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Corticosteroid Pregnancy: C — adrenal crisis takes precedence; safe at standard doses

Hydrocortisone

Brand names: Solu-Cortef, Hydrocortistab

Adult dose

Dose: Anaphylaxis / adrenal crisis: 200mg IV. Asthma: 100mg IV. Septic shock: 200mg/24h
Route: IV / IM
Frequency: QDS (6-hourly) for asthma/COPD exacerbation; varies by indication
Max: 400mg/day for most indications
Anaphylaxis: 200mg IV (secondary to adrenaline — delayed onset 4–6h). Adrenal crisis: 100mg IV stat, then 200mg/24h infusion. Status asthmaticus: 100mg IV QDS. Septic shock (APROCCHSS trial): 200mg/24h infusion.

Paediatric dose

Dose: 4 mg/kg
Route: IV
Frequency: 6-hourly
Max: 100mg
Concentration: 50 mg/ml

Dose adjustments

Renal

No adjustment required.

Hepatic

No adjustment required.

Paediatric weight-based calculator

Clinical pearls

  • Anaphylaxis: hydrocortisone is SECONDARY to adrenaline — it has a 4–6h onset and is given to reduce biphasic reactions. Never delay adrenaline.
  • Adrenal crisis: if in doubt, give without waiting for cortisol result. 100mg IV stat. Potentially life-saving.
  • Monitor blood glucose 4-hourly — corticosteroids commonly cause steroid-induced hyperglycaemia requiring insulin correction.
  • Hydrocortisone has both glucocorticoid AND mineralocorticoid activity — suitable as sole replacement in adrenal crisis (unlike dexamethasone).

Contraindications

  • Systemic fungal infections (without concurrent antifungal treatment)
  • Live vaccines (within 3 months of high-dose steroids)
  • Active peptic ulcer — combine with PPI prophylaxis

Side effects

  • Hyperglycaemia (check BM 4-hourly)
  • Fluid retention, hypertension
  • Immunosuppression — increased infection risk
  • GI bleeding (combine with PPI in high-risk patients)
  • Hypokalaemia
  • Agitation, insomnia (common in high doses)

Interactions

  • NSAIDs: increased GI bleeding risk
  • Anticoagulants: may reduce or increase anticoagulant effect — monitor INR
  • Oral hypoglycaemics: reduced hypoglycaemic effect — increase monitoring
  • Rifampicin: significantly reduces steroid levels via CYP3A4 induction

Monitoring

  • Blood glucose 4-hourly
  • serum potassium
  • BP
  • signs of infection

Reference: BNFc; NICE BNF 84; RCUK Anaphylaxis 2021; BTS/SIGN Asthma 2023; APROCCHSS Trial NEJM 2018. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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