It may be used topically for allergicrashes,eczema,psoriasis,itching, and otherinflammatory skin conditions.Topical hydrocortisone creams and ointments are available in most countries without prescription in strengths ranging from 0.05% to 2.5% (depending on local regulations) with stronger forms available by prescription only.[citation needed]
Hydrocortisone has lowpotency relative tosynthetic corticosteroids.[14] Compared to hydrocortisone,prednisolone is about 4times aspotent anddexamethasone about 40times as potent in terms ofanti-inflammatory effect.[25] Prednisolone can also be used as cortisol replacement, and at replacement dose levels (rather than anti-inflammatory levels), prednisolone is about 8times more potent than cortisol.[26] The equivalent doses and relative potencies of hydrocortisone compared to various other synthetic corticosteroids have also been reviewed and summarized.[14]
Theendogenousproduction rate of cortisol is approximately 5.7 to 9.9mg/m2 per day, which corresponds to an oral hydrocortisone dose of approximately 15 to 20mg/day (for a 70-kg person).[27][28] One review described daily cortisol production of 10mg in healthy volunteers and reported that daily cortisol production could increase up to 400mg in conditions of severestress (e.g.,surgery).[12]
The total and/or free concentrations of cortisol/hydrocortisone required for various glucocorticoid effects have been determined.[12]
Thetopicalpercutaneousabsorption of hydrocortisone varies widely depending on experimental circumstances and has been reported to range from 0.5 to 14.9% in different studies.[29] Some skin application sites, like thescrotum andvulva, absorb hydrocortisone much more efficiently than other application sites, like theforearm.[29][30][31] In one study, the amount of hydrocortisone absorbed ranged from 0.2% to 36.2% depending on the application site, with the ball of the foot having the lowest absorption and the scrotum having the highest absorption.[31] The absorption of hydrocortisone by the vulva has ranged from 4.4 to 8.1%, relative to 1.3 to 2.8% for the arm, in different studies and subjects.[31][32][33]
In March 2021, theCommittee for Medicinal Products for Human Use (CHMP) of theEuropean Medicines Agency (EMA) adopted a positive opinion, recommending the granting of a marketing authorization for the medicinal product Efmody, intended for the treatment of congenital adrenal hyperplasia (CAH) in people aged twelve years and older.[39] The applicant for this medicinal product is Diurnal Europe BV.[39] Hydrocortisone (Efmody) was approved for medical use in the European Union, in May 2021, for the treatment ofcongenital adrenal hyperplasia (CAH) in people aged twelve years and older.[10]
In the UK, theCompetition and Markets Authority (CMA) concluded an investigation into the supply of hydrocortisone tablets, finding that from October 2008 onwards, drug suppliers Auden McKenzie andActavis plc had charged "excessive and unfair prices" for 10mg and 20mg tablets and entered into agreements with potential competitors, paying companies who agreed not to enter the hydrocortisone market and enabling Auden McKenzie and Actavis to supply the drugs as "generic" rather than branded products and thereby escape price controls until eventually other companies entered the market. Auden and Actavis overcharged the UK'sNational Health Service for over ten years. Fines totalling over £255m were levied against the companies involved in this breach ofcompetition law.[40]
Cortisol levels have been found to be altered in people withmyalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).[41][42][43] Hydrocortisone has been clinically studied in the treatment of ME/CFS.[44][45][46] A 2016systematic review found that it had been assessed for this purpose in six clinical studies.[44] Its clinical effectiveness was conflicting in the studies, ranging from not effective, to slightly or mildly effective, to moderately effective.[44] Four of the studies came from one research group.[44] The systematic review called for higher-quality trials.[44] A 2015 systematic review found that the clinical data on hydrocortisone for ME/CFS was inconclusive.[47]
Hydrocortisone was found to be effective in reducing mortality rate of critically illCOVID-19 patients when compared to other usual care or a placebo.[48]
^abcdefg"Hydrocortisone".Drugs.com. American Society of Health-System Pharmacists. 9 February 2015.Archived from the original on 20 September 2016. Retrieved30 August 2016.
^ab"Efmody EPAR".European Medicines Agency (EMA). 24 March 2021.Archived from the original on 14 June 2021. Retrieved14 June 2021. Text was copied from this source which is copyright European Medicines Agency. Reproduction is authorized provided the source is acknowledged.
^abcdefghiLennernäs H, Skrtic S, Johannsson G (June 2008). "Replacement therapy of oral hydrocortisone in adrenal insufficiency: the influence of gastrointestinal factors".Expert Opinion on Drug Metabolism & Toxicology.4 (6):749–758.doi:10.1517/17425255.4.6.749.PMID18611115.S2CID73248541.
^World Health Organization (2019).World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization.hdl:10665/325771. WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
^Britz MB, Maibach HI, Anjo DM (1980). "Human percutaneous penetration of hydrocortisone: the vulva".Archives of Dermatological Research.267 (3):313–316.doi:10.1007/BF00403852.PMID7406539.S2CID33367289.
^Oriba HA, Bucks DA, Maibach HI (February 1996). "Percutaneous absorption of hydrocortisone and testosterone on the vulva and forearm: effect of the menopause and site".The British Journal of Dermatology.134 (2):229–233.doi:10.1111/j.1365-2133.1996.tb07606.x.PMID8746334.S2CID30076779.
^Boron WF, Boulpaep EL (2011).Medical Physiology (2nd ed.). Philadelphia: Saunders.ISBN978-1-4377-1753-2.
^Nikolaou N, Hodson L, Tomlinson JW (March 2021). "The role of 5-reduction in physiology and metabolic disease: evidence from cellular, pre-clinical and human studies".The Journal of Steroid Biochemistry and Molecular Biology.207 105808.doi:10.1016/j.jsbmb.2021.105808.PMID33418075.S2CID230716310.
^ab"Efmody: Pending EC decision".European Medicines Agency (EMA). 25 March 2021. Archived fromthe original on 4 May 2021. Retrieved27 March 2021. Text was copied from this source which is copyright European Medicines Agency. Reproduction is authorized provided the source is acknowledged.
^abcdeCollatz A, Johnston SC, Staines DR, Marshall-Gradisnik SM (June 2016). "A Systematic Review of Drug Therapies for Chronic Fatigue Syndrome/Myalgic Encephalomyelitis".Clin Ther.38 (6): 1263–1271.e9.doi:10.1016/j.clinthera.2016.04.038.PMID27229907.
^Cleare AJ, Heap E, Malhi GS, Wessely S, O'Keane V, Miell J (February 1999). "Low-dose hydrocortisone in chronic fatigue syndrome: a randomised crossover trial".Lancet.353 (9151):455–458.doi:10.1016/S0140-6736(98)04074-4.PMID9989716.
^McKenzie R, O'Fallon A, Dale J, Demitrack M, Sharma G, Deloria M, et al. (1998). "Low-dose hydrocortisone for treatment of chronic fatigue syndrome: a randomized controlled trial".JAMA.280 (12):1061–1066.doi:10.1001/jama.280.12.1061.PMID9757853.
^Smith ME, Haney E, McDonagh M, Pappas M, Daeges M, Wasson N, et al. (June 2015). "Treatment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Systematic Review for a National Institutes of Health Pathways to Prevention Workshop".Ann Intern Med.162 (12):841–850.doi:10.7326/M15-0114.PMID26075755.
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This article incorporates text published under the BritishOpen Government Licence: Competition and Markets Authority,Decision: Hydrocortisone tablets. Excessive and unfair pricing and Anti-competitive agreements, published 31 March 2022, accessed 1 June 2023