Primacort 100mg Injection 5ml

Hydrocortisone is the synthetic form of cortisol, which is the body's endogenous glucocorticoid steroid hormone. It is used across multiple routes of administration (oral, intravenous, topical, rectal) for a wide range of conditions, such as hormone replacement in adrenal insufficiency (Addison's disease), as an anti-inflammatory and immunosuppressant for conditions such as severe allergic reactions, inflammatory bowel disease, and rheumatic disorders, and topically for mild-to-moderate inflammatory skin conditions. It contains both glucocorticoid (anti-inflammatory, metabolic) and mild mineralocorticoid (sodium/water retention) effects.

Primacort 100mg Injection 5ml is a naturally occurring steroid hormone produced by the adrenal cortex under stimulation from ACTH (adrenocorticotropic hormone) released by the pituitary. As a glucocorticoid, it helps maintain glucose metabolism, immune function, inflammation, and the stress response.

Synthetic hydrocortisone is identical to the one released by the body. It is used for physiological replacement (low doses mimicking normal cortisol output) and pharmacological anti-inflammatory/immunosuppressant therapy (higher doses).

In people suffering from adrenal insufficiency, hydrocortisone is observed as the primary replacement agent. In acute adrenal crisis, high-dose hydrocortisone given intravenously is life-saving.

As an anti-inflammatory agent, hydrocortisone is less potent than synthetic glucocorticoids (prednisolone, dexamethasone) and is sometimes preferred with a mineralocorticoid or for a shorter duration. Topically, it is classified as a mild (Class VI/VII) corticosteroid, safe for use on the face and in skin fold areas and for shorter durations in children.

Adrenal insufficiency (Addison's disease)

Physiological glucocorticoid replacement therapy.

Adrenal crisis

High-dose intravenous (IV) hydrocortisone as emergency life-saving treatment.

Congenital adrenal hyperplasia (CAH)

Suppresses excess adrenal androgen production.

Severe allergic reactions and anaphylaxis

IV Hydrocortisone as adjunctive treatment.

Inflammatory conditions

Inflammatory bowel disease, rheumatoid arthritis, asthma, and others.

Topical

Mild eczema, contact dermatitis, insect bite reactions, and nappy rash.

Rectal

Proctitis and distal ulcerative colitis.

• The only glucocorticoid suitable for physiological replacement in adrenal insufficiency due to its similarity to endogenous cortisol.

• Life-saving in adrenal crisis and severe anaphylaxis when given IV.

• Mild topical potency makes it one of the safest topical steroids for use on the face and in children.

• Short half-life allows more flexible dosing schedules that mimic the normal diurnal cortisol rhythm.

• Available in multiple formulations such as oral, IV, topical, and rectal for versatile clinical use.

Common (upon regular use):

• Weight gain, increased appetite, central obesity

• Mood changes such as euphoria, irritability, or insomnia

• Increased blood glucose

• Fluid retention and hypertension (high blood pressure)

• Skin thinning and bruising (topical and systemic)

Uncommon side effects:

• Osteoporosis and increased fracture risk with prolonged systemic use

• Peptic ulcer or gastric bleeding, seen with concurrent NSAIDs

• Increased risk of infections

• Muscle weakness and wasting

Serious side effects requiring immediate attention:

• Adrenal crisis on abrupt withdrawal after prolonged use, which may present as severe weakness, vomiting or hypotension

• Severe infections due to immunosuppression

• Avascular necrosis of bone with prolonged high-dose use

• Severe psychiatric reactions such as psychosis, severe depression & mania

• Oral: For adrenal replacement, take two to three divided doses daily to mimic the normal diurnal cortisol pattern (larger dose in the morning, smaller in the afternoon). Take with food or milk to reduce gastric irritation.
• Topical: Apply a thin layer to the affected area 1 to 2 times daily. Do not apply to broken or infected skin. Hydrocortisone is administered via the intravenous or intramuscular route by healthcare professionals in emergency or perioperative settings.

Cortisol is the body's primary stress hormone, produced by the adrenal cortex and released in response to physical or psychological stress. Hydrocortisone is chemically identical to cortisol and works the same way.

After entering the cell, hydrocortisone binds to glucocorticoid receptors (GRs) in the cytoplasm. This complex travels to the nucleus and switches genes on or off in two ways.

It switches on production of anti-inflammatory proteins, most importantly lipocortin-1, which blocks the enzyme phospholipase A2, cutting off the supply of arachidonic acid and stopping the production of prostaglandins, leukotrienes, and thromboxanes.

It switches off the genes responsible for producing pro-inflammatory cytokines (IL-1, IL-2, IL-6, TNF-alpha, IFN-gamma) by blocking the transcription factors NF-kB and AP-1 that normally activate them.

At the immune cell level, hydrocortisone triggers the death of lymphocytes and eosinophils, reduces mast cell activity, prevents neutrophils and macrophages from migrating into inflamed tissue, and blocks the immune system's ability to recognise and respond to inflammatory triggers.

In adrenal insufficiency, the absence of cortisol causes low blood sugar, dangerously low blood pressure (as blood vessels stop responding to adrenaline), and sodium loss with potassium retention. Hydrocortisone replacement corrects all of these. Its mild salt-retaining effect also partially restores sodium balance, though fludrocortisone is usually added alongside it for complete correction in Addison's disease.

• Grapefruit juice (MODERATE): CYP3A4 is the main enzyme responsible for the metabolism of hydrocortisone in the liver. Grapefruit inhibits CYP3A4, potentially increasing systemic hydrocortisone exposure. Limit consumption.

• Alcohol (MODERATE): Increases risk of gastrointestinal bleeding when used with systemic hydrocortisone. Avoid during treatment.

• Calcium and Vitamin D supplements (BENEFICIAL): Recommended during prolonged systemic use to offset corticosteroid-induced osteoporosis.

• High-sodium foods (CAUTION): May worsen hydrocortisone's mild sodium-retaining (mineralocorticoid) effect, increasing blood pressure and oedema (swelling due to fluid retention).

NSAIDs (aspirin, ibuprofen)

MODERATE

Additional risk of gastrointestinal bleeding in those with ulceration. Use a proton pump inhibitor if the combination is necessary.

Antidiabetic agents

CAUTION

Hydrocortisone raises blood glucose.

Vaccines (live attenuated)

AVOID

Hydrocortisone may cause immunosuppression; hence, live vaccines (MMR, varicella, BCG) must be avoided

CYP3A4 inducers (rifampicin, phenytoin)

MODERATE

Accelerate hydrocortisone metabolism, reducing its efficacy.

Antifungals (ketoconazole)

CAUTION

Inhibit CYP3A4, increasing hydrocortisone levels in plasma and risk of systemic corticosteroid side effects.

• Diabetes mellitus: Glucocorticoids increase blood glucose levels and lower peripheral insulin sensitivity. Regular glucose monitoring is required.

• Hypertension: Mineralocorticoid effect causes retention of sodium and water, worsening high blood pressure.

• Osteoporosis: Systemic glucocorticoids reduce bone formation and increase bone resorption. Consult with a doctor if prolonged use is required.

• Peptic ulcer disease: Glucocorticoids reduce prostaglandin-mediated gastric mucosal protection. Simultaneous NSAID use further increases bleeding risk.

• Tuberculosis / Fungal infections: Systemic hydrocortisone can reactivate latent TB and disseminate fungal infections. Screen for latent TB before prolonged systemic use.

Acute overdose of a single large dose is rarely dangerous in adults but may cause gastrointestinal discomfort, hyperglycaemia, and fluid retention. Prolonged high-dose use may cause iatrogenic Cushing's syndrome characterised by central obesity, moon face, buffalo hump, skin striae, hypertension, diabetes, osteoporosis, and severe immunosuppression. Abrupt discontinuation after prolonged use causes adrenal crisis, which may require immediate IV hydrocortisone. If systemic corticosteroid overdose is suspected, seek medical attention promptly.

For adrenal replacement therapy, never skip your doses. Take the missed dose as soon as you remember. If it is close to the next dose time, take the missed dose anyway and then resume your regular schedule. During illness, injury, or surgery, you may increase your dose after consulting a doctor. Contact your endocrinologist immediately if you are unwell and unable to take oral hydrocortisone. For topical use, apply the missed dose as soon as you remember. If it is near the next application time, skip and resume normally.