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 :484.5 (486.4 as sodium phosphate)

%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

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 :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

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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