Active Ingredient: Hydrocortisone
For this indication, competent medicine agencies globally authorize below treatments:
For:
Oral, between 10 milligrams hydrocortisone and 30 milligrams hydrocortisone, divided 2 times daily.
10-30 mg in divided doses is the normal daily requirement.
In patients requiring replacement therapy, the daily dose should be given when practicable, in two doses. The first dose in the morning should be larger than the second dose in the evening, thus simulating the normal diurnal rhythm of cortisol secretion.
For:
Regimen A, in case that there is decreased body growth
Oral, between 10 milligrams hydrocortisone per square meter of body surface and 15 milligrams hydrocortisone per square meter of body surface, divided 2 times daily.
Regimen B, in case that there is normal growth
Oral, between 15 milligrams hydrocortisone and 25 milligrams hydrocortisone, divided 2 times daily.
Recommended replacement doses of hydrocortisone are 10-15 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.
The morning dose should be taken on an empty stomach at least 1 hour before a meal and the evening dose taken at bedtime at least 2 hours after the last meal of the day.
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 at the same total daily dose as modified-release hydrocortisone should be given in three divided doses; modified-release hydrocortisone should be continued as well with the usual regimen (i.e. a doubled daily dose of modified-release hydrocortisone) 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.
If a dose is missed it is recommended that it be taken as soon as possible.
For:
Oral, between 15 milligrams hydrocortisone and 25 milligrams hydrocortisone, divided 2 times daily.
Recommended replacement dose of hydrocortisone is 15-25 mg/day in adult patients with CAH. 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.
The morning dose should be taken on an empty stomach at least 1 hour before a meal and the evening dose taken at bedtime at least 2 hours after the last meal of the day.
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 at the same total daily dose as modified-release hydrocortisone should be given in three divided doses; modified-release hydrocortisone should be continued as well with the usual regimen (i.e. a doubled daily dose of modified-release hydrocortisone) 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.
If a dose is missed it is recommended that it be taken as soon as possible.
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