Therefore, patients receiving a large dose of a potent topical steroid applied to a large surface area or under an occlusive dressing should be evaluated periodically for evidence of HPA axis suppression by using the urinary free cortisol and ACTH stimulation tests. If HPA axis suppression is noted, an attempt should be made to withdraw the drug, to reduce the frequency of application, or to substitute a less potent steroid. Recovery of HPA axis function is generally prompt and complete upon discontinuation of the drug. Infrequently, signs and symptoms of steroid withdrawal may occur, requiring supplemental systemic corticosteroids.
This information should not be used to decide whether or not to take hydrocortisone cream, gel, ointment, and solution or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to hydrocortisone cream, gel, ointment, and solution. This information is not specific medical advice and does not replace information you receive from the healthcare provider. You must talk with the healthcare provider for complete information about the risks and benefits of using this medicine.
Samples for serum cortisol are taken at t=0 (typically 8am) prior to the patient’s first hydrocortisone dose, then at one, two, five and nine hours after this dose. For patients taking hydrocortisone three times a day, the second dose should be given after the five hour sample and the third after the nine hour sample. Patients taking hydrocortisone twice daily should take their second dose at seven hours with an additional sample taken at that time. Clearly mark the patient’s details, date and time on each bottle.