Parenteral Manual

Hydrocortisone sodium succinate

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
Systemic corticosteroid
Original Date: 
August 2005
Revised Date: 
December 2019
  • Acute adrenal insufficiency, shock, acute hypersensitivity reactions, disseminated lupus erythematosus and other disorders
Reconstitution and Stability: 




100 mg

1.8 mL

50 mg/mL

250 mg

4.8 mL

50 mg/mL

500 mg

9.8 mL

50 mg/mL

  • Reconstituted solutions stable for 3 days at room temperature. Protect from light
  • Infusion solutions in D5W or 0.9% NaCl stable 24 hrs at concentrations <1 mg/mL
  • Act-0-Vial (self-contained powder for injection plus diluent) may be reconstituted by pressing into the center of the stopper to force diluent into the powder compartment.  Following gentle agitation, solution may be withdrawn via syringe through a needle inserted into the center of the stopper.
    - Reconstitution of Act-0-Vial 100 mg yields a final concentration of 50 mg/mL/  Discard any remaining contents of single-use vial.

- Solutions Compatible: dextrose up to D20W, 0.9% NaCl, 0.45% NaCl, dextrose-saline combinations, ringer's solution

- Additives/Above Cassette Compatible: amphotericin B, KCl, furosemide

- Y-site Compatible: morphine, TPN (amino acids/dextrose), ampicillin, calcium gluconate, digoxin, lidocaine, heparin

Incompatible: ciprofloxacin, phenobarbital, phenytoin


(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

IV Direct

Usual dilution: 1 mg/mL, 10 mg/mL or 50 mg/mL
Infusion time: 3-5 min; doses >500 mg should be given over 10 min

IV Intermittent Infusion YES
Usual dilution: 1 mg/mL, 10 mg/mL or 50 mg/mL
Infusion time: 20-30 minutes
IV Continuous Infusion



(For neonatal dosages, refer to Neonatal IV Drug Manual.)

- Acute adrenal insufficiency:

  • 50 - 100 mg/m2  IV x 1 , then 25 mg/m2/dose IV/IM Q6H

Click here to go to Lexicomp online to calculate the Body Surface Area.  From this page, type in "body surface area " in the lookup box, click on lookup tab and choose Body Surface Area:  Pediatric.

- Anti-inflammatory:  1 - 5 mg/kg/day IV divided Q12-24H                                             

- Status asthmaticus: ED Load: 8 mg/kg/dose (MAX 400 mg) IV x1.

                                Maintenance 5 mg/kg/dose, MAX 400 mg IV Q6H

- Shock:  2 mg/kg IV x 1, then 1 mg/kg/dose IV Q6H

- Acute adrenal insufficiency:

  • 100 mg IV bolus, then 300 mg/day IV/IM divided Q 8 hours or as a continuous infusion
  • Once patient is stable, change to oral

- Anti-inflammatory:  15-240 mg IM/IV Q 12 hours

-- Shock:  0.5-2 g IV Q 2-6 hours

Potential hazards of parenteral administration: 
  • Thrombophlebitis, burning, itching at IV site
  • Increased blood pressure
  • Psychotic reactions, seizures (rare)
  • Cushing's syndrome, growth suppression, suppression of HPA function
  • Hypokalemia, hyperglycemia, edema, hypernatremia, CHF
  • Precipitation of diabetic ketoacidosis
  • Anaphylaxis
  • Monitor BP, serum glucose, electrolytes, growth (pediatric patients)
  • May mask signs and dissemination of an infection
  • Acute adrenal insufficiency may occur with abrupt withdrawal after long-term therapy or with stress
  • Use with caution in patients with hyperthyroidism, hypertension, cirrhosis, nonspecific ulcerative colitis, hypertension, osteoporosis, thromboembolic tendencies, CHF, convulsive disorders, thrombophlebitis, peptic ulcer, diabetes, glaucoma, hepatic impairment
  • 4 mg hydrocortisone = 1 mg prednisone
  • 1 mg of hydrocortisone per mg of amphotericin (Max 25 mg of hydrocortisone) in buretrol is compatible

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