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): 
SOLU-CORTEF®
Classification: 
Systemic corticosteroid
Original Date: 
August 2005
Revised Date: 
March 2026
Indications: 
  • Acute adrenal insufficiency, shock, acute hypersensitivity reactions, disseminated lupus erythematosus and other disorders
Reconstitution and Stability: 

VIAL SIZE

STERILE WATER for INJECTION REQUIRED

FINAL CONCENTRATION

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  Following gentle agitation, solution may be withdrawn via syringe through a needle inserted into the center of the stopper.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.
Compatibility: 

- 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

Administration: 

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

SC NO
IM YES
IV Direct

YES
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

YES
Dosage: 

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

Pediatric Dosing:

Acute Adrenal Insufficiency

Adrenal Crisis, Severe Illness, Surgery

  • 100 mg/m2 IV x 1 (MAX 100 mg), then 25 mg/m2/dose IV/IM Q6H (MAX 50 mg/dose)

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 (MAX 100 mg), then 1 mg/kg/dose IV Q6H (MAX 50 mg/dose)
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
Notes: 
  • 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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