medicationInjectablePrescription only (US)Oral and injectable hydrocortisone are FDA-approved for adrenocortical insufficiency and other glucocorticoid-responsive conditionsLow-strength topical hydrocortisone (up to 1%) is available over the counter in the US for minor skin irritation, which is a separate use from the systemic replacement dosing studied in the cited trials
HydrocortisoneBenefits, Dosage & Interactions
Also known as: Cortef
Hydrocortisone is a corticosteroid, a class of steroid hormones naturally produced by the adrenal glands. As a medication, it is used to replace these hormones when the body does not produce enough, such as in adrenal insufficiency (Addison's disease). It is typically taken in the morning.
Researched by DoseRoutine R&D TeamReviewed for accuracy by Nicholas Alexander, RSELast updated
Evidence: Strong — 2 human randomized trials and regulatory approval on file.
Evidence strengthStrong · 4/4
PreclinicalStrong human evidence
2 human randomized trials and regulatory approval on file.
Plasma half-life
Not established
Typical timing
morning
Food rule
with food
Default unit
mg
What published protocols report
Ranges documented in the literature, shown for reference. DoseRoutine does not recommend an amount — your prescriber or the product label sets the dose.
- Reported amounts
- The PULSES trial used each participant's usual hydrocortisone replacement dose delivered by pulsed subcutaneous pump versus standard oral care; the crossover well-being trial compared 10 mg–0–5 mg–0 and 10 mg–5 mg–0–5 mg daily hydrocortisone split-dose regimens against a 5 mg prednisone regimen[1][2]
- Route studied
- Subcutaneous pump infusion in the PULSES trial; oral tablets in split daily doses in the well-being crossover trial[1][2]
Reported for Hydrocortisone in the cited sources. Published ranges are not dosing advice.
References & evidence
Documents the Hydrocortisone entry is written from. Each number matches an inline marker above.
- [1]Ultradian hydrocortisone replacement alters neuronal processing, emotional ambiguity, affect and fatigue in adrenal insufficiency: The PULSES trialRussell G, Kalafatakis K, Durant C, Marchant N, Thakrar J, Thirard R, King J, Bowles J, Upton T, et al, Lightman SL · Journal of Internal Medicine · 2024 · Peer-reviewed · PMID 37857352
- [2]Effects of standard glucocorticoid replacement therapies on subjective well-being: a randomized, double-blind, crossover study in patients with secondary adrenal insufficiencyBenson S, Neumann P, Unger N, Schedlowski M, Mann K, Elsenbruch S, Petersenn S · European Journal of Endocrinology · 2012 · Peer-reviewed · PMID 22930487
How to track Hydrocortisone doses
Tracking Hydrocortisone well takes four fields and a habit. Here is what to record so the log is still useful in three months.
- 1
Add the dose and unit
Log Hydrocortisone with its dose in mg so totals stay comparable over time — including days when you split the dose or skip it.
- 2
Set the time of day and food rule
Typical timing is morning. Take it with food, and record it that way so absorption stays consistent. Reminders fire at that time and can export to your calendar.
- 3
Check it against the rest of the stack
Run Hydrocortisone through the interaction checker against everything else in the routine — supplements, peptides, hormones and prescriptions — before it becomes a daily habit.
- 4
Log adherence, not intentions
Mark each dose taken, skipped or delayed as it happens. Weeks of honest logs are what make an adherence rate or a trend line meaningful; retrospective guessing is not.
- 5
Review against outcomes
Review Hydrocortisone alongside your logged metrics and any relevant blood work every few weeks before changing the dose, so the change is a response to data rather than to a good or bad day.
What to log each time
- Dose in mg
- Time of day and whether it was taken with food
- Taken / skipped / delayed
- Any side effects or notable changes
References & Evidence
Sources on this page that document Hydrocortisone dosing, timing and safety.
- [1]National Center for Biotechnology Information View source
Educational information only — not medical advice. Dose ranges vary by person, indication and prescriber.
What is Hydrocortisone?Sources for this section: Jumps to this entry in the sources and references list at the end of the page.
Hydrocortisone is a corticosteroid, a class of steroid hormones naturally produced by the adrenal glands. As a medication, it is used to replace these hormones when the body does not produce enough, such as in adrenal insufficiency (Addison's disease). It also functions as an anti-inflammatory and immunosuppressant agent, meaning it can reduce swelling, redness, itching, and allergic reactions. It is available in various forms, including oral tablets, topical creams, injections, and rectal preparations, for a wide range of conditions from skin diseases to asthma and autoimmune disorders. The specific use and formulation depend on the condition being treated and the route of administration required. (NIH ODS) (MedlinePlus)
What does the research say about Hydrocortisone?
Tap a section to expand.
Hydrocortisone functions by mimicking the effects of cortisol, a glucocorticoid hormone naturally produced by the adrenal cortex. Once administered, it binds to glucocorticoid receptors in target cells throughout the body. This binding initiates a complex cascade of events, ultimately leading to changes in gene expression. These changes result in several key physiological effects.
Primarily, hydrocortisone exerts potent anti-inflammatory actions by inhibiting the release of inflammatory mediators like prostaglandins and leukotrienes. It also suppresses the activity of immune cells such as lymphocytes, macrophages, and neutrophils, thereby reducing the body's immune response. This immunosuppressive effect is beneficial in treating autoimmune diseases and preventing organ rejection.
In addition to its anti-inflammatory and immunosuppressive properties, hydrocortisone influences carbohydrate, protein, and fat metabolism. It promotes gluconeogenesis (glucose production), shifts fat distribution, and affects protein breakdown. It also plays a role in maintaining cardiovascular function, blood pressure, and fluid balance due to its mild mineralocorticoid activity. (DrugBank) (PubChem)
Source for this section: Sources for How does Hydrocortisone work?: Jumps to this entry in the sources and references list at the end of the page.
Hydrocortisone offers a broad spectrum of therapeutic benefits, primarily due to its potent anti-inflammatory and immunosuppressive properties, as well as its ability to replace deficient adrenal hormones. Key applications include:
* **Adrenal insufficiency:** It serves as replacement therapy for individuals whose adrenal glands do not produce sufficient cortisol, such as in Addison's disease or congenital adrenal hyperplasia. (MedlinePlus)
* **Inflammatory conditions:** It effectively reduces inflammation associated with various conditions, including:
* **Allergic reactions:** Severe allergic reactions, asthma, and allergic rhinitis. (MedlinePlus)
* **Skin conditions:** Eczema, dermatitis, psoriasis, and insect bites. (MedlinePlus)
* **Arthritic conditions:** Rheumatoid arthritis, osteoarthritis, and other joint inflammations. (MedlinePlus)
* **Gastrointestinal disorders:** Inflammatory bowel diseases like Crohn's disease and ulcerative colitis. (MedlinePlus)
* **Autoimmune diseases:** It suppresses the immune system in autoimmune disorders such as lupus, multiple sclerosis, and certain types of vasculitis. (MedlinePlus)
* **Respiratory conditions:** Management of asthma and chronic obstructive pulmonary disease (COPD) exacerbations. (MedlinePlus)
* **Eye conditions:** Certain inflammatory eye conditions like uveitis. (MedlinePlus)
* **Cancer:** Used in some cancer treatment regimens to reduce inflammation, swelling, and associated symptoms. (MedlinePlus)
The duration and form of hydrocortisone treatment vary significantly depending on the specific condition, its severity, and patient response.
Hydrocortisone has been a cornerstone in medical therapy for decades, with extensive clinical evidence supporting its efficacy across numerous conditions.
For **adrenal insufficiency**, hydrocortisone is the standard replacement therapy. A Cochrane review highlighted its role in maintaining physiological cortisol levels and improving quality of life in patients with Addison's disease, noting its preference over other glucocorticoids due to its balanced glucocorticoid and mineralocorticoid activity. (Cochrane)
In **inflammatory and autoimmune conditions**, multiple studies and clinical guidelines endorse hydrocortisone. For acute asthma exacerbations, parenteral hydrocortisone is frequently used, demonstrating a reduction in hospital admissions and length of stay when administered early. (MedlinePlus)
Topical hydrocortisone is widely recognized for its effectiveness in mild to moderate **skin conditions** like eczema and dermatitis. Numerous randomized controlled trials (RCTs) confirm its ability to reduce itching, redness, and inflammation. (PubChem)
In **inflammatory bowel disease (IBD)**, systemic hydrocortisone is used for inducing remission in moderate to severe flares. Evidence from clinical trials supports its short-term efficacy in reducing disease activity in both Crohn's disease and ulcerative colitis. (MedlinePlus)
The FDA label for hydrocortisone provides comprehensive information on its approved uses, dosages, and safety profile, reflecting the extensive clinical data and regulatory review. (FDA label)
Like all medications, hydrocortisone can cause side effects, which vary depending on the dose, duration of treatment, and route of administration. Some common side effects include:
* **Short-term/Topical use:** Skin thinning, bruising, acne, increased hair growth, changes in skin color, itching, burning, dryness (topical). (MedlinePlus)
* **Oral/Systemic use (short-term):** Increased appetite, weight gain, fluid retention, mood changes (irritability, anxiety), sleep disturbances, increased blood sugar, headache, dizziness, upset stomach. (MedlinePlus)
* **Oral/Systemic use (long-term/high dose):** Adrenal suppression (the body stops producing its own cortisol), osteoporosis (bone thinning), high blood pressure, cataracts, glaucoma, Cushing's syndrome (characterized by a moon face, buffalo hump, and central obesity), increased risk of infections, muscle weakness, stunted growth in children. (MedlinePlus)
More serious but less common side effects can include severe allergic reactions, peptic ulcers, pancreatitis, and seizures. It's crucial to report any persistent or severe side effects to a healthcare provider. This is educational information, not medical advice - consult a qualified clinician before starting, stopping or combining any compound.
Hydrocortisone use requires careful consideration due to potential risks and interactions. Important warnings include:
* **Adrenal Suppression:** Long-term or high-dose systemic hydrocortisone can suppress the body's natural cortisol production. Abruptly stopping the medication can lead to adrenal crisis, a life-threatening condition. Dosage reduction should always be gradual under medical supervision. (FDA label)
* **Infection Risk:** Hydrocortisone can weaken the immune system, increasing susceptibility to infections (bacterial, viral, fungal, parasitic) and potentially masking their symptoms. Avoid exposure to chickenpox or measles if not immune, and report any signs of infection. (MedlinePlus)
* **Diabetes:** It can increase blood glucose levels, potentially leading to or worsening diabetes. Blood sugar monitoring may be necessary, especially for individuals with diabetes. (MedlinePlus)
* **Cardiovascular Effects:** Can cause fluid retention, high blood pressure, and electrolyte imbalances (e.g., low potassium), which can exacerbate heart conditions. (FDA label)
* **Gastrointestinal Effects:** May increase the risk of peptic ulcers and gastrointestinal bleeding, particularly when used with NSAIDs. (MedlinePlus)
* **Ocular Effects:** Long-term use can increase the risk of cataracts and glaucoma. Regular eye exams are recommended. (MedlinePlus)
* **Psychiatric Effects:** Can cause mood swings, depression, anxiety, insomnia, euphoria, and in rare cases, psychosis. (MedlinePlus)
* **Osteoporosis:** Prolonged use can lead to bone thinning. Calcium and vitamin D supplementation, and bone density monitoring, may be advised. (MedlinePlus)
* **Children and Adolescents:** Can stunt growth. Growth should be monitored. (MedlinePlus)
* **Pregnancy and Breastfeeding:** Use during pregnancy and breastfeeding should be carefully weighed against the potential risks. Consult a clinician. (FDA label)
**Never adjust the dosage or discontinue hydrocortisone without consulting a licensed clinician**, especially after prolonged use. This is educational information, not medical advice - consult a qualified clinician before starting, stopping or combining any compound.
Hydrocortisone is contraindicated in certain situations where its use could be harmful. These include:
* **Systemic fungal infections:** Except when used as replacement therapy in adrenal insufficiency where corticosteroids are essential. Its immunosuppressive effects can worsen fungal infections. (FDA label)
* **Known hypersensitivity:** Patients who have previously experienced an allergic reaction to hydrocortisone or any component of its formulation should avoid its use. (FDA label)
* **Live or live-attenuated vaccines:** During systemic hydrocortisone therapy, especially high doses, as it can suppress the immune response, making vaccination ineffective or causing the vaccine to cause disease. (FDA label)
* **Ocular Herpes Simplex:** Topical ophthalmic hydrocortisone is contraindicated as it can exacerbate this viral infection. (MedlinePlus)
Relative contraindications and conditions requiring extreme caution include active infections (especially tuberculosis, herpes simplex of the eye), peptic ulcer disease, diverticulitis, recent intestinal anastomoses, uncontrolled hypertension, congestive heart failure, diabetes mellitus, osteoporosis, glaucoma, cataracts, and psychiatric disorders. A thorough medical history and assessment of risks versus benefits are vital before prescribing. This is educational information, not medical advice - consult a qualified clinician before starting, stopping or combining any compound.
Mixing hydrocortisone with certain medications can alter its effectiveness or increase the risk of adverse effects. It is crucial to inform your doctor about all prescription, over-the-counter, and herbal supplements you are taking. Significant interactions include:
* **CYP3A4 Inducers/Inhibitors:** Medications that affect the CYP3A4 enzyme can alter hydrocortisone metabolism. For example, strong CYP3A4 inducers (e.g., rifampin, phenytoin, barbiturates) can decrease hydrocortisone levels, reducing its efficacy. Strong CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, clarithromycin, ritonavir, grapefruit juice) can increase hydrocortisone levels, leading to increased side effects. (FDA label)
* **Nonsteroidal Anti-inflammatory Drugs (NSAIDs):** Concurrent use with NSAIDs (e.g., ibuprofen, naproxen) can significantly increase the risk of gastrointestinal ulceration and bleeding. (MedlinePlus)
* **Diuretics (Potassium-depleting):** When combined with thiazide or loop diuretics, there is an increased risk of hypokalemia (low potassium levels). (FDA label)
* **Anticoagulants (e.g., warfarin):** Hydrocortisone can alter the effects of anticoagulants, potentially increasing or decreasing their efficacy. Close monitoring of INR is necessary. (FDA label)
* **Insulin and Oral Hypoglycemics:** As hydrocortisone can increase blood glucose, diabetic patients may require adjustments to their insulin or oral hypoglycemic medication dosages. (MedlinePlus)
* **Live Vaccines:** As noted under contraindications, live or live-attenuated vaccines should not be given during systemic hydrocortisone therapy, especially high doses, due to the risk of vaccine-induced illness. (FDA label)
* **Cholinesterase Inhibitors (e.g., neostigmine, pyridostigmine):** Concurrent use may lead to severe muscle weakness in patients with myasthenia gravis, potentially progressing to cholinergic crisis. (FDA label)
This list is not exhaustive. Always consult a healthcare professional regarding potential drug interactions. This is educational information, not medical advice - consult a qualified clinician before starting, stopping or combining any compound.
The typical timing for oral hydrocortisone, especially for adrenal insufficiency or replacement therapy, is **morning**. This timing aims to mimic the body's natural diurnal rhythm of cortisol secretion, which is highest in the morning. When multiple doses are prescribed, they are often spaced throughout the day, with larger doses earlier in the day and smaller doses later to align with natural cortisol patterns.
Hydrocortisone should generally be taken **with food** to minimize gastrointestinal irritation, such as stomach upset or heartburn. For topical applications, timing and frequency are user-directed, but typically mean applying to the affected area thin and evenly, often once or twice daily, as directed by a clinician. For injectable forms, the timing and frequency are determined by the treating clinician based on the acute needs of the patient.
Source for this section: Sources for When should you take Hydrocortisone?: Jumps to this entry in the sources and references list at the end of the page.
What interacts with Hydrocortisone?
| Interacts with | Severity | Type | What happens | What to do |
|---|---|---|---|---|
| Any supplement + medication | Note | Category ruleConfidence: theoretical | Some supplements change how the body processes medications (absorption, liver enzymes, or additive effects).Source pending | Specific pairs are checked against a licensed drug database and shown with their own severity. Always confirm with your provider or pharmacist. |
| Any vitamin + medication | Note | Category ruleConfidence: theoretical | Certain vitamins interact with specific medications (e.g., vitamin K with blood thinners).Source pending | Specific pairs are checked against a licensed source; confirm with your provider. |
Frequently asked questions about Hydrocortisone
Hydrocortisone is a medication. It is also known as Cortef. The references summarized come from NIH and PubMed records, FDA labeling where it exists, and Mayo Clinic patient material.
Hydrocortisone is commonly discussed in the context of the goals discussed on its profile page. Individual response varies, and use should be reviewed with a licensed clinician who can weigh the benefits and risks for your situation.
For Hydrocortisone, it is typically taken in the morning and it is usually taken with food. Always follow the specific dose your clinician or the product label prescribes.
Hydrocortisone carries potential side effects and drug interactions, documented in NIH, Mayo Clinic, and FDA label sources. Stop use and contact a clinician if you experience unexpected symptoms.
As a medication, Hydrocortisone can overlap with other supplements, prescription medicines, hormones and peptides. Because Hydrocortisone is usually taken in the morning, most avoidable conflicts come from what else lands in that same window. Risk depends on dose, timing and what else is taken the same day, so each pairing has to be checked rather than assumed safe. The free checker at https://doseroutine.com/interaction-checker covers Hydrocortisone with no sign-up.
Whether Hydrocortisone fits alongside testosterone replacement therapy depends on the protocol — dose, ester and ancillaries such as HCG or anastrozole — and on current bloodwork. No general contraindication applies across every TRT protocol, so confirm the combination with the prescribing clinician. See the free TRT interaction reference: https://doseroutine.com/trt-supplement-interactions
"Peptides" is not one category — healing peptides, GLP-1 agonists, growth-hormone secretagogues and melanocortins each behave differently next to Hydrocortisone. Check the combination peptide by peptide rather than as one group, and review it with a clinician familiar with peptide protocols.
Published frequency for Hydrocortisone varies by protocol and formulation, so the label or prescription is what sets it. It is typically taken in the morning. Most protocols have it taken with food. Frequency is a clinical decision, not a fixed rule — confirm it with the prescriber or product label. Comparison of apps that keep a schedule like this: https://doseroutine.com/best-dose-tracking-apps
The effect of a missed dose of Hydrocortisone depends on the protocol and formulation you are on. Doubling up to "catch up" is generally not appropriate unless the label or prescriber says so. Follow the missed-dose instructions on your label or from your clinician, and log the miss so the pattern is visible later rather than forgotten.
For Hydrocortisone the useful record is the dose, the time it was actually taken, and what else was taken in the same window. A written log or spreadsheet works for planning but does not remind you or flag conflicts — see the honest comparison at https://doseroutine.com/vs/spreadsheet and the wider roundup at https://doseroutine.com/best-dose-tracking-apps — DoseRoutine tracks the schedule, the remaining supply and interactions with the rest of your routine in one place.
Which studies looked at Hydrocortisone?
Peer-reviewed research indexed in PubMed. Each entry links to the original record.
- 1.Hydrocortisone in Severe Community-Acquired Pneumonia(opens PubMed in a new tab)N Engl J Med · 2023 · PMID 36942789 · https://pubmed.ncbi.nlm.nih.gov/36942789/
- 2.Effect of hydrocortisone on mortality in patients with severe community-acquired pneumonia : The REMAP-CAP Corticosteroid Domain Randomized Clinical Trial(opens PubMed in a new tab)Intensive Care Med · 2025 · PMID 40261382 · https://pubmed.ncbi.nlm.nih.gov/40261382/
- 3.Hydrocortisone plus Fludrocortisone for Adults with Septic Shock(opens PubMed in a new tab)N Engl J Med · 2018 · PMID 29490185 · https://pubmed.ncbi.nlm.nih.gov/29490185/
- 4.Effectiveness of Fludrocortisone Plus Hydrocortisone versus Hydrocortisone Alone in Septic Shock: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials(opens PubMed in a new tab)Am J Respir Crit Care Med · 2024 · PMID 38271488 · https://pubmed.ncbi.nlm.nih.gov/38271488/
Sources cited on this page
Specific documents referenced by the numbered markers above. Each number matches the marker in the text.
- PubChem CID 5754(opens in a new tab)National Center for Biotechnology Information · pubchem.ncbi.nlm.nih.gov/compound/5754
Verify at
Publisher search links for Hydrocortisone. These are places to check the information — they are not citations, so they are not numbered.
- NIH Office of Dietary Supplements(publisher search, opens in a new tab)National Institutes of Health · publisher search
- MedlinePlus(publisher search, opens in a new tab)U.S. National Library of Medicine · publisher search
- DrugBank(publisher search, opens in a new tab)DrugBank Online · publisher search
- FDA-approved labeling (DailyMed)(publisher search, opens in a new tab)U.S. Food and Drug Administration · publisher search
- Cochrane Library(publisher search, opens in a new tab)Cochrane · publisher search
- PubMed literature search(publisher search, opens in a new tab)National Library of Medicine · publisher search
- Wikipedia entry(publisher search, opens in a new tab)Wikipedia · publisher search
DoseRoutine compiles summaries from publicly available scientific and regulatory references. Always verify important decisions with a licensed clinician. How we source and review this information.
What is the short answer on Hydrocortisone?
Plain-text summary, safe to quote verbatim:
Hydrocortisone is a corticosteroid, a class of steroid hormones naturally produced by the adrenal glands. As a medication, it is used to replace these hormones when the body does not produce enough, such as in adrenal insufficiency (Addison's disease). It is typically taken in the morning.
Source: DoseRoutine — https://doseroutine.com/library/hydrocortisone
Cite this page
Using this in an article, AI answer, or research note? Please attribute:
DoseRoutine. (2026). Hydrocortisone — Overview, Benefits & Side Effects. Retrieved from https://doseroutine.com/library/hydrocortisone
What compounds are similar to Hydrocortisone?
Others in the medication category or studied for the same goals.