carbamazepine, phenytoin, phenobarbitoneoral medicines to reduce blood clotting, e.g. However, in certain overwhelming, acute, life-threatening situations, administration in dosages exceeding the usual dosages may be justified and may be in multiples of the oral dosages.This dose may be repeated at intervals of 2, 4, or 6 hours as indicated by the patient's response and clinical condition.In pediatric patients, the initial dose of hydrocortisone may vary depending on the specific disease entity being treated. In general, high dose corticosteroid therapy should be continued only until the patient's condition has stabilized, usually not beyond 48 to 72 hours. Metabolic clearance of corticosteroids is decreased in hypothyroid patients and increased in hyperthyroid patients. Discontinuation of corticosteroids may result in clinical improvement.As sodium retention with resultant edema and potassium loss may occur in patients receiving corticosteroids, these agents should be used with caution in patients with congestive heart failure, hypertension, or renal insufficiency.Drug-induced secondary adrenocortical insufficiency may be minimized by gradual reduction of dosage. If you are in any doubt please consult your doctor. Corticosteroids can produce reversible HPA axis suppression with the potential for glucocorticosteroid insufficiency after withdrawal of treatment. side effects can only be found when your doctor does tests to check on your progress. These may be serious side effects. Accessed 2014 May 19. http://www.fda.gov/Drugs/DrugSafety/ucm394280.htm1002. It does not contain SOLU-CORTEF contains hydrocortisone sodium succinate as the active ingredient.Each vial also contains the following inactive ingredients:The diluent for the ACT-O-VIALs consists of Water for Injections. medicines used to treat breast cancer or hormone disorderThese medicines may be affected by SOLU-CORTEF or may affect how well it works. Habituellement, le gouvernement catégorise les médicaments qui peuvent être addictif comme des substances contrôlées. Epidural corticosteroid injection: Drug safety communication - risk of rare but serious neurologic problems. Number which is found on the carton. )Short-term palliative therapy for acute exacerbations and systemic complications of ulcerative colitis, regional enteritis, and celiac diseaseRarely indicated for maintenance therapy in chronic GI diseases (e.g., ulcerative colitis, celiac disease) since does not prevent relapses and may produce severe adverse reactions with long-term administration.Occasionally, low dosages, in conjunction with other supportive therapy, may be useful for disease unresponsive to the usual therapy indicated for chronic conditions.Management of mildly to moderately active and moderately to severely active Crohn’s disease.Some experts state that conventional glucocorticoids should not be used for the management of mildly to moderately active disease, because of the high incidence of adverse effects and their use should be reserved for patients with moderately to severely active disease.Parenteral glucocorticoids recommended for patients with severe fulminant Crohn’s diseaseGlucocorticoids should not be used for maintenance therapy of Crohn’s disease, because they usually do not prevent relapses and the drugs may produce severe adverse reactions with long-term administration.Glucocorticoids have been used in the management of moderately to severely active Crohn’s disease and in mild esophageal or gastroduodenal Crohn’s diseaseAlone or as a component of various chemotherapeutic regimens in the palliative treatment of neoplastic diseases of the lymphatic system (e.g., leukemias and lymphomas in adults and acute leukemias in children).Treatment of breast cancer; glucocorticoids alone not as effective as other agents (e.g., cytotoxic agents, hormones, antiestrogens) and should be reserved for unresponsive disease.Glucocorticoids alone or as a component of various combination chemotherapeutic regimens for palliative treatment of advanced, symptomatic (i.e., painful) hormone-refractory prostate cancer.Glucocorticoids are drugs of choice for the management of acute relapses of multiple sclerosisAnti-inflammatory and immunomodulating effects accelerate neurologic recovery by restoring the blood-brain barrier, reducing edema, and possibly improving axonal conduction.Shortens the duration of relapse and accelerates recovery; remains to be established whether the overall degree of recovery improves or the long-term course is altered.Parenterally for the treatment of myasthenic crisis.In massive dosage, used concomitantly with other immunosuppressive drugs to prevent rejection of transplanted organsIncidence of secondary infections is high with immunosuppressive drugs; limit to clinicians experienced in their use.Treatment of trichinosis with neurologic or myocardial involvement.Treatment of idiopathic nephrotic syndrome without uremia.Can induce diuresis and remission of proteinuria in nephrotic syndromeRoute of administration and dosage depend on the condition being treated and the patient response.Alternate-day therapy in which a single dose is administered every other morning is the dosage regimen of choice for long-term oral glucocorticoid treatment of most conditions.Some conditions (e.g., rheumatoid arthritis, ulcerative colitis) require daily glucocorticoid therapy because symptoms of the underlying disease cannot be controlled by alternate-day therapy.A steroid withdrawal syndrome consisting of lethargy, fever, and myalgia can develop following abrupt discontinuance.If used for only brief periods (a few days) in emergency situations, may reduce and discontinue dosage quite rapidly.Very gradually withdraw systemic glucocorticoids until recovery of HPA-axis function occurs following long-term therapy with pharmacologic dosages.Exercise caution when transferring from systemic glucocorticoid to oral or nasal inhalation corticosteroid therapy.Many methods of slow withdrawal or “tapering” have been described.In one suggested regimen, decrease by 10–20 mg every 3–7 days until the physiologic dose (20 mg) is reached.Other recommendations state that decrements usually should not exceed 10 mg every 1–2 weeks.For certain acute allergic conditions (e.g., contact dermatitis such as poison ivy) or acute exacerbations of chronic allergic conditions, glucocorticoids may be administered short term (e.g., for 6 days).Administer orally, by IV injection or infusion, or by IM injection.May be administered by sub-Q injection (as hydrocortisone sodium phosphate; no longer commercially available in US) or administered for local effect by intra-articular, intralesional, or soft-tissue injection (as hydrocortisone acetate; no longer commercially available in US).Generally reserve IM or IV therapy for patients who are not able to take the drug orally or for use in an emergency situation.Administer hydrocortisone sodium succinate by IV injection or infusion.Reconstitute for IV injection with bacteriostatic water for injection or bacteriostatic 0.9% sodium chloride injection according to the manufacturer’s instructions.For IV infusion, further dilute the reconstituted hydrocortisone sodium succinate solutions with 5% dextrose, 0.9% sodium chloride, or 5% dextrose in 0.9% sodium chloride injection to a concentration of 0.1–1 mg/mL.When the drug is administered by direct IV injection, administer over a period of at least 30 seconds.Administer hydrocortisone sodium succinate by IM injection.Reconstitute for IM injection with bacteriostatic water for injection or bacteriostatic 0.9% sodium chloride injection according to the manufacturer’s instructions.Available as hydrocortisone and hydrocortisone sodium succinate; dosage expressed in terms of hydrocortisone.After a satisfactory response is obtained, dosage should be decreased in small decrements to the lowest level that maintains an adequate clinical response, and discontinue the drug as soon as possible.Monitor patients continually for signs that indicate dosage adjustment is necessary, such as remissions or exacerbations of the disease and stress (surgery, infection, trauma).High dosages may be required for acute situations of certain rheumatic disorders and collagen diseases; after a response has been obtained, drug often must be continued for long periods at low dosage.High or massive dosages may be required in the treatment of pemphigus, exfoliative dermatitis, bullous dermatitis herpetiformis, severe erythema multiforme, or mycosis fungoides.Massive dosages may be required for the treatment of shock.If used orally for prolonged anti-inflammatory therapy, consider an alternate-day dosage regimen.Base pediatric dosage on severity of the disease and the response of the patient rather than on strict adherence to dosage indicated by age, body weight, or body surface area.Hydrocortisone sodium succinate: 0.16–1 mg/kg or 6–30 mg/mHydrocortisone sodium succinate: 0.16–1 mg/kg or 6–30 mg/mHydrocortisone: Initially, 10–320 mg daily (usually administered in 3 or 4 divided doses), depending on the disease being treated.Hydrocortisone sodium succinate: 100 mg to 8 g daily.Hydrocortisone sodium succinate: 100 mg to 8 g daily.Life-threatening shock: Massive doses of hydrocortisone sodium succinate such as 50 mg/kg by direct IV injection (over a period of one to several minutes) initially and repeated in 4 hours and/or every 24 hours if needed.Alternatively, 0.5–2 g by direct IV injection (over a period of one to several minutes) initially and repeated at 2- to 6-hour intervals as required.In such cases, administer by direct IV injection over a period of one to several minutes.Continue high-dose therapy only until the patient’s condition has stabilized and usually not beyond 48–72 hours.If massive corticosteroid therapy is needed beyond 72 hours, use a corticosteroid which causes less sodium retention (e.g., methylprednisolone sodium succinate or dexamethasone sodium phosphate) to minimize the risk of hypernatremia.Known hypersensitivity to hydrocortisone, any ingredient in the respective formulation, or any other corticosteroid.Concurrent administration of live virus vaccines in patients receiving immunosuppressive doses of corticosteroids.IM administration for conditions prone to bleeding (e.g., idiopathic thrombocytopenic purpura [ITP]).Hydrocortisone sodium succinate injection preparations containing benzyl alcohol in premature infants.May precipitate mental disturbances ranging from euphoria, insomnia, mood swings, depression and anxiety, and personality changes to frank psychoses.Use with caution in patients with myasthenia gravisSerious, potentially permanent, and sometimes fatal adverse neurologic events (e.g., spinal cord infarction, paraplegia, quadriplegia, cortical blindness, stroke, seizures, nerve injury, brain edema) reported rarely, often within minutes to 48 hours following epidural glucocorticoid injection given either with or without fluoroscopic guidance.FDA states efficacy and safety of epidural glucocorticoid administration not established; not FDA-labeled for this use.When given in supraphysiologic doses for prolonged periods, glucocorticoids may cause decreased secretion of endogenous corticosteroids by suppressing pituitary release of corticotropin (secondary adrenocortical insufficiency).The degree and duration of adrenocortical insufficiency is highly variable among patients and depends on the dose, frequency and time of administration, and duration of glucocorticoid therapy.Acute adrenal insufficiency (even death) may occur if the drugs are withdrawn abruptly or if patients are transferred from systemic glucocorticoid therapy to local (e.g., inhalation) therapy.Withdraw hydrocortisone very gradually following long-term therapy with pharmacologic dosages.Adrenal suppression may persist up to 12 months in patients who receive large dosages for prolonged periods.Until recovery occurs, signs and symptoms of adrenal insufficiency may develop if subjected to stress (e.g., infection, surgery, trauma) and replacement therapy may be required.If the disease flares up during withdrawal, dosage may need to be increased and followed by a more gradual withdrawal.Increased susceptibility to infections secondary to glucocorticoid-induced immunosuppression.Administration of live virus vaccines, including smallpox, is contraindicated in patients receiving immunosuppressive dosages of glucocorticoids.Glucocorticoids, especially in large doses, increase susceptibility to and mask symptoms of infection.Infections with any pathogen, including viral, bacterial, fungal, protozoan, or helminthic infections in any organ system, may be associated with glucocorticoids alone or in combination with other immunosuppressive agents.Infections may be mild, but they can be severe or fatal, and localized infections may disseminate.Some infections (e.g., varicella [chickenpox], measles) can have a more serious or even fatal outcome, particularly in children.Children and any adult who are not likely to have been exposed to varicella or measles should avoid exposure to these infections while receiving glucocorticoids.If exposure to varicella or measles occurs in susceptible patients, treat appropriately (e.g., VZIG, IG, acyclovir).Fatal outcome (e.g., in those developing hemorrhagic varicella) may not always be avoided even if appropriate therapy is initiated aggressively.Immunosuppression may result in activation of latent infection or exacerbation of intercurrent infections (e.g., those caused by Use with great care in patients with known or suspected May exacerbate fungal infections and should not be used in the presence of such infection unless needed to control drug reactions to amphotericin B; however, cases of cardiac enlargement and CHF have been reported with concomitant use of hydrocortisone and amphotericin B.Not effective and can have detrimental effects (prolongation of coma, higher incidence of pneumonia and GI bleeding) in the management of cerebral malaria.Muscle wasting, muscle pain or weakness, delayed wound healing, and atrophy of the protein matrix of the bone resulting in osteoporosis, vertebral compression fractures, aseptic necrosis of femoral or humeral heads, or pathologic fractures of long bones are manifestations of protein catabolism that may occur during prolonged therapy with glucocorticoids.An acute, generalized myopathy can occur with the use of high doses of glucocorticoids, particularly in patients with disorders of neuromuscular transmission (e.g., myasthenia gravis) or in patients receiving concomitant therapy with neuromuscular blocking agents (e.g., pancuronium).Tendon rupture, particularly of the Achilles tendon.Osteoporosis and related fractures are one of the most serious adverse effects of long-term glucocorticoid therapy.To minimize the risk of glucocorticoid-induced bone loss, the smallest possible effective dosage and duration should be used.