Adrenal insufficiency (AI)

Active Ingredient: Hydrocortisone

Indication for Hydrocortisone

Population group: only adolescents (12 years - 18 years old) , adults (18 - 65 years old)
Therapeutic intent: Curative procedure

Hydrocortisone is indicated in adolescents aged 12 years and over and adults for the treatment of adrenal insufficiency (AI).

For this indication, competent medicine agencies globally authorize below treatments:

8-10 mg/m²/day in adolescents who have not completed growth, and 15-25 mg/day in adolescents who have completed growth

For:

Dosage regimens

Regimen A, in the case that there is decreased body growth :

Oral, between 8 milligrams hydrocortisone per square meter of body surface and 10 milligrams hydrocortisone per square meter of body surface, divided 2 times daily.

Regimen B, in the case that there is normal growth :

Oral, between 15 milligrams hydrocortisone and 25 milligrams hydrocortisone, divided 2 times daily.

Detailed description

Recommended replacement doses of hydrocortisone is 8-10 mg/m²/day in adolescents aged 12 years and over who have not completed growth, and 15-25 mg/day in adolescents who have completed growth. In patients with some remaining endogenous cortisol production a lower dose may be sufficient.

At initiation the total daily dose should be split into two doses with two thirds to three quarters of the dose given in the evening at bedtime and the rest given in the morning. Patients should then be titrated based on their individual response.

Hydrocortisone can be taken with or without food.

During serious trauma, intercurrent illness or periods of stress

In severe situations, an increase in dose is immediately required and oral administration of hydrocortisone must be replaced with parenteral treatment.

In less severe situations when parenteral administration of hydrocortisone is not required, during periods of physical and/or mental stress, additional immediate release hydrocortisone (IRHC) at the same total daily dose as hydrocortisone should be given in three divided doses (i.e. a doubled total daily dose of hydrocortisone is given). Hydrocortisone should be continued with the usual regimen to allow for easy return to the normal replacement dose of hydrocortisone once additional hydrocortisone is no longer required.

In case of long-term increases in hydrocortisone daily dose due to prolonged periods of stress or illness, the additional hydrocortisone should be carefully weaned off.

Missed doses

If a dose of hydrocortisone is missed, it is recommended that it be taken as soon as possible.

15-25 mg/day

For:

Dosage regimens

Oral, between 15 milligrams hydrocortisone and 25 milligrams hydrocortisone, divided 2 times daily.

Detailed description

Recommended replacement dose of hydrocortisone is 15-25 mg/day in adult patients with AI. In patients with some remaining endogenous cortisol production a lower dose may be sufficient.

At initiation the total daily dose should be split into two doses with two thirds to three quarters of the dose given in the evening at bedtime and the rest given in the morning. Patients should then be titrated based on their individual response.

Hydrocortisone can be taken with or without food.

During serious trauma, intercurrent illness or periods of stress

In severe situations, an increase in dose is immediately required and oral administration of hydrocortisone must be replaced with parenteral treatment.

In less severe situations when parenteral administration of hydrocortisone is not required, during periods of physical and/or mental stress, additional immediate release hydrocortisone (IRHC) at the same total daily dose as hydrocortisone should be given in three divided doses (i.e. a doubled total daily dose of hydrocortisone is given). Hydrocortisone should be continued with the usual regimen to allow for easy return to the normal replacement dose of hydrocortisone once additional hydrocortisone is no longer required.

In case of long-term increases in hydrocortisone daily dose due to prolonged periods of stress or illness, the additional hydrocortisone should be carefully weaned off.

Missed doses

If a dose is missed it is recommended that it be taken as soon as possible.

Active ingredient

Hydrocortisone

Hydrocortisone is the main glucocorticoid secreted by the adrenal cortex. Hydrocortisone is an anti-inflammatory steroid. Its anti-inflammatory action is due to reduction in the vascular component of the inflammatory response and reduction in the formation of inflammatory fluid and cellular exudates.

Read more about Hydrocortisone

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