"Hydrocortisone": instructions for use. Hydrocortisone - official instructions for use

Many people are familiar with this medicine. Hydrocortisone ointment is a popular external medicine, which has a number of advantages over other drugs of a similar active group. The effect of the drug is complex, the spectrum is wide. Almost any painful skin problem can be solved by using this product. hormonal ointment. The medicine is especially recommended for people suffering eye diseases. He has an average stage of addiction, not much a large number of side effects and powerful anti-inflammatory effects.

Composition and action

This glucocorticosteroid is considered a hormonal substance, which is used only locally and under professional supervision, accompanied by systemic blood tests, measurements blood pressure, checking changes in body weight and mental state. The active basis that gives the drug its name is hydrocortisone, a derivative of cortisone.. It is secreted in crystallized form from the apices of the adrenal glands (available in the adrenal cortex of both mammals and humans). The substance is then synthesized and converted into hydrocortisone acetate. Synthesis helps increase efficiency, reduce the possibility of manifestation side effects and enhance the anti-inflammatory effect.

Form

The drug in the form of an ointment is manufactured by the pharmaceutical industry in the following containers and dosages:

• external cutaneous form, 1% – 5 or 10 grams, tube;
• external eye ointment, 1% – 2.5 grams, tube;
• the same, but 0.5% - 3, 5 and 10 grams, tube;
• and eye form 2.5% - 2.5 grams each, tube.

Ingredients

1. The general use ointment contains 0.01 grams of hydrocortisone per gram of active ingredient. The filling also contains the substance lanolin.
2. In the form of an ophthalmic solution, 0.5% - 0.005 grams of acetate. The fillers and ingredients are petroleum jelly and methyl parahydroxybenzoate.
3. Eye ointment concentrate 1% and 2.5% includes 0.01 and 0.025 grams of acetate, and liquefied paraffin is added to the fillers.

Pharmacology

The active component, as soon as applied, immediately begins to provide anti-inflammatory assistance. It also acts as an immunosuppressant and is an allergy reliever. These manifestations are associated with the ability of the active base to inhibit the production of mediators of any inflammatory level. It reduces the activity of leukocytes, slows down the action of macrophages (blood cells moving into the inflammatory focus). This is achieved by artificial thinning small vessels and a decrease in the outflow of liquid masses from the bloodstream.

The effect of an immunosuppressant is explained by the ability to suppress immune blood cells, since when activated autoimmune processes their excessive activity is observed.

The antiallergic effect consists of suppressing the formation of antibodies and the destruction of cell granules by histamines and leukotrienes - the main mediators of the allergic process.

Usage

In therapeutic practice, the drug is widely used. It may be prescribed in the following cases:

• skin inflammation due to chemical exposure;
• frostbite;
• physical inflammation;
• burns;
• seborrhea;
• trophic ulcers;
• lichen (flat, warty, pink);
• eczema;
• conjunctivitis;
• allergies;

The list of diseases can be continued - only the most famous and common ones are given here.

By the way. Local application applied to the surface of the body promotes the rapid accumulation of the active substance in the epidermal layer. Part of the drug is metabolized in the epidermis, but the lion's share enters the bloodstream, penetrates the liver and is excreted through bile and urine.

Table. Application for specific diseases.

Skin ointment	Eye ointment
Autoimmune psoriasis. Non-microbial scleroderma. Systemic lupus erythematosus. Contact dermatitis. Allergic dermatitis. Neurodermatitis. Neuroallergic eczema. Skin burns. Frostbite of the skin. Ulceration of the skin layer with trophic ulcers.	Allergenic conjunctivitis. Inflammation of the eyelid - bepharitis. The process of infection in the cornea is keratitis. Inflammation simultaneously on the skin of the eyelid and the mucous membrane of the eye - blepharoconjunctivitis. The inflammatory form of iris damage is iritis. The iris is inflamed along with the ciliary body - iridocyclitis. Eye burn (of any origin).

How to use the drug

1. Firstly, it is very important to start using it only after it has been approved by a doctor.. Well drug therapy in the case of hydrocortisone ointment, it usually lasts no longer than two weeks, but with deep character damage, intensive dynamics, based on need, treatment can be extended for up to twenty days.
2. Secondly, it is important to follow the instructions and apply the medicine strictly in accordance with it. This means that the ointment is applied twice or thrice a day. It is not applied to the covers in a thick layer (about a millimeter), only to the designated area. When using an eye product, it is placed into the conjunctival sac up to two times a day (can be once). In this case, an occlusive dressing is applied.
3. Thirdly, in no case should you extend the use after the prescription has expired. This hormonal formation, which, if exposed for too long, will cause reverse and side effects, instead of promoting healing of the affected areas.

When used therapeutically, the medicine copes well with all the tasks assigned to it: it relieves and stops inflammatory process, reduces swelling, reduces redness and exfoliates the affected skin layer. But with prolonged use (longer than the period prescribed by the doctor), it can seriously reduce immune function.

Important! It is especially important to observe the prescribed course duration when treating children with hydrocortisone. In them, adrenal suppression with a temporary overdose of cortisone develops too quickly and irreversibly.

Contraindications and side effects

Side effects are mainly associated with prolonged and uncontrolled use of the ointment. After a temporary overdose, patients begin to experience the following problems.

1. Steroid type diabetes. This side effect results in an increase in glucose content in the blood system, since one of the functions of glucocorticosteroids is the synthesis of glucose, which occurs due to the breakdown of protein compounds and glycogen.
2. Possible atrophy of the adrenal cortex and cessation of the adrenal glands synthesizing their hormones.
3. In children it occurs growth disturbance and may be diagnosed with osteoporosis(up to the age of one and a half years, growth disorders are reversible, then not).
4. Calcium deficiency leading to various kinds diseases. Eliminating calcium from bone tissue occurs due to the retention of sodium ions to compensate for their excess in the plasma.

Important! Hydrocortisone must be prescribed with caution during pregnancy and lactation. It should not be allowed to enter the mother's bloodstream when the embryo is developing bone tissue for more than ten days. The same applies to children. Therefore, for pregnant women and children, the course of ointment administration is from seven to ten days.

All of these effects do not occur in every patient who uses the ointment for longer than the recommended period, they are even infrequent, but, nevertheless, their severity should force patients to carefully handle this medicine. It is also important to take into account the possibility of side effects that may occur in patients with increased individual sensitivity. This is increased swelling, the occurrence (or persistence) of itching, skin atrophy, redness, hypertrichosis and other changes in the condition of the skin.

Who should not use hydrocortisone?

The ointment - both skin and eye - has serious contraindications. These include the following diseases and conditions.

1. Tuberculosis.
2. Pyoderma (ulcers on the skin).
3. Skin tumors.
4. Mycosis.
5. Syphilis (its epidermal manifestations).
6. Skin ulcers.
7. Individual sensitivity to corticoids.
8. Glaucoma disease.
9. Active vaccination.
10. Lack of a complete membrane in the eyes.
11. For eye ointment – ​​age under 18 years.

Advice. When carrying out therapy, the patient must independently carefully monitor the effect of the drug. If, after a week from the start of use, no improvements are recorded, or, on the contrary, deterioration occurs, you should stop therapy until consulting a doctor.

Combination and analogues

Combination with other hydrocortisone medications is possible, but it must be agreed with your doctor. Especially if you are required to take the longest possible course, tell your doctor what other medications you are using. What you should pay attention to:

• diuretics (potassium-sparing) remove calcium from the body, in addition to hydrocortisone;
• aspirin prevents the stomach from protecting itself from its acidic environment, when hydrocortisone is added to it, ulcers can form on the mucous membrane;
• Patients with asthma using glucocorticosteroid inhalers must inform their doctor immediately.

There are many analogues of the drug. In addition to natural ones isolated from liver hormones, more and more synthetic analogues are used today. They have fewer side effects and are often more effective.

The following drugs are produced with an active substance similar to hydrocortisone:

• "Nycomed";
• "Hydrocort";
• "Courtade";
• "Highton";
• "Acortin".

Prednisolone-based substitutes are used as analogues. This is still the first degree of replacement. At the second level are medications with the active substance dexamethasone. Clobetasol, cloveit and others belong to the third line of substitutes.

The cheapest of all groups is pre-step hydrocortisone, the second-stage drug is descamethasone, and the third-stage drug is clobetasol. They are generic, so they remain the most budget-friendly option.

Video - How to use eye ointment

List of analogues based on other corticosteroids:

Contraindications

The drug based on hydrocortisone acetate is contraindicated:

• in case of hypersensitivity to the active substance or auxiliary components of the drug;
• in the presence of wound and ulcerative skin lesions;
• for skin diseases of a bacterial, viral or fungal nature;
• at cutaneous form tuberculosis or syphilitic lesions skin;
• for tumor changes in the skin, as well as rosacea, acne vulgaris, perioral dermatitis;
• during pregnancy and during breastfeeding.

An absolute contraindication is childhood up to two years.

The drug should be used with extreme caution and under the supervision of a doctor in the presence of:

• diabetes mellitus;
• systemic tuberculosis lesions.

Side effects

Sometimes there is hyperemia, swelling and itching in the areas of application. Long-term use of the drug can provoke the development of secondary infectious skin lesions, as well as atrophic changes in the skin and hypertrichosis. In addition, prolonged use of the ointment in combination with an occlusive dressing over large areas skin lesions, can cause the development of symptoms characteristic of hypercortisolism, which is due to the manifestation of the resorptive activity of hydrocortisone.

The occurrence of an acute overdose is unlikely, however, excessive or prolonged use of the drug may stimulate chronic overdose accompanied by symptoms of hypercortisolism. In case of overdose, symptomatic treatment is necessary. Manifestation toxic effect of a chronic nature requires gradual withdrawal of the drug.

Composition and pharmacokinetics

The active substance is represented by hydrocortisone acetate in an amount of 1.0 grams. The excipients included in the ointment are:

• methyl parahydroxybenzoate or nipagin in the amount of 0.08 grams;
• propyl parahydroxybenzoate or nipazole in the amount of 0.02 grams;
• Vaseline in the amount of 45 grams;
• stearic acid in the amount of 3 grams;
• anhydrous lanolin in the amount of 10 grams;
• pentaerythrityl dioleate or pentol in the amount of 5 grams;
• purified water up to 100 grams of ointment.

special instructions

When using the ointment in children in the facial area and using occlusive dressings, the total duration of treatment should not exceed fourteen days. For children aged two to twelve years, the drug is prescribed only under the supervision of a doctor.

If therapy using ointment for seven days does not lead to improvement, then the drug should be stopped and consult a doctor. medical institution.

Long-term treatment, as well as applying ointment to a large area skin surface, requires a diet and sodium restriction while increasing the amount of potassium. It is advisable to include a sufficient amount of protein in the diet.

Special attention attention should be paid to monitoring blood pressure, blood glucose levels, as well as blood clotting indicators, diuresis, the patient’s body weight and plasma cortisol concentrations. Warning infectious lesions facilitates the simultaneous administration of antibacterial and antifungal agents.

Shelf life: 3 years, at a temperature of 8–15 °C, out of the reach of children. Available without a prescription.

Excipients: methyl parahydroxybenzoate - 2 mg, white - up to 1 g.

3 g - aluminum tubes (1) - cardboard packs.

pharmachologic effect

Hydrocortisone is a glucocorticoid that has anti-inflammatory and antiallergic effects.

Reduces inflammatory cell infiltrates, reduces the migration of leukocytes, incl. lymphocytes to the area of ​​inflammation. Stabilizes cellular and subcellular, incl. lysosomal membranes and mast cell membranes. Reduces binding to receptors on the cell surface and inhibits the synthesis or release of cytokines (interleukins and interferons) from lymphocytes and macrophages. Reduces release arachidonic acid from phospholipids and the synthesis of its metabolites (prostaglandins, leukotrienes, thromboxane). Reduces the exudative reaction, helps reduce capillary permeability. Reduces the severity of the early immunological response. Has an antimetabolic effect and inhibits development connective tissue and scarring.

Pharmacokinetics

Suction and p distribution

Hydrocortisone does not penetrate the cornea well into intraocular fluid. Penetrates the epidermis and epithelium of the mucous membrane, can be slightly absorbed into the systemic circulation and have a systemic effect. In the blood, 80% binds to transcortin and 10% to .

Metabolism and excretion

Hydrocortisone is metabolized directly in the epidermis and epithelium of the mucous membrane; subsequently, a small amount of it, after absorption, enters the general bloodstream and is biotransformed in the liver. Hydrocortisone metabolites are excreted by the kidneys and through the intestines.

Indications

- allergic eye diseases (eyelids, blepharitis, conjunctivitis and keratoconjunctivitis);

- inflammatory diseases of the anterior part of the eye in the absence of a violation of the integrity of the corneal epithelium (blepharitis, conjunctivitis and keratoconjunctivitis);

- thermal and chemical eye(after complete epithelization of corneal defects).

Contraindications

- purulent, viral, tuberculous, fungal diseases eye;

- glaucoma;

- trachoma;

— vaccination period;

- violation of the integrity of the membranes of the eye;

— age up to 18 years;

— increased sensitivity to the components of the drug.

Dosage

Side effects

Maybe: allergic reactions, burning, scleral injection, short-term blurred vision.

At long-term use more than 10 days may be observed:

Increased intraocular pressure with possible subsequent development of steroid-induced glaucoma with damage optic nerve and impairment of visual fields (therefore, when using drugs containing GCS for more than 10 days, intraocular pressure should be regularly measured);

Formation of posterior subcapsular cataract;

Slowing down the wound healing process (in diseases that cause thinning of the cornea, its perforation is possible).

Secondary bacterial infection may arise as a consequence of suppression defensive reaction the patient's body. For acute purulent diseases eyes glucocorticoids can mask or intensify an existing infectious process.

Fungal infections of the cornea tend to occur especially frequently with long-term use of glucocorticoids. The appearance of non-healing ulcers on the cornea after long-term treatment glucocorticoids may indicate the development of fungal invasion.

Overdose

Overdose is extremely rare.

Symptoms: local side effects may occur.

When the drug is discontinued, the overdose phenomena disappear on their own.

Drug interactions

With long-term use, due to possible resorption of the drug into the general bloodstream, hydrocortisone reduces the effectiveness of insulin, oral hypoglycemic drugs, antihypertensive drugs, reduces the concentration of salicylates in the blood, reduces the concentration of praziquantel in the blood serum.

Increase the risk of developing side effects of hydrocortisone androgens, estrogens, oral contraceptives, anabolic steroid(hirsutism, acne); antipsychotics, carbutamide, azathioprine (cataracts); anticholinergics, antihistamines, tricyclic antidepressants, nitrates (glaucoma); diuretics (hypokalemia).

When used with cardiac glycosides, the development of glycoside intoxication is possible.

Simultaneous use of lead and silver with preparations leads to mutual inactivation.

special instructions

When using eye drops the time interval between their installation and application of the ointment is at least 15 minutes.

When used for more than 10 days and if there is a history of open- or closed-angle glaucoma, monitoring of intraocular pressure is necessary.

Impact on the ability to drive vehicles and operate machinery

If the patient's vision is temporarily reduced after using the drug, it is not recommended to drive a car or engage in other activities that require increased attention until it is restored.

Pregnancy and lactation

Studies of the safety and effectiveness of hydrocortisone in pregnant and lactating women have not been conducted. There is no precise data on penetration into breast milk corticosteroids for local application. However, the risk cannot be completely eliminated. The use of hydrocortisone in pregnant and lactating women is allowed only as prescribed by the attending physician, when the expected healing effect for the mother exceeds the potential risk to the fetus or child. The duration of use should not exceed 7-10 days.

Use in childhood

Contraindicated in people under 18 years of age.

Conditions for dispensing from pharmacies

The drug is available without a prescription.

RUS-OPH-CRN-LUX-06-2018-1194

Storage conditions and periods

The drug should be stored out of the reach of children at a temperature not exceeding 25°C. Shelf life - 2 years. Do not use after expiration date.

Shelf life after opening the tube is 4 weeks.

Synonyms

Interchangeable drugs included in the same pharmaceutical group.

• - Lyophilisate for the preparation of solution for intravenous and intramuscular injection 100 mg; 500 mg
• - Suspension for intramuscular and intraarticular administration 25 mg/ml
• - Lyophilisate for the preparation of solution for intravenous and intramuscular administration 100 mg

Analogs

These are drugs belonging to the same pharmaceutical group, which contain different active substances (INN), differ in name, but are used to treat the same diseases.

• - Suspension for injection 40 mg/ml
• - Tablets 4 mg
• - Pills
• - Solution for intravenous and intramuscular administration
• - Tablets 4 mg
• - Lyophilisate for the preparation of solution for intravenous and intramuscular administration 250 mg
• - Tablets 4 mg; 16mg;
• - Pills
• - Tablets 5 mg
• - Suspension for injection 25 mg/ml
• - Solution for intravenous and intramuscular administration 30 mg/ml
• - Solution for intravenous and intramuscular administration 30 mg/ml
• - Solution for intravenous and intramuscular administration 5 mg
• - Tablets 5 mg
• - Ointment for external use 0.5%
• - Suppositories 100 mg
• - Lyophilisate for preparing a solution for intravenous and intramuscular administration
• - Suspension for injection 7 mg/ml

Indications for use of the drug Hydrocortisone

Inflammatory and allergic skin diseases of non-microbial etiology:

Allergic and contact dermatitis;

Neurodermatitis;

Psoriasis.

Release form of the drug Hydrocortisone

powder substance; two-layer polyethylene bag (bag) 1 kg metal drum 1;

Powder substance; two-layer polyethylene bag (bag) 5 kg metal drum 1;

Powder substance; two-layer polyethylene bag (bag) 10 kg metal drum 1;

Powder substance; two-layer polyethylene bag (bag) 15 kg metal drum 1;

Powder substance; two-layer polyethylene bag (bag) 20 kg metal drum 1;

Powder substance; two-layer polyethylene bag (bag) 25 kg metal drum 1;

Powder substance; bag (pouch) two-layer polyethylene 30 kg metal drum 1;

Powder substance; bag (pouch) two-layer polyethylene 50 kg metal drum 1;

Pharmacodynamics of the drug Hydrocortisone

GCS. Suppresses the functions of leukocytes and tissue macrophages. Limits the migration of leukocytes to the area of ​​inflammation. It disrupts the ability of macrophages to phagocytose, as well as to form interleukin-1. Helps stabilize lysosomal membranes, thereby reducing the concentration of proteolytic enzymes in the area of ​​inflammation. Reduces capillary permeability due to the release of histamine. Suppresses fibroblast activity and collagen formation.

Inhibits the activity of phospholipase A2, which leads to suppression of the synthesis of prostaglandins and leukotrienes. Suppresses the release of COX (mainly COX-2), which also helps to reduce the production of prostaglandins.

Reduces the number of circulating lymphocytes (T- and B-cells), monocytes, eosinophils and basophils due to their movement from the vascular bed to lymphoid tissue; suppresses the formation of antibodies.

Hydrocortisone suppresses the release of ACTH and β-lipotropin by the pituitary gland, but does not reduce the level of circulating β-endorphin. Inhibits the secretion of TSH and FSH.

When directly applied to blood vessels, it has a vasoconstrictor effect.

Hydrocortisone has a pronounced dose-dependent effect on the metabolism of carbohydrates, proteins and fats. Stimulates gluconeogenesis, promotes the uptake of amino acids by the liver and kidneys and increases the activity of gluconeogenesis enzymes. In the liver, hydrocortisone enhances the deposition of glycogen, stimulating the activity of glycogen synthetase and the synthesis of glucose from protein metabolism products. An increase in blood glucose levels activates the release of insulin.

Hydrocortisone inhibits the uptake of glucose into fat cells, which leads to activation of lipolysis. However, due to increased insulin secretion, lipogenesis is stimulated, which leads to fat accumulation.

It has a catabolic effect in lymphoid and connective tissue, muscles, adipose tissue, skin, bone tissue. To a lesser extent than mineralocorticoids, it affects the processes of water-electrolyte metabolism: it promotes the excretion of potassium and calcium ions, the retention of sodium and water ions in the body. Osteoporosis and Itsenko-Cushing syndrome are the main factors limiting long-term GCS therapy. As a result of the catabolic effect, growth suppression in children is possible.

IN high doses hydrocortisone can increase the excitability of brain tissue and helps lower the seizure threshold. Stimulates excess production of hydrochloric acid and pepsin in the stomach, which contributes to the development of peptic ulcers.

When used systemically, the therapeutic activity of hydrocortisone is due to its anti-inflammatory, antiallergic, immunosuppressive and antiproliferative effects.

When applied externally and locally, the therapeutic activity of hydrocortisone is due to its anti-inflammatory, antiallergic and antiexudative (due to the vasoconstrictor effect) effect.

Its anti-inflammatory activity is 4 times weaker than prednisolone, and its mineralocorticoid activity is superior to other corticosteroids.

Pharmacokinetics of the drug Hydrocortisone

Plasma protein binding - 40-90%. Metabolized primarily in the liver. T1/2 - 80-120 min. It is excreted by the kidneys mainly in the form of metabolites.

Use of the drug Hydrocortisone during pregnancy

The use of corticosteroids during pregnancy is possible if the expected effect of therapy outweighs the potential risk to the fetus (adequate and strictly controlled safety studies have not been conducted). Women of childbearing age should be warned of the potential risk to the fetus (corticosteroids cross the placenta). It is necessary to carefully monitor newborns whose mothers received corticosteroids during pregnancy (adrenal insufficiency may develop in the fetus and newborn). Should not be used frequently large doses, over a long period of time.

Breastfeeding women are advised to stop either breast-feeding, or the use of drugs, especially in high doses (corticosteroids pass into breast milk and can suppress growth, the production of endogenous corticosteroids and cause unwanted effects in a newborn). When using external forms of hydrocortisone, do not apply the drug to the skin of the breast.

Contraindications to the use of the drug Hydrocortisone

Hypersensitivity (for short-term systemic use for health reasons is the only contraindication).

For intra-articular and periarticular use: previous arthroplasty, conditions after intestinal anastomosis, pregnancy, breastfeeding.

When applied to the skin: bacterial, viral and fungal skin diseases, skin manifestations syphilis, skin tuberculosis, skin tumors, violation of the integrity of the skin (ulcers, wounds), rosacea, acne vulgaris, perioral dermatitis, post-vaccination period, pregnancy, breastfeeding.

For eye ointment: purulent, viral, tuberculous and fungal eye diseases, trachoma, primary glaucoma, violation of the integrity of the corneal epithelium; vaccination period, pregnancy, breastfeeding.

Side effects of the drug Hydrocortisone

The incidence and severity of side effects depend on the method, duration of use, dose used and the ability to comply circadian rhythm prescription of drugs.

Systemic effects

Metabolic: Na+ and fluid retention in the body, hypokalemia, hypokalemic alkalosis, negative nitrogen balance, hyperglycemia, glucosuria, weight gain.

From the outside endocrine system: secondary adrenal and hypothalamic-pituitary insufficiency (especially during stressful situations such as illness, injury, surgery); Cushing's syndrome; growth suppression in children; violations menstrual cycle; decreased tolerance to carbohydrates; manifestation of latent diabetes mellitus, increased need for insulin or oral antidiabetic drugs in patients with diabetes mellitus.

From the outside of cardio-vascular system and blood (hematopoiesis, hemostasis): increased blood pressure, development (in predisposed patients) or increased severity of chronic heart failure, hypercoagulation, thromboembolism, ECG changes characteristic of hypokalemia; in patients with acute and subacute myocardial infarction - the spread of necrosis, slowing down the formation of scar tissue with possible rupture of the heart muscle, obliterating endarteritis, hematological changes.

From the musculoskeletal system: muscle weakness, steroid myopathy, loss muscle mass, osteoporosis, compression fracture spine, aseptic necrosis femoral head and humerus, pathological fractures long tubular bones, tendon ruptures, primarily Achilles.

From the gastrointestinal tract: steroid ulcer with possible perforation and bleeding, pancreatitis, flatulence, ulcerative esophagitis, indigestion, nausea, vomiting, increased/decreased appetite; after treatment with corticosteroids, an increase in the levels of ALT, AST and alkaline phosphatase in the blood serum was observed; Usually these changes are minor and are not associated with any clinical syndromes and are reversible after cessation of treatment.

From the skin: atrophic stripes, acne, delayed wound healing, thinning of the skin, petechiae and ecchymosis, erythema, increased sweating.

From the outside nervous system and sensory organs: convulsions, increased intracranial pressure with optic nerve congestion syndrome (pseudotumor cerebri - more often in children, usually after too rapid dose reduction, symptoms - headache, deterioration of visual acuity or double vision); vertigo, headache, malaise, mental disorders; formation of posterior subcapsular cataract, increased intraocular pressure, glaucoma; steroid exophthalmos.

Allergic reactions: generalized ( allergic dermatitis, urticaria, anaphylactic shock) and locals.

Other: masking symptoms infectious diseases, withdrawal syndrome; reactions at the injection site - burning, numbness, pain, paresthesia and infection, hyper- or hypopigmentation, scarring; skin atrophy and subcutaneous tissue, sterile abscess.

When applied to the skin: irritation, burning, dry skin, local allergic reactions, incl. hyperemia, swelling, itching; with long-term use, especially under impermeable dressings or on large areas of skin - systemic side effects; steroid acne, purpura, telangiectasia; development of hypercortisolism as a manifestation of a resorptive effect (in these cases the drug is discontinued); with long-term use, it is also possible to develop secondary infectious skin lesions, atrophic changes, and hypertrichosis.

Eye ointment: allergic reactions, burning, scleral injection, increased intraocular pressure, exophthalmos; if the integrity of the corneal epithelium is violated, delayed healing and perforation of the cornea are possible; with long-term use, the development of steroid glaucoma is possible; frequent repeated courses of treatment can lead to the formation of posterior subcapsular cataracts; addition of a secondary infection.

Interactions of the drug Hydrocortisone with other drugs

With simultaneous use, hydrocortisone increases the toxicity of cardiac glycosides (due to the resulting hypokalemia, the risk of developing arrhythmias increases); With acetylsalicylic acid- accelerates its elimination and reduces its concentration in the blood plasma (when hydrocortisone is discontinued, the concentration of salicylates in the blood increases and the risk of side effects increases); with paracetamol - increased risk of developing the hepatotoxic effect of paracetamol (induction of liver enzymes and the formation of a toxic metabolite of paracetamol); with cyclosporine - increased side effects of hydrocortisone due to inhibition of its metabolism; with ketoconazole - increased side effects of hydrocortisone due to a decrease in its clearance.

Hydrocortisone reduces the effectiveness of hypoglycemic agents; enhances the effect indirect anticoagulants coumarin derivatives.

Hydrocortisone reduces the effect of vitamin D on the absorption of calcium ions in the intestinal lumen. Ergocalciferol and parathyroid hormone prevent the development of osteopathy caused by GCS.

Hydrocortisone increases the metabolism of isoniazid, mexiletine (especially in “fast acetylators”), which leads to a decrease in their plasma concentrations; increases (with long-term therapy) the content folic acid; reduces the concentration of praziquantel in the blood.

Hydrocortisone in high doses reduces the effect of somatropin.

Hypokalemia caused by GCS can increase the severity and duration of muscle blockade due to muscle relaxants.

Antacids reduce the absorption of corticosteroids.

When used simultaneously with GCS, thiazide diuretics, carbonic anhydrase inhibitors, other GCS, amphotericin B increase the risk of hypokalemia, drugs containing sodium ions increase the risk of edema and increased blood pressure.

NSAIDs and ethanol increase the risk of developing ulceration of the gastrointestinal mucosa and bleeding; in combination with NSAIDs for the treatment of arthritis, it is possible to reduce the dose of GCS due to summation therapeutic effect. Indomethacin, displacing GCS from its connection with albumin, increases the risk of developing its side effects.

Amphotericin B and carbonic anhydrase inhibitors increase the risk of osteoporosis.

The therapeutic effect of GCS is reduced under the influence of inducers of microsomal liver enzymes (including phenytoin, barbiturates, ephedrine, theophylline, rifampicin) due to an increase in the rate of metabolism of these substances.

Inhibitors of adrenal function (including mitotane) may require increasing the dose of GCS.

The clearance of GCS increases against the background of thyroid hormone preparations.

Immunosuppressants increase the risk of developing infections and lymphoma or other lymphoproliferative disorders associated with Epstein-Barr virus.

Estrogens (including oral estrogen-containing contraceptives) reduce the clearance of GCS, prolong T1/2 and their therapeutic and toxic effects. The appearance of hirsutism and acne is facilitated by the simultaneous use of other steroid hormonal drugs - androgens, estrogens, anabolic steroids, oral contraceptives.

Tricyclic antidepressants may increase the severity of depression caused by taking corticosteroids (not indicated for the treatment of these side effects).

The risk of developing cataracts increases when used in combination with other corticosteroids, antipsychotics(neuroleptics), carbutamide and azathioprine. Simultaneous administration with m-anticholinergic blockers, as well as with drugs that have an m-anticholinergic effect (including antihistamines, tricyclic antidepressants), with nitrates increases intraocular pressure.

With the simultaneous use of GCS with live antiviral vaccines and against the background of other types of immunization, the risk of viral activation and the development of infections increases.

Precautions when taking Hydrocortisone

During the treatment period, vaccination is not recommended (due to the immunosuppressive effect of hydrocortisone). Intra-articular administration should be carried out under conditions of strict asepsis and antisepsis and only after excluding an infectious process in the joint. IM injection is made as deep as possible into the gluteal muscle to prevent the development muscle atrophy. During long-term therapy, monitoring of potassium levels in the blood (and its administration) and regular ECG studies are recommended. To prevent the development of secondary hypocortisolism caused by discontinuation of treatment, the dose should be reduced gradually. Glucocorticoids can mask some manifestations of the infectious process; new infections may occur due to a decrease in resistance. When treated with corticosteroids or in combination with other drugs that suppress cell, humoral immunity or neutrophil function may be manifested by various viral, bacterial, fungal, protozoal infections and helminthic infestations, which previously occurred latently. The risk of infection and its more severe course increases in proportion to the increase in the dose of the drug.

Sudden cessation of treatment may cause acute failure adrenal cortex; with long-term use, the drug should not be suddenly discontinued; the dose should be reduced gradually. In case of sudden cancellation after long-term use withdrawal syndrome may develop, manifested by increased body temperature, myalgia and arthralgia, and malaise. These symptoms can appear even in cases where there is no adrenal insufficiency.

Eye ointment. If, after application of the eye ointment, clarity of vision is temporarily lost, it is not recommended to drive a car or work with objects immediately after application. complex mechanisms. During treatment you should refrain from wearing contact lenses. With excessive and frequent use eye ointment during the day or using it in children may have a systemic effect of hydrocortisone (if the drug is discontinued, the symptoms go away on their own). When using other drugs in the form of eye drops, the time interval between their application and the use of the ointment should be at least 15 minutes. When using the ointment for more than 2 weeks and having a history of open- or closed-angle glaucoma, monitoring of intraocular pressure is necessary. Children have more high probability development of systemic effects of hydrocortisone than in adults. In this regard, ointment should be used in children, if possible. short courses(5–7 days).

Forms for external use. For children under 12 years of age, the drug is prescribed only under strict medical supervision. When using the ointment in children over 1 year of age, it should be limited total duration treatment and exclude conditions leading to increased drug resorption (warming, fixing and occlusive dressings). Avoid contact of the ointment with the eyes. The drug should be used with extreme caution on the skin of the face due to the possibility of side effects (telangiectasia, atrophy, dermatitis perioralis), even after short-term use. To prevent infectious skin lesions, hydrocortisone ointment is recommended to be prescribed in combination with antibacterial and antifungal agents.

Special instructions when taking the drug Hydrocortisone

Use with caution for 8 weeks before and 2 weeks after vaccination, for lymphadenitis after BCG vaccinations, in immunodeficiency conditions (including AIDS or HIV infection).

Use with caution for gastrointestinal diseases: peptic ulcer stomach and duodenum, esophagitis, gastritis, acute or latent peptic ulcer, recently created intestinal anastomosis, nonspecific ulcerative colitis with the threat of perforation or abscess formation, diverticulitis.

Use with caution for diseases of the cardiovascular system, incl. after recently suffered a heart attack myocardium (in patients with acute and subacute myocardial infarction, the necrosis focus may spread, the formation of scar tissue may slow down and, as a result, the heart muscle will rupture), with decompensated chronic heart failure, arterial hypertension, hyperlipidemia), with endocrine diseases - diabetes mellitus(including impaired carbohydrate tolerance), thyrotoxicosis, hypothyroidism, Itsenko-Cushing's disease, with severe chronic renal and/or liver failure, nephrourolithiasis, with hypoalbuminemia and conditions predisposing to its occurrence, with systemic osteoporosis, myasthenia gravis, acute psychosis, obesity (III-IV degree), poliomyelitis (except for the form of bulbar encephalitis), open- and closed-angle glaucoma, pregnancy, lactation.

If intra-articular administration is necessary, use with caution in patients with general serious condition, ineffectiveness (or short duration) of the action of 2 previous administrations (taking into account the individual properties of the GCS used).

If hydrocortisone is insufficiently effective within 48-72 hours and longer therapy is necessary, it is advisable to replace hydrocortisone with another glucocorticoid drug, not causing delays sodium in the body. During treatment with hydrocortisone, it is recommended to prescribe a sodium-restricted diet and increased content potassium

Relative adrenal insufficiency caused by hydrocortisone may persist for several months after its discontinuation. Taking this into account, when stressful situations arising during the specified period, hormone therapy resumed with the simultaneous administration of salts and/or mineralocorticoids.

In patients with active form tuberculosis, hydrocortisone should be used in combination with appropriate anti-tuberculosis therapy. In the case of a latent form of tuberculosis or during the period of change in tuberculin tests, the patient’s condition should be carefully monitored, and, if necessary, chemoprophylaxis should be carried out.

Storage conditions for the drug Hydrocortisone

List B: In a dry place, protected from light, at a temperature not exceeding 25 °C.

Shelf life of the drug Hydrocortisone

The drug Hydrocortisone belongs to the ATX classification:

D Dermatotropic drugs

D07 Corticosteroids for the treatment of skin diseases for external use

D07A Corticosteroids

D07AA Low-active corticosteroids (group I)

Inflammatory eye diseases can occur due to various reasons. Infections, injuries, allergies have negative action on the mucous membrane, choroid, epithelial tissue. For each pathological case your medicine is selected. A wide selection of ophthalmic drugs allows you to take into account the cause of the disease, the state of health of the person, and the price of the drug when choosing a prescription.

What is Hydrocortisone

Hydrocortisone is a glucocorticosteroid produced by the adrenal glands. In the human body, cortisol regulates carbohydrate metabolism, ensuring the conservation of energy resources.

In ophthalmology, hydrocortisone acetate or sodium hemisuccinate is used. Basics active substance Hydrocortisone eye ointment – ​​Hydrocortisone acetate. The synthetic steroid is highly soluble in liquids and has qualities similar to the natural hormone.

Properties of eye ointment:

• anti-inflammatory. But what there are and which of them are the best, the information from the link will help you understand;
• antiallergic;
• antiexudative.

Peculiarity medicinal product explained by its ability to penetrate the cell membrane and suppress the source of inflammation. As a result of the action of Hydrocortisone, the release of exudate (fluid produced by cells during inflammation) is reduced, cell destruction and the proliferation of connective tissue are prevented.

For pregnant women, the drug may pose a threat to the health of the unborn child, as it passes through the placenta and can cause underdevelopment of the adrenal glands.

The use of an ophthalmic agent should be carried out under medical supervision as a last resort.

During lactation, corticosteroids pass into breast milk and may suppress adrenal function.

With prolonged use of eye ointment, manifestations are possible: systemic violations, characteristic for intravenous, intramuscular administration:

• water retention;
• hypernatremia (high sodium content);
• hypokalemia (decreased potassium levels);
• increased capillary permeability;
• effect on the liver (increased glycogen levels).

Control required:

• behind intraocular pressure with open-angle and closed-angle glaucoma. But the information on the link will help you understand how this happens;
• content of potassium and sodium in the blood;
• condition of the heart muscle.

Shift in water-salt metabolism– the cause of signs of hypertension (high blood pressure).

A 30 mg dose of Hydrocortisone (as a result of accumulation) leads to the development of Itsenko-Cushing syndrome (hypercortinism). Overdose symptoms hormonal drug are violations fat metabolism, destruction of muscles and bones, susceptibility to infection.

During therapy with eye ointment, the function of the adrenal glands and pituitary gland is inhibited. If you stop taking it abruptly, withdrawal syndrome occurs (deterioration of the condition compared to the start of treatment).

Cortisol has the property of reducing the number of white blood cells in the blood. The body's ability to respond to infections and allergies decreases, and tissue healing slows down.

Cortisol is a stress hormone that mobilizes the body's defenses. Antagonist hormones suppress the effect of Cortisol: Beclomethasone, Ketocanazole.

The level of Cortisol in the blood is not affected by gender and age. The exception is pregnant women: in the last months of pregnancy, the percentage of the hormone is 2 to 5 times higher than normal.

Children are more susceptible to the effects of Cortisol due to the risk of developing a secondary infection, helminthic infection. During treatment, vaccination is not recommended due to reduced immunity.

Useful information on the topic! Find out what it is and what treatments are available.

Instructions for use

The ointment is produced in the form of an aluminum tube with a volume of 10 g as an external and local remedy.

Composition: 5 mg Hydrocortisone acetate per 1 g ointment (0.5%).

Appointed:

• with inflammation of the eyelids. But how to properly use eye ointment against inflammation for children will help you understand this
• irises (iritis);
• iris and vascular tissue of the ciliary muscle (iridocyclitis);
• cornea. But how recurrent erosion of the cornea of ​​the eye is treated and by what means is indicated
• allergic conjunctivitis;
• for barley and dermatitis;
• after injuries and chemical burns (after full recovery eye tissues);
• in the postoperative period.

Contraindications for use:

• infectious nature of inflammation (bacterial, viral, fungal);
• initial stage of glaucoma;
• tuberculosis;
• violation of the integrity of the corneal layer. But what are the symptoms and treatment of inflammation of the cornea of ​​the eye, this information will help you understand;
• pregnancy;
• lactation period;
• age up to 2 years;
• during vaccination;
• wearing contact lenses;
• hypertension.

Possible visual disturbances:

• burning in the eyes;
• redness of the sclera. But which ones should be used in the eyes for redness and which of them are the best.
• increased intraocular pressure;
• glaucoma (with a long course of treatment). But the information from the article will help you understand how this happens.
• cataract (with frequent use);
• corneal ulceration. But what are the diseases of the cornea in humans, you can find out from

The video shows the rules for using the product:

• possibility of arrhythmia (when combined with cardiac medications);
• blocking the action of Acetylsalicylic acid;
• toxic effect on the liver (simultaneous use with Paracetamol);
• gastric bleeding (with non-steroidal anti-inflammatory drugs).

After applying the ointment, it takes time to restore visual acuity when driving.

Prices and analogues

In terms of release form and action, an analogue of Hydrocortisone is Maxidex eye ointment with the active substance Dexamethasone. The combined anti-inflammatory drug Dexa-gentamicin (antibacterial, antiallergic) is available in the form of an ointment.

In other cases, analogs are steroid eye drops Dexamethasone, Prednisolone, Maxidex.

Price of eye hormonal agents:

In terms of efficiency and price, Hydrocortisone is the cheapest ophthalmic hormonal drug.