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E54 Endocrinology Common Medications Toronto Notes 2019
Adrenal Medications
Drug Class Mineralocorticoid Activity
Generic Drug Name
Potency Relative Equivalent toCortisol) Dose(mg)
Duration of Action (t1/2 inh)
Dosing
Comments
Hydrocortisone Yes
cortef solu-Cortef
1.0 20
8
Adrenal Crisis: 50-100 mg IV bolus, then 50-100 mg q8h (continuous infusion x 24-48 h) PO once stable (50 mg q8h x 48 h, then taper over 14 d)
Chronic AI: 15-20 mg PO OD (2/3 AM, 1/3 PM)
In high doses, mineralocorticoid side effects may emerge (salt + water retention, ECF volume expansion, HTN, low K+ metabolic alkalosis)
Cortisone Acetate Yes
cortisone acetate
0.8 25
oral = 8 IM = 18+
Adrenal Crisis: 75-300 mg/d PO/IM divided q12-24h Chronic AI: 25 mg/d
Pro-drug which is converted to active form as hydrocortisone High doses can result in mineralocorticoid side effects (see above)
Mineralocorticoid
Fludrocortisone 100% Prednisone No
— prednisone
—
4 5
Chronic: 0.1 mg daily
Replaces aldosterone in primary adrenal insufficiency Pro-drug which is converted to active form as prednisolone
Dexamethasone No
dexamethasone
30 0.7
Adrenal Crisis: 4 mg IV; repeat q2-6h if necessary
Used for undiagnosed adrenal insufficiency (does not interfere with measurement of serum cortisol levels)
16-36 36-54
Adrenal Crisis: 15-60 mg/d PO qd or divided bid/qid Chronic AI: 5 mg daily