Nosological classification (ICD-10)
- A41.9 Septicemia, unspecified
- A49.9 Bacterial infection, unspecified
- C95.0 Acute leukemia of unspecified cell type
- C95.9 Leukemia, unspecified
- D59 Acquired hemolytic anemia
- D69.3 Idiopathic thrombocytopenic purpura
- D70 Agranulocytosis
- E05.5 Thyroid crisis or coma
- E06 Thyroiditis
- E27.1 Primary adrenal insufficiency
- E27.2 Addison's crisis
- E83.5.0* Hypercalcemia
- G93.6 Cerebral edema
- J44 Other chronic obstructive pulmonary disease
- J45 Asthma
- J46 Status asthmaticus
- J98.8.0* Bronchospasm
- L30.9 Dermatitis, unspecified
- M13.9 Arthritis, unspecified
- M19.9 Arthrosis, unspecified
- M24.5 Joint contracture
- M35.9 Systemic connective tissue disorders, unspecified
- M65.9 Synovitis and tenosynovitis, unspecified
- M71.9 Bursopathy, unspecified
- M77.0 Medial epicondylitis
- M77.1 Lateral epicondylitis
- M79.0 Rheumatism, unspecified
- R57.9 Shock, unspecified
- T78.2 Anaphylactic shock, unspecified
- T78.4 Allergy, unspecified
Procedure
The sensor for physiotherapy is similar to that used for ultrasound diagnostics. The only difference will be that the conductor for ultrasound is not a gel, but an ointment based on hydrocortisone. The stages of the session are no different:
- disinfection of the skin area that will be affected;
- applying hydrocortisone ointment and distributing it evenly;
- exposure to ultrasound of a certain power within different frequencies.
This approach ensures rapid penetration of hydrocortisone into tissues. And alternating different frequencies gives good results in the long term, despite the short duration of the session. After completing the phonophoresis procedure with hydrocortisone, you should not remove the ointment from the body for another 2-3 hours. To obtain a positive effect, a course of 10–14 daily procedures is required. Please note that re-treatment is possible no earlier than after 3-5 months.
Mechanism of action
Transport of any drug through the skin is limited by its ability to penetrate the epidermis (top layer of skin) and dermis (deep layer). The easiest and surest route is through the sebaceous glands and hair follicles, so warming the skin before the procedure significantly increases the rate and percentage of drug transfer.
Warming up immediately after phonophoresis significantly increases the time of absorption of hydrocortisone by the body’s vascular system. Sensors and devices used in physical therapy have many modes of operation at different frequencies and intensities. When choosing a device, the doctor focuses on solving the main problem without damaging the skin. And only then, he sets the pace and frequency of the impact, taking into account the patient’s sensations and the characteristics of his body, excluding contraindications and pathologies.
Directions for use and doses
IM (deep) into the gluteal muscle at a dose of 50–300 mg to 1000–1500 mg/day. Before use, the contents of the ampoules must be shaken until a homogeneous suspension is formed.
For acute, life-threatening conditions, 100–150 mg is administered every 4 hours for 48 hours; then - every 8-12 hours. Children - every 4 hours 1-2 mg/kg, the optimal daily dose is 6-9 mg/kg.
5–25 mg (0.1–1 ml (depending on the size of the joint)) is injected into the joint cavity once a week. 3–5 injections per course. The effect of the drug begins 6–25 hours after administration and lasts several days or weeks
Hydrocortisone-Richter suspension 25 mg+5 mg/ml 5 ml
From the endocrine system: decreased glucose tolerance and increased need for a hypoglycemic drug; manifestation of latent diabetes mellitus; steroid diabetes mellitus. With long-term treatment - suppression of adrenal function; Itsenko-Cushing syndrome; growth retardation in children and adolescents. From the gastrointestinal tract: nausea; vomit; pancreatitis; peptic ulcer; esophagitis; bleeding and perforation of the gastrointestinal tract; increased appetite; flatulence; hiccups; in rare cases - increased activity of liver transaminases and alkaline phosphatase. From the cardiovascular system: lidocaine can cause conduction disturbances (in doses exceeding therapeutic doses), peripheral vasodilation; with large doses of hydrocortisone: increased blood pressure; hypokalemia and its characteristic ECG changes; thromboembolism; heart failure. From the nervous system: insomnia, irritability, anxiety, agitation, euphoria, epileptiform convulsions; mental disorders; delirium; disorientation; hallucinations; exacerbation of manic-depressive psychosis while taking the drug; depression; paranoia; increased intracranial pressure with swelling of the optic nerve nipple, dizziness; pseudotumor of the cerebellum; headache. Metabolism: weight gain, negative nitrogen balance, increased sweating. From the organ of vision: ulceration of the cornea; posterior capsular cataract (more likely in children); increased intraocular pressure with possible damage to the optic nerve; secondary bacterial, fungal, viral eye infections; trophic changes in the cornea; exophthalmos, glaucoma. From the musculoskeletal system: slowing of growth and ossification processes in children (premature closure of epiphyseal growth zones); osteoporosis; very rarely - pathological bone fractures; aseptic necrosis of the head of the humerus and femur; muscle tendon rupture; steroid myopathy; decreased muscle mass; arthralgia. Effects caused by the mineralocorticoid activity of the drug: fluid and sodium retention with the formation of peripheral edema; hypernatremia; hypokalemia, arrhythmia, myalgia, muscle spasm, increased weakness, fatigue. From the immune system: opportunistic infections, exacerbation of latent tuberculosis, hypersensitivity reactions; local and generalized: skin rash, itching; anaphylactic shock; delayed wound healing; tendency to develop pyoderma and candidiasis, exacerbation of infections, especially with vaccination and simultaneous treatment with immunosuppressive drugs. From the skin and mucous membranes: petechiae; ecchymoses; hyper- or hypopigmentation; steroid acne; striae; folliculitis, hirsutism, telangiectasia. Local reactions: tissue swelling and pain at the injection site, which spontaneously disappear after a few hours, increased pain in the joint when the drug is injected into the joint, burning, numbness, paresthesia at the injection site, atrophy of the skin and subcutaneous tissue at the injection site (if accidentally administered into the deltoid muscle), rarely - necrosis of surrounding tissues, scar formation at the injection site. Other: malaise, withdrawal syndrome (high body temperature, myalgia, arthralgia, adrenal insufficiency); leukocyturia, leukocytosis. Elderly patients are at higher risk of developing adverse reactions. With long-term treatment and the use of large doses of hydrocortisone and lidocaine, systemic side effects may develop.
Indications and contraindications for the use of Hydrocortisone
As a component of systemic and replacement therapy, the drug is indicated for the following conditions: adrenal insufficiency, shock of various origins, hepatic coma, allergic laryngeal edema, status asthmaticus, exacerbation of Crohn's disease and ulcerative colitis, gouty, rheumatoid and psoriatic arthritis, SLE, dermatomyositis.
Local use of the drug is indicated for eczema, various dermatitis, psoriasis, scabies, and insect bites.
Eye ointment is used to treat chronic or allergic blepharoconjunctivitis, acute keratitis, anterior and posterior uveitis, and burns of the ocular surface.
Contraindications to the systemic administration of Hydrocortisone are a history of allergic reactions, epilepsy, hypertensive crisis, Itsenko-Cushing syndrome and disease, osteoporosis, peptic ulcer and duodenal ulcer, diabetes mellitus type 1 and 2, HIV infection, pregnancy, lactation, and childhood.
Skin ointment should not be used for malignant neoplasms, syphilis, tuberculosis, viral, fungal and bacterial local infections.
The ophthalmic form of Hydrocortisone should not be prescribed for violations of the integrity of the cornea, infectious diseases, or trachoma.
Drug interactions
The effectiveness of Hydrocortisone when used systemically can be reduced by drugs of the following pharmacological groups:
- Antihistamines.
- Diuretics.
- Anticonvulsants.
Taking this drug together with non-steroidal anti-inflammatory drugs significantly increases the risk of drug ulcers.
Hydrocortisone reduces the effectiveness of glucose-lowering medications, and its simultaneous use with amphotericin B provokes the development of cardiovascular failure.
Hydrocortisone
If any of the side effects indicated in the instructions worsen, or any other side effects not listed in the instructions are noted, you should immediately inform your doctor.
Overdose
Acute overdose is unlikely, however, when using the drug on large areas of affected skin with increased capacity for resorption, for a long time or using an occlusive dressing, chronic overdose is possible, accompanied by signs of hypercortisolism.
Treatment: symptomatic, if necessary, correction of water and electrolyte balance, drug withdrawal (with long-term therapy - gradual withdrawal).
Interaction with other drugs
No interaction of Hydrocortisone when used externally with other drugs has been identified.
special instructions
If there are signs of hypersensitivity or skin irritation associated with the use of the drug, you should stop treatment and consult a doctor. With long-term treatment, when applying the drug to large surfaces of the skin, when using occlusive dressings, and also in children, systemic absorption of the glucocorticosteroid is possible: suppression of the function of the hypothalamic-pituitary-adrenal system and the development of symptoms of hypercortisolism are possible. Atrophic changes may appear on the skin of the face more often than on other surfaces of the body after long-term treatment with topical glucocorgicosteroids; the course of treatment in this case should not exceed 5 days.
Care must be taken when applying the drug to the face, folds, natural folds, and areas with thin skin.
Avoid getting the drug into your eyes. Do not apply the drug to mucous membranes.
It should be borne in mind that glucocorticosteroids can change the manifestations of some skin diseases, which can complicate the diagnosis. In addition, the use of glucocorticosteroids may delay wound healing. With long-term therapy with glucocorticosteroids, sudden cessation of therapy can lead to the development of rebound syndrome, which manifests itself in the form of dermatitis with intense redness of the skin and a burning sensation. Therefore, after long-term treatment, drug withdrawal should be carried out gradually, for example, by transferring to an intermittent treatment regimen before stopping it completely. Propyl parahydroxybenzoate, which is part of the drug, can cause allergic reactions (possibly of a delayed type). In such cases, you should stop using the drug.
