Roxacort

Indications

Hydrocortisone is a corticosteroid (a man-made version of the body's own stress hormone, cortisol). It comes as skin creams and ointments, tablets and injections.

• Skin: mild to moderate eczema, dermatitis, insect bites and other itchy, inflamed skin conditions.
• Tablets: replacement therapy when the adrenal glands do not make enough cortisol (Addison's disease, adrenal insufficiency) and some inflammatory conditions.
• Injection: emergencies such as severe allergic reactions, severe asthma attacks and adrenal crisis, and other serious inflammatory conditions.

How It Works

Hydrocortisone calms the immune system and reduces inflammation, so redness, swelling and itching settle. In people whose adrenal glands do not work properly, it replaces the missing hormone.

Dosage and Administration

• Cream or ointment (usually 1%): apply a thin layer to the affected skin once or twice a day. Do not use for more than 7 days on the face, or longer than advised by a doctor elsewhere.
• Tablets for adrenal insufficiency: commonly 15 to 30 mg a day in divided doses, with the larger dose in the morning, as prescribed. Do not stop suddenly.
• Injection: given by a doctor or nurse; the dose depends on the condition.
• Children: only as prescribed.

Interactions

For tablets and injections: Rifampicin, Phenytoin and Carbamazepine can reduce its effect, while Ritonavir, Itraconazole and Clarithromycin can increase it. It can raise blood sugar (affecting diabetes medicines), increase the risk of stomach bleeding with NSAIDs such as Ibuprofen and Aspirin, lower potassium together with diuretics, and change the effect of Warfarin. Live vaccines should be avoided during high-dose treatment. Skin creams rarely cause interactions.

Contraindications

• Allergy to hydrocortisone or any ingredient of the product.
• Skin products: untreated bacterial, fungal or viral skin infections (such as cold sores or chickenpox), acne, rosacea and broken skin unless a doctor advises.
• Tablets: serious untreated infections, unless a doctor decides treatment is essential.

Side Effects

Skin products used briefly rarely cause problems; long use can thin the skin, cause stretch marks or change skin colour. Tablets and injections can cause increased appetite, weight gain, mood changes, sleep problems, high blood sugar, raised blood pressure and a higher chance of infection. Long-term use can weaken bones and muscles.

Get urgent medical help for signs of a serious allergic reaction (swelling of the face or throat, difficulty breathing), black or bloody stools, vomiting blood, severe stomach pain, signs of serious infection, or severe weakness, dizziness and vomiting after stopping tablets.

Pregnancy and Lactation

Short-term use of skin cream is generally considered acceptable. Tablets and injections may be used in pregnancy and breastfeeding when a doctor decides they are needed, for example for adrenal insufficiency, which must not go untreated. Do not apply cream to the breast before feeding.

Precautions and Warnings

• Never stop tablets suddenly after more than a few weeks; the dose must be reduced slowly as advised.
• Carry a steroid card or tell any doctor, dentist or surgeon that you take steroids.
• Take extra care with diabetes, high blood pressure, stomach ulcer, osteoporosis, glaucoma, depression, tuberculosis and in elderly people.
• Avoid contact with chickenpox or measles if you have not had them, and see a doctor if exposed.
• Do not use skin products under bandages or nappies unless told to.

Overdose

A single large dose is rarely dangerous. Using too much for a long time can cause Cushing's syndrome (round face, weight gain, high blood sugar, thin skin). Contact a doctor if too much has been taken, especially by a child.

Therapeutic Class

Corticosteroid (glucocorticoid); topical corticosteroid of mild potency.

Storage

Store below 30°C in a dry place, away from light. Do not freeze creams. Keep out of reach of children.