Hydrocortisone (ICU — Stress Dosing)
Brand names: Solu-Cortef
Hydrocortisone is a glucocorticoid (with some mineralocorticoid activity) used for adrenal-insufficiency replacement, in acute severe allergic/inflammatory conditions, and as stress-dose steroid in critical illness or peri-operatively for those at risk of adrenal suppression.
ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.
US labelling (FDA)
Reference — US labelling, may differ from UKDirections • for itching of skin irritation, inflammation, and rashes: • adults and children 2 years of age and older: apply to affected area not more than 3 to 4 times daily • children under 2 years of age: do not use, ask a doctor • for external anal and genital itching, adults: • when practical, clean the affected area with mild soap and warm water and rinse thoroughly • gently dry by patting or blotting with toilet tissue or a soft cloth before applying • apply to affected area not more than 3 to 4 times daily • children under 12 years of age: ask a doctor
Source: US FDA prescribing information (openFDA / DailyMed), label dated 2024-09-17. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.
Clinical monograph
How it works
It activates glucocorticoid receptors to suppress inflammation and, via mineralocorticoid activity, supports sodium and water balance; it replaces cortisol in adrenal insufficiency.
Prescribing in practice
- In known or suspected adrenal insufficiency, do not omit doses and increase ('stress dose') during illness, surgery or trauma to avoid an adrenal crisis.
- Patients on long-term steroids need a steroid card and must not stop abruptly.
- The usual glucocorticoid adverse effects apply with prolonged use (hyperglycaemia, infection risk, etc.).
Monitoring
Monitor blood glucose, blood pressure, fluid balance and electrolytes; in replacement therapy review for under- or over-treatment.
Counselling the patient
- If you are steroid-dependent, never miss doses and increase the dose when unwell — carry a steroid card.
- Seek urgent help if you cannot keep doses down when ill (risk of adrenal crisis).
Evidence & guidelines
Standard for adrenal-insufficiency replacement and stress dosing, and used in acute allergic/inflammatory emergencies.
Reference: APROCCHSS Trial (NEJM 2018); ADRENAL Trial (NEJM 2018); Surviving Sepsis Campaign 2021; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).
Related
Curated clinical cross-links plus same-class fallbacks.