Hydrocortisone for intravenous administration. The use of hydrocortisone. Terms of dispensing from pharmacies

In severe forms of allergic diseases, accompanied by an active inflammatory process, doctors prescribe local and systemic glucocorticosteroids. Good effect in the treatment of dermatitis, neurodermatitis, eczema gives the drug Hydrocortisone. The use of a potent agent for allergies suppresses negative processes on the skin and inside the body.

What forms of corticosteroid are prescribed for diseases of an allergic nature? What is the course of using Hydrocortisone Ointment? Can the medicine be used in childhood? Answers in the article.

Composition and action

The active ingredient of an effective hormonal drug is hydrocortisone. The active ingredient exhibits antiallergic, anti-inflammatory effect.

The active substance suppresses the functions of tissue macrophages and leukocytes, stabilizes lysosomal membranes, and suppresses the release of inflammatory mediators. Under the influence of the active substance, the synthesis of Pg, the metabolism of arachidonic acid, decreases. Vascular permeability after the release of histamine returns to normal values.

The drug reduces the size of inflammatory infiltrates, prevents the migration of lymphocytes and leukocytes to the inflammation zone, suppresses the production of antibodies to stimuli in case of hypersensitivity of the body. Subject to one-time and daily allowance potent remedy does not disrupt the production of hormones.

Release form

As part of complex therapy for allergic diseases, certain types of corticosteroid are prescribed:

Hydrocortisone ointment. The drug for external use is supplied to pharmacies in tubes (from 5 to 30 g). An ointment of 1% concentration is used to treat inflamed areas on the body. For application on the face, 1% cream (Nycomed) is suitable.
Hydrocortisone eye ointment. The drug is used for severe form allergic conjunctivitis. The content of hydrocortisone acetate is 25 or 10 mg in 1 g of ointment for eye treatment. The medicine is packaged in tubes of 3, 5 or 10 g.
Hydrocortisone ampoules. The suspension contains hydrocortisone acetate (in 1 ml of the product - 25 mg of the active ingredient). The preparation in ampoules is suitable for intramuscular and intravenous administration.
Hydrocortisone substance powder in vials. This form of the drug is also used to relieve acute symptoms of allergy. Lyophilisate for solution preparation - 100 and 500 mg; for dilution, the package contains alcohol in ampoules. Hydrocortisone injections are prescribed for intramuscular and intravenous patients of different ages... The active ingredient is sodium hydrocortisone hemisuccinate.

Indications for use

diffuse;
psoriasis;
intoxication after stinging a wasp, hornet or bee;

Contraindications

It is forbidden to process the skin in the following cases:

intolerance to the main substance or additional components;
ulcers, wounds, microcracks, scratches on the face and body, damage to the eye epithelium;
fungal, bacterial or viral infections skin and eyes;
the presence of rosacea and acne vulgaris;
a child or adult has recently been vaccinated;
dermatitis develops in the area around the mouth.

Caution is needed in the following cases:

severe lesions with tuberculosis;
period of breastfeeding;
pregnancy, especially the first trimester;
diabetes.

Limitations for systemic use:

osteoporosis;
immune diseases: HIV, AIDS;
peptic ulcers;
severe forms of hypertension;
pregnancy and lactation;
hypersensitivity to hydrocortisone;
severe renal failure;
the patient underwent arthroplasty;
Itsenko-Cushing's syndrome;
herpes fever;
mycoses;
diverticulitis;
myasthenia gravis;
an operation was recently performed;
problems with blood vessels, a tendency to form blood clots.

Instructions for use

Suspension for intramuscular and intravenous administration is dispensed only by prescription, formulations for external use are over-the-counter forms of the hormonal agent.

During therapy, blood pressure, cortisol and blood glucose levels are monitored. Need a sodium-restricted diet and increased content potassium. It is important to monitor urination, patient weight. If any adverse reactions occur, discontinue therapy and consult a doctor.

Important! It is forbidden to use Hydrocortisone for longer than the period prescribed by the doctor: if the rule is violated, it is possible side effects, malfunctions in the body.

Hydrocortisone ointment

Application features:

treatment of the affected areas two to three times a day. A thin layer is required, application only to the affected areas;
the optimal duration of treatment is from 6 to 14 days, in the case of a persistent course of the disease, the doctor can extend the course up to 20 days;
during therapy, it is important to receive increased amount protein, limit sodium intake;
children do not use occlusive dressings, up to two years old, the application of a hormonal agent is prohibited, the maximum duration of treatment is 14 days.

Corticosteroid ampoules

Application features:

at acute form for allergic diseases, intravenous administration of a hormonal agent is prescribed. Use ampoules with suspension or lyophilisate for solution preparation;
the initial dosage depends on the severity of the disease, the volume is from 100 to 500 ml. The introduction of the drug is carried out at the discretion of the attending physician: every 2, 4 or 6 hours, course - no more than three days;
when the condition is stabilized, the single and daily dose is immediately reduced;
if it is necessary to continue anti-inflammatory therapy, doctors select substitutes that do not retain sodium in the body;
in childhood, the dosage is lower - 25 mg.

Side effects

When applied topically:

hyperemia;
depigmentation of the epidermis;
irritation, burning in the area of application of the hormonal agent;
acne-like rashes;
swelling;
dryness, peeling of the skin;
secondary infectious lesions of the treated areas;
stretch marks on the body;
increased hair growth in the area of application of ointment and cream;
dermatoconjunctivitis;
perforation of the cornea in the case of scleral treatment in violation of the integrity;
eczema of the eyelids;
cataract;
with prolonged use - secondary steroid glaucoma;
redness of the conjunctiva;
atrophy of the treated areas.

For systemic use:

convulsions;
decreased immunity;
increased excretion of potassium;
pathological fractures, the development of osteoporosis;
fluid and sodium retention;
steroid myopathy;
disruptions in the menstrual cycle;
ulcerative lesions of mucous membranes in organs digestive tract;
growth retardation in childhood;
more frequent heart rate;
high rates intracranial pressure;
nervous disorders;
congestive heart failure;
hypokalemic alkalosis.

Overdose

Violation of the rules for use, more frequent skin treatment or the introduction of a drug above the specified rate causes side reactions. Undesirable effects occur when extending the course, processing large areas of the face and body. In most cases, problems appear with the systemic use of a hormonal agent.

Negative reactions in case of overdose:

hyperglycemia;
arterial hypertension;
water and sodium retention;
exacerbation of signs of chronic pathologies;
nausea, vomiting;
oppression of the adrenal cortex;
development of Itsenko-Cushing's syndrome.

Storage rules and cost

It is important to comply with the conditions:

temperature regime for ointment - from +5 to +15 degrees, for ampoules - up to +25 degrees;
store the hormonal agent in a dry room, protect ampoules from sunlight;
shelf life of the drug Hydrocortisone: for external use - 36 months, ampoules and vials - 5 years.

The hormonal agent based on hydrocortisone is available in pharmacies at an affordable price:

eye ointment - from 40 to 130 rubles (different manufacturers);
ointment for external use, 10 and 20 g - 30 and 65 rubles, respectively;
the price of Hydrocortisone in suspension for injection No. 10 is 150 rubles.

Go to the address and see the selection effective methods treatment of allergic dermatitis on the face in children and adults.

Analogs

Other types of drugs with hydrocortisone are selected by the attending physician. It is forbidden to independently acquire hormonal formulations for systemic and topical application: it is important to take into account contraindications, the selection of the optimal dosage on an individual basis.

Analogs:

solution for injections Solpocort N;
powder for injection Solu-Cortef;
Cortef tablets.

Hydrocortisone ointments:

Laticort.
Hyoxysone.
Lokoid Lipokrem.
Courtade.

According to the instructions, Hydrocortisone is used in several ways. Treating most inflammations requires the use of hormonal agents... This medicine is actively used for non-infectious pathologies.

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Instructions for use

The dosage form of the drug has a wide range application. Treatment methods directly depend on the diagnosis made by the doctor.

Injections are given by the intravenous method (injections or droppers). Sometimes the drug is injected intramuscularly, near the joints.

For acute or neglected forms ailment injection solution is injected into the patient intravenously with an increased dosage.

According to the instructions, Hydrocortisone in ampoules is used in the treatment of purulent processes in the sinuses. In the treatment of bronchitis, laryngotracheitis, asthma. Inhalation is performed with Hydrocortisone. In addition, the medication is widely used in the form of a compress for joint pains, bruises, sprains.

Taking the drug Hydrocortisone is permissible only after examination by a specialist!

Main indications for use

Hydrocortisone is a corticosteroid medication that can treat the following ailments:

synovitis (inflammation and accumulation of fluid in the joints);
osteoarthritis (damage to cartilage tissue);
arthritis and osteoarthritis;
epicondylitis (degeneration of tissue in the elbow joint);
bursitis (inflammation of the mucous membrane);
tenosynovitis (inflammation of the synovial film);
hypoplasia of the adrenal glands;
shock conditions;
necrosis;
orthostatic collapse;
short-term loss of consciousness;
stroke (hemorrhagic);
liver disease;
bronchial asthma;
bleeding;
myxedema coma;
thyroiditis (thyroid gland);
hepatitis.

In addition, Hydrocortisone treats post-transfusion complications, skin, non-infectious diseases, anemia.

The initial dosage is 100 ml, the volume of fluid administration is gradually increased to 500 ml. The course of treatment is not more than three days, the injection is administered 3-4 times a day, depending on the severity and form of the disease.

Therapy for children is carried out taking into account the age and weight barrier. The approximate daily dose is 25 mg.

Medicinal properties for the body

Effective corticosteroids are used for inflammatory processes in the body. They are the ones who are able to heal severe forms diseases.

TO medicinal properties the drug can be attributed:

Quick disposal of allergic symptoms... This action is due to active ingredient acetate, which is part of Hydrocortisone.
Suppression of the functioning of leukocytes and macrophages.
Stabilization of the membrane, which leads to the release of histamine components.
Suppression of the activity of the main cellular junctions and the formation of collagen.
Decrease in the production of antibodies.

In addition, Hydrocortisone has: antitoxic, antipruritic, anti-shock, immunosuppressive, anti-allergenic and stabilizing medicinal properties.

Contraindications and side effects

Before starting treatment with Hydrocortisone in ampoules, you must carefully read the contraindications indicated in the instructions.

chronic hypertension;
extensive lesions of the central nervous system;
diabetes mellitus;
stomach ulcer;
chronic epilepsy;
AIDS;
malignant tumors;
hypersensitivity to the constituent elements of the drug;

Also, the use of a medicinal, liquid agent is not recommended for patients with skin disease, which are accompanied by extensive ulcers, acne, open wounds. With these ailments, it is better to use another medication, which is softer and more imperceptible to adapt by the body and directly affects the lesions.

To achieve the maximum effect of treatment with hydrocortisone ampoules, specialists prescribe complex therapy, in which there is an opportunity side effects.

The patient can observe:

swelling inherent in the limbs;
weight gain;
convulsions;
violation of menstruation;
visual distraction;
mental disorder;
insomnia.

There is a possibility of skin abnormalities, which can manifest as acne, eczema, irritation. If these side symptoms, you should stop using Hydrocortisone Ampoules.

In this situation, it is better to use Hydrocortisone ointment. It is safer and softer for the affected organism. For greater confidence, visit a medical institution, where the doctor will conduct an appropriate examination and prescribe the correct therapy.

Inhalation use

According to the instructions for use, Hydrocortisone in ampoules for inhalation is very effective. The presented drug is able to have a therapeutic effect on the foci of inflammation. The effectiveness of the therapy is very high.

Just a few procedures and the patient's condition improves significantly, pain symptoms in the form of shortness of breath, swelling disappear, while the inflammatory process becomes softer.

At acute stage Inhalation bronchitis using liquid hydrocortisone is a must. The drug is able to remove all irritants from the mucous membranes of the trachea of the bronchi.

Inhalation with Hydrocortisone is considered one of the most effective means therapy. In some cases, for a faster cure, the main drug is used in combination with lidocoin.

It acts as an excellent analgesic element. After such inhalation processes, the patient has deep sleep, significant pain reduction and improvement general condition.

The hormonal drug Hydrocortisone is used only as directed by a specialist. Skilled medical worker will determine the peculiarity of the disease, calculate correct dosage, taking into account the age barriers of the patient and possible complications.

Video

Use in the nose

When a liquid of a yellow-green hue is secreted from the nose, prevailing with a thick consistency, perhaps this is the beginning of a purulent inflammatory process sinuses.

The presented ailment requires special therapy, which is expressed in the preparation complex drops with the use of hydrocortisone in ampoules.

Let's get acquainted with the treatment instructions:

flushing the sinuses with sea salt and warm water;
add to one ampoule of Hydrocortisone, the same amount of Mezaton and Dioxidin;
shake the suspensions until smooth;
with the obtained medicine, instill in each nostril (two drops).

Stored remedy in a cold place out of the reach of children. The course of treatment should not exceed five days. Shake well before using the liquid formulation.

Hydrocortisone ampoules are often used to treat sinusitis. In addition to instilling the nasopharynx, doctors prescribe complex therapy.

It consists in flushing the maxillary sinuses with Hydrocortisone. For this, the septic tank dioxidine, hydrocortisone and adrenaline are mixed.

This solution is quite effective when other means are powerless. He is able to overcome rhinitis (allergic, vasomotor), the initial stage of sinusitis.

Hydrocortisone, when interacting with the presented components, destroys pathogenic organisms and prevents them from multiplying. The agent is instilled into the nose in 2-3 drops, at least five times a day. The course of treatment is 7-10 days.

Correct injection

By introducing an injection of Hydrocortisone, inflammation, edema, redness and pain symptoms are relieved. Injections effectively resist arthritis, asthma, damage skin, renal failure, diseases associated with thyroid and intestinal disorders... The injection reduces the side effects caused by other drugs.

Liquid hydrocortisone is injected into muscle tissue, a vein, and is often added to an intravenous fluid composition and administered to a patient using a needle or catheter.

The dosage of the medication for adults ranges from 1 to 100 mg. It all depends on the degree and severity of the disease. Children are limited to 10-30 mg of the drug, which is divided into several doses.

For elderly patients, the dose of the drug is determined by the doctor, since the side effects in this category of people are more intense than in a young body.

In the articular part, the injection is made no more than three times a day. The course of treatment is 2-3 days, then a three-week break. In the treatment of joints, the negative effect of hydrocortisone on cartilage (hyaline) is often observed. Therefore, therapy of one joint is permissible no more than three times a year.

In case of tendinitis, it is not recommended to inject the solution directly into the tendon, the correct site is the tendon sheath. Therefore, the injection must be made by a medical professional.

Hydrocortisone is not used to treat tendons (Achilles). If for some reason it is not possible to consult a doctor, read carefully the instructions for use of the drug, follow all instructions.

If the doctor prescribed regular administration of the drug (hourly), but there was a slight delay, the drug should be administered immediately. If more time is missed and the next injection comes up, then act according to the schedule.

Do not enter double doses in order to catch up with the missed ones.

Hydrocortisone ampoules are stored at room temperatures, away from children. Storage in hot conditions with high humidity is unacceptable. The drug is not subject to freezing. Overdue funds are immediately disposed of.

Burying in the ears

Patients often complain about pain around the ears. It can be - otitis media, inflammation of the inner, outer or middle ear. The most common treatment for this ailment is with ear drops.

They are able to penetrate directly to the lesion. Antibiotics, radiation, ointments, medicinal solutions are used in combination with drops.

If the ear pain is accompanied by allergic reactions, then the doctor prescribes the administration of a suspension of Hydrocortisone. Sometimes the agent is added to the antibiotic, it can be used separately. A single dose for an adult is 50 mg.

Hydrocortisone in ampoules is recommended to be infused through the nostrils. Then the agent goes to the infectious source. Such actions are associated with the ear drum, which prevents the direct passage and administration of the medication.

Drops are buried in the sinuses, which are located near the sore ear, while the head is thrown back in the same direction. As a result, the suspension easily penetrates to the mouth auditory tube and to the site of inflammation.

Composition

active substance: 1 ml of suspension contains hydrocortisone acetate in terms of 100% dry matter 25 mg;

excipients: lpropylene glycol, benzyl alcohol, sorbitol (E 420), povidone, sodium chloride, water for injection.

Description

suspension of white or white with yellowish

shade of color, settling when standing

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pharmachologic effect

Hydrocortisone acetate belongs to the group of glucocorticosteroids natural origin It has anti-shock, anti-toxic, immunosuppressive, anti-exudative, antipruritic, anti-inflammatory, desensitizing, anti-allergic effects. Inhibits hypersensitivity reaction, proliferative and exudative processes in the focus of inflammation. The action of hydrocortisone acetate is mediated through specific intracellular receptors. The anti-inflammatory effect consists in inhibiting all phases of inflammation: stabilizing cell and subcellular membranes, reducing the release of proteolytic enzymes from lysosomes, inhibiting the formation of superoxide anion and other free radicals Hydrocortisone inhibits the release of inflammatory mediators, including interleukin-1 (IL-1), histamine, serotonin, bradykinin, etc., reduces the release of arachidonic acid from phospholipids and the synthesis of prostaglandins, leukotrienes, thromboxane Reduces inflammatory cell infiltrates, reduces the migration of leukocytes and lymphocytes to the inflammation focus. It inhibits connective tissue reactions during the inflammatory process and reduces the intensity of scar tissue formation. Reduces the amount mast cells producing hyaluronic acid, inhibits the activity of hyaluronidase and helps to reduce capillary permeability. Inhibits collagenase production and activates the synthesis of protease inhibitors. Reduces synthesis and enhances protein catabolism in muscle tissue. By stimulating steroid receptors, it induces the formation of a special class of proteins - lipocortins, which have a decongestant effect. Has a counterinsular effect, increasing the level of glycogen in the liver, causing the development of hyperglycemia Retains sodium and water in the body, while increasing the volume of circulating blood and increasing blood pressure (anti-shock effect). Stimulates the excretion of potassium, reduces the absorption of calcium from the digestive tract, reduces bone mineralization Like other glucocorticoids, hydrocortisone reduces the number of T-lymphocytes in the blood, thereby reducing the effect of T-hellers on B-lymphocytes, inhibits the formation of immune complexes, reducing manifestations allergic reactions.

Pharmacokinetics

Topically applied hydrocortisone can be absorbed and act systemically. Relatively slowly absorbed from the injection site.

Up to 90% of the drug binds to blood proteins (with transcortin - 80%, with albumin - 10%), about 10% is free faction... Metabolism is carried out in the liver. Unlike synthetic derivatives, a small amount of the drug penetrates the placenta (up to 67% is destroyed in the placenta itself to inactive metabolites). Hydrocortisone metabolites are excreted primarily by the kidneys.

Indications for use

Osteoarthritis;

Various monoarthrosis (knee, elbow, hip joints); rheumatoid arthritis and arthritis of other origin (except

Tuberculous and gonorrheal arthritis);

Shoulder-scapular periart

Tenosynovitis;

before surgery on ankylosed joints;

Contraindications

Hypersensitivity to the components of the drug, intraarticular, periarticular infection; pregnancy; infectious diseases and sepsis without antibacterial therapy; Itsenko-Cushing's syndrome; baking of the Achilles tendon; vaccination period; vaccination with live vaccines; ulcers of the stomach and duodenum; osteoporosis; tendency to thromboembolism; pyelonephritis and glomerulonephritis with renal failure; arterial hypertension heavy course; herpes simplex; chicken pox; shingles; active tuberculosis; syphilis; diabetes; severe atherosclerosis; alcoholism; epilepsy; mental illness; trophic ulcers.

Pregnancy and lactation

The drug is contraindicated in pregnancy and lactation.

Method of administration and dosage

Before use, the contents of the ampoule are shaken until a homogeneous suspension is formed.

Adults and children over 14 years old: single dose depending on the size of the joint and the severity of the disease - 5-50 mg of hydrocortisone in the joint cavity and periarticularly For 24 hours, adults can be injected into no more than three joints Children: a single dose of hydrocortisone, depending on the size of the joint and the severity of the disease - 5 -30 mg in the joint cavity and periarticular.

The therapeutic effect with intra-articular administration of the drug occurs within 6-24 hours and lasts from several days to several weeks. Re-introduction of the drug is possible after 3 weeks.

The drug should not be injected directly into the tendons, therefore, for tendinitis, the drug should be injected into the tendon sheath.

The drug should not be used for systemic corticosteroid therapy.

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Side effect

With intra-articular use of a steroid drug, one of the side effects may be swelling or pain at the injection site.Usually, this phenomenon disappears on its own a few hours after the administration of the drug.With prolonged and uncontrolled use of a suspension of Hydrocortisone acetate, side reactions can be observed that are typical for all corticosteroids (systemic effect ).

Violations of water and electrolyte balance: sodium and fluid retention in the body; hypokalemia, hypokalemic alkalosis; heart failure, arterial hypertension

Violations from the outside musculoskeletal system: aseptic necrosis, steroid myopathy, osteoporosis, growth retardation in children.

Disturbances from the gastrointestinal tract: peptic ulcer with possible perforation and bleeding; stomach bleeding, pancreatitis, esophagitis, increased appetite, nausea, vomiting.

Dermatological disorders: hypopigmentation, delayed wound healing,

skin atrophy, stretch marks, acne, pruritus, folliculitis, irritation, dryness, thinning and hypersensitivity skin, expansion of cutaneous capillaries.

Metabolic disorders: negative nitrogen balance.

Neurological disorders: increased intracranial pressure with swelling of the nipple optic nerve(congestive nipple symptom); mental disorders, convulsions, dizziness, headache, insomnia, agitation, euphoria, depression. Endocrine Disorders: suppression of adrenal function, especially with prolonged use or with high doses, Itsenko-Cushing's syndrome, decreased carbohydrate tolerance and increased need for insulin or oral hypoglycemic drugs; delayed sexual development in children, menstrual irregularities, hirsutism.

Ophthalmic disorders: increased intraocular pressure, glaucoma; exophthalmos; corneal ulcer; the likelihood of developing cataracts in children increases.

Overdose

There is no characteristic clinical syndrome in case of an overdose of hydrocortisone acetate.

In case of an overdose, there may be an increase in both local and systemic adverse reactions.

Baking: symptomatic. There is no specific antidote. In case of a significant overdose, dialysis is possible.

Overdose can cause nausea and vomiting, sodium and water retention, hyperglycemia, and sometimes gastrointestinal bleeding. For the treatment of the latter, cimetidine (200-400 mg intravenously every 6 hours) or ranitidine (50 mg intravenously every 6 hours) are used.

Interaction with other medicinal products

It is necessary to avoid the combination with barbiturates when treating patients with Addison's disease (can lead to a crisis).

Care must be taken with the simultaneous appointment of:

With barbiturates, phenylbutazone, phenytoin and rifampicin (the effect of corticosteroids may decrease);

With oral antidiabetic agents (it is necessary to change their dose taking into account the hyperglycemic effect of corticosteroids);

with anticoagulants (strengthening or weakening of the anticoagulant effect);

- (the risk of developing hypokalemia increases);

With oral contraceptives (the concentration of corticosteroids in the blood increases);

With antihypertensive drugs (corticosteroids reduce the effectiveness of antihypertensive drugs);

With mifepristone (decreases the effectiveness of corticosteroids).

Erythromycin and ketoconazole may suppress corticosteroid metabolism.

Ritonavir can increase the plasma concentration of hydrocortisone.

Hydrocortisone weakens the growth-stimulating effect of somatropin.

Concomitant use with methotrexate increases bone marrow damage.

Application features

Application in children. For the treatment of children during the growth period, the drug is used only according to absolute readings... Corticosteroids cause growth retardation in infancy, childhood and adolescence, this influence may be irreversible.

The duration of treatment and dosage of hydrocortisone acetate should be minimized. The drug contains benzyl alcohol, therefore it is not recommended for use by children under the age of 3 years. When using prednisolone acetate in children under 10 years of age, it is necessary to monitor body weight, height, the level of free cortisol in the blood and urine, the results of the stimulation ACTH test

Use in the elderly. Common adverse effects of corticosteroids can lead to more serious consequences in old age, such as osteoporosis, hypertension, hypokalemia, diabetes mellitus, susceptibility to infections and thinning of the skin. Use with caution. Influence on the ability to drive vehicles and work with moving machinery.

In the case when dizziness, convulsions, etc. are observed during treatment with the drug, one should refrain from driving and performing work that requires attention.

Precautionary measures

Intra-articular corticosteroid administration may increase the likelihood of recurrence of inflammation. The drug can provoke bacterial infection of the joint, therefore, Hydrocortisone acetate can only be administered under aseptic conditions.

During treatment with hydrocortisone, vaccination should not be carried out due to the high risk of developing neurological complications and inhibition of antibody formation.During therapy with corticosteroids, the body's resistance and the ability to localize the infection may decrease.

The administration of conventional and high doses of corticosteroids can cause an increase in blood pressure, enhance the retention of sodium and water in the body and stimulate the excretion of potassium from the body. All corticosteroids increase the excretion of calcium from the body.

With latent tuberculosis, it can only be used in conjunction with tuberculostatics.

For infectious diseases, use with caution and only in conjunction with specific antibiotic therapy.

When treating with hydrocortisone acetate, it is necessary to adjust the dose of oral antidiabetic agents and anticoagulants.

Electrolyte metabolism in the body should be monitored while using diuretics

With prolonged use, potassium supplements should be additionally prescribed to prevent hypokalemia.

In childhood and adolescence, the drug should be used for a shorter time in the minimum effective dose due to the possibility of growth retardation.

During treatment, it is necessary to regularly monitor blood pressure, indicators general analysis blood and urine levels, glycemic levels. Finish treatment should be a gradual decrease in the dose of hydrocortisone acetate. If it is necessary to assess the state of the hypothalamic-pituitary-adrenal system, conduct a stimulation ACTH test.

When used together with salicylates, if the dose of corticosteroid is reduced, it is necessary to simultaneously reduce the dose of salicylate.

Care should be taken to prescribe the drug to patients with a history of psychosis, diabetes mellitus (including a family history), arterial hypertension, glaucoma, steroid myopathy, epilepsy, a history of tuberculosis.

Atrophy of the adrenal cortex develops when long-term therapy hydrocortisone and may persist for many years after stopping treatment. Withdrawal of corticosteroids after prolonged therapy should occur gradually, over several weeks or months, depending on the dose and duration of treatment, in order to avoid acute adrenal insufficiency Suppression of inflammatory and immune reactions with corticosteroids increases the susceptibility to infections and the severity of their course, can mask the manifestations of such serious infections like sepsis and tuberculosis. The risk of developing new infections increases. Chickenpox is of particular concern because this usually minor illness can lead to death in immunocompromised patients Patients or parents of children who are not immune to chickenpox should avoid contact with patients with shingles or chickenpox; if there is such contact and the risk of infection, they should seek urgent medical attention. Patients receiving hydrocortisone injections should avoid contact with patients with measles and seek immediate medical attention if this occurs.

With caution, hydrocortisone acetate is prescribed to the following categories of patients: with osteoporosis (women are at particular risk after menopause); with manifestations of congestive heart failure;

with heavy affective disorders(especially with a history of previous

steroid psychoses);

with peptic ulcers

with hepatic or renal impairment;

with a recent myocardial infarction;

With hypothyroidism.

Release form

2 ml in glass ampoules. 10 ampoules each together with instructions for medical use and a scarifier approved for medical use, packed in a bundle. When packing ampoules with a colored break ring or break point, the attachment of the scarifier is excluded.

Storage conditions

Store in a dark place at a temperature of 8 ° C to 15 ° C. Keep out of the reach of children. Freezing is not allowed.

Hydrocortisone suspension is a drug that belongs to the group of glucocorticoids. It is used mainly for intramuscular (sometimes intraarticular) administration.

Active substance this tool(in 1 ml) hydrocortisone acetate remains at a dose of 25 mg, if converted to dry residue. Additional ballast ingredients remain:

Propylene glycol.
Benzyl alcohol.
Collect.

It also includes saline and water for injection.

Hydrocortisone is available as a white suspension that may have a slight yellowish tinge. When standing, it tends to sink.

pharmachologic effect

Hydrocortisone is a naturally occurring glucocorticoid. Possesses a whole range unique properties... Among them:

Anti-shock.
Anti-inflammatory.
Reducing toxic damage to the body.
Suppression of immunity.
Reducing the manifestations of allergic reactions.
Reduction of exudation in the parenchymal and cavity organs.

Due to these effects, Hydrocortisone remains one of the most popular, which is widely used in medical practice. Its action is based on the effect on specific intracellular receptors.

The anti-inflammatory activity of hydrocortisone is due to the stabilization of cell membranes with a decrease in the secretion of enzymes. In addition, it blocks the release of free radicals and the progression of lipid peroxidation (LPO).

The antiallergic effect of Hydrocortisone is due to the ability to reduce the release of inflammatory mediators (eg, bradykinin, interleukin-1, and others). The mast cell membrane is stabilized, the active release of substances responsible for the development of allergies is suppressed. In addition, the permeability of the vascular wall decreases, which contributes to the regression of edema in the damaged area of the body.

One of the important aspects of the work of almost all glucocorticoids is a decrease in the formation of connective tissue. This is manifested by a decrease in the rate of scarring at the sites of injuries and cuts.

The important metabolic effects of hydrocortisone acetate remain the effect on carbohydrate metabolism... It promotes an increase in glycogen deposits in hepatocytes. In a simple way, it leads to an increase in blood sugar levels.

Talking about influence on cardiovascular system, you need to know that hydrocortisone acetate promotes the retention of sodium salts in the body. The result of its accumulation is a rise in blood pressure (BP). This effect is very important when treating patients in shock, when blood pressure drops to almost zero.

One of the most important aspects of the effect of Hydrocortisone on the human body remains its suppression. immune system... Because of this, glucocorticoids are the treatment of choice for autoimmune diseases or during transplantation, when you need to make the body forget that the transplanted organ is foreign.

After local administration of Hydrocortisone, it is absorbed into the bloodstream and exhibits a systemic effect. Almost all of the active substance (approximately 90%) binds to plasma proteins for transport through the body. The remainder of the hydrocortisone acetate is in the form of free substances. The main metabolic reactions to modify the drug occur in the "biochemical laboratory" of the body - the liver. Most of waste metabolites are excreted in the urine.

A small percentage of hydrocortisone acetate (approximately 30%) can cross the placental barrier.

Indications for use

Hydrocortisone acetate is used mainly in the treatment of joint pathologies:

Arthritis and arthrosis.
Synovitis in the presence of effusion in the joint capsule. The exceptions are infectious variants of the disease (tuberculous, gonorrheal etiology, etc.)
Rheumatoid arthritis.
Shoulder-hand cider.
Epicondylitis and tenosynovitis.

Contraindications to the use of hydrocortisone acetate

Situations where the use of hydrocortisone acetate is prohibited are:

Individual intolerance to the components of the drug.
The presence of an infection in the joint.
Do not use Hydrocortisone during pregnancy.

Progression of the infectious process in the body without adequate antibiotic therapy.
Achilles tendon pathology.
The presence of ulcerative lesions of the stomach or duodenum.
Pathological tendency to form blood clots.
Kidney disease with the progression of the corresponding failure.
Severe hypertension.

Diabetes.
Lack of bone mineral stability (osteoporosis).
Infectious diseases (tuberculosis, syphilis, gonorrhea, chickenpox and others).
Mental disorders, epilepsy.
Progressive atherosclerosis.

For intramuscular injection There are many contraindications for hydrocortisone. However, it also cannot be injected directly into the joint in the presence of internal fractures, infection of the affected area, a history of arthroplasty, dry joint syndrome.

Pregnancy and lactation

Hydrocortisone is not used by women during the period of gestation or breastfeeding.

Dosage and administration of Hydrocortisone

Immediately before injection into the joint or periarticular area, Hydrocortisone inside the ampoule must be shaken well until a homogeneous liquid is formed. Instructions for use of the product provide for the calculation of the dose of Hydrocortisone, depending on the size of the affected joint and the degree of progression of the problem. Adults can be administered from 5 to 50 mg when it comes to the intra-articular route. If necessary intramuscular injection the dose is increased to 125-250 mg of hydrocortisone per day.

Children can be administered from 5 to 30 mg of Hydrocortisone per day. A single dose for intra-articular injection ranges from 25 to 75 mg, depending on the age of the patient. If it is necessary to administer Hydrocortisone for inflammatory processes in the tendons, the injection should be done in the tendon sheath. An important aspect of hydrocortisone is the impossibility of using it for systemic steroid therapy.

Side effects of hydrocortisone acetate

Hydrocortisone injection may cause localized edema or painful sensations... These reactions are typical for any injections. If the dosage of hydrocortisone acetate is not observed and if it is taken incorrectly, constant intake, there are characteristic side effects inherent in the entire group of glucocorticoid drugs.

On the part of the endocrine system, there is a violation of carbohydrate metabolism. If the patient suffered from diabetes mellitus, then the dose of hypoglycemic agents should be increased. The so-called steroid diabetes is progressing. Long-term use of hydrocortisone acetate can lead to adrenal pathology with manifestation characteristic symptoms for Itsenko-Cushing's syndrome.

On the part of the digestive tract, dyspeptic disorders such as nausea, vomiting, and a significant increase in appetite are observed. Often develops ulcerative lesion the mucous membrane of the stomach and duodenum, which may be aggravated by bleeding or perforation. From the side of the heart, progression is noted arterial hypertension... The amount of potassium decreases with a characteristic picture on the ECG. Perhaps the development of cardiac muscle failure.

Disorders nervous system are manifested by emotional lability with a predominance of irritability and aggressive behavior. Delirious states, hallucinations, mental disorders may occur. In rare cases, cerebral edema forms. In metabolism, there is a decrease in the total concentration of potassium with a predominance of sodium. Basal metabolism and sweating increase. Obesity progresses.

The organ of vision suffers from ulceration of the cornea, possibly the development of cataracts. An increase in total blood pressure can cause acute attack glaucoma. Skeleton and muscles. Osteoporosis progresses. In children, bone growth zones may close too early. It is extremely rare that aseptic necrosis of the muscles and connective tissue develops.

From the side of the immune system, its suppression is observed. Against this background, various infectious diseases are progressing, which under normal conditions would not develop. All sorts of rashes and itching may appear on the skin. Wounds take much longer to heal due to impaired connective tissue functioning.

The use of hydrocortisone acetate must always be approved by your doctor. In no case should you self-medicate.

Overdose

There is no particular and characteristic complex of symptoms that would be appropriate with excessive administration of Hydrocortisone into the body. Basically, a significant increase in side reactions is simply observed.

Interaction of hydrocortisone with other drugs

Taking into account the peculiarities of the metabolism of Hydrocortisone, it is necessary to exclude the possibility of joint application hydrocortisone acetate with barbiturates. In addition, it is not recommended for use in patients with diabetes mellitus. In the presence of urgent need, it is important to adjust the dosage of hypoglycemic agents to prevent hypo- or hyperglycemic coma.

It is necessary to use carefully Hydrocortisone with anticoagulants and antihypertensive drugs. Also controversial is the combination of hydrocortisone acetate with oral contraceptives.

Antibacterial and antifungal drugs Erythromycin and Ketoconazole have an inhibitory effect on the activity of Hydrocortisone. The parallel use of hydrocortisone acetate with methotrexate is undesirable due to the aggravation of bone marrow lesions.

Features of use, taking into account age

Hydrocortisone should be used with extreme caution in children. It slows growth and promotes sexual immaturity in adolescents with prolonged use. If possible, you should try to minimize the duration of therapy and carry it out only if there are absolute indications.

In elderly people, hydrocortisone causes a sharp progression of osteoporosis, which is fraught with pathological fractures. In addition, it aggravates the course of arterial hypertension. It is important to constantly monitor the pressure and monitor the patient's performance.

Precautionary measures

In the course of therapy with hydrocortisone acetate, it is worth remembering a number of possible unpleasant consequences:

Intra-articular administration of hydrocortisone potentially leads to an increase in the inflammatory process due to mechanical intervention. In addition, the risk of microbial contamination remains during the injection process.
The introduction of hydrocortisone acetate causes an increase in blood pressure and retention of sodium salts in the body.
The use of Hydrocortisone affects carbohydrate metabolism. A prerequisite for high-quality therapy is the constant correction of antihyperglycemic drugs.
When used in patients in childhood and adolescence, it is necessary to try to minimize the duration of therapy.
Hydrocortisone should be used with caution in patients who suffer from various forms of mental disorders.

The use of steroid drugs is always fraught with a number of adverse reactions. The general condition of the patient must be constantly monitored.

Other details

Hydrocortisone is produced in ampoules of 2 ml and 10 pieces per package. It must be stored in a dark place out of the reach of children at a temperature of 8 to 15 degrees Celsius. In no case should it be frozen. After that, it loses its effectiveness. You can store hydrocortisone acetate for up to three years. In the pharmacy, they get it with a doctor's prescription.

In addition to suspension, there are other forms of hydrocortisone acetate:

Pills.
Eye drops.
Hydrocortisone emulsion.
Ointment.
Powder for injection.

Depending on the localization of the pathology, the use of one or another dosage form of Hydrocortisone will be justified. For example, eye drops are used for different forms uveitis, keratitis and other lesions of the organ of vision, which are accompanied by inflammation or an allergic reaction. The same is true for other types of medication.

Bibliography

Bessonov P.P. Medical and labor expertise.
A guide for emergency medical doctors. help. Edited by V.A. Mikhailovich, A.G. Miroshnichenko. 3rd edition. SPb, 2005.
Internal diseases in 2 volumes. Ed. A.I. Martynova M .: GEOTARD, 2004. (stamp UMO)
Artamonova V.G., Shatalov N.N. Occupational diseases. 3rd ed., M., Medicine. 1996
Secrets of endocrinology: textbook. allowance: per. from English - 2nd ed., Rev. and add. - M.: BINOM; SPb. : Nevsky dialect, 2001 .-- 464 p. : ill.

Hydrocortisone is hormonal drug with a pronounced anti-inflammatory effect, which used to treat diseases of the musculoskeletal system, respiratory organs, blood, as well as relief of acute conditions of an allergic nature, for example, anaphylactic shock. Instructions for the use of Hydrocortisone in the form of an ointment and in ampoules contains various contraindications, therefore, before starting use, you must carefully read the annotation and strictly follow the indications for use.

Composition

In the manufacture of the drug, hydrocortisone is used in the form of acetate. The substance belongs to glucocorticosteroid hormones - natural or synthetic substances that pharmacological properties belong to a subgroup of adrenal cortex hormones. Hydrocortisone is considered a highly active hormone, since the bioavailability of the substance is almost 40% higher than that of cortisone, a hormone of the adrenal cortex that is synthesized in the human body in small quantities and is responsible for regulating metabolic processes and suppressing lymphoid tissues.

Hydrocortisone in the form of acetate belongs to the group of synthetic esters and has predominantly anti-inflammatory activity. It inhibits the synthesis of prostaglandins (inflammatory mediators) and inhibits the movement of leukocytes with phagocytic functions to the inflammation focus.

Of great importance in the complex treatment of shock and inflammatory pathologies is the growth retardation of cells that form connective tissue and synthesize the extracellular matrix.

Inhibition histamine receptors allows you to inhibit the release of histamine - "provocateur" of allergy symptoms. With systemic and local use, Hydrocortisone reduces the sensitivity of the body, eliminates the manifestations of hyperemia - a condition in which the blood vessels are overflowing with blood (manifested by redness of the skin).

Injection of hydrocortisone reduces the accumulation of exudate in inflamed vessels, reduces the permeability of capillary walls and inhibits the activity of proteolytic enzymes.

increases blood glucose levels;
delays sodium and potassium ions in the body, preventing the development of heart failure;
stimulates the synthesis of glucose in the liver, which leads to the release of insulin;
enhances the excretion of calcium ions (with urine);
has an anti-shock effect;
has immunosuppressive activity.

During treatment, it is important to understand that different dosage forms Hydrocortisones have varying degrees of active substance activity, therefore, the prescribed drug cannot be changed without the agreement of the attending physician.

Patients should know what Hydrocortisone ointment is used for, and in which cases an injection of the drug is indicated. The medicine in the form of an ointment is prescribed mainly for the treatment of diseases of an allergic and anti-inflammatory nature, as well as conditions accompanied by increased exudation in the vessels and capillaries.

Release form

Topical hydrocortisone comes in the form of a 1% ointment. Eye ointment, intended for the correction of pathologies of the anterior segment of the eye, contains a lower concentration of hydrocortisone - 0.5%.

For intra-articular and intramuscular administration, the drug is available in the form of a suspension that contains 25 mg of hydrocortisone acetate. The volume of one ampoule is 2 ml, the package can contain 5 or 10 ampoules.

Shelf life and storage temperature are:

for ampoules - 5 years at a temperature not higher than 25 °;
for ointment - 3 years at a temperature of 5 ° to 15 °.

Topical ointment and eye ointment are available from pharmacies without a prescription. To buy the injections, you need a prescription from your doctor.

Indications for use

Suspension. The introduction of the suspension is shown for systemic treatment allergic, shock conditions, and inflammatory diseases different etiology and localization. The drug is widely used in cardiology to provide emergency care for cardiogenic and traumatic shock, as well as for the complex treatment of arterial hypotension - a chronic decrease in arterial or venous pressure to 110/70 and below. Intramuscular administration of Hydrocortisone is shown in the composition resuscitation with a sharp fall blood pressure and acute violation blood supply is vital important organs provoked by Addison's disease.

synovitis of the knee or hip joint, which develops against the background of autoimmune and metabolic pathologies;
inflammation of the fluid filling the synovial bursa located at the point of contact of the soft tissues of the joint with the bony protrusions (acute bursitis);
inflammation of the protective membranes that cover the tendons (tendosynovitis);
rheumatoid arthritis;
inflammatory and degenerative tissue changes elbow joint(epicondylitis);
osteoarthritis;
carpal tunnel syndrome.

As part of complex therapy, the suspension can be used to treat hay fever, lupus erythematosus, anaphylactic shock, hepatic coma, nephrotic syndrome, bronchial asthma(in patients with asthmatic status). A good effect is given by the use of hydrocortisone acetate in the relief of edematous syndrome with damage to the brain and respiratory organs.

allergic skin diseases, prone to recurrent course and characterized by acute tissue inflammation (neurodermatitis);
violation of nervous and neuroendocrine function sebaceous glands leading to increased sebum secretion (seborrhea);
dermatitis accompanied by itching (psoriasis, eczema);
increased skin sensitivity to ultraviolet rays(photodermatosis);
swelling and itching of the skin caused by insect and arthropod bites.

An indication for the use of hydrocortisone ointment can also be the relief of itching in the genital area and anorectal region (for example, with inflammation of the hemorrhoidal veins).

Instructions for the use of hydrocortisone ointment for eyes recommends the inclusion of the drug in the combined treatment regimens for conjunctivitis, blepharitis, iridocyclitis and other eye diseases, accompanied by inflammation of the eye components and manifestations of allergic reactions. Shows the use of hydrocortisone ointment for the eyes after surgery, as well as injuries and burns (including chemical burns).

Contraindications

Hydrocortisone has a large number of contraindications. Many of the diseases included in this list develop in persons over 40-50 years old, therefore, this category of patients should be prescribed the drug with increased caution after a thorough history collection and study of laboratory parameters of biological material (urine and blood).

Intravenous and intramuscular administration of hydrocortisone acetate is contraindicated in diabetes mellitus, arterial hypertension (with an increase in pressure up to 150/100 and above), acute psychosis, systemic fungal infection of the body.

Since the metabolites of the active substance are excreted from the body by the kidneys, the drug should not be prescribed to persons with severe pathologies of the renal system. Absolute contraindication for treatment is nephrosis - a dystrophic lesion of the renal parenchyma, characterized by degeneration of the tubules and connective structures of the organ.

progressive diseases of the skeleton, characterized by a decrease in bone density (osteoporosis);
epilepsy;
increased secretion of hydrochloric acid and pepsin, leading to the formation of local mucous defects on the surface of the digestive tract (peptic ulcer);
tuberculosis (in active form);
immunodeficiency syndrome.

Systemic use of Hydrocortisone after vaccination is not allowed, as well as in children under 1 year of age and pregnant women.

Hydrocortisone ointment is contraindicated for any infectious skin diseases, syphilis, vulgar acne, cutaneous tuberculosis, violation of the integrity of the skin (wounds, abrasions, cracks). An absolute contraindication for external and local use of hydrocortisone ointment is skin neoplasms and tumors, as well as perioral dermatitis - a lesion of the skin around the mouth, which occurs in 1% of patients.

The use of eye ointment is prohibited for purulent, bacterial, fungal and viral eye lesions. Trachoma - a chronic infection of the mucous membranes of the eye with chlamydia - is an absolute restriction for the use of hydrocortisone ointment.

Side effects

high risk

convulsive syndrome;
accumulation of blood in blood vessels and arteries (hyperemia);
diseases of the gastrointestinal tract and organs of the hepatobiliary system (pancreatitis, peptic ulcer, gastritis);
congestive heart failure, provoked by edematous syndrome, which develops against the background of sodium and fluid retention in the body;
heart rhythm disturbance;
mental disorders;
increased intracranial pressure.

The use of hydrocortisone in children can suppress physical growth, inhibit the activity of the immune system, and cause psychoemotional and behavioral changes. In women, prolonged use of the drug can cause menstrual irregularities and hormone-dependent diseases of the female reproductive system: endometrial hyperplasia, endometritis, endometriosis, uterine myoma.

With external use, it is possible to increase pigmentation, swelling, dryness and increased flaking of the skin. If the ointment was applied to areas with signs of an infectious process, secondary superinfection may develop.

burning and redness of the eye sclera;
eczema of the eyelids;
displacement of the eyeball, bulging eyes syndrome (exophthalmos);
cataract;
secondary glaucoma (chronic increase in intraocular pressure) of the steroid type.

If the integrity of the cornea is violated, its perforation is possible, therefore the maximum period of use of the eye ointment is limited to two weeks.

Instructions for use

Long-term use of Hydrocortisone can lead to serious side effects, so read the instructions before starting treatment.

Suspension

The suspension is intended for deep intramuscular injection or injection into the joint cavity. Intramuscularly, the drug is injected deep into the buttock. Before using the suspension, the bottle must be shaken so that the composition is homogeneous in its consistency. The dosage is calculated individually and can range from 50 mg to 1-1.5 g of hydrocortisone per day.

If the patient is in serious condition, forced administration of the drug at a dosage of 100-150 mg with an interval of 4 hours is indicated. On the third day of treatment, the interval between applications increases to 8-12 hours. This scheme must be adhered to until the acute condition is relieved.

When prescribing the drug, children should take into account not only their age, but also their body weight. For emergency care, the suspension is injected into the muscle every 4 hours at a rate of 1-2 mg / kg. The daily dose for children of any age should not exceed 9 mg / kg.

In cases where Hydrocortisone is used to treat pathologies of the musculoskeletal system, intra-articular suspension administration is indicated. The dosage depends on the main diagnosis, concomitant pathologies, the size of the joint, the severity of the inflammatory process, the general condition of the patient and can range from 5 to 50 mg of hydrocortisone. Injections must be given once a week. The standard duration of therapy is 3 to 5 weeks.

Ampoules

The drug in ampoules is a lyophilisate for solution preparation. It must be diluted with the solvent supplied in the package according to the instructions. The prepared solution should be injected into a muscle or vein at a daily dosage of 1000-1500 mg. It is recommended to divide this amount into 2 parts and inject the medicine twice a day: in the morning and in the evening.

« Lyophilization is a method of soft drying of substances, in which the dried preparation is frozen and then placed in a vacuum chamber, where the solvent is sublimated. Wikipedia.»

emergency

anaphylactic shock

100 mg for 30 seconds;
400-500 mg within 10 minutes after the first dose;
repeat the introduction of the drug (at a dosage of up to 500 mg) after 2-4 hours.

Treatment with ampoules should not last longer than 72 hours. For cupping serious condition the solution should be injected every 4-6 hours. In critical situations, the drug is injected every 2 hours, but daily dosage should not exceed 1.5 g of hydrocortisone.

Eye ointment

For the treatment of ophthalmic diseases, hydrocortisone ointment is placed behind the lower eyelid, which must be gently pulled towards itself. When applying the ointment, it is important to ensure that the aluminum tube does not touch the mucous membrane of the eye. If this happens, the drug should be disposed of, as it is not suitable for use due to the high probability of infection in the tube. The strip of ointment should be about 1-2 cm.Use the drug 3 times a day. The duration of treatment is usually 10-14 days. If the drug is prescribed to a pregnant woman, the course of therapy is shortened to 7-10 days.

When using combined treatment regimens, when the patient is prescribed several drugs, it is necessary to lay hydrocortisone ointment 15-20 minutes after using others medicines... It is forbidden to wear contact lenses during treatment.

Price

Hydrocortisone is included in the list of vital and essential medicines, therefore its cost is considered socially oriented and affordable for all categories of patients. The price of hydrocortisone eye ointment in pharmacies in St. Petersburg and Moscow ranges from 24 to 43 rubles (for a Russian-made drug). Hydrocortisone eye ointment 0.5% of Polish manufacturers costs several times more - from 120 to 141 rubles.

in Moscow - from 151 to 220 rubles;
in St. Petersburg - from 153 to 226 rubles.

Ointment for external use can be bought from 21 to 50 rubles.

On the territory of Ukraine, the cost of Hydrocortisone starts from 124 hryvnia (for ampoules and suspensions).