Solu-Cortef
Solu-Cortef (hydrocortisone) is a corticosteroid (or steroid) injection. It can help with many conditions in adults and children, including severe inflammatory conditions and flare-ups of certain autoimmune conditions. For most conditions, Solu-Cortef (hydrocortisone) is given as an infusion through the veins in a hospital or clinic setting by a healthcare professional (HCP). But HCPs might prescribe Solu-Cortef (hydrocortisone) Act-O-Vial for people who are at high risk for adrenal crisis to give as a self-injection in case of a medical emergency. Some potential side effects of this medication include mood changes and trouble sleeping.
What is Solu-Cortef (hydrocortisone)?
What is Solu-Cortef (hydrocortisone) used for?
Solu-Cortef (hydrocortisone) is typically used short-term for severe autoimmune or inflammatory conditions. Some examples include:
Asthma and serious allergic reactions
Joint conditions (e.g., rheumatoid arthritis)
Skin conditions (e.g. Stevens-Johnson syndrome)
Hormone conditions
Gut problems (e.g., ulcerative colitis)
Conditions related to red blood cells, white blood cells, and platelets
Certain cancers (e.g., leukemia)
Nervous system conditions (e.g. brain swelling)
Eye conditions
Lung conditions
Kidney conditions
How Solu-Cortef (hydrocortisone) works
Solu-Cortef (hydrocortisone) is a corticosteroid. Corticosteroids are man-made steroids that are like cortisol, a natural hormone your body makes. These medications work by lowering certain chemicals in your body that normally cause itching, redness, swelling, or pain.
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What are the side effects of Solu-Cortef (hydrocortisone)?
Common Side Effects
- High blood pressure
- High blood sugar
- Muscle weakness
- Stomach pain
- Bloating
- Nausea
- Trouble sleeping (insomnia)
- Changes in your mood
- Headache
- Acne
- Weight gain
- Greater appetite
Other Side Effects
- Changes in electrolytes (like sodium and potassium)
Serious Side Effects
- Severe allergic reaction: trouble breathing or swallowing, swelling (on your face, lips, mouth, or throat), peeling skin, rash, hives
- Infection: fever, chills, flu-like symptoms, cough, pain with passing urine, a wound that won't heal
Source: DailyMed
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Cushing syndrome—increased fat around the midsection, upper back, neck, or face, pink or purple stretch marks on the skin, thinning, fragile skin that easily bruises, unexpected hair growth
- High blood sugar (hyperglycemia)—increased thirst or amount of urine, unusual weakness or fatigue, blurry vision
- Increase in blood pressure
- Infection—fever, chills, cough, sore throat, wounds that don't heal, pain or trouble when passing urine, general feeling of discomfort or being unwell
- Low adrenal gland function—nausea, vomiting, loss of appetite, unusual weakness, fatigue, dizziness
- Mood and behavior changes—anxiety, nervousness, confusion, hallucinations, irritability, hostility, thoughts of suicide or self-harm, worsening mood, feelings of depression
- Stomach bleeding—bloody or black, tar-like stools, vomiting blood or brown material that looks like coffee grounds
- Swelling of the ankles, hands, or feet
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
- Acne
- General discomfort and fatigue
- Headache
- Increase in appetite
- Nausea
- Trouble sleeping
- Weight gain
Pros and cons of Solu-Cortef (hydrocortisone)
Pros
Starts working within 1 hour to lower symptoms, like swelling or asthma attacks
Can be given to adults and children
Option for people who can't take medications by mouth
Cons
Can raise blood pressure and cause swelling
Might cause mood changes
Injections can be uncomfortable or painful
Pharmacist tips for Solu-Cortef (hydrocortisone)
If you have certain hormone-related conditions, like adrenal insufficiency, your healthcare team might recommend you to keep Solu-Cortef (hydrocortisone) Act-O-Vial at home for emergencies. Make sure you and your caregiver(s) understand and follow your prescriber's instructions on how to inject Solu-Cortef (hydrocortisone) at home safely.
If you gave yourself a Solu-Cortef (hydrocortisone) injection during a medical emergency, it's important that you still call 911 for help even if you feel some symptoms improving. It's likely that you still need more medical attention afterwards.
Solu-Cortef (hydrocortisone) can raise your blood sugar and blood pressure levels. If you have high blood pressure or diabetes, it's important that you check your blood pressure and blood sugar levels while taking this medication.
Avoid live vaccines when you're receiving Solu-Cortef (hydrocortisone) injections, as corticosteroids can weaken your immune system. Live vaccines include Varivax (varicella) for chicken pox, Yf-Vax for yellow fever, or MMR (measles, mumps, and rubella). If you're not sure which vaccines you can receive, ask your primary care provider or pharmacist.
Call your healthcare team right away if you have a fever, chills, flu-like symptoms, cough, pain with passing urine, or a wound that won't heal. These could be signs of an infection. Taking a corticosteroid, like Solu-Cortef (hydrocortisone), can raise your risk of an infection.
If you need Solu-Cortef (hydrocortisone) for a longer period of time, your prescriber will lower your dose slowly before completely stopping it or transitioning you to oral corticosteroids. Lowering the dose slowly over time will help prevent steroid withdrawal symptoms, such as body aches or tiredness. Don't stop taking this medication suddenly without talking to your prescriber first.
Frequently asked questions about Solu-Cortef (hydrocortisone)
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What are the risks and warnings for Solu-Cortef (hydrocortisone)?
Solu-Cortef (hydrocortisone) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Skin changes
Solu-Cortef (hydrocortisone) injections can result in loss of fat and changes in the skin at the injection site. The risk is higher if you're receiving higher doses of the medication. Your healthcare team will avoid injecting Solu-Cortef (hydrocortisone) into the deltoid muscle, where loss of fat is most likely to happen.
Heart and kidney problems
Risk factors: History of heart failure, high blood pressure, or kidney problems
Solu-Cortef (hydrocortisone) can cause high blood pressure, unexplained weight gain, and changes in kidney function that affect your electrolyte levels. If you have a history of heart failure, high blood pressure, or kidney problems, let your healthcare team know so that they can monitor your vitals, electrolyte levels, and other labs closely during treatment.
Poor adrenal gland function
Risk factors: Taking high doses of Solu-Cortef (hydrocortisone) | Using Solu-Cortef (hydrocortisone) for a long time | Stress, such as trauma, injury, or infection
Your adrenal gland makes certain hormones for your body. Taking Solu-Cortef (hydrocortisone) for a long time can cause adrenal suppression. This is when your adrenal glands stop making your own natural hormones. This can happen if you're using the medication for a long time. Symptoms include joint or muscle pain, extreme low energy, and dizziness. Make sure to report any new side effects of this medication to your healthcare team.
Greater risk of infections
Risk factors: Taking other medications that weaken the immune system | Using Solu-Cortef (hydrocortisone) for a long time | People who aren't vaccinated against viral illnesses | Coming into contact with people who have viral illnesses | History of bacterial or viral conditions | Live vaccines
Taking Solu-Cortef (hydrocortisone) for a long time can lower your immune system. This raises your risk of getting an infection and can hide some signs of infection. Be careful not to be in contact with anyone who has chicken pox or measles. If you had tuberculosis (TB) in the past, your prescriber will need to monitor you while you're taking Solu-Cortef (hydrocortisone) to make sure the TB virus doesn't return. You might need to take medications to prevent TB from coming back. Also, talk to your prescriber first before getting any vaccine because they might not work as well. Live vaccines might raise your chances of getting an infection.
Stomach problems
Risk factors: History of stomach ulcers or other stomach problems | History of ulcerative colitis | Taking Solu-Cortef (hydrocortisone) with other medications that can cause stomach problems
Solu-Cortef (hydrocortisone) can raise the risk of damage to your stomach. Your risk is higher if you have stomach problems like ulcers or ulcerative colitis, or if you've been regularly taking other medications that can irritate your stomach, like ibuprofen (Advil) or naproxen (Aleve). Tell your prescriber right away if you experience stomach pain that doesn't go away or you get bloody or dark stools.
Bone problems (weakening of bones and slower growth rate in children)
Risk factors: Taking Solu-Cortef (hydrocortisone) at high doses or for a long time | Infants and young children | People at risk of osteoporosis (e.g., older age, females after menopause)
Long-term use of Solu-Cortef (hydrocortisone) can cause your bones to weaken and raise your risk of developing osteoporosis. This can lead to a higher risk of bone fractures. Solu-Cortef (hydrocortisone) can also slow the growth in infants and children. This is more likely to happen if the medication is used for a long period of time. If your child needs to take Solu-Cortef (hydrocortisone) for a long time, their pediatrician will closely keep track of their growth during treatment. Discuss any concerns you have with your prescriber.
Mood and behavior changes
Risk factors: History of mental health conditions
Like most corticosteroid medications, Solu-Cortef (hydrocortisone) can cause changes in your mood or behavior. Tell your prescriber right away if you feel depressed or have mood swings, trouble sleeping, anxiety, or hallucinations (hearing or seeing things that aren't there) while taking this medication, because they might need to lower your dose.
Eye problems with long-term use
Risk factors: Cataracts or glaucoma | History of herpes simplex virus (HSV) in the eye
Long-term use of Solu-Cortef (hydrocortisone) can lead to a higher risk of cataracts, glaucoma, and certain eye infections. Don't take Solu-Cortef (hydrocortisone) if you have a herpes simplex infection in the eye. Let your prescriber know if you have blurry vision, eye pain, or any vision changes. If you're taking this medication for a long time, you might need to get regular eye exams.
Solu-Cortef (hydrocortisone) dosage forms
Typical dosing for Solu-Cortef (hydrocortisone)
Solu-Cortef (hydrocortisone) is usually given in a hospital setting by a healthcare professional (HCP) to treat serious conditions or when oral corticosteroids aren't a good option. Your healthcare team will determine your dose of Solu-Cortef (hydrocortisone) based on your condition and how severe it is.
The typical starting dose of Solu-Cortef (hydrocortisone) ranges from 100 mg to 500 mg. It's usually given as an infusion through the veins (intravenous or IV) by a healthcare professional, though sometimes it can be injected into the muscle (intramuscular, or IM). Your healthcare team might give you additional doses every few hours, depending on how your body responds.
HCPs might prescribe Solu-Cortef (hydrocortisone) Act-O-Vial to people with certain hormone-related conditions, such as adrenal insufficiency. In this case, this medication can be self-injected into the muscles during a medical emergency.
How much does Solu-Cortef (hydrocortisone) cost?
Solu-Cortef (hydrocortisone) contraindications
Current fungal infection that has spread throughout the body
Blood condition where you have low platelet levels (idiopathic thrombocytopenic purpura) - for IM administration only
Giving Solu-Cortef (hydrocortisone) into the spinal canal (intrathecal)
What are alternatives to Solu-Cortef (hydrocortisone)?
Solu-Cortef (hydrocortisone) is typically used short-term for severe autoimmune or inflammatory conditions. Some examples include:
Asthma and serious allergic reactions
Joint conditions (e.g., rheumatoid arthritis)
Skin conditions (e.g. Stevens-Johnson syndrome)
Hormone conditions
Gut problems (e.g., ulcerative colitis)
Conditions related to red blood cells, white blood cells, and platelets
Certain cancers (e.g., leukemia)
Nervous system conditions (e.g. brain swelling)
Eye conditions
Lung conditions
Kidney conditions
Conditions affecting certain hormones (e.g., low adrenal hormones)
Joint conditions (e.g., rheumatoid arthritis)
Skin conditions (e.g., Stevens-Johnson syndrome)
Allergic reactions
Eye inflammation
Lung problems
Conditions related to blood cells
Cancer of blood cells (e.g., leukemia)
Gut conditions (e.g., ulcerative colitis)
Allergies or allergic reactions
Conditions affecting certain hormones (e.g., low adrenal hormones)
Eye conditions
Lung conditions
Gut conditions (e.g., ulcerative colitis)
Conditions related to blood cells
Certain cancers (e.g., leukemia
Nervous system conditions (e.g., multiple sclerosis)
Joint conditions (e.g., rheumatoid arthritis)
Solu-Cortef (hydrocortisone) images
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References
Best studies we foundAmerican Cancer Society. (n.d.). Leukemia.
Bornstein, S. R., et al. (2016). Diagnosis and treatment of primary adrenal insufficiency: An Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology and Metabolism.
Elshimy, G., et al. (2023). Adrenal crisis. StatPearls.
Memorial Sloan Kettering Cancer Center. (2023). How to give an emergency shot using Solu-Cortef® Act-O-Vial®.
National Adrenal Diseases Foundation. (2021). Emergency kit for adrenal insufficient patients.
National Institute of Diabetes and Digestive and Kidney Diseases. (2018). Adrenal insufficiency & Addison’s disease.
Pharmacia & Upjohn Company LLC. (2024). Solu-Cortef- hydrocortisone sodium succinate injection, powder, for solution [package insert]. DailyMed.
Society for Endocrinology. (n.d.). Adrenal crisis information.
Zoorob, R. J., et al. (1998). A different look at corticosteroids. American Family Physician.
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