hydrocortisone sodium succinate

CLINICAL USE


Corticosteroid:Anti-inflammatory agent in respiratory, GI, endocrine disorders, and allergic statesShock

DOSE IN NORMAL RENAL FUNCTION

Oral: 20–30 mg in divided doses for replacementIV/IM: 100–500 mg, 3–4 times in 24 hours, or as required

PHARMACOKINETICS

  • Molecular weight &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :484.5 (486.4 as sodium phosphate)
  • %Protein binding &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :>90
  • %Excreted unchanged in urine &nbsp &nbsp : Minimal

  • Volume of distribution (L/kg) &nbsp &nbsp &nbsp :0.4–0.7

  • half-life – normal/ESRD (hrs)&nbsp &nbsp &nbsp :Approx 100 minutes/ Unchanged

    DOSE IN RENAL IMPAIRMENT

    GFR (mL/MIN)

  • 20 to 50 &nbsp &nbsp : Dose as in normal renal function
  • 10 to 20 &nbsp &nbsp : Dose as in normal renal function
  • <10 &nbsp &nbsp &nbsp &nbsp &nbsp : Dose as in normal renal function

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

  • CAPD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp:Unlikely to be dialysed. Dose as in normal renal function

  • HD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :Unlikely to be dialysed. Dose as in normal renal function
  • HDF/high flux &nbsp :Unlikely to be dialysed. Dose as in normal renal function
  • CAV/VVHD &nbsp &nbsp &nbsp:Unlikely to be dialysed. Dose as in normal renal function

    IMPORTANT DRUG INTERACTIONS

    Potentially hazardous interactions with other drugs
  • Antibacterials: metabolism accelerated by rifampicin; metabolism possibly inhibited by erythromycin
  • Anticoagulants: efficacy of coumarins may be altered
  • Anti-epileptics: metabolism accelerated by carbamazepine, barbiturates, phenytoin and primidone
  • Antifungals: increased risk of hypokalaemia with amphotericin – avoid concomitant use; metabolism possibly inhibited by itraconazole and ketoconazole
  • Antivirals: concentration possibly increased by ritonavir
  • Ciclosporin: rare reports of convulsions in patients on ciclosporin and high-dose corticosteroidsCytotoxics: increased risk of haematological toxicity with methotrexate
  • Diuretics: enhanced hypokalaemic effects of acetazolamide, loop diuretics and thiazide diureticsVaccines: high dose corticosteroids can impair immune response to vaccines – avoid concomitant use with live vaccines

    ADMINISTRATION

    Reconstition

    IV injection, IM injection: add 2 mL of sterile water for injection

    IV infusion

    : add not more than 2 mL water for injection, then add to 100–1000 mL (not less than 100 mL) glucose 5% or sodium chloride 0.9%

    Route

    IV injection,

    IV infusion

    , IM

    Rate of Administration

    IV bolus: 2–3 minutes

    Comments

    Minimum volume 100 mg in 50 mL. (UK Critical Care Group, Minimum Infusion Volumes for fluid restricted critically ill patients, 3rd Edition, 2006)

    OTHER INFORMATION

    Non-plasma protein bound hydrocortisone is removed by
  • HD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :One study has shown that plasma clearance rates of hydrocortisone during haemodialysis were 30–63% higher than after dialysis. No recommendations exist to indicate dosing should be altered to take account of this
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