Hydrocortisone

Benjamin Clanner-Engelshofen is a freelance writer in the medical department. He studied biochemistry and pharmacy in Munich and Cambridge / Boston (USA) and noticed early on that he particularly enjoyed the interface between medicine and science. That is why he went on to study human medicine.

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The active ingredient hydrocortisone is also commonly referred to as "cortisone" (which, strictly speaking, is not true). It has anti-inflammatory effects, suppresses the immune system and also acts as a "stress hormone". The glucocorticoid hydrocortisone naturally formed in the body served as a template for the numerous chemically modified glucocorticoids, which often have an even stronger effect. Here you can read everything interesting about the effects and use of hydrocortisone, side effects and interactions.

This is how hydrocortisone works

Hydrocortisone (also called "cortisol") is made by the body from cholesterol in the adrenal cortex. The amount of hormone produced is mainly regulated by pituitary hormones. A lot of hydrocortisone is produced, especially in stressful situations, in order to ensure, among other things, that the body remains productive. Such stress can be caused by lifestyle, lack of sleep, addictions, infections, and other factors. This also explains the various consequences in the body. In the event of stress, energy reserves are mobilized (i.e. fat is broken down), easily usable sugars are formed in the liver and proteins are increasingly broken down. In addition, the immune system, inflammatory reactions and wound healing, which cost the body a lot of energy, are slowed down.

The release of hydrocortisone in the body is subject to a day-night rhythm (circadian rhythm). This internal clock ensures seven to ten burst releases of the hormone throughout the day, with the largest release occurring immediately after waking up.

After the release of hydrocortisone, it enters the various tissues via the bloodstream. There it penetrates the cells and ensures that proteins are increasingly formed that support the stress-related effects described. In order to stop its effects, hydrocortisone is converted into the inactive, i.e. non-effective, cortisone in some tissues such as the kidneys and the intestines.

Hydrocortisone uptake, breakdown and excretion

After ingestion, hydrocortisone is absorbed through the intestinal wall into the blood, where it reaches its highest blood level after about an hour. The level drops by half after about one and a half hours, which is why hydrocortisone is also one of the short-acting glucocorticoids. However, it stays longer in the tissue, which is why it lasts eight to twelve hours. Hydrocortisone and cortisone are finally broken down further in the liver and then excreted in the urine via the kidneys. Two days after ingestion, 90 percent of the active ingredient left the body.

When is hydrocortisone used?

Hydrocortisone is used in the following cases:

• if there is a deficiency in the body as replacement therapy (Addison's disease)
• for inflammatory skin diseases, eczema and psoriasis

Depending on the dosage form, the active ingredient is sometimes administered as a so-called “prodrug”, which is only converted into the actually effective hydrocortisone in the body. In glucocorticoids, this chemical change is called esterification. In this modified form, hydrocortisone shows better penetration and prolonged release when applied to the skin, and better water solubility when used as a syringe (in acute illnesses).

Depending on the disease, hydrocortisone can be used for a short or long term.

This is how hydrocortisone is used

Hydrocortisone is used either topically, i.e. directly on diseased parts of the body, or systemically, i.e. swallowed or injected, which means that the active ingredient can reach any tissue via the blood.

The topical application with fewer side effects is of course only suitable for corresponding diseases of the skin, the eyes or the mucous membrane (for example the intestine). Usually, for example, hydrocortisone cream and ointment are applied thinly to the affected area once or twice a day at the beginning and then only once a day when it improves. An eye ointment with the active ingredient is placed in the conjunctival pocket two to three times a day for a maximum of two weeks (after pulling down the lower eyelid) or applied from the outside to the edge of the eyelids, depending on the doctor's instructions. Rectal foam is used for inflammatory bowel diseases (Crohn's disease, ulcerative colitis) at the beginning once or twice a day, after a few weeks only once every two days.

The systemic use of hydrocortisone takes place by taking tablets, whereby the daily fluctuations in blood levels are mimicked in the dosage. Most of the active ingredient is taken in the morning (around two-thirds to three-quarters of the total daily amount), and the remainder in the afternoon. Overall, the daily dose of hydrocortisone depends on various factors, such as whether the adrenal glands are still producing a small amount of the hormone themselves or not at all. In certain situations, such as severe stress or febrile infections, an increase in the dose may be necessary. To discontinue the therapy, the medical intake plan must be followed exactly so that there are no increased side effects.

What are the side effects of hydrocortisone?

Hydrocortisone side effects are not to be expected with short-term, low-dose therapy. This is different with longer or high-dose therapy in which the so-called "Cushing threshold" is exceeded. This is an individually dependent dose of the administered glucocorticoid, from which side effects occur, as they occur in Cushing's disease (abnormally increased hydrocortisone blood level): moon face, trunk obesity, bull's neck, high blood pressure, increased thirst and frequent urination, bone loss, Muscle loss, back and joint pain, delayed wound healing and increased susceptibility to infections.

Because of these serious side effects, many people, especially in the past, were afraid of "cortisone treatment". At that time, however, even higher doses of hydrocortisone were used than today. In the meantime, such side effects can usually be avoided with an adequate dosage.

What should be considered when using hydrocortisone?

The higher doses of hydrocortisone in particular can lead to disturbances in the body's salt and water balance, for example through increased potassium excretion. This can worsen with the simultaneous use of active substances that drain water (diuretics such as furosemide or hydrochlorothiazide). A potassium deficiency caused by the increased excretion can also intensify the effect of cardiac glycosides such as digitoxin and digoxin.

The blood sugar-increasing effect of hydrocortisone weakens the blood-sugar lowering effect of many diabetes active ingredients. The effects of coumarin-type anticoagulants such as phenprocoumon and warfarin are also weakened.

In contrast, the combination of hydrocortisone with non-steroidal anti-inflammatory drugs, which are often taken as pain relievers (ibuprofen, naproxen, acetylsalicylic acid / ASA, diclofenac) can lead to increased bleeding in the gastrointestinal tract.

Hydrocortisone can be used during pregnancy and breastfeeding for substitution therapy under medical supervision. Treatment with greatly increased doses should not be carried out during this time.

Hydrocortisone can be administered at any age in appropriately adjusted doses.

How to get medication with hydrocortisone

Preparations for use on the skin (as hydrocortisone cream or spray) do not require a prescription in concentrations of 0.25 to 0.5 percent and can be purchased without a prescription at the pharmacy.

Preparations with hydrocortisone in higher doses, for the treatment of chronic inflammatory diseases and for taking as a tablet, require a prescription.

How long has hydrocortisone been known?

Hydrocortisone, cortisone and related substances were discovered by the American chemist Edward Calvin Kendall, who received the Nobel Prize in Medicine for them in 1950. Hydrocortisone was marketed by the pharmaceutical company Merck & Co. as early as 1949 and is now also available as a generic.

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