Hydrocortisone – Uses, Side Effects, Interactions

Last updated: February 7, 2026Reviewed date: February 7, 2026Reading time: 10 min read
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Hydrocortisone is the main glucocorticoid secreted by the ADRENAL CORTEX. Its synthetic counterpart is used, either as an injection or topically, in the treatment of inflammation, allergy, collagen diseases, asthma, adrenocortical deficiency, shock, and some neoplastic conditions. Hydrocortisone is a Corticosteroid. The mechanism of action of hydrocortisone is...

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Article Summary

Hydrocortisone is the main glucocorticoid secreted by the ADRENAL CORTEX. Its synthetic counterpart is used, either as an injection or topically, in the treatment of inflammation, allergy, collagen diseases, asthma, adrenocortical deficiency, shock, and some neoplastic conditions. Hydrocortisone is a Corticosteroid. The mechanism of action of hydrocortisone is as a Corticosteroid Hormone Receptor Agonist. Therapeutic Hydrocortisone is a synthetic or semisynthetic analog of natural hydrocortisone hormone produced by the adrenal glands with...

Key Takeaways

  • This article explains Mechanism of action of Hydrocortisone in simple medical language.
  • This article explains Indications of Hydrocortisone in simple medical language.
  • This article explains Dosage of Hydrocortisone in simple medical language.
  • This article explains Side Effects of Hydrocortisone in simple medical language.
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Hydrocortisone is the main glucocorticoid secreted by the ADRENAL CORTEX. Its synthetic counterpart is used, either as an injection or topically, in the treatment of infection, or irritation, often causing pain, swelling, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।" data-rx-term="inflammation" data-rx-definition="Inflammation is the body’s response to injury, infection, or irritation, often causing pain, swelling, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।">inflammation, allergy, collagen diseases, asthma, adrenocortical deficiency, shock, and some neoplastic conditions. Hydrocortisone is a Corticosteroid. The mechanism of action of hydrocortisone is as a Corticosteroid Hormone Receptor Agonist.
Therapeutic Hydrocortisone is a synthetic or semisynthetic analog of natural hydrocortisone hormone produced by the adrenal glands with primary glucocorticoid and minor mineralocorticoid effects. As a glucocorticoid receptor agonist, hydrocortisone promotes protein catabolism, gluconeogenesis, capillary wall stability, renal excretion of calcium, and suppresses immune and inflammatory responses.
Definition

Hydrocortisone is the name for the hormone cortisol when supplied as a medication. Uses include conditions such as adrenocortical insufficiency, adrenogenital syndrome, high blood calcium, thyroiditis, pain, swelling, stiffness, or reduced movement. সহজ বাংলা: জয়েন্টের প্রদাহ।" data-rx-term="arthritis" data-rx-definition="Arthritis means joint inflammation causing pain, swelling, stiffness, or reduced movement. সহজ বাংলা: জয়েন্টের প্রদাহ।">arthritis: Rheumatoid arthritis is an autoimmune joint disease causing infection, or irritation, often causing pain, swelling, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।" data-rx-term="inflammation" data-rx-definition="Inflammation is the body’s response to injury, infection, or irritation, often causing pain, swelling, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।">inflammation, pain, and swelling. সহজ বাংলা: রোগপ্রতিরোধ ব্যবস্থার ভুল আক্রমণে জয়েন্টের প্রদাহ।" data-rx-term="rheumatoid arthritis" data-rx-definition="Rheumatoid arthritis is an autoimmune joint disease causing inflammation, pain, and swelling. সহজ বাংলা: রোগপ্রতিরোধ ব্যবস্থার ভুল আক্রমণে জয়েন্টের প্রদাহ।">rheumatoid arthritis, dermatitis, asthma, and COPD. It is the treatment of choice for adrenocortical insufficiency.T he main glucocorticoid secreted by the adrenal cortex. Its synthetic counterpart is used, either as an injection or topically, in the treatment of inflammation, allergy, collagen diseases, asthma, adrenocortical deficiency, shock, and some neoplastic conditions.

Mechanism of action of Hydrocortisone

Hydrocortisone binds to the cytosolic glucocorticoid receptor. After binding the receptor the newly formed receptor-ligand complex translocates itself into the cell nucleus, where it binds to many glucocorticoid response elements (GRE) in the promoter region of the target genes. The DNA-bound receptor then interacts with basic transcription factors, causing the increase in the expression of specific target genes. The infection, or irritation, often causing pain, swelling, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।" data-rx-term="inflammation" data-rx-definition="Inflammation is the body’s response to injury, infection, or irritation, often causing pain, swelling, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।">inflammation, pain, or swelling. সহজ বাংলা: প্রদাহ/ফোলা/ব্যথা কমায়।" data-rx-term="anti-inflammatory" data-rx-definition="Anti-inflammatory means reducing inflammation, pain, or swelling. সহজ বাংলা: প্রদাহ/ফোলা/ব্যথা কমায়।">anti-inflammatory actions of corticosteroids are thought to involve lipocortins, phospholipase A2 inhibitory proteins which, through inhibition arachidonic acid, control the biosynthesis of prostaglandins and leukotrienes. Specifically, glucocorticoids induce lipocortin-1 (annexin-1) synthesis, which then binds to cell membranes preventing phospholipase A2 from coming into contact with its substrate arachidonic acid. This leads to diminished eicosanoid production. The cyclooxygenase (both COX-1 and COX-2) expression is also suppressed, potentiating the effect. In other words, the two main products in inflammation Prostaglandins and Leukotrienes are inhibited by the action of Glucocorticoids. Glucocorticoids also stimulate the lipocortin-1 escaping to the extracellular space, where it binds to the leukocyte membrane receptors and inhibits various inflammatory events: epithelial adhesion, emigration, chemotaxis, phagocytosis, respiratory burst, and the release of various inflammatory mediators (lysosomal enzymes, cytokines, tissue plasminogen activator, chemokines, etc.) from neutrophils, macrophages, and mastocytes. Additionally, the immune system is suppressed by corticosteroids due to a decrease in the function of the lymphatic system, a reduction in immunoglobulin and complement concentrations, the precipitation of lymphocytopenia, and interference with antigen-antibody binding.

or

Reactive oxygen species (ROS) generation by polymorphonuclear leukocytes (PMNL) and mononuclear cells (MNC) is inhibited following the intravenous administration of hydrocortisone. This is associated with a parallel decrease in intranuclear NFkappaB, known to modulate inflammatory responses including ROS generation. Plasma levels of interleukin-10 (IL-10), an infection, or irritation, often causing pain, swelling, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।" data-rx-term="inflammation" data-rx-definition="Inflammation is the body’s response to injury, infection, or irritation, often causing pain, swelling, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।">inflammation, pain, or swelling. সহজ বাংলা: প্রদাহ/ফোলা/ব্যথা কমায়।" data-rx-term="anti-inflammatory" data-rx-definition="Anti-inflammatory means reducing inflammation, pain, or swelling. সহজ বাংলা: প্রদাহ/ফোলা/ব্যথা কমায়।">anti-inflammatory and immunosuppressive cytokine produced by TH2 cells, are also increased after hydrocortisone administration. In this study, we have investigated the effect of hydrocortisone on p47(phox) subunit, a key component of nicotinamide adenine dinucleotide phosphate (NADPH) oxidase, in MNC and the pharmacodynamics of this effect with ROS generation and plasma IL-10 levels /were investigated/. p47(phox) subunit protein levels in MNC showed a progressive decrease after hydrocortisone administration. It reached a nadir at 4 hours and increased thereafter to a baseline level at 24 hours. ROS generation also decreased, reached a nadir between 2 and 4 hours, and returned to a baseline level at 24 hours. IL-10 concentrations increased, peaked at 4 hours, and reverted to the baseline levels at 24 hours. In conclusion, p47(phox) subunit suppression may contribute to the inhibition of ROS generation in MNC after hydrocortisone administration. This suppression occurs in parallel with the suppression of NF-kappaB and an increase in IL-10 plasma levels. Therefore, it would appear that the decrease in intranuclear NFkappaB and an increase in IL-10 may cause the inhibitory modulation on p47(phox) subunit and ROS generation by MNC following hydrocortisone and other glucocorticoids.

Indications of Hydrocortisone

  • Asthma, acute
  • Inflammatory Conditions
  • Adrenocortical Insufficiency
  • Addison’s Disease
  • Inflammatory Bowel Disease
  • Shock
  • Ulcerative Colitis
  • Ulcerative Proctitis
  • Acute Gouty pain, swelling, stiffness, or reduced movement. সহজ বাংলা: জয়েন্টের প্রদাহ।" data-rx-term="arthritis" data-rx-definition="Arthritis means joint inflammation causing pain, swelling, stiffness, or reduced movement. সহজ বাংলা: জয়েন্টের প্রদাহ।">Arthritis
  • Allergic Rhinitis (AR)
  • Allergic corneal marginal ulcers
  • Ankylosing Spondylitis (AS)
  • Anterior Segment Inflammation
  • Aspiration Pneumonitis
  • Asthma Bronchial
  • Atopic Dermatitis (AD)
  • Berylliosis
  • Bullous dermatitis herpetiformis
  • Congenital Adrenal Hyperplasia (CAH)
  • Conjunctivitis, Seasonal Allergic
  • Corneal Inflammation
  • Crohn’s Disease (CD)
  • Dermatitis, Contact
  • Dermatomyositis
  • Dermatosis
  • Drug hypersensitivity reaction
  • Epicondylitis
  • Erythroblastopenia
  • Hypercalcemia of Malignancy
  • Idiopathic Thrombocytopenic Purpura (ITP)
  • Iridocyclitis
  • Iritis
  • Leukemia, Acute
  • Leukemias
  • Loeffler’s syndrome
  • Malignant Lymphomas
  • Mycosis Fungoides (MF)
  • Ophthalmia, Sympathetic
  • Optic Neuritis
  • Pemphigus
  • Primary adrenocortical insufficiency
  • Proteinuria
  • Psoriatic Arthritis
  • Rheumatic heart disease, unspecified
  • Rheumatoid Arthritis
  • Rheumatoid Arthritis, Juvenile
  • Secondary adrenocortical insufficiency
  • Secondary thrombocytopenia
  • Serum Sickness
  • Severe Seborrheic Dermatitis
  • Stevens-Johnson Syndrome
  • Synovitis
  • Systemic Lupus Erythematosus (SLE)
  • Trichinosis
  • Tuberculous Meningitis
  • Ulcerative Colitis (UC)
  • Acquired immune hemolytic anemia
  • Acute Bursitis
  • Acute Tenosynovitis
  • Diffuse posterior uveitis
  • Disseminated Pulmonary Tuberculosis
  • Exfoliative erythroderma
  • Fulminating Pulmonary Tuberculosis
  • Non-suppurative Thyroiditis
  • Severe Psoriasis
  • Subacute Bursitis
  • Symptomatic Sarcoidosis
  • Systemic Dermatomyositis
  • Varicella-zoster virus acute retinal necrosis

Dosage of Hydrocortisone

Strengths: 10 mg; 20 mg; acetate 50 mg/mL; sodium phosphate 50 mg/mL;

Adrenocortical Insufficiency

Acute Adrenal Crisis

  • 100 mg IV followed by IV infusion of 200 mg over 24 hours OR 50 mg IV every 6 hours; then 100 mg IV the following day

Management of Primary Adrenal Insufficiency (PAI)

  • 15 mg to 25 mg orally in 2 or 3 divided doses per day
  • Highest dose should be given in the morning, then 2 hours after lunch (2-dose/day regimen) or at lunch and afternoon (3-dose/day regimen)

Prevention of Acute Adrenal Crisis

  • Adjust dose according to the severity of illness or magnitude of the stressor

Anti-inflammatory

Dosing should be individualized on the basis of disease and patient response

Oral

  • Initial dose: 20 mg to 240 mg orally per day

Parenteral

  • Initial dose: 100 mg to 500 mg IV or IM; may repeat doses at intervals of 2, 4, or 6 hours as indicated by the response and clinical indication
  • Maintenance dose: After a favorable initial response, the dose should be decreased in small amounts to the lowest dose that maintains an adequate clinical response; if a positive response is not achieved after a reasonable period of time, alternative therapy should be sought.

 Asthma

  • 100 mg IV every 8 hours during the surgical period; dose should be rapidly reduced within 24 hours after surgery

Ulcerative Colitis

  • 100 mg rectally (retention enema) nightly for 21 days or until both clinical and pathological remission occurs
  • Difficult cases may require 2 or 3 months of treatment

Multiple Sclerosis

  • Acute exacerbation: 800 mg oral/IV/IM once a day for 1 week followed by 320 mg oral/IV/IM every other day for 1 month

Pediatric Adrenocortical Insufficiency

Acute Adrenal Crisis

  • Initial dose: 2 to 3 mg/kg IV or intraosseous (IO) over 3 to 5 minutes; Maximum dose: 100 mg

Follow with

  • Infants: 1 to 5 mg/kg IV/IO every 6 hours
  • Children: 12.5 mg/m2 IV/IO every 6 hours OR 50 mg/m2 IV followed by 50 to 100 mg/m2 IV in divided doses every 6 hours or via 24-hour continuous IV infusion

Management of Primary Adrenal Insufficiency (PAI)

  • 8 mg/m2 orally in 3 or 4 divided doses per day
  • Highest dose should be administered in the morning

Prevention of Acute Adrenal Crisis

  • Adjust dose according to the severity of illness or magnitude of the stressor

Side Effects of Hydrocortisone

The most common

More common

Less common

  • Abnormal dreams
  • change in sense of taste
  • congestion
  • discouragement, feeling sad, or empty
  • Suicide attempts
  • Acting on dangerous impulses
  • Aggressive or violent behavior
  • Thoughts about suicide or dying
  • New or worse depression
  • New or worse anxiety or panic attacks
  • Agitation, restlessness, anger, or irritability
  • Trouble sleeping

Drug Interactions of Hydrocortisone

Hydrocortisone may interact with the following drugs, supplements & may decrease the efficacy of the drug

Pregnancy & Lactation

FDA Pregnancy Category C

Pregnancy

The safety of using this medication during pregnancy has not been established. This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Lactation

It is not known if clioquinol – hydrocortisone passes into breast milk. If you are a breastfeeding mother and are using this medication, it may affect your baby. Talk to your doctor about whether you should continue breastfeeding.

References

Hydrocortisone - Uses, Side Effects, Interactions

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  • Write when the problem started and how it changed.
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Questions to ask

  • What is the most likely cause of my symptoms?
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  • Which tests are necessary now, and which can wait?
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  • When should I come for follow-up?

Tests to discuss

  • Vital signs: temperature, pulse, blood pressure, oxygen saturation
  • Basic physical examination by a clinician
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Avoid these mistakes

  • Do not use antibiotics, steroid tablets/injections, or strong painkillers without proper medical advice.
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  • Do not delay emergency care when danger signs are present.

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Safe first steps

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  • Discuss physiotherapy, X-ray, or MRI only when clinically needed.

OTC medicine safety

  • For mild back pain, pain-relief medicine may be discussed with a doctor or pharmacist.
  • Avoid repeated painkiller use if you have kidney disease, stomach ulcer, uncontrolled blood pressure, or are taking blood thinners.

Avoid these mistakes

  • Do not start antibiotics without a proper medical decision.
  • Do not use steroid tablets or injections casually for quick relief.
  • Do not delay emergency care because of home remedies.

Get urgent help if

  • Back pain with leg weakness, numbness around private area, loss of urine/stool control, fever, cancer history, or major injury needs urgent care.
Medicine names, dose, and timing must be decided by a qualified clinician or pharmacist after checking age, pregnancy, allergy, other diseases, and current medicines.

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Write your symptoms, medicines already taken, test results, and questions before visiting a doctor. This note stays on your device unless you print or copy it.

Doctor to discuss: Orthopedic / spine specialist, physical medicine doctor, or qualified clinician
Tests to discuss with doctor
  • Neurological examination for leg power, sensation, reflexes, and straight leg raise
  • X-ray only if injury, deformity, long-lasting pain, or doctor suspects bone problem
  • MRI discussion if severe nerve symptoms, weakness, bladder/bowel problem, or persistent symptoms
Questions to ask
  • What is the most likely cause of my symptoms?
  • Which warning signs mean I should go to emergency care?
  • Which tests are really needed now?
  • Which medicines are safe for my age, pregnancy status, allergy, kidney/liver/stomach condition, and current medicines?
  • Is physiotherapy, posture correction, or activity modification needed?

Emergency warning signs such as chest pain, severe breathing difficulty, sudden weakness, confusion, severe dehydration, major injury, or loss of bladder/bowel control need urgent medical care. Do not wait for online information.

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Care roadmap for: Hydrocortisone – Uses, Side Effects, Interactions

Use this simple roadmap to understand the next safe steps. It is educational and does not replace examination by a doctor.

Go to emergency care if you notice:
  • Severe or rapidly worsening symptoms
  • Breathing difficulty, chest pain, fainting, confusion, severe weakness, major injury, or severe dehydration
Doctor / service to discuss: Qualified healthcare provider; specialist depends on symptoms and examination.
  1. Step 1

    Check danger signs first

    If danger signs are present, seek emergency care and do not wait for online information.

  2. Step 2

    Record the symptom story

    Write when symptoms started, severity, medicines already taken, allergies, pregnancy status, and test results.

  3. Step 3

    Visit a qualified clinician

    A doctor, nurse, or qualified healthcare provider can examine you and decide which tests or treatment are needed.

  4. Step 4

    Do only useful tests

    Do tests after clinical assessment. Avoid unnecessary tests, random antibiotics, or repeated medicines without diagnosis.

  5. Step 5

    Follow up and return early if worse

    If symptoms worsen, new warning signs appear, or treatment is not helping, return for review quickly.

Rural patient practical tips
  • Take a written symptom diary and all previous prescriptions/test reports.
  • Do not hide medicines already taken, even herbal or over-the-counter medicines.
  • Ask which warning signs mean urgent referral to hospital.

This roadmap is for education. A real diagnosis and treatment plan requires history, examination, and clinical judgment.

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Frequently Asked Questions

Is this article a replacement for a doctor?

No. It is educational content only. Patients should consult a qualified clinician for diagnosis and treatment.

When should I seek urgent care?

Seek urgent care for severe symptoms, rapidly worsening condition, breathing difficulty, severe pain, neurological changes, or any emergency warning sign.

References

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