hydrocortisone acetate

CLINICAL USE

Corticosteroid:Local inflammation of joints and soft tissue

DOSE IN NORMAL RENAL FUNCTION

5–50 mg according to joint size

PHARMACOKINETICS

Molecular weight :404.5

%Protein binding :>90

%Excreted unchanged in urine : Minimal

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

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

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Dose as in normal renal function

10 to 20 : Dose as in normal renal function

<10 : Dose as in normal renal function

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

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

HD :Unlikely to be dialysed. Dose as in normal renal function

HDF/high flux :Unlikely to be dialysed. Dose as in normal renal function

CAV/VVHD :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