DOSAGE AND ADMINISTRATION
This preparation may be administered by intravenous
injection, by intravenous infusion, or by intramuscular injection,
the preferred method for initial emergency use being intravenous injection.
Following the initial emergency period, consideration should be given
to employing a longer acting injectable preparation or an oral preparation.
Therapy is initiated by administering A-Hydrocort sterile
powder intravenously over a period of 30 seconds (eg, 100 mg) to 10
minutes (eg, 500 mg or more). In general, high-dose corticosteroid
therapy should be continued only until the patient’s condition
has stabilized − usually not beyond 48 to 72 hours. Although
adverse effects associated with high-dose, short-term corticoid therapy
are uncommon, peptic ulceration may occur. Prophylactic antacid therapy
may be indicated.
When high-dose hydrocortisone
therapy must be continued beyond 48-72 hours, hypernatremia may occur.
Under such circumstances it may be desirable to replace hydrocortisone
sodium succinate with a corticoid such as methylprednisolone sodium
succinate which causes little or no sodium retention.
The initial dose of A-Hydrocort sterile powder is 100 mg to 500 mg,
depending on the severity of the condition. This dose may be repeated
at intervals of 2, 4 or 6 hours as indicated by the patient’s
response and clinical condition. While the dose may be reduced for
infants and children, it is governed more by the severity of the condition
and response of the patient than by age or body weight but should
not be less than 25 mg daily.
to severe stress following corticosteroid therapy should be observed
closely for signs and symptoms of adrenocortical insufficiency.
Corticoid therapy is an adjunct to, and not a replacement
for, conventional therapy.
Preparation of Solutions
− For intravenous
or intramuscular injection, prepare solution by aseptically adding
not more than 2 mL
of Bacteriostatic Water
for Injection or Bacteriostatic Sodium Chloride Injection to the contents
of one vial.
Further dilution is not necessary
for intravenous or intramuscular
injection. For intravenous infusion,
first prepare solution
not more than 2 mL
Bacteriostatic Water for Injection to the vial; this solution may
then be added to 100 to 1000 mL of the following: 5% dextrose in water
(or isotonic saline solution or 5% dextrose in isotonic saline solution
if patient is not on sodium restriction). In cases where administration
of a small volume of fluid is desirable, 100 mg of hydrocortisone
sodium succinate may be added to 50 mL of the above diluents. The
resulting solutions are stable for at least 4 hours and may be administered
either directly or by IV piggyback.
as directed, pH’s of the solutions range from 7 to 8 and the
tonicities are: 100 mg vial,.36 osmolar. (Isotonic saline =.28 osmolar.)