisone for a prolonged period of time, do not stop taking it immediately. This action can cause withdrawal symptoms in patients, such as joint pain, muscle pain, or fever. To avoid such risks, consult with a doctor. They will lower your doses gradually.
• Allergies: The usage of hydrocortisone can cause various allergic reactions like itching, hives, swelling, and breathing problems. If you notice such symptoms, call the medical authorities right away.
• Infection and Surgery: During your treatment or within 12 months with this drug, if you notice or undergo infection, injury, or surgery, call your doctor immediately.
• High Blood Pressure: Hydrocortisone can increase a patient’s blood pressure; therefore, use it with caution if you have high blood pressure or heart problems. Keep an eye on your health while taking this medication.
• Diabetes: Hydrocortisone can raise your blood sugar levels. Monitor your sugar levels frequently when taking this medication.
• Glaucoma: It can increase the pressure in your eyes and may make your condition worse. Consult with your doctor and closely monitor your eyes. 
• Stomach or Intestinal Problems: This drug can irritate the patient’s stomach or intestines, which can worsen the intestinal problems. Do not take Cortef if you have a stomach ulcer.
• Liver Issues: Hydrocortisone is processed in your liver. In cases of severe liver disease, it might accumulate in your body and cause harmful effects. You may require a reduced dose of this medication.
• Thyroid Conditions: If your thyroid function is low, you might be more prone to the effects of hydrocortisone.
• Mental Health Problems: Hydrocortisone may exacerbate mood swings, personality shifts, depression, and hallucinations. Adjustments to your mental health medication dosages are essential to avoid major problems.
• Congestive Heart Failure: This medication causes your body to hold onto water and salt, which can increase the risks of heart failure. You might need to follow a low-salt diet and adjust your heart medication.
• Cushing Syndrome: Those with this condition already have an excess of steroid hormones. Taking hydrocortisone could intensify the symptoms of Cushing syndrome.
• Low Potassium: Hydrocortisone, especially at high doses, may increase potassium loss through urine. Your doctor will monitor your potassium levels, and you may need potassium supplements.
• Ocular Herpes Simplex: If you are suffering from this condition, take this medication cautiously, as it may increase the risk of corneal perforation.
• Pregnant Women: Discuss with your doctor if you are pregnant or planning to become pregnant, as hydrocortisone may harm your pregnancy. 
• Breastfeeding Women: Hydrocortisone may affect your breastfeeding child. Consult your doctor to decide whether to discontinue breastfeeding or the medication.
• For Seniors: This medication could increase your risk of fractures and developing osteoporosis.
• For Children: Hydrocortisone may restrict growth and development in children and infants. Take medical assistance, as they will keep track of your child’s growth if they are on this medication.

 Precautions

• Before taking hydrocortisone medication, tell your medical professional if you are allergic to the product or have general allergies. This product may contain certain inactive ingredients, which can result in allergic reactions.
• Tell your doctor about your medical history, especially if you have eye diseases, heart problems, osteoporosis, infections, blood clots, mental conditions, or seizures.
• One of the side effects of this medication is stomach bleeding. So, if you consume alcohol on a daily basis while taking Cortef, you are increasing your chances of stomach bleeding. Limit your alcohol intake and consult with your healthcare provider for detailed information.
• Using corticosteroid medications for a prolonged period of time can make it harder for your body to handle physical stress. Therefore, before any surgery, tell your doctor about the medications you take or have taken in the past years. 
• If you experience any unusual tiredness or weight loss, contact your healthcare provider immediately.
• This medication makes you more prone to infections or may further exacerbate your infections. So, maintain distance from anyone who has an infection that is easily spreadable, like chickenpox, COVID-19, or flu. 
• If you are on Cortef medications, talk to your medical professional before getting any vaccinations. Try to stay away from people who have recently received their vaccines.
• Discuss every risk and benefit associated with hydrocortisone to avoid any complications in the future.

Contraindications

Hydrocortisone is contraindicated in patients:

• Known hypersensitivity to the ingredients used in the formation of this medication or any other corticosteroid.
• Having systemic fungal infections unless required to manage drug reactions caused by amphotericin B.
• Administered with live vaccines while receiving immunosuppressive doses of corticosteroids.
• Having herpes simplex of the eye, except when used for short term.
• Having vaccinia and varicella, except when used for short term.

Missed Dose

• Take the missed dose as soon as you remember.
• Skip the medication if it is almost time for the next dose.
• Do not take double doses just to make up for the skipped one.
• Consult with your doctor if you have any concerns or questions.

[Note: If you have missed a medication dose and are unsure when to take the next one, consult your doctor or pharmacist immediately.]

Overdose  

If someone has overdosed their medication mistakenly, immediately contact your medical professional. Doctors will treat the condition with appropriate supportive and symptomatic therapy. If a patient has been taking overdoses for a long period, especially if they need continuous steroid treatment for a severe illness, the amount of medication might be temporarily lowered.

[Note: If you consumed more than the recommended dose, get medical help right away or call the Poison Help line at 1-800-222-1222.]

Storage

• Store the medication at room temperature of 15°C to 30°C.
• Keep the tablets out of the reach of children and pets.
• Do not keep the medication in the direct sunlight.
• Do not store it in moist or damp areas like bathrooms or near the sink.
• Do not keep the medication if it’s past the expiration date.
• Discard them when not in use.
• Do not flush the tablets down the toilet.
• Keep the medicine in a closed container.
• Read the product label or ask a medical professional/pharmacist to properly discard the medication.

[Note: Discuss with your healthcare professional about the proper disposal of any unused medicine and any questions you may have regarding its storage.]

Cortef Interactions

There are certain drugs that patients need to be mindful of while taking hydrocortisone to avoid severe drug interactions. These are: 

• CYP3A4 Inhibitors: Drugs like ketoconazole, itraconazole, clarithromycin, and grapefruit juice can slow down the breakdown of hydrocortisone in the liver, leading to higher levels of hydrocortisone in the blood. To prevent steroid toxicity, it may be necessary to reduce the hydrocortisone dose when using these inhibitors.
• CYP3A4 Inducers: These drugs may increase the metabolism of corticosteroids and hepatic clearance, along with a reduction in plasma concentrations of hydrocortisone. Therefore, the dose of hydrocortisone might need to be increased when using it with drugs like barbiturates, rifampin, carbamazepine, phenobarbital, and phenytoin to maintain its effectiveness.
• CYP3A4 Substrates: When hydrocortisone is used with other drugs that affect liver enzymes similarly, dosage adjustments may be required due to impaired hydrocortisone clearance. There’s also an increased risk of side effects when these drugs are used together.
• Anticholinergics: The use of corticosteroids along with anticholinergics can lead to muscle weakness, especially when taking high doses. 
• Anticholinesterases: The combined use of corticosteroids like hydrocortisone with anticholinesterases has the potential to produce weakness in patients with myasthenia gravis. Therefore, it is advised to stop using anticholinesterase at least 24 hours before starting steroid treatment.
• Cardiac Glycosides: Concurrent use of corticosteroids with cardiac glycosides may increase the risk of arrhythmias or digitalis toxicity due to low potassium levels. So, it is important to monitor potassium closely in patients taking both medications.
• Hypoglycemics: In diabetic patients, corticosteroids can raise blood sugar levels. Dosage adjustments of diabetes medications may be necessary when starting or adjusting corticosteroid therapy to ensure proper blood sugar control.
• Hormone Drug: Coadministration of glucocorticosteroid therapy with hormonal drugs like somatropin is likely to restrict the response to somatropin in patients.  

[Note: This isn’t a complete list, and there could be other drugs that interact with Cortef. Make sure to tell your doctor about any prescription, over-the-counter medicines, and herbal products you’re taking.]

Cortef Alternatives

• Entyvio
• Zeposia
• Mesalamine
• Lialda
• Sulfasalazine
• Remicade
• Azathioprine
• Infliximab
• Upadacitinib
• Triamcinolone 
• Hisone
• Celestone
• Prednisone 
• Triamcinolone 
• Dexamethasone

[Note: Your doctor will choose what’s best for you. Don’t use any of these alternative medications without consulting your healthcare provider. Taking them by yourself may cause serious side effects.] 

Frequently Asked Questions

Are hydrocortisone (Cortef) and cortisone the same?

While hydrocortisone and cortisone are identical short-acting corticosteroids, they are not the same. Cortisone is a prodrug that requires conversion by the body into cortisol to become effective. Whereas hydrocortisone is a man-made version of cortisol that is naturally produced by the adrenal glands. While both drugs are used to reduce inflammation and suppress the immune system, hydrocortisone’s direct activity often makes it the preferred choice for immediate therapeutic effects. 

Can you gain weight with Cortef?

Yes, weight gain is a possible side effect of Cortef and other corticosteroids. It has been observed that these medications increase patients’ appetite and cause changes in how their body stores fat, leading to weight gain. If you are concerned about weight gain while taking Cortef, consult with a medical professional. They can suggest some strategies for weight management.

How long can I take Cortef?

There is no fixed time period for taking Cortef. The duration is dependent on factors such as the severity of the condition, the dose, and the patient’s health. It is essential for you to follow your doctor’s instructions regarding the length of treatment. If it is an acute condition, the medication is prescribed for a few weeks. For chronic conditions, such as certain autoimmune diseases, longer-term use may be necessary. 

How long does Cortef take to show its effects?

The effects of Cortef (hydrocortisone) can start to be noticeable within hours of taking the medication. However, the full extent of its effects, especially for reducing inflammation, may take several days of consistent use to become fully apparent. For precise information, you can consult with a medical provider.

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