Active substance

Hydrocortisone

Dosage form

Manufacturer

Tatkhimpharmpreparaty, Russia

Composition

Active ingredient: hydrocortisone acetate - 0.5 g;
Excipients: methyl parahydroxybenzoate (methylparaben), petroleum jelly.

pharmachologic effect

Hydrocortisone is a natural glucocorticosteroid. It has anti-inflammatory, anti-allergic effects. Reduces inflammatory cell infiltrates, reduces the migration of leukocytes and lymphocytes in the area of \u200b\u200binflammation. Stabilizes cellular and subcellular, including lysosomal and mast cell membranes. Reduces the binding of immunoglobulins to receptors on the cell surface and inhibits the synthesis or release of cytokines (interleukins and interferon) from lymphocytes and macrophages. Reduces the release of arachidonic acid from phospholipids and the synthesis of its metabolites (prostaglandins, leukotrienes, thromboxane). Reduces exudative reaction, helps to reduce capillary permeability. Reduces the severity of an early immunological response. It has a catabolic effect and inhibits the development of connective tissue and scarring.

GKS. Suppresses the function of leukocytes and tissue macrophages. Limits the migration of leukocytes to the area of \u200b\u200binflammation. Violates the ability of macrophages to phagocytosis, as well as the formation of interleukin-1. Promotes the stabilization of lysosomal membranes, thereby reducing the concentration of proteolytic enzymes in the area of \u200b\u200binflammation. Reduces capillary permeability due to the release of histamine. Suppresses fibroblast activity and collagen formation.

Inhibits the activity of phospholipase A2, which leads to suppression of the synthesis of prostaglandins and leukotrienes. Suppresses the release of COX (mainly COX-2), which also helps to reduce the production of prostaglandins.

Reduces the number of circulating lymphocytes (T- and B-cells), monocytes, eosinophils and basophils due to their movement from the vascular bed into the lymphoid tissue; suppresses the formation of antibodies.

Hydrocortisone inhibits the release of ACTH and β-lipotropin by the pituitary gland, but does not decrease the level of circulating β-endorphin. Inhibits the secretion of TSH and FSH.

When applied directly to the vessels, it has a vasoconstrictor effect.

Hydrocortisone has a pronounced dose-dependent effect on the metabolism of carbohydrates, proteins and fats. Stimulates gluconeogenesis, promotes the uptake of amino acids by the liver and kidneys, and increases the activity of gluconeogenesis enzymes. In the liver, hydrocortisone enhances the storage of glycogen, stimulating the activity of glycogen synthetase and the synthesis of glucose from the products of protein metabolism. An increase in blood glucose activates the release of insulin.

Hydrocortisone inhibits the uptake of glucose by fat cells, which leads to the activation of lipolysis. However, due to the increase in insulin secretion, lipogenesis is stimulated, which leads to the accumulation of fat.

It has a catabolic effect in lymphoid and connective tissue, muscles, adipose tissue, skin, bone tissue. IN lesser degreethan mineralocorticoids, it affects the processes of water-electrolyte metabolism: it promotes the excretion of potassium and calcium ions, the retention of sodium and water ions in the body. Osteoporosis and Itsenko-Cushing's syndrome are the main factors limiting long-term GCS therapy. As a result of the catabolic action, growth inhibition in children is possible.

In high doses, hydrocortisone can increase the excitability of brain tissue and help lower the seizure threshold. Stimulates excess production of hydrochloric acid and pepsin in the stomach, which contributes to the development of peptic ulcers.

With systemic use, the therapeutic activity of hydrocortisone is due to its anti-inflammatory, antiallergic, immunosuppressive and antiproliferative effects.

When applied topically and locally, the therapeutic activity of hydrocortisone is due to its anti-inflammatory, antiallergic and antiexudative (due to the vasoconstrictor effect) action.

In terms of anti-inflammatory activity, it is 4 times weaker than prednisone, in mineralocorticoid activity it surpasses other GCS.

Pharmacokinetics

Plasma protein binding - 40-90%. It is metabolized mainly in the liver. T1 / 2 - 80-120 min. It is excreted by the kidneys mainly in the form of metabolites.

Indications

• allergic gas diseases (eyelid dermatitis, blepharitis, conjunctivitis and keratoconjunctivitis);
• inflammatory diseases of the anterior eye in the absence of a violation of the integrity of the corneal epithelium (blepharitis, conjunctivitis and keratoconjunctivitis);
• thermal and chemical burns (after complete epithelialization of corneal defects).

Application during pregnancy and lactation

Studies of the safety and efficacy of hydrocortisone in pregnant and lactating women have not been conducted. There is no exact data on the penetration of glucocortisternoids into breast milk when applied topically. However, the risk cannot be completely ruled out. The use of hydrocortisone in pregnant and lactating women is allowed only as directed by the attending physician, when the expected therapeutic effect for the mother outweighs the potential risk for the fetus and child.

Experimental studies have shown that GCS can cause fetal development disorders. There is currently no clear confirmation of these data in humans.

Contraindications

• purulent, viral, tuberculous, fungal eye diseases;
• glaucoma;
• trachoma;
• vaccination period;
• violation of the integrity of the membranes of the eye

Side effects

Allergic reactions, burning, scleral injection, short-term blurred vision.
With prolonged use for more than 10 days, you may experience:
- an increase in intraocular pressure with the possible subsequent development of steroid glaucoma with damage to the optic nerve and impaired visual fields (therefore, when using drugs containing glucocorticosteroids, intraocular pressure should be measured regularly for more than 10 days);
- formation of posterior subcapsular cataract;
- slowing down the process of wound healing (in diseases that cause thinning of the cornea, its perforation is possible). Secondary bacterial infection can occur as a result of suppression of the protective reaction of the patient's body. In acute purulent diseases of the eye, glucocorticosteroids can mask or intensify the existing infectious process.
Fungal damage to the cornea tends to occur especially frequently with prolonged use of glucocorticosteroids. The appearance of non-healing ulcers on the cornea after long-term treatment with glucocorticosteroids may indicate the development of fungal invasion.

Interaction

The effect is weakened by barbiturates, hypokalemia is enhanced by diuretics. Reduces the effect of hypoglycemic agents.

With long-term use of the drug with possible resorption of the drug into the general bloodstream, hydrocortisone reduces the effectiveness of insulin, oral hypoglycemic drugs, antihypertensive drugs, anticoagulants, reduces the concentration of salicylates in the blood, reduces the concentration of praziquantel in the blood serum. Increase the risk of developing side effects hydrocortisone: androgens, estrogens, oral contraceptives, anabolic steroid (hirsutism, acne); antipsychotics, carbutamide, azathioprine (cataract); anticholinergics, antihistamines, tricyclic antidepressants, nitrates (glaucoma); diuretics (hypokalemia). When used with cardiac glycosides, digitalis intoxication may develop. Simultaneous use with lead and silver preparations leads to mutual inactivation.

Overdose

Symptoms: excessive and frequent use during the day or use in children may cause systemic effects of the drug.
Treatment: when the drug is canceled, the overdose phenomena disappear on their own.

Special instructions

It is not recommended to exceed the course of treatment. When used for more than 2 weeks and a history of open or closed angle glaucoma, intraocular pressure control is necessary.
Use in pediatrics: it is possible to use Hydrocortisone to treat children as directed by the attending physician, if the expected therapeutic effect outweighs the risk of developing possible side effects. Children are more likely to develop systemic action of hydrocortisone than adults. Therefore, in children, the drug should be used carefully, if possible, in a short course (5-7 days).
Influence on the ability to drive vehicles and control mechanisms: the drug does not limit psychophysical activity, the ability to drive vehicles and service moving mechanisms. Patients who temporarily lose vision clarity after application are not recommended to drive a car or work with complex equipment immediately after application of the drug.

In this medical article, you can read drug Hydrocortisone ointment. The instructions for use will explain in which cases you can take an ointment or cream, what the medicine helps from, what are the indications for use, contraindications and side effects. The annotation presents the form of release of the drug and its composition.

In the article, doctors and consumers can only leave real reviews about Hydrocortisone ointment, from which you can find out whether the medicine helped in the treatment of skin pathologies in adults and children, for which it is also prescribed. The instructions list analogues of Hydrocortisone ointment, drug prices in pharmacies, as well as its use during pregnancy.

The topical corticosteroid medicine is hydrocortisone ointment. The instructions for use explain that this ointment has anti-allergic and anti-inflammatory properties.

Release form and composition

The drug is produced in the following dosage forms:

• ointment for eyes and mucous membranes (0.5%) - produced in tubes of 10, 5 and 3 g;
• ointment for external use (1%) - produced in aluminum tubes of 5 - 30 g;
• surface treatment cream (1%) - available in metal tubes of 30, 20, 15 and 10 g.

The main active ingredient of the drug is the hormone hydrocortisone.

Ointment Hydrocortisone 1% is available in aluminum tubes with a volume of 3 or 5 g in a cardboard box with the attached instructions.

pharmachologic effect

The active ingredient, hydrocortisone acetate, when applied externally, has anti-inflammatory, immunosuppressive and anti-allergic effects.

The immunosuppressive effect is achieved by suppressing the activity of immune blood cells - T and B-lymphocytes, interferon, interleukins and other mediators, excessive production and pathologically enhanced work of which takes place in autoimmune processes.

The anti-inflammatory effect is associated with inhibition of the production of inflammatory mediators, a decrease in the activity of leukocytes and macrophages - blood cells migrating to the inflammation focus, narrowing of small vessels, a decrease in the release of fluid from the bloodstream and the formation of inflammatory edema.

Antiallergic action includes suppression of the production of antibodies and the destruction of mast cell granules, the contents of which are the main mediators of allergy - histamine and leukotrienes.

Indications for use

What does Hydrocortisone Ointment help with? The drug is prescribed for:

• non-microbial eczema;
• inflammatory skin diseases;
• neurodermatitis;
• external symptoms of allergies.

In practice, the range of prescriptions is twice as wide, since Hydrocortisone ointment has found its use for the treatment of cosmetic problems, diseases of the joints and even ENT organs.

Instructions for use

Hydrocortisone ointment 1% applied to the affected skin areas according to the doctor's instructions in a thin layer. The drug should be lightly rubbed in until completely absorbed, then thoroughly wash your hands with soap and water. The ointment is applied only to clean skin from 1 to 3 times a day, depending on the severity of the pathological process.

The duration of the course of drug therapy is determined by the doctor on an individual basis, however, according to the instructions, the treatment cannot be continued for more than 5 days, since the body quickly gets used to hormones, which can lead to the development of negative reactions from the adrenal glands.

Hydrocortisone ointment 0.5% used for eye diseases of an infectious or inflammatory nature, provided the integrity of the cornea. The drug is applied with a thin strip on the lower inner edge of the eyelid, without touching the mucous membrane cap, after which the patient closes the eye and gently massages the eyelid to evenly distribute the ointment over the eyeball.

The number of applications of the drug per day varies from 1 to 4 times, depending on the severity of the inflammatory process and the individual characteristics of the patient's body. The duration of the course of therapy should not exceed 3-5 days.

Hydrocortisone anti-wrinkle ointment

Apply to problem areas with light massaging movements 2 times / day. Before using the medicine, you should wash off the cosmetics, cleanse the epidermis from contamination. A sensitivity test is recommended before using hydrocortisone.

Also read this article: Candide

Ultrasound with hydrocortisone

The ointment is applied with a spatula to the affected area in a small amount. At the end of the procedure, it is not recommended to wipe off the remnants of the product; it is better to leave them on the skin, covered with tracing paper or cellophane on top.

Avoid contact with the mucous membrane of the eyes. If during the week of treatment with ointment there is no effect or the symptoms of the disease worsen, you should stop using the drug and consult a specialist.

Contraindications

It is important to understand that Hydrocortisone drugs are serious hormonal agents, so you cannot use them without a doctor's prescription! Before starting therapy with ointment, you should carefully study the attached instructions, since the drug has a number of the following contraindications.

Hydrocortisone should not be taken if:

• osteoporosis;
• psychosis;
• active forms of tuberculosis in the absence of specific treatment;
• severe forms of hypertension;
• jade;
• systemic fungal diseases;
• diabetes mellitus;
• itsenko-Cushing's disease;
• peptic ulcer of the stomach and duodenum;
• hypersensitivity to its components.

Side effects

When using Hydrocortisone, some patients may experience allergic reactions and side effects due to disruption of the internal organs (hypothalamus, adrenal glands or pituitary gland).

Hydrocortisone ointment can provoke tissue atrophy of dermatological etiology:

• problems with pigmentation of the epidermis;
• the formation of acne, rash, stretch marks;
• aggravation of infectious diseases;
• damage to the dermis by a fungus;
• local hemorrhage;
• tissue atrophy.

Ophthalmic problems: an increase in pressure inside the lens, eyes, partial or complete loss of vision, the development of cataracts.

To avoid these hazards, it is important to adhere to simple directions for the use of the pharmaceutical product.

Children, during pregnancy and breastfeeding

Hydrocortisone during pregnancy Despite the development of modern medicine, doctors have not yet been able to fully study the effects of Hydrocortisone ointment on the health of a pregnant woman and her unborn child.

In any case, it is better to refuse large dosages of the drug and long-term therapy. This is due to the fact that some components of the drug can be absorbed into the bloodstream, due to which there is a likely negative effect on the health of the child.

Hydrocortisone ointment is contraindicated for children under 2 years of age. Up to 12 hours, liniment is applied under the guidance and supervision of a doctor.

special instructions

The drug Hydrocortisone in any of its dosage form should not be used for more than 3 days, in extreme cases, no more than 5 days. Drug therapy should be discontinued gradually: mixing Hydrocortisone ointment with a regular cream, daily increasing the dose of the cream and decreasing the amount of ointment. Thus, the impact on the adrenal glands will be minimal.

In the absence of the expected effect against the background of treatment with ointment as early as 1-2 days from the start of therapy, the patient should consult a doctor again in order to clarify the diagnosis and the adequacy of the prescribed therapy.

When using ophthalmic hydrocortisone ointment, patients wearing contact lenses should be discarded for the period of therapy.

Drug interactions

The risk of developing cataracts increases when antipsychotics (neuroleptics), carbutamide and azathioprine are used against the background of GCS.

The simultaneous use of GCS with anticholinergics (including antihistamines, tricyclic antidepressants) and nitrates increases intraocular pressure.

Analogues of the drug Hydrocortisone ointment

Analogs - ointments have a similar effect:

1. Acortin;
2. Erythomycin;
3. Tetracycline;
4. Tobrex;
5. Cortef;
6. Dexa-Gentamicin;
7. Courtade.

Vacation conditions and price

The average cost of Hydrocortisone ointment (tube of 0.5% 5g) in Moscow is 40 rubles. The drug is dispensed in pharmacies without a prescription from a doctor.

The shelf life of the drug is 3 years. Store Hydrocortisone ointment instructions for use prescribe in a place protected from children at an air temperature of 10-20 ° C.

Characteristic

Hydrocortisone, a hormone secreted by the adrenal cortex, is a glucocorticoid. In medical practice, natural hydrocortisone or its esters (hydrocortisone acetate and sodium hydrocortisone hemisuccinate) are used for systemic and local use.

Hydrocortisone is a white or off-white powder, odorless, bitter taste. Solubility (mg / ml) at 25 ° C: water 0.28; ethanol 15.0; methanol 6.2; acetone 9.3; chloroform 1.6; propylene glycol 12.7; ether - about 0.35. Let's dissolve in concentrated sulfuric acid to form an intense green fluorescent solution. Molecular weight 362.47.

Hydrocortisone acetate is a synthetic steroid, white or white with a slightly yellowish sheen, odorless crystalline powder. Slightly hygroscopic. Solubility in water: 1 mg / 100 ml, in ethanol: 0.45 g / 100 ml, in methanol: 3.9 mg / ml, in acetone: 1.1 mg / g, in ether: 0.15 mg / ml , in chloroform: 1 g / 200 ml, well soluble in dimethylformamide, soluble in dioxane. Molecular weight 404.50.

Hydrocortisone sodium hemisuccinate - a synthetic steroid, white or white with a slightly yellowish tinge porous mass or amorphous hygroscopic white powder; solubility in water about 500 mg / ml. Easily soluble in methanol, ethanol, it is difficult to dissolve in chloroform. Molecular weight 484.51.

Hydrocortisone 17-butyrate - molecular weight 432.55.

pharmachologic effect

Anti-inflammatory, anti-allergic, immunosuppressive, antipruritic, anti-shock, anti-exudative, glucocorticoid.

Pharmacodynamics

Inhibits hypersensitivity reactions, proliferative and exudative processes in connective tissue, in the focus of inflammation. Reduces local flushing and hyperthermia of the skin. The action is mediated through specific intracellular receptors. Prevents the activation of phospholipase A2 by stimulating the formation of its inhibitor - lipomodulin and, due to direct action on cell membranes, disrupts the synthesis of PG and the release of macrophage chemotactic factor, inhibits the activation of tissue kinins. Reduces the migration of macrophages and lymphocytes to the inflammatory focus. Blocks Fc receptors on the surface of macrophages for IgG and C3 complement components. Stabilizes lysosomal membranes, preventing the release of lysosomal enzymes. Suppresses alteration, exudation and proliferation. In large doses, it inhibits the development of lymphoid and connective tissue, inhibits the activity of hyaluronidase, and reduces capillary permeability. It inhibits the production of collagenase and activates the synthesis of protease inhibitors. Blocks the synthesis and release of histamine and other biologically active substances from sensitized mast cells and basophils, suppresses various stages of immunogenesis, without exerting a mitostatic effect. Increases the level of glycogen in the liver, inhibits the excretion of sodium and water, increases - potassium. Affects protein (causes negative nitrogen balance due to increased catabolism) and lipid metabolism. Increases BCC, tissue hydrophilicity, increases blood pressure, has an anti-shock effect. The threshold dose leading to the development of Cushing's syndrome with prolonged use is about 30 mg. With prolonged use, atrophy of the adrenal cortex develops, the formation of ACTH and thyroid stimulating hormone of the pituitary gland is inhibited.

Hydrocortisone acetate is characterized by a slow-developing, but longer-lasting, effect than that of water-soluble drugs. It is used for administration to sites of injury, joints and soft tissues, where it has a local anti-inflammatory effect, although systemic hormonal effects may develop. The therapeutic effect with intra-articular administration occurs within 6-24 hours and lasts from several days to several weeks. Hydrocortisone sodium succinate has both metabolic and anti-inflammatory activity. After intravenous administration, the action appears after 1 hour, its duration varies. Excretion of the administered dose is carried out within 12 hours. If it is necessary to maintain high plasma concentrations, it is recommended to administer it every 4–6 hours. This hydrocortisone salt is rapidly absorbed and, when administered intramuscularly, is excreted in the same way as with intravenous application.

Well absorbed after oral administration. Cmax is reached after 1 hour. After intramuscular administration, absorption occurs slowly (24–48 hours). It binds to plasma transcortin by 70-80%, with albumin - 10%, about 10% is in the form of a free fraction. It penetrates well through mucous membranes and histohematogenous barriers. Metabolized in the liver. It is excreted mainly through the kidneys in the form of inactive metabolites. In the placenta, about 70% of hydrocortisone is metabolized with the formation of an inactive 11-keto form.

When using an ophthalmic ointment (in the form of hydrocortisone acetate), it penetrates poorly through the cornea into the intraocular fluid, but penetrates into the epidermis and epithelium of the mucous membrane. After application to the skin (in the form of hydrocortisone acetate and hydrocortisone 17-butyrate), it accumulates in the epidermis. To a small extent, it can be absorbed through the skin and have a systemic effect. The absorbed part is metabolized in the epidermis and then in the liver. Metabolites and a small part of hydrocortisone are excreted in the urine or bile.

Indications for use

For systemic use: acute allergic reactions, severe attack of bronchial asthma, asthmatic condition, serum sickness, hypersensitivity reactions to drug administration; emergency conditions - hypotension, incl. orthostatic, collapse in Addison's disease, myocardial infarction, hemorrhagic stroke, Morgagni-Adams-Stokes syndrome, coma in case of cerebrovascular accident and inflammatory brain diseases, hypothyroid and hepatic coma, multiple bleeding, acute hepatic insufficiency in case of allergic reactions, laryngeal edema lesions, burns and injuries, poisoning with vitamin D, strong acids, organophosphorus substances, quinine, chlorine, post-transfusion complications, Mendelssohn's syndrome, snake and scorpion bites; anaphylactic, hemorrhagic, cardiogenic and traumatic shock; endocrine diseases - Waterhouse-Friderichsen syndrome, primary or secondary adrenal cortex insufficiency (natural cortisone and hydrocortisone are preferable, synthetic analogs should be used in combination with mineralocorticoids), adrenogenital syndrome with sodium loss, thyroiditis; hypercalcemia associated with cancer; rheumatic diseases - psoriatic, rheumatoid, juvenile and acute gouty arthritis, ankylosing spondylitis, acute and subacute bursitis, periarthritis of the shoulder scapula, systemic lupus erythematosus, acute rheumatic carditis, dermatomyositis; sarcoidosis, Leffler's syndrome, beryllium disease, fulminant or disseminated pulmonary tuberculosis, aspiration pneumonitis (in combination with specific chemotherapy); idiopathic thrombocytopenic purpura in adults, autoimmune hemolytic and congenital hypoplastic anemia, erythroblastopenia, palliative therapy for leukemia and lymphomas in adults, acute leukemia in children; nephrotic syndrome without signs of uremia (to reduce proteinuria and induce diuresis), severe exacerbations of ulcerative colitis and Crohn's disease, tuberculous meningitis with subarachnoid block, trichinosis with neurological and myocardial manifestations, acute manifestations of multiple sclerosis of the lungs (disseminated cancer) diagnosis of idiopathic and drug-induced leukopenia.

Intra-articular and periarticular administration (hydrocortisone acetate): reactive synovitis (including with deforming osteoarthritis), rheumatoid arthritis, acute and subacute bursitis, acute gouty arthritis, epicondylitis, acute nonspecific tendosynovitis, post-carpal tunnel syndrome.

When applied to the skin: inflammatory and allergic skin diseases of non-microbial etiology, incl. eczema, dermatitis (allergic, atopic, bullous herpetiformis, exfoliative, seborrheic, contact); itchy dermatoses, photodermatoses, anogenital pruritus, insect bites, pemphigus, erythroderma, psoriasis.

In ophthalmology (hydrocortisone acetate in the form of an ophthalmic ointment): allergic conjunctivitis, blepharitis, eyelid dermatitis, keratitis, restoration of the transparency of the cornea and suppression of neovascularization after keratitis, chemical and thermal burns (after complete epithelialization of the cornea); iritis, iridocyclitis, anterior segment inflammation, diffuse posterior uveitis and choroiditis, sympathetic ophthalmia, condition after surgery.

IV with keloids, localized hypertrophic, infiltrative, inflammatory lesions, lichen planus, psoriatic plaques, annular granuloma, neurodermatitis, discoid lupus erythematosus, diabetic lipoid necrobiosis, alopecia areata, cystic tumors of aponeurosis tendon.

Contraindications for use

Hypersensitivity (for short-term systemic use for health reasons is the only contraindication).

For intra-articular and periarticular use: previous arthroplasty, conditions after an intestinal anastomosis operation, pregnancy, breastfeeding.

When applied to the skin: bacterial, viral and fungal skin diseases, skin manifestations of syphilis, skin tuberculosis, skin tumors, violation of the integrity of the skin (ulcers, wounds), rosacea, acne vulgaris, perioral dermatitis, post-vaccination period, pregnancy, breastfeeding.

For eye ointment: purulent, viral, tuberculous and fungal eye diseases, trachoma, primary glaucoma, violation of the integrity of the corneal epithelium; vaccination period, pregnancy, breastfeeding.

Use during pregnancy and children

The use of corticosteroids during pregnancy is possible if the expected effect of therapy outweighs the potential risk to the fetus (adequate and strictly controlled safety studies have not been carried out). Women of childbearing age need to be warned of the potential risk to the fetus (corticosteroids pass through the placenta). It is necessary to carefully monitor newborns whose mothers received corticosteroids during pregnancy (adrenal insufficiency may develop in the fetus and newborn). Should not be used frequently, in large doses, over a long period of time.

Nursing women are advised to stop either breastfeeding or the use of drugs, especially in high doses (corticosteroids pass into breast milk and can inhibit growth, the production of endogenous corticosteroids and cause unwanted effects in the newborn). When using topical forms of hydrocortisone, do not apply the drug to the skin of the breast.

Side effects

The frequency of development and the severity of side effects depend on the method, duration of use, the dose used and the possibility of observing the circadian rhythm of drug administration.

Systemic effects

From the side of metabolism: retention of Na + and fluid in the body, hypokalemia, hypokalemic alkalosis, negative nitrogen balance, hyperglycemia, glucosuria, weight gain.

From the endocrine system: secondary adrenal and hypothalamic-pituitary insufficiency (especially during stressful situations such as illness, trauma, surgery); Cushing's syndrome; growth suppression in children; menstrual irregularities; decreased tolerance to carbohydrates; manifestation of latent diabetes mellitus, increased need for insulin or oral antidiabetic drugs in patients with diabetes mellitus.

From the side of cardio-vascular system and blood (hematopoiesis, hemostasis): increased blood pressure, development (in predisposed patients) or increased severity of chronic heart failure, hypercoagulation, thromboembolism, ECG changes characteristic of hypokalemia; in patients with acute and subacute myocardial infarction - the spread of the focus of necrosis, slowing of the formation of scar tissue with possible rupture of the heart muscle, obliterating endarteritis, hematological changes.

From the side of the musculoskeletal system: muscle weakness, steroid myopathy, loss of muscle mass, osteoporosis, compression fracture of the spine, aseptic necrosis of the femoral head and humerus, pathological fractures of the long bones, tendon ruptures, primarily Achilles.

From the digestive tract: steroid ulcer with possible perforation and bleeding, pancreatitis, flatulence, ulcerative esophagitis, indigestion, nausea, vomiting, increased / decreased appetite; after treatment with corticosteroids, an increase in the level of ALT, AST and ALP in the blood serum was observed; usually these changes are insignificant, are not associated with any clinical syndromes and are reversible after discontinuation of treatment.

On the part of the skin: atrophic stripes, acne, delayed wound healing, thinning of the skin, petechiae and ecchymosis, erythema, increased sweating.

From the nervous system and sensory organs: convulsions, increased intracranial pressure with congestive optic papilla syndrome (pseudotumor of the brain - more often in children, usually after a too rapid dose reduction, symptoms - headache, deterioration of visual acuity or double vision); vertigo, headache, malaise, mental disorders; formation of posterior subcapsular cataract, increased intraocular pressure, glaucoma; steroid exophthalmos.

Allergic reactions: generalized (allergic dermatitis, urticaria, anaphylactic shock) and local.

Others: masking symptoms of infectious diseases, withdrawal syndrome; reactions at the injection site - burning, numbness, pain, paresthesia and infection, hyper- or hypopigmentation, scarring; atrophy of the skin and subcutaneous tissue, sterile abscess.

When applied to the skin: irritation, burning, dry skin, local allergic reactions, incl. hyperemia, swelling, itching; with prolonged use, especially under impervious dressings or on large areas of the skin - systemic side effects; steroid acne, purpura, telangiectasia; the development of hypercortisolism as a manifestation of a resorptive action (in these cases, the drug is canceled); with prolonged use, it is also possible to develop secondary infectious skin lesions, atrophic changes, hypertrichosis.

Eye ointment: allergic reactions, burning, scleral injection, increased intraocular pressure, exophthalmos; in case of violation of the integrity of the corneal epithelium, delayed healing and corneal perforation are possible; with prolonged use - the development of steroid glaucoma is possible; frequent repeated courses of treatment can lead to the formation of a posterior subcapsular cataract; accession of a secondary infection.

Drug interactions

Barbiturates, antiepileptic drugs, and antihistamines reduce effectiveness. NSAIDs increase the risk of ulceration in the gastrointestinal tract, paracetamol - hepatotoxicity. Hydrocortisone reduces the level of salicylates in the blood (increases clearance) and the activity of antidiabetic agents, changes the effectiveness of anticoagulants. Cardiac glycosides and non-potassium-sparing diuretics potentiate hypokalemia, anabolic steroids increase tissue hydrophilicity. When combined with amphotericin B, the development of dilated myocardial damage and heart failure is possible.

Dosage

IV, IM, inside, intraarticular and periarticular, IV, topically.

Precautions

During the treatment period, vaccination is not recommended (due to the immunosuppressive effect of hydrocortisone). Intra-articular administration should be carried out under strict aseptic and antiseptic conditions and only after excluding the infectious process in the joint. IM injection is performed as deep as possible into the gluteus muscle to prevent the development of muscle atrophy. With prolonged therapy, it is recommended to monitor the content of potassium in the blood (and its purpose) and regular ECG studies. To prevent the development of secondary hypocorticism caused by treatment withdrawal, the dose should be reduced gradually. Glucocorticoids can mask some manifestations of the infectious process, possibly the addition of new infections due to a decrease in resistance. When treating with corticosteroids or their combination with other drugs that suppress cellular, humoral immunity or the function of neutrophils, various viral, bacterial, fungal, protozoal infections and helminthic invasions, which were previously latent, may appear. The risk of infection and its more severe course increases in proportion to the increase in the dose of the drug.

Sudden discontinuation of treatment can cause the development of acute adrenal cortex insufficiency; with prolonged use, the drug should not be suddenly canceled, the dose should be reduced gradually. With a sudden cancellation after prolonged use, it is possible to develop a withdrawal syndrome, manifested by an increase in body temperature, myalgia and arthralgia, and malaise. These symptoms can appear even in the case when adrenal insufficiency is not noted.

Eye ointment. If, after the application of the eye ointment, the clarity of vision is temporarily lost, it is not recommended to drive a car or work with complex mechanisms immediately after the application. During treatment, you must refrain from wearing contact lenses. With excessive and frequent use of ophthalmic ointment during the day or its use in children, the systemic effect of hydrocortisone is possible (if the drug is discontinued, the symptoms disappear on their own). When using other drugs in the form of eye drops, the time interval between their application and the use of the ointment should be at least 15 minutes. When using the ointment for more than 2 weeks and a history of open or closed-angle glaucoma, it is necessary to control the intraocular pressure. Children are more likely to develop systemic effects of hydrocortisone than adults. In this regard, the ointment should be used in children, if possible, in short courses (5-7 days).

Forms for external use. For children under 12 years of age, the drug is prescribed only under strict medical supervision. When using the ointment in children over 1 year old, the total duration of treatment should be limited and conditions leading to increased resorption of the drug (warming, fixing and occlusive dressings) should be excluded. Avoid getting the ointment in the eyes. With extreme caution, the drug should be applied to the skin of the face due to the possibility of side effects (telangiectasia, atrophy, dermatitis perioralis), even after short-term use. To prevent infectious skin lesions, hydrocortisone ointment is recommended to be prescribed in combination with antibacterial and antifungal agents.

eye ointment

Owner / Registrar

TATHIMFARMPREPARATY, JSC

International Classification of Diseases (ICD-10)

A15 Tuberculosis of the respiratory system, bacteriologically and histologically confirmed A17.0 Tuberculous meningitis (G01 *) A18 Tuberculosis of other organs B75 Trichinosis C84.0 Fungal mycosis C91.0 Acute lymphoblastic leukemia C92.0 Acute myeloid leukemia D59 Acquired hemolytic apotential anemia (erythroblastopenia) D69.3 Idiopathic thrombocytopenic purpura D86 Sarcoidosis E06 Thyroiditis E27.4 Other and unspecified adrenal insufficiency H10.1 Acute atopic conjunctivitis H10.2 Other acute conjunctivitis H10.4 Chronic conjunctivitis H16 H16 H16 .0 Acute and subacute iridocyclitis H20.1 Chronic iridocyclitis J45 Asthma J46 Status asthmaticus J69 Pneumonitis due to solids and liquids J82 Pulmonary eosinophilia, not elsewhere classified K50 Crohn's disease [regional enteritis] K51 Ulcerative colitis L13 Pemphigus 0 Dermatitis herp atopic dermatitis L20.8 Other atopic dermatitis L21 Seborrheic dermatitis L26 Exfoliative dermatitis L28.0 Lichen simplex L28.1 Prurigo nodosum L30.0 Coin-like eczema L40 Psoriasis L43 Lichen planus L51.1 Bullous erythema multiforme M30 Nodular polyarteritis and genus lupus M33 Dermatopolymyositis M34 Systemic sclerosis N04 Nephrotic syndrome R57.0 Cardiogenic shock R57.1 Hypovolemic shock R57.8 Other types of shock S05 Injury to the eye and orbit T78.2 Anaphylactic shock, unspecified T78.3 Angioedema T79.4 Traumatic shock Z help

Pharmacological group

GCS for local use in ophthalmology

pharmachologic effect

GKS. Suppresses the function of leukocytes and tissue macrophages. Limits the migration of leukocytes to the area of \u200b\u200binflammation. Violates the ability of macrophages to phagocytosis, as well as the formation of interleukin-1. Promotes the stabilization of lysosomal membranes, thereby reducing the concentration of proteolytic enzymes in the area of \u200b\u200binflammation. Reduces capillary permeability due to the release of histamine. Suppresses fibroblast activity and collagen formation.

Inhibits the activity of phospholipase A 2, which leads to suppression of the synthesis of prostaglandins and leukotrienes. Suppresses the release of COX (mainly COX-2), which also helps to reduce the production of prostaglandins.

Reduces the number of circulating lymphocytes (T- and B-cells), monocytes, eosinophils and basophils due to their movement from the vascular bed into the lymphoid tissue; suppresses the formation of antibodies.

Hydrocortisone inhibits the release of ACTH and β-lipotropin by the pituitary gland, but does not decrease the level of circulating β-endorphin. Inhibits the secretion of TSH and FSH.

When applied directly to the vessels, it has a vasoconstrictor effect.

Hydrocortisone has a pronounced dose-dependent effect on the metabolism of carbohydrates, proteins and fats. Stimulates gluconeogenesis, promotes the uptake of amino acids by the liver and kidneys, and increases the activity of gluconeogenesis enzymes. In the liver, hydrocortisone enhances the storage of glycogen, stimulating the activity of glycogen synthetase and the synthesis of glucose from the products of protein metabolism. An increase in blood glucose activates the release of insulin.

Hydrocortisone inhibits the uptake of glucose by fat cells, which leads to the activation of lipolysis. However, due to the increase in insulin secretion, lipogenesis is stimulated, which leads to the accumulation of fat.

Has a catabolic effect in lymphoid and connective tissue, muscles, adipose tissue, skin, bone tissue. To a lesser extent than mineralocorticoids, it affects the processes of water-electrolyte metabolism: it promotes the excretion of potassium and calcium ions, the retention of sodium and water ions in the body. Osteoporosis and Itsenko-Cushing's syndrome are the main factors limiting long-term GCS therapy. As a result of the catabolic action, growth inhibition in children is possible.

In high doses, hydrocortisone can increase the excitability of brain tissue and help lower the seizure threshold. Stimulates excess production of hydrochloric acid and pepsin in the stomach, which contributes to the development of peptic ulcers.

With systemic use, the therapeutic activity of hydrocortisone is due to its anti-inflammatory, antiallergic, immunosuppressive and antiproliferative effects.

When applied topically and locally, the therapeutic activity of hydrocortisone is due to its anti-inflammatory, antiallergic and antiexudative (due to the vasoconstrictor effect) action.

In terms of anti-inflammatory activity, it is 4 times weaker than prednisone, in mineralocorticoid activity it surpasses other GCS.

Pharmacokinetics

Plasma protein binding - 40-90%. It is metabolized mainly in the liver. T 1/2 - 80-120 min. It is excreted by the kidneys mainly in the form of metabolites.

For parenteral use: acute adrenal insufficiency, immediate allergic reactions, status asthmaticus, prevention and treatment of shock, myocardial infarction, complicated by cardiogenic shock, thyrotoxic crisis, thyroiditis, congenital adrenal hyperplasia, hypercalcemia due to tumor disease in acute diseases, collagen diseases, pemphigus, bullous herpetiformis dermatitis (Dühring's disease), polymorphic bullous erythema, exfoliative dermatitis, fungal mycosis, severe forms of psoriasis and seborrheic dermatitis, severe acute and chronic allergic and inflammatory processes with lesion of the eyes, symptomatic syndrome not amenable to other types of therapy, beryllium disease, focal or disseminated form of tuberculosis with simultaneous anti-tuberculosis chemotherapy, aspiration pneumonitis, idiopathic thrombocytopenic purpura in adults (only in / c!), secondary thrombocytopenia in adults, acquired (autoimmune) hemolytic anemia, erythroblastopenia, congenital (erythroid) hypoplastic anemia, palliative therapy in adult leukemia and lymphomas, in acute leukemia in children, to increase diuresis or to reduce proteinuria without nephrotic syndrome , with idiopathic nephrotic syndrome or with lupus erythematosus, in the critical stage of ulcerative colitis and regional regional enteritis (as a systemic treatment), tuberculous meningitis with the development of subarachnoid block or with its threat (in combination with anti-tuberculosis chemotherapy), trichinosis with damage to the nervous system or myocardium, bronchial asthma, joint diseases.

For topical application: inflammation of the anterior part of the eyeball with intact corneal epithelium and after trauma and surgery on the eyeball.

For external use: allergic dermatitis, seborrhea, various forms of eczema, neurodermatitis, psoriasis, pruritus, lichen planus.

For short-term use for health reasons - hypersensitivity to hydrocortisone.

For intra-articular injection and injection directly into the lesion: previous arthroplasty, pathological bleeding (endogenous or caused by the use of anticoagulants), intra-articular bone fracture, infectious (septic) inflammatory process in the joint and periarticular infections (including history), as well as general infection, pronounced periarticular osteoporosis, no signs of inflammation in the joint ("dry" joint, for example, in osteoarthritis without synovitis), pronounced bone destruction and joint deformity (sharp narrowing of the joint space, ankylosis), joint instability as an outcome of arthritis, aseptic necrosis of the epiphyseal bones forming the joint ...

For external use: bacterial, viral, fungal skin diseases, tuberculosis of the skin, skin manifestations of syphilis, skin tumors, post-vaccination period, violation of the integrity of the skin (ulcers, wounds), childhood (up to 2 years, with itching in the anus - up to 12 years), rosacea , acne vulgaris, perioral dermatitis.

For use in ophthalmology: bacterial, viral, fungal eye diseases, tuberculosis of the eyes, trachoma, violation of the integrity of the eye epithelium.

From the endocrine system: decreased glucose tolerance, steroid diabetes mellitus or manifestation of latent diabetes mellitus, inhibition of adrenal function, Itsenko-Cushing's syndrome (including moon face, pituitary obesity, hirsutism, increased blood pressure, dysmenorrhea, amenorrhea, myasthenia gravis, striae), delay sexual development in children.

From the side of metabolism: increased excretion of calcium ions, hypocalcemia, increased body weight, negative nitrogen balance (increased protein breakdown), increased sweating, fluid and sodium ion retention (peripheral edema), hypernatremia, hypokalemic syndrome (including hypokalemia, arrhythmia, myalgia or spasm muscles, unusual weakness and fatigue).

From the side of the central nervous system: delirium, disorientation, euphoria, hallucinations, manic-depressive psychosis, depression, paranoia, increased intracranial pressure, nervousness or anxiety, insomnia, dizziness, vertigo, cerebellar pseudotumor, headache, convulsions.

On the part of the cardiovascular system: arrhythmias, bradycardia (up to cardiac arrest); development (in predisposed patients) or increased severity of chronic heart failure, ECG changes characteristic of hypokalemia, increased blood pressure, hypercoagulation, thrombosis. In patients with acute and subacute myocardial infarction - the spread of the focus of necrosis, slowing down the formation of scar tissue, which can lead to rupture of the heart muscle; with intracranial administration - epistaxis.

From the side digestive system: nausea, vomiting, pancreatitis, steroid stomach and duodenal ulcer, erosive esophagitis, bleeding and perforation of the gastrointestinal tract, increased or decreased appetite, flatulence, hiccups; rarely - increased activity of hepatic transaminases and alkaline phosphatase.

From the senses: sudden loss of vision (with parenteral administration in the region of the head, neck, nasal concha, scalp, crystals of the drug may be deposited in the vessels of the eye), posterior subcapsular cataract, increased intraocular pressure with possible damage to the optic nerve, a tendency to develop secondary bacterial, fungal or viral infections eyes, trophic changes in the cornea, exophthalmos.

From the musculoskeletal system: slowdown in growth and ossification processes in children (premature closure of the epiphyseal growth zones), osteoporosis (very rarely - pathological bone fractures, aseptic necrosis of the humerus and femur head), rupture of muscle tendons, steroid myopathy, decreased muscle mass (atrophy); with intra-articular administration - increased pain in the joint.

Dermatological reactions: delayed wound healing, petechiae, ecchymosis, thinning of the skin, hyper- or hypopigmentation, steroid acne, striae, a tendency to develop pyoderma and candidiasis.

Allergic reactions: generalized (including skin rash, itching of the skin, anaphylactic shock), local allergic reactions.

Effects due to immunosuppressive action: development or exacerbation of infections (co-administered immunosuppressants and vaccinations contribute to this side effect).

Local reactions: with parenteral administration - burning, numbness, pain, paresthesias and infections at the injection site; rarely - necrosis of surrounding tissues, scarring at the injection site; with intramuscular injection (especially in the deltoid muscle) - atrophy of the skin and subcutaneous tissue.

Others: leukocyturia, withdrawal syndrome.

With the on / in the introduction - arrhythmias, "hot flushes" of blood to the face, convulsions.

For external use: rarely - itching, hyperemia, burning, dryness, folliculitis, acne, hypopigmentation, perioral dermatitis, allergic dermatitis, skin maceration, secondary infection, skin atrophy, striae, prickly heat. With prolonged use or application to large areas of the skin, the development of systemic side effects characteristic of GCS is possible.

special instructions

Use with caution within 8 weeks before and 2 weeks after vaccination, with lymphadenitis after BCG vaccination, with immunodeficiency conditions (including AIDS or HIV infection).

Use with caution in diseases of the gastrointestinal tract: gastric ulcer and duodenal ulcer, esophagitis, gastritis, acute or latent peptic ulcer, newly created intestinal anastomosis, ulcerative colitis with the threat of perforation or abscess formation, diverticulitis.

Use with caution in diseases of the cardiovascular system, incl. after a recent myocardial infarction (in patients with acute and subacute myocardial infarction, the spread of the necrosis focus, slowing of the formation of scar tissue and, as a result, rupture of the heart muscle is possible), with decompensated chronic heart failure, arterial hypertension, hyperlipidemia), with endocrine diseases - diabetes mellitus ( including impaired carbohydrate tolerance), thyrotoxicosis, hypothyroidism, Itsenko-Cushing's disease, with severe chronic renal and / or hepatic insufficiency, nephrourolithiasis, with hypoalbuminemia and conditions predisposing to its occurrence, with systemic osteoporosis, psychosis, psychosis, , obesity (III-IV degrees), with poliomyelitis (except for the form of bulbar encephalitis), open and closed angle glaucoma, pregnancy, lactation.

If necessary, intra-articular administration should be used with caution in patients with a general severe condition, ineffectiveness (or short duration) of the action of 2 previous injections (taking into account the individual properties of the GCS used).

With insufficient effectiveness of hydrocortisone for 48-72 hours and the need for longer therapy, it is advisable to replace hydrocortisone with another glucocorticoid drug that does not cause sodium retention in the body. During treatment with hydrocortisone, it is recommended to prescribe a diet with limited sodium and increased potassium.

Hydrocortisone-induced relative adrenal insufficiency may persist for several months after its withdrawal. Considering this, in case of stressful situations that arise during the specified period, hormone therapy renewed with the simultaneous administration of salts and / or mineralocorticoids.

In patients with active tuberculosis, hydrocortisone should be used in combination with appropriate anti-tuberculosis therapy. With a latent form of tuberculosis or during the bend of tuberculin tests, the patient's condition should be carefully monitored, and, if necessary, chemoprophylaxis should be carried out.

With renal failure

Use with caution in severe chronic renal failure.

In case of liver dysfunction

Use with caution in severe hepatic impairment.

Application during pregnancy and lactation

Use during pregnancy is possible only if the intended benefit to the mother outweighs the potential risk to the fetus; it is recommended to use the minimum dose and short-term therapy. Children whose mothers received hydrocortisone during pregnancy should be closely monitored for signs of adrenal insufficiency.

If necessary, use during lactation should decide on the termination of breastfeeding.

IN experimental research it has been shown that GCS can cause fetal development disorders. There is currently no clear confirmation of these data in humans.

Drug interactions

With the simultaneous use of hydrocortisone increases the toxicity of cardiac glycosides (due to hypokalemia that occurs, the risk of arrhythmias increases); with acetylsalicylic acid - accelerates its excretion and reduces its concentration in the blood plasma (when hydrocortisone is canceled, the concentration of salicylates in the blood increases and the risk of side effects increases); with paracetamol - increasing the risk of developing the hepatotoxic effect of paracetamol (induction of liver enzymes and the formation of a toxic metabolite of paracetamol); with cyclosporine - increased side effects of hydrocortisone due to inhibition of its metabolism; with ketoconazole - increased side effects of hydrocortisone due to a decrease in its clearance.

Hydrocortisone reduces the effectiveness of hypoglycemic agents; enhances the effect of indirect anticoagulants of coumarin derivatives.

Hydrocortisone reduces the effect of vitamin D on the absorption of calcium ions in the intestinal lumen. Ergocalciferol and parathyroid hormone prevent the development of osteopathy caused by GCS.

Hydrocortisone enhances the metabolism of isoniazid, mexiletine (especially in "fast acetylators"), which leads to a decrease in their plasma concentrations; increases (with prolonged therapy) the content folic acid; reduces the concentration of praziquantel in the blood.

Hydrocortisone in high doses reduces the effect of somatropin.

Hypokalemia caused by GCS can increase the severity and duration of muscle blockade against the background of muscle relaxants.

Antacids reduce the absorption of GCS.

With simultaneous use with corticosteroids, thiazide diuretics, carbonic anhydrase inhibitors, other corticosteroids, amphotericin B increase the risk of hypokalemia, drugs containing sodium ions - edema and increased blood pressure.

NSAIDs and ethanol increase the risk of ulceration of the gastrointestinal mucosa and bleeding; in combination with NSAIDs for the treatment of arthritis, it is possible to reduce the GCS dose due to the summation of the therapeutic effect. Indomethacin, displacing GCS from its association with albumin, increases the risk of developing its side effects.

Amphotericin B and carbonic anhydrase inhibitors increase the risk of osteoporosis.

The therapeutic effect of GCS decreases under the influence of inducers of microsomal liver enzymes (including phenytoin, barbiturates, ephedrine, theophylline, rifampicin) due to an increase in the metabolic rate of these substances.

Inhibitors of adrenal cortex function (including mitotane) may necessitate an increase in the GCS dose.

The clearance of corticosteroids increases against the background of thyroid hormone preparations.

Immunosuppressants increase the risk of infections and lymphoma or other lymphoproliferative disorders associated with Epstein-Barr virus.

Estrogens (including oral estrogen-containing contraceptives) reduce the clearance of corticosteroids, lengthen T 1/2 and their therapeutic and toxic effects. The appearance of hirsutism and acne is facilitated by the simultaneous use of other steroid hormonal agents - androgens, estrogens, anabolic steroids, oral contraceptives.

Tricyclic antidepressants can increase the severity of depression caused by taking GCS (not indicated for the treatment of these side effects).

The risk of developing cataracts increases when used against the background of other GCS, antipsychotics (neuroleptics), carbutamide and azathioprine. Simultaneous administration with m-anticholinergics, as well as with drugs with m-anticholinergic action (including antihistamines, tricyclic antidepressants), with nitrates increases intraocular pressure.

With the simultaneous use of GCS with live antiviral vaccines and against the background of other types of immunization, the risk of virus activation and the development of infections increases.

For parenteral administration. The dosage regimen is individual. Apply i / v jet, i / v drip, rarely i / m. For emergency treatment, IV administration is recommended. The initial dose is 100 mg (administered over 30 seconds) - 500 mg (administered over 10 minutes), then repeated every 2-6 hours, depending on the clinical situation. High doses should be used only until the patient's condition has stabilized, but usually no more than 48-72 hours. development of hypernatremia is possible. Children - at least 25 mg / kg / day. In the form of a depot form, it is administered intra- or periarticularly at a dose of 5-50 mg once with an interval of 1-3 weeks. V / m - 125-250 mg / day.

In ophthalmology, it is used 2-3 times / day.

Outwardly - 1-3 times / day.

The ointment is white, shades from yellowish to greenish or grayish are possible.

Composition

Active ingredient: hydrocortisone acetate - 0.5 g.

Excipients: methyl parahydroxybenzoate (nipagin), petroleum jelly, anhydrous lanolin.

pharmachologic effect

Glucocorticosteroid, has anti-inflammatory and anti-allergic effects. Reduces inflammatory cell infiltrates, reduces the migration of leukocytes and lymphocytes to the area of \u200b\u200binflammation. Stabilizes cellular and subcellular, including lysosomal and mast cell membranes. Reduces the binding of immunoglobulins to receptors on the cell surface and inhibits the synthesis or release of cytokines (interleukins and interferon) from lymphocytes and macrophages. Reduces exudative reaction, helps to reduce capillary permeability. Reduces the severity of an early immunological response. It has an antimetabolic effect and inhibits the development of connective tissue and scarring.

Pharmacokinetics

Hydrocortisone does not penetrate well through the cornea into the intraocular fluid; penetrates into the epidermis and epithelium of the mucous membrane, may be slightly absorbed into the systemic circulation and have a systemic effect. It is metabolized directly in the epidermis and epithelium of the mucous membrane, and later, a small amount of it after absorption enters the general bloodstream and is metabolized in the liver. In the blood, 80% binds to transcortin and 10% to albumin. Hydrocortisone metabolites are excreted by the kidneys and intestines.

Side effects

Allergic reactions, burning, scleral injection, short-term blurred vision.

With prolonged use for more than 10 days, it can be observed: an increase in intraocular pressure with the possible subsequent development of steroid glaucoma with damage to the optic nerve and impaired visual fields (therefore, when using glucocorticosteroids for more than 10 days

intraocular pressure should be measured regularly), formation of posterior subcapsular cataract, slowing of the wound healing process (in diseases that cause thinning of the cornea, its perforation is possible).

Secondary bacterial infection can occur as a result of suppression of the body's defense reaction. In acute purulent diseases, glucocorticosteroids can mask or enhance the existing infectious process.

Fungal damage to the cornea tends to occur especially frequently with prolonged use of glucocorticosteroids. The appearance of non-healing ulcers on the cornea after long-term treatment with glucocorticosteroids may indicate the development of fungal invasion.

Selling features

Available without a prescription

Special conditions

When used for more than 10 days and a history of open or closed-angle glaucoma, intraocular pressure control is necessary.

If the patient's vision temporarily decreases after using the drug, it is not recommended to drive vehicles and engage in activities that require clear visual perception until it is restored.

Indications

Allergic eye diseases (eyelid dermatitis, blepharitis, conjunctivitis and keratoconjunctivitis).

Inflammatory diseases of the anterior part of the eye in the absence of a violation of the integrity of the corneal epithelium (blepharitis, conjunctivitis and keratoconjunctivitis).

Thermal and chemical burns of the eyes (after complete epithelialization of corneal defects).

Contraindications

Hypersensitivity, purulent, viral, tuberculous, fungal diseases of the eyes, glaucoma, trachoma, vaccination period, violation of the integrity of the membranes of the eye, children's age (up to 18 years).

Carefully

Pregnancy, lactation period.

Application during pregnancy and during breastfeeding

Studies of the safety and effectiveness of the use of Hydrocortisone during pregnancy and lactation have not been conducted.

There are no precise data on the penetration of glucocorticosteroids into breast milk when applied topically, but the risk cannot be completely excluded. The use of Hydrocortisone during pregnancy and lactation is possible only when the expected therapeutic effect outweighs the potential risk to the fetus or child. The duration of use in these cases should not exceed 7-10 days.

Drug interactions

With prolonged use of the drug due to possible resorption into the systemic circulation, hydrocortisone can reduce the effectiveness of insulin, oral hypoglycemic, hypotensive medicines, anticoagulants, the concentration of salicylates and praziquantel in blood plasma. Simultaneous use with lead and silver preparations leads to mutual inactivation.

Before use HYDROCORTISON 0.5% 5G. CH.OINT be sure to consult with your doctor.