Reviewed by Dr Jane Harding, Brenda Hughes, and Dorothy Cooper
August 1996
Administration Newborn Drug Protocol Index Newborn Services Home Page

Dose and Administration

  1. For adrenal crisis: 1mg/kg IM/IV q 4 hourly.
  2. For maintenance: 1mg/kg/day PO


  1. Replacement therapy in acute and chronic adrenocortical insufficiency.

Contraindication and Precautions

  1. Infection.
  2. Abrupt discontinuation in longterm therapy may result in withdrawal-like symptoms.
  3. CAUTION concurrent use with amphotericin, potassium depleting diuretics, indomethacin, theophyllines.

Clinical Pharmacology

Hydrocortisone is the principle glucorticoid of the human adrenal cortex. The rate of secretion follows a characteristic diurnal rhythm. Secretion increases in the early hours of the morning and gradually declines toward late evening.

The three major effects of adrenal steroids are on metabolism, mineral metabolism and inflammation.

Hydrocortisone is about 25-30 times less potent than dexamethasone.

Possible Adverse Effects

  1. Increased susceptibility to and suppression of the usual symptoms and signs of infection.
  2. Hyperglycaemia, glycosuria.
  3. Sodium and water retention.
  4. Hypertension.
  5. Poor growth.
  6. Gastrointestinal disturbance, aggravation of peptic ulcers, bleeding.
  7. Hypokalaemia.
  8. Hypocalcaemia.
  9. Thrombocytopenia.
  10. Interferes with tissue granulation and repair, wound healing.
  11. Rash.
  12. Osteoporosis.
  13. Prolonged use may produce posterior subcapsular cataracts.

Special Considerations

  1. The manufacturer recommends that Solu-Cortef is contraindicated in premature infants because it contains benzyl alcohol. Benzyl alcohol has been reported to be associated with the fatal gasping syndrome in premature infants. However, no other preparation is currently available.
  2. Dangerous to stop if using for adrenal crisis.
  3. Infants born to mothers receiving this drug need to be monitored for signs of hypoadrenalism.
  4. Phenobarbitone and phenytoin may increase the clearance of corticosteroids.
  5. Hydrocortisone may increase or decrease theophylline levels.