Solu-Cortef Indications/Uses

Sterile SOLU-CORTEF (hydrocortisone sodium succinate) is indicated in situations requiring a rapid and intense hormonal effect.
Acute Adrenocortical Insufficiency - This syndrome may be induced by severe stress (e.g., surgery, trauma, or infection) in patients with Addison's disease, panhypopituitarism, or latent adrenocortical insufficiency due to corticosteroid therapy. Patients in these categories should be prepared for elective surgery with prophylactic doses of cortisone or hydrocortisone. Should evidence of adrenal insufficiency develop despite preparation, SOLU-CORTEF should be administered promptly to support the patient. Cases in this group which require emergency surgery that does not permit prophylactic preparation with steroids should receive this product intravenously before the operative procedure and at the same time be started on intramuscular cortisone or hydrocortisone. The latter therapy should be continued for an appropriate interval into the post-operative period.
Bilateral Adrenalectomy - Patients who are to undergo this procedure should be prepared with intramuscular injections of cortisone and hydrocortisone before surgery. Hydrocortisone sodium succinate should be given intravenously immediately prior to operation and at appropriate intervals to support the patient through the period of maximum stress. Steroid dosage should be tapered following the procedure and the patient eventually transferred to oral replacement therapy.
Severe Shock - In severe shock, adjunctive use of intravenous SOLU-CORTEF may aid in achieving hemodynamic restoration. Corticoid therapy should not replace standard methods of combating shock, but present evidence indicates that concurrent use of large doses of corticoids with other measures may improve survival rates.
Acute Hypersensitivity Reactions - In status asthmaticus and allergic drug anaphylactic reactions, epinephrine or other vasopressor substances should be given before or along with hydrocortisone sodium succinate.
Overwhelming Infections with Severe Toxicity - In patients moribund from overwhelming infections for which specific antibiotic therapy is available, intensive SOLU-CORTEF therapy may permit survival until the antibiotic has time to take effect. Necessary procedures for the establishment of a bacterial diagnosis should be carried out and intensive antibiotic treatment begun on the basis of the proven or probable etiology before steroid therapy is started. In the presence of infection, this product should be administered for the shortest time compatible with adequate clinical response and must be discontinued before the antibiotics by at least 3 days. In the case of surgical infections, definitive surgical therapy should be scheduled as promptly as the patient's condition permits. Clinical improvement resulting from steroid therapy must not be the cause to defer surgical treatment.
Systemic Lupus Erythematosus in Relapse - In this condition, intravenous administration of SOLU-CORTEF is of value in initiating therapy. Oral therapy with appropriate doses of adrenal steroids should be employed as soon as clinical improvement occurs.
Aspiration Pneumonitis - Intravenous administration of hydrocortisone has been found to be beneficial in the management of pneumonitis produced by aspiration of vomitus. The beneficial effect appears to be due to inhibition of the inflammatory response to chemical irritation.
Aspiration of vomitus usually occurs during inhalation anesthesia. Obstetrical patients appear to be particularly liable. Such aspiration may be followed by the development of a clinical syndrome (Mendelson's syndrome) within two to five hours, consisting of cyanosis, dyspnea, tachycardia and shock. Physical signs may include those due to shock and those due to pulmonary edema and bronchoconstriction. X-ray of the chest may show soft, patchy areas of consolidation throughout the lung fields. Deterioration of the patient's condition with a fatal termination may occur rapidly.
Treatment consists of the immediate institution of all measures necessary to oxygenate the patient and clear the airway. These include discontinuance of the general anesthetic, aspiration of vomitus from the pharynx and larynx, clearance of the larynx and bronchial tree under direct laryngoscopy and bronchoscopy, and positioning of the patient to minimize the possibility of further aspiration.
SOLU-CORTEF 100 mg should be given immediately and repeated every six to eight hours for two or three days or until the chest is clear. The same dosage may be employed in children. Intravenous administration of the initial dose is recommended. If desired, subsequent doses may be given by intravenous infusion or intramuscularly. Full doses of a broad range antibiotic or combination of antibiotics should be given to prevent the development of secondary infection. Oxygen should be given. If bronchoconstriction is prominent, intravenous administration of a bronchodilator drug (aminophylline, isoproterenoI) may be beneficial. Expectorant cough mixtures may aid in the removal of bronchial secretions.