Chapter 27 - Intravenous, Intramuscular and Other Forms of Hydrocortisone

Abstract

Hydrocortisone can be administered orally, as well as by intramuscular or intravenous injections. Intramuscular injections are used for emergency care when there is vomiting or the person is unconscious. Intravenous injections are used in hospitals for emergencies as well as surgical operations. Hydrocortisone can also be infused if the person is not able to take oral tablets after a major operation. An intravenous bolus injection of 30 mg, gives a rapid peak of over 2500 nmol/l which drops to about 1000 nmol/l, after 90 minutes. This is because cortisol is rapidly cleared from the body through urine as the saturation of the cortisol binding globulin protein is exceeded. This is why double doses do not lead to double the amount of cortisol in the blood. An intramuscular injection of 30 mg peaks at a lower level of 1500 nmol/l. An oral dose of 30 mg takes longer to reach a peak (60 minutes compared to the 30–35 minutes of the other routes). All last for approximately 4–6 hours. Suppositories and Hydrocortisone Muco-Adhesive Buccal Tablets should not be used as cortisol replacement therapy or for emergencies. Hydrocortisone can also be delivered using the pump method which slowly infuses the hydrocortisone continuously into the subcutaneous layer of the skin which is directly below the dermis and epidermis, collectively referred to as the cutis. The pump has a bolus function, as well as the ability to be set to deliver twice or 3 times the normal dose in illness.