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Name: Hydrocortisone butyrate

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Pregnancy Category C

Drug classes

• Corticosteroid, short acting
• Glucocorticoid
• Mineralocorticoid
• Adrenal cortical hormone (hydrocortisone)
• Hormonal agent

Therapeutic actions

Enters target cells and binds to cytoplasmic receptors; initiates many complex reactions that are responsible for itsanti-inflammatory, immunosuppressive (glucocorticoid), and salt-retaining (mineralocorticoid) actions. Some of these actions are considered undesirable, depending on the indication for which the drug is being used.

Indications

• Replacement therapy in adrenal cortical insufficiency
• Hypercalcemia associated with cancer
• Short-term management of various inflammatory and allergic disorders, such as rheumatoid arthritis, collagen diseases (eg, SLE), dermatologic diseases (eg, pemphigus), status asthmaticus, and autoimmune disorders
• Hematologic disorders-thrombocytopenic purpura, erythroblastopenia
• Trichinosis with neurologic or myocardial involvement
• Ulcerative colitis, acute exacerbations of multiple sclerosis, and palliation in some leukemias and lymphomas Intra-articular or soft-tissue administration: Arthritis, psoriatic plaques, and so forth.
• Retention enema: For ulcerative colitis/proctitis
• Dermatologic preparations: To relieve inflammatory and pruritic manifestations of dermatoses that are steroid responsive
• Anorectal cream, suppositories: To relieve discomfort of hemorrhoids and perianal itching or irritation
• Note that synthetic analogues with weaker mineralocorticoid activity may be preferable to hydrocortisone, except for replacement therapy. Local administration to the affected site (eg, by the use of ophthalmic corticosteroid preparations for eye disorders) may be preferable to
  systemic use.

Contraindications/cautions

Systemic administration: infections, especially tuberculosis, fungal infections, amebiasis, hepatitis B, vaccinia, or varicella, and antibiotic-resistant infections; kidney disease (predisposes to edema); liver disease, cirrhosis, hypothyroidism; ulcerative colitis with impending perforation; diverticulitis; recent GI surgery; active or latent peptic ulcer; inflammatory bowel disease (drug may cause exacerbations or bowel perforation); hypertension, CHF; thromboembolitic tendencies, thrombophlebitis, osteoporosis, convulsive disorders, metastatic carcinoma, diabetes mellitus; lactation. Retention enemas, intrarectal foam: systemic fungal infections, recent  intestinal surgery, extensive fistulas.

Topical dermatologic administration: fungal, tubercular, herpes simplex skin infections; vaccinia, varicella; ear application when eardrum is perforated; lactation.

Adverse effects

Systemic

• CNS: Vertigo, headache, paresthesias, insomnia, convulsions, psychosis
• GI: Peptic or esophageal ulcer, pancreatitis, abdominal distention, nausea, vomiting, increased appetite and weight gain (long-term therapy)
• CV: Hypotension, shock, hypertension and CHF secondary to fluid retention, thromboembolism, thrombophlebitis, fat embolism, cardiac arrhythmias secondary to electrolyte disturbances
• Hematologic: Na+ and fluid retention, hypokalemia, hypocalcemia, increased blood sugar, increased serum cholesterol, decreased serum T3 and T4 levels
• MS: Muscle weakness, steroid myopathy and loss of muscle mass, osteoporosis, spontaneous fractures (long-term ther-apy)
• EENT: Cataracts, glaucoma (long-term therapy), increased intraocular pressure
• Dermatologic: Thin, fragile skin; petechiae; ecchymoses; purpura; striae; subcutaneous fat atrophy
• Hypersensitivity: Anaphylactoid or hypersensitivity reactions
• Endocrine: Amenorrhea, irregular menses, growth retardation, decreased carbohydrate tolerance and diabetes mellitus, cushingoid state (long-termtherapy), hypothalamic-pituitary-adrenal (HPA) suppression systemic with therapy longer than 5 d
• Other: Immunosuppression, aggravation or masking of infections, impaired wound healing

Adverse Effects Related to Specific Routes of Administration

• IM repository injections: Atrophy at injection site
• Retention enema: Local pain, burning; rectal bleeding; systemic absorption and adverse effects (above)
• Intra-articular: Osteonecrosis, tendon rupture, infection
• Intraspinal: Meningitis, adhesive arachnoiditis, conus medullaris syndrome
• Intralesional therapy, head and neck: Blindness (rare)
• Intrathecal administration: Arachnoiditis
• Topical dermatologic ointments, creams, sprays: Local burning, irritation, acneiform lesions, striae, skin atrophy. Systemic absorption can lead to HPA suppression (see above), growth retardation in children, and other systemic adverse effects. Children may be at special risk of systemic absorption because of their larger skin surface area to body weight ratio.

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