[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Corticosteroids (glucocorticoids)](https://durgical.com/en/pharmacology/classes/corticosteroids/) › Hydrocortisone

[Pharmacology](https://durgical.com/en/pharmacology/) · [Corticosteroids (glucocorticoids)](https://durgical.com/en/pharmacology/classes/corticosteroids/)

# Hydrocortisone

The pharmaceutical form of cortisol, the body's own stress hormone. It is the replacement of choice when the adrenal glands fail.

Updated 2026-11-01

- Class: [Corticosteroids (glucocorticoids)](https://durgical.com/en/pharmacology/classes/corticosteroids/)
- Receptor: Glucocorticoid receptor (GR), a nuclear receptor
- ATC code: H02AB09
- WHO Model List of Essential Medicines

Also called: Cortisol

◎**Glucocorticoid receptor (GR), a nuclear receptor**Hydrocortisone

ⓘ The figure shows cortisol (hydrocortisone itself) in the ligand-binding domain of the human glucocorticoid receptor.

**Target in 3D:** Glucocorticoid receptor (GR), a nuclear receptor. PDB structure 4P6X (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/4P6X) · Drag to rotate · pinch to zoom

## Mechanism of action

Hydrocortisone is identical to cortisol. It binds the glucocorticoid receptor, which enters the nucleus and changes gene transcription: anti-inflammatory and metabolic genes are switched on and pro-inflammatory ones repressed. Unlike synthetic analogues it also has some mineralocorticoid action, so at replacement doses it covers part of the salt-retaining need.

- Hydrocortisone (cortisol) binds the glucocorticoid receptor
- The drug-receptor complex moves into the nucleus
- It switches on anti-inflammatory genes and represses NF-κB and AP-1
- Fewer cytokines, prostaglandins and immune cells reach the tissue

## Pharmacokinetics

**Absorption**
Well absorbed by mouth; the sodium succinate form is given IV or IM

**Metabolism**
Mostly in the liver; in the kidney part is turned into inactive cortisone

**Half-life**
Short-acting compared with synthetic glucocorticoids

## Indications

- Primary or secondary adrenal insufficiency, including adrenal crisis (IV) [Adrenal insufficiency →](https://durgical.com/en/conditions/adrenal-insufficiency/)
- Congenital adrenal hyperplasia
- Severe allergic reactions, as an adjunct to adrenaline [Anaphylaxis →](https://durgical.com/en/conditions/anaphylaxis/)
- Severe asthma and inflammatory bowel disease flares [Ulcerative colitis →](https://durgical.com/en/conditions/ulcerative-colitis/)

## Adverse effects

### Common

- Fluid retention and higher blood pressure at higher doses
- Hyperglycaemia
- Insomnia and mood changes
- Acne
- Irregular menstrual periods

### Serious (rare, important)

- Infections, which the drug can also mask
- Adrenal suppression: adrenal insufficiency if stopped abruptly after prolonged use
- Osteoporosis and fractures with long use
- Peptic ulcer and gastrointestinal bleeding, especially with NSAIDs
- Posterior subcapsular cataract and glaucoma
- Psychiatric reactions (euphoria, depression, psychosis)
- Slowed growth in children

## Contraindications

- Systemic fungal infections
- Hypersensitivity to the product
- Live or live attenuated vaccines during immunosuppressive doses

## Key interactions

**CYP3A4 inducers (rifampicin, phenytoin, carbamazepine, barbiturates)**
Faster clearance and a weaker corticosteroid effect

**Strong CYP3A4 inhibitors (ketoconazole)**
Higher corticosteroid levels and more side effects

**Aspirin and other NSAIDs**
Higher risk of gastrointestinal ulcer and bleeding

**Potassium-depleting drugs (loop or thiazide diuretics, amphotericin B)**
Hypokalaemia; with digoxin, more risk of arrhythmia

**Warfarin**
The anticoagulant response changes; INR is checked more often

## What is monitored

- Blood glucose
- Blood pressure and weight
- Potassium
- Signs of infection
- Eye pressure and bone density with long use

## Administration and safety

- For adrenal crisis the sodium succinate injection is given IV; it is reconstituted as the product label describes
- Replacement doses are split through the day to mimic the natural cortisol rhythm
- Patients on replacement need extra («stress») cover during illness or surgery, as ordered

## Nursing care

- In adrenal crisis, check blood pressure, glucose, sodium and potassium closely
- Watch for infection: fever and other signs may be blunted
- Watch mood and sleep; report agitation, depression or confusion
- Teach that a long course is not stopped suddenly; it is tapered under medical supervision
- Teach people on replacement to carry an alert card and to seek care if vomiting stops them keeping tablets down

## Pregnancy and breastfeeding

Used in pregnancy when the benefit justifies it; newborns of mothers on substantial doses are watched for adrenal insufficiency.

## Memory aid

Hydrocortisone = the original: cortisol itself, with a little salt retention, so it replaces both jobs of the adrenal cortex.

## Test yourself

Think of the answer, then tap the question to see it.

## Why is hydrocortisone the drug of choice for adrenal insufficiency?

It is cortisol itself, with glucocorticoid and some mineralocorticoid action; in primary disease it is often combined with fludrocortisone.

## A patient with Addison disease has gastroenteritis and cannot keep tablets down. What is the risk?

Adrenal crisis: hypotension, shock, hyponatraemia, hyperkalaemia and hypoglycaemia. Parenteral hydrocortisone is needed urgently.

## Which enzyme in the kidney inactivates cortisol to cortisone?

11β-hydroxysteroid dehydrogenase type 2, which protects the mineralocorticoid receptor from cortisol.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/hydrocortisone/)

## Related drugs

- [Fludrocortisone](https://durgical.com/en/pharmacology/fludrocortisone/)
- [Prednisolone](https://durgical.com/en/pharmacology/prednisolone/)
- [Dexamethasone](https://durgical.com/en/pharmacology/dexamethasone/)

## Related conditions

- [Adrenal insufficiency](https://durgical.com/en/conditions/adrenal-insufficiency/)
- [Anaphylaxis](https://durgical.com/en/conditions/anaphylaxis/)
- [Ulcerative colitis](https://durgical.com/en/conditions/ulcerative-colitis/)

[← Back to the class: Corticosteroids (glucocorticoids)](https://durgical.com/en/pharmacology/classes/corticosteroids/)

Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [Hydrocortisone: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a682206.html) (MedlinePlus (U.S. National Library of Medicine), 2025); [DailyMed - HYDROCORTISONE SODIUM SUCCINATE injection, powder, for solution](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=bfe185a6-b657-2fbb-4ac2-e085373f15f3) (DailyMed (U.S. National Library of Medicine), 2026); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=H02AB09) (WHO Collaborating Centre for Drug Statistics Methodology, 2026); Farmacología básica y clínica (Katzung), 16.ª ed., cap. 39 (McGraw Hill, 2025).

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Representative model, for educational purposes only.

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