Hydrocortisone

About Hydrocortisone

Hydrocortisone on the skin eases the redness, swelling and itching of conditions that respond to corticosteroids. Prescription 1 and 2.5 percent creams and the 2.5 percent ointment are applied as a thin film two to four times a day, and the labels allow covering the skin with plastic film for psoriasis or stubborn patches when the prescriber directs. Hydrocortisone butyrate 0.1 percent cream, which patient references describe as stronger than plain hydrocortisone, is used for the same range of conditions, and a 0.1 percent solution is labeled for seborrheic dermatitis; both go on two or three times a day. Hydrocortisone valerate 0.2 percent cream, labeled as medium potency, is for adults, two or three times a day, with a review if there is no improvement within two weeks.

Absorbed steroid can suppress the adrenal glands and cause Cushing’s syndrome, high blood sugar or sugar in the urine, more likely over large areas, with long use or under a covering. Children absorb proportionally more, so they get the least amount that works, and long use may affect growth. The treated skin is not bandaged unless the prescriber says so, and on a child’s diaper area tight diapers or plastic pants are avoided. Burning, itching, irritation, dryness, acne, unwanted hair growth and skin color changes are among the side effects; a severe rash or signs of skin infection need a prompt call. Over-the-counter hydrocortisone is not used for longer than 7 days unless a doctor advises it, and a prescription product that has not helped within 2 weeks calls for a word with the prescriber.

Plain hydrocortisone, the butyrate and the valerate are different products, so a pharmacist cannot exchange one for another. Within the butyrate, Locoid cream and Locoid Lipocream are rated as separate products, the butyrate lotion and ointment are listed as discontinued, and the solution is alcohol based. Hydrocortisone tablets (Cortef, 5, 10 and 20 mg) are a first choice for adrenal insufficiency and are also used for many other conditions; they are not stopped suddenly, and the tablets and the skin products cannot stand in for each other.

Taking Hydrocortisone

How to take it

Apply a small amount as a thin, even film and rub it in gently, usually one to four times a day as directed, then wash your hands. Keep it out of the eyes and mouth, shake a lotion before use, and do not bandage the area unless told to.

If you miss a dose

Apply it when you remember, unless the next application is nearly due; then skip the missed one. Never apply a double amount.

Storage

At room temperature in the closed original container, away from heat and moisture and out of reach of children; do not freeze. Use a take-back program rather than flushing.

Interactions to know about

Medicines used on the skin are unlikely to be affected by other drugs, but tell the prescriber about any other steroid products you use. Hydrocortisone tablets interact with many medicines, including warfarin, diabetes medicines and NSAIDs such as ibuprofen. Call promptly for a severe rash or signs of infection where it was applied.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Hydrocortisone differs from pharmacy to pharmacy

Plain hydrocortisone cream is an old generic from several companies that is also sold over the counter, so a prescription quote is mostly the dispensing fee, the markup and the size written, from small tubes to one-pound jars. The butyrate and valerate come from fewer makers, so a pharmacy may need to order them and quotes vary more.

Each ester, form and base is a separate product: a pharmacist cannot fill a prescription for plain hydrocortisone with the butyrate, or a cream with a solution, without the prescriber, and a prescription that names a brand and blocks substitution is priced as a brand.

Ways to pay less for Hydrocortisone without insurance

• Ask for a generic, and check that the prescription allows substitution.
• Ask for the size that matches the area and length of treatment, and compare more than one pharmacy.
• For a minor rash, ask the prescriber whether an over-the-counter hydrocortisone would do; without a doctor’s advice it is not used for longer than 7 days.
• If a butyrate or valerate product is quoted high, ask the prescriber whether plain hydrocortisone or another generic steroid would suit you.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Hydrocortisone

1. 1.Is my prescription for plain hydrocortisone, the butyrate or the valerate, and which strength?
2. 2.How long can I use it, and where on my body should I avoid it?
3. 3.Can I use an over-the-counter hydrocortisone instead, or alongside it?
4. 4.How much is safe to use on my child?

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