Hydrocortison Bidiphar injection powder helps fight inflammation, allergies, anti -itching (1 tube x 2ml)

Dosage form Box
Specifications Hydrocortison Sodium Succinat

Ingredient

Composition information	Content
Hydrocortison Sodium Succinat	100mg

Uses

Indications

Hydrocortison drugs are indicated in cases where the fast and strong effects of corticosteroids are as follows:

Allergies: Control serious allergies or loss of treatment in cases of asthma, atopic dermatitis, contact dermatitis, drug hypersensitivity reactions, prolonged or seasonal allergic, serum, blood transfusion reactions.

Skin -related diseases: Herpes puffer dermatitis, flaking dermatitis, fungal warts, pemphigus disease, severe diverse roses (Stevens - Johnson syndrome).

Glue -generating diseases: Lupus erythematosus.

Endocrine disorders: A decrease in the adrenal - primary kidney or secondary (hydrocortison or cortison is a chosen drug; similar synthetic substances can be used in combination with mineralocorticoids if appropriate; in children, the supplement of mineralocorticoids is particularly important), congenital hyperkemia, hypercalcemia related to cancer. Pus.

Gastrointestinal diseases: Help patients overcome the critical stage of infections related to each area (systematic treatment) and ulcerative colitis.

Hematological disorders: Hematopopistic anemia (autoimmune), congenital anemia (red blood cell) (diamond blackfan anemia), spontaneous platelet hemorrhage committee in adults (only intravenously, contraindicated use of intramuscular patho), mere red blood cell property, cases of secondary platelets.

Mixed mixture of: Telococcal worms in the heart and nervous system, tuberculosis caused by tuberculosis with subarachia or life -threatening blocks when used simultaneously with appropriate tuberculosis therapy.

Tumor related diseases: To reduce leukemia and lymphoma.

Nervous system: Acute severe severe stiffness, brain edema related to primary or metastatic brain tumors, or skull surgery.

Eye diseases: sympathetic eye inflammation, uveitis and eye infections that do not respond to local corticosteroids.

Diseases in the kidneys: To reduce the increase in urinary or decrease in proteinuria in nephrotic syndrome or lupus erythematosus.

Respiratory diseases: Berili poisoning syndrome, spreading tuberculosis or outbreaks when used simultaneously with appropriate tuberculosis therapy, spontaneous gagging pneumonia, symptoms of granuloma (sarcoidosis), gastric inhalation.

Rheumatoid arthritis: such as supportive therapy for short -term treatment (help patients through acute or severe disease) in acute arthritis, acute rheumatoid rheumatitis, joint spondylitis, psoriasis arthritis, rheumatoid arthritis, including rheumatoid arthritis among teenagers (selective cases may need low -dose maintenance therapy). For treatment of dermatitis, temporal arteritis, polyautritis.

Pharmacokinus

hydrocortison is corticosteroids secreted from the adrenal gland, the glucocorticoid group has anti -inflammatory, allergic, anti -itching and immunosuppressive effects. Hydrocortison Succinat, water -soluble, quickly hydrolyzed into activated hydrocortison thanks to the blood ester in blood

Pharmacokinetics

absorption

When using intravenously, hydrocortisone sodium sucinat soluble in water and quickly reach high concentrations in body fluids.

Distribution

About 90% of the drug is attached to plasma proteins, mainly with corticosteroids - binding globuli (CBG, a type of A2 Globulin synthesized in the liver) and albumin. Only the drug in the form of free to penetrate the target cell and cause pharmacological effects.

Metabolism and elimination

Hydrocortison's waste time is about 100 minutes. Hydrocortison is metabolized in the liver and most of the tissue in the body into hydrogenation and tetrahydrocortisone and tetrahydrocortisol. These substances are excreted in the urine, mainly in the form of glucuronid and small amounts in the form of unchanged. Hydrocortison also passes the placenta.

Before taking Hydrocortison Bidiphar injection powder helps fight inflammation, allergies, anti -itching (1 tube x 2ml)

How to use

Dissolve the dough jar with the attached solvent. The mixed solution is preserved ≤ 25 ° C, avoiding light, using only transparent solution, not used after more than 3 days.

The solution is not durable with heat so it is not sterilized. The drug is mixed for intramuscular or intravenously and if needed for intravenous transmission, then dilute to a concentration of 0.1 - 1 mg/ml with a 5% or 0.9% dextrose solution.

Dosage

hydrocortison can be used in intravenous, intravenous or intramuscular injection, the priority method when using the initial emergency is intravenously. After the initial emergency phase, it is necessary to consider the use of a longer injection effect or a oral drug.

Dosage usually ranges from 100 mg to 500 mg depending on the severity of the patient, intravenous injection for 1 to 10 minutes. This dose may be repeated for a period of 2.4 or 6 hours, indicated depending on the response of the patient and the clinical condition.

In general, high doses of corticosteroid therapy should only continue until the patient's condition is stable - usually no more than 48 to 72 hours. If you continue treatment with hydrocortison for more than 48 to 72 hours, the phenomenon of hyperiemia can occur.

Therefore, it is recommended to replace hydrocortisone with another corticosteroid like methylprednisolone sodium sucinat because the phenomenon of sodium keeps occurs with little or does not occur. Although there are few side effects related to short -term high -dose corticosteroid therapy, stomach ulcers may occur. Can be prescribed prophylaxis with antacids.

Patients with severe stress after treatment with corticosteroids should be closely monitored with signs and symptoms of adrenal - kidney -impaired decline.

Corticosteroid treatment is a supportive and non -replacement therapy.

In patients with liver disease, the effect may increase and need to consider reducing the dose.

Elderly patients: Hydrocortison is mainly used in short -term conditions. There is no information that suggests that the change of the amount of guaranteed amount in the elderly. However, it should be noted that the more serious complications of the side effects are often encountered by corticosteroids when treating elderly patients and need to have close clinical supervision.

Children: Although the dose may be reduced for babies and children, it should be adjusted according to the severity and response of patients rather than age or weight and should not be less than 25 mg daily.

Note: The above dose is for reference only. Specific dosage depends on the condition and level of progression of the disease. For a suitable dose, you need to consult a doctor or medical specialist.What do

do when overdose? In cases of overdose, no typical antagonistic drugs, only supportive treatment and symptomatic treatment.

Notify the doctor the unwanted effects encountered when using the drug

What to do when forgetting a dose?

Side Effects

When using hydrocortison, you may experience unwanted effects (ADR).

Infections and parasites: Covering signs of infection; Opportunity infections. It is possible to inhibit reactions in skin tests.

Blood disorders and lymphatic systems: leukemia

endocrine disorders: Cushing syndrome; Inhibiting the adrenal glands - pituitary glands. Drug condensation syndrome: A decrease in corticosteroid dose too fast after long -term treatment can lead to acute adrenal failure, lower blood pressure and death. However, this case occurs more for corticosteroid treatment. Condensation syndrome may occur including: fever, muscle pain, joint pain, rhinitis, conjunctivitis, skin pain and weight loss. Urinary glucose, hemorrhoids, potential diabetes, menstrual disorders, inhibit children's development. suicide thought). The reactions related to mental disorders (such as Hung Cam, delusion, hallucinations, worsen schizophrenia); behavioral disorders. Easy to be stimulated, anxiety, sleep disorders. Cognitive dysfunction includes confusion and memory loss. Convulsions, depression, headache, insomnia, sensory disorders (after using endocardic tract), paresthesia, dizziness. increase benign intracranial pressure; convulsion; fertilizer fat accumulation; neuritis, neuropathy; Spider film, meningitis, mild paralysis of the lower limbs/lower limb (after using endocardic tract). glaucoma; Eye bulging; Increased internal pressure, may cause visual neurological damage; thin cornea or conjunctiva; worsen fungal or viral eye diseases; dark retinopathy of the center of the epidemic; Rarely encounter cases of blindness when injected around the eyes. heart rupture after myocardial infarction; Slow heart rate, cardiac arrhythmic, irritation, enlarged heart, hypertrophic myocardial pain in premature babies, tachycardia.

vascular disorders: Hypertension; thrombosis includes thrombosis; Circulation, fat embolism, pulmonary edema, fainting, thrombosis, vasculitis. pulmonary embolism. stomach bleeding; pancreatitis; bloating; esophageal ulcer; esophageal fungal infection; Perforation of small intestine and large intestine (especially in patients with bowelitis); indigestion; nausea; Bladder/bladder dysfunction (after endometrial lines), increased liver enzyme levels (often recovered after treatment), liver energy. capillary dilatation; Blood bruises; Skin atrophy and subcutaneous tissue; streaks on the skin; Increase skin pigmentation; Reduce skin pigmentation; him; acne; increase sweating; Allergic, hot or nerve dermatitis (especially in the perineum, after intravenous injection), dry scales, edema, skin rash, rash, inhibiting reactions of the test on the skin, thin skin, thin scalp hair, urticaria, sterile abscess. muscle weakness; Bone necrosis: Aseptic necrosis at the tip of the femur and arm bone; osteoporosis; fractures of long bones; bone retardation; Charcot joint disease, reducing muscle mass, reaction of the erythematosus after injection (after the injection in the joint). menstrual loss. Aseptic abscess; uncomfortable. Increasing insulin demand (or oral hypoglycemia in people with diabetes); Hematopathy is reduced; Negative nitrogen balance (due to catabolism of protein); calcium in urine increases; Alanin aminotransferase increases; Aspartat aminotransferase increases; Alkaline phosphatase in the blood increases. The tendon broken (especially the tendon of Achilles).

can minimize cushing fake syndrome and osteoporosis by carefully selecting steroid drugs. The program uses drugs 1 day or interrupted; Auxiliary therapy can be effective in the treatment of osteoporosis caused by steroids (calcium, vitamin D, ...). Must often pay attention to bacterial infections caused by "opportunities" bacteria. If necessary, antibiotics must be used.

Warnings

Before using the drug you need to read the instructions carefully and refer to the information below.

Contraindicated

Hydrocortisone drugs contraindicated in the following cases:

Patients with systemic fungal infection unless used anti -bacterial therapy.

Using live vaccines or reduced energy in patients using corticosteroid immunosuppressants.

Patients with hypersensitivity to hydrocortison or any ingredients of the drug.

intramuscularly for patients with spontaneous platelets.

Endometrial injection. There have been reports on serious influence due to this use of drugs.

Caution when using

Warning

Serious adverse reactions when using epidural injection:

Serious neurological effects, some deaths, have been reported when injecting corticosteroids. Specific effects have been reported but not limited to: the infarction of the marrow, the lower limb, the paralysis of the limbs, the brain blindness and the stroke. These serious effects are reported or not using fluorescent solutions. The safety and effectiveness of corticosteroid injections have not been established and corticosteroids have not been approved for this use.

general

Hydrocortison injection can lead to changes in the skin and subcutaneous tissue forming the concave on the skin at the injection site. To reduce the rate of skin atrophy and subcutaneous tissue, caution must not exceed the recommended injection dose. Delta muscle should be avoided due to increased rate of subcutaneous atrophy.

In rare cases, anaphylactic reaction occurred in patients treated with corticosteroids.

For patients with abnormal stress corticosteroids, indicated to increase the dose of corticosteroids quickly before, during and after stress.

The results from a central, random and placebo study are controlled with methylprednisolon hemisuccinat, which shows an increase in the risk of early death (2 weeks) and late (6 weeks) in patients with traumatic brain injury without other clear indications for corticosteroid treatment. High doses of corticosteroids have a systematic effect, including hydrocortison, should not be used for treatment for patients with brain damage.

heart - kidney

Medium and large corticosteroid dose may cause hypertension, salt and water, increased potassium excretion. These effects seem to be less likely to the synthetic substances unless used in high doses. Potassium supplement and salt limit may be necessary. All corticosteroids increase the secretion of calcium.

The reports show that there is a clear relationship between the use of corticosteroids and breaking the left ventricular freedom after the recent heart attack, so it is especially cautious when using corticosteroids for these patients.

endocrine

Inhibiting pituitary -adrenal - underlying - hypothalamus (HPA), Cushing syndrome and hyperglycemia. Track these conditions when long -term use for patients. After treatment, corticosteroids can inhibit the HPA axis with a recovery with the ability to reduce the effect of glucocorticosteroid.

The adrenal - secondary renal shell failure because the drug can be minimized by gradually reducing the dose of use. However, this adrenal - kidney disability can last several months after the treatment. Therefore, hormone treatment should be used in any case of stress occurring during this time.

Infections

general

Patients who are using corticosteroids are more susceptible to infections than healthy people. It is possible to reduce resistance and cannot determine the type of infection when using corticosteroids. Infection with any pathogens (viruses, bacteria, fungi, protozoa or helminths) in any part of the body may be related to the use of solitary corticosteroids or in combination with other immunosuppressants.

These infections may be mild but may be severe and sometimes fatal. The rate of complications due to infection increases when increased corticosteroid dose. Corticosteroids can also cover some signs of infection. Do not use the injection in the joint, in the case of the epidemic or in the tendon to have a local effect when the infection is local.

Fungal infection

corticosteroids may worsen the body's fungal infection and therefore should not be used in this case; Unless corticosteroids are used to control drug reactions. There have been cases of large heart and congestive heart failure after use simultaneously amphotericin B and hydrocortison.

Special pathogens

The hidden diseases can be activated or can worsen recurrent infections due to pathogens including: AMOEBA, Candida, Cryptococcus, Mycobacterium, Nocardia, Pneumocystis and Toxoplasma.

Recommendation: It is necessary to eliminate the possibility of infection of hidden or active amoeba diseases before starting corticosteroid treatment in any patient in the tropics; or in patients with unexplained diarrhea.

Similarly, should be especially cautious when using corticosteroids for patients infected or suspected of Strongyloides infection (needle worm). In these patients, corticosteroid immunosuppressants can lead to excessive Strongyloides infection and quickly spread the larvae, often accompanied by severe intestinal inflammation and likely to infect gram -negative bacteria.

corticosteroids should not be used in brain malaria. Currently there is no evidence of the benefits of using steroids in this condition.

tuberculosis

Using corticosteroids in tuberculosis should be limited to cases of progressive or widespread tuberculosis, in which corticosteroids are used to control the disease in a combination with an appropriate tuberculosis regimen.

If corticosteroid is indicated in patients with hidden tuberculosis or tuberculin reaction, careful monitoring should be monitored because it may relapse. In prolonged corticosteroid treatment, these patients should be prophylactic.

vaccinated

Contraindicated for live vaccination or reducing activity in patients with corticosteroid immunosuppressants. Dead or inactivated vaccines can be used. However, it is unpredictable to respond to these vaccines. Immune tricks can be performed in patients using corticosteroids as alternative therapy (for example, for Addison disease).

virus infection

Chickenpox and measles may be more serious or even fatal in children and adults when using corticosteroids. In children and adults without these diseases, it is necessary to take special care to avoid exposure. The effects of these diseases and/or corticosteroid treatment earlier with this risk is not known.

If exposed to chickenpox, it can be appointed with Varicella Zoster (Vzig). If exposed to measles, immune globulin can be appointed (IG). If chickenpox progresses, you should consider treatment with antiviral drugs.

Neurology

There have been reports on serious impact due to drug -related drugs using endocardium.

Eyes

The use of corticosteroids can cause chisels under the following, glaucoma that can cause optic nerve damage and can increase secondary eye infections caused by bacteria, fungi or viruses. Oral corticosteroid use is not recommended in the treatment of optic neuritis and may increase the risk of new phases.

corticosteroids should be used cautiously in patients with eye -eyed herpes Simplex due to corneal perforation. Corticosteroids should not be used for patients infected with herpes virus.

Precautions

general

Should use the lowest possible dose of corticosteroids to control the condition. When the dose can be reduced, it should be slowly reduced.

Because complications when treated with glucocorticoid depends on the dosage and treatment time, the risk/benefit decision should be done in each separate case, as well as the dosage and duration of treatment and as well as the use of daily or interruption therapy.

Sarcoma Kaposi has been reported in patients treated with corticosteroids, most common for chronic diseases. Corticosteroids can stop using clinical improvement.

heart - kidney

Due to the sodium -holding and potassium loss may occur in patients with corticosteroids, these drugs should be used in patients with congestive heart failure, high blood pressure or renal failure.

Endocrine

The metabolic clearance of corticosteroids decreases in patients with hypothyroidism and increased in hyperthyroidism patients. The dose may be needed when there is a change in the thyroid condition of these patients.

Stomach - guts

Steroids should be carefully used in progressive or hidden stomach ulcers, excess bags, both connecting intestines and non -specific colon ulcers, because they may increase the risk of perforation. The signs of peritoneal irritation after gastric -intestine in patients with corticosteroids may be reduced or not available.

In patients with cirrhosis, the effect of corticosteroids increases due to metabolic decline.

skeletal muscle

corticosteroids reduce bone formation and increase bone reabsorption based on the process of regulating calcium (for example, reducing absorption and increasing excretion) and inhibiting the function of bone cells. This is along with reducing bone protein, due to an increase in protein metabolism and gender hormonal production, which can lead to bone development in children and the progression of osteoporosis at any age. Pay special attention to patients at high risk of osteoporosis (eg postmenopausal women) before starting corticosteroid treatment.

Do not regularly inject steroids in the same infection position before.

Neuros - Mental

The controlled clinical trials show that corticosteroids are effective in promoting serious exacerbations of multi -sclerosis. However, these tests do not show that corticosteroids affect the consequences of darkness or natural history. These studies clearly show that in order to prove a significant effect, it is necessary to use relatively high corticosteroid doses.

Acute muscle pain has been observed when using high doses of corticosteroids, often occurs in patients with neurotranosis disorders (such as muscle weakness) or in patients treated simultaneously with neurotransmitter (eg pancuronium). This acute muscle pain is common, may include eye and respiratory muscles and can lead to weak limbs. Increase creatin kinase can occur. After stopping corticosteroids, it may take several weeks to several years to improve or recover clinical.

Mental disorders may appear when using corticosteroids according to the levels from refreshment, insomnia, feeling of flying, changing the temperament and severe depression to clear mental disorders. In addition, the current emotional instability or mental disorders may be more serious due to corticosteroids.

Eyes

Interior pressure can increase in some individuals. Should monitor internal pressure if treatment with steroids lasts more than 6 weeks.

Other

adrenal marrow tumors, which can be fatal, have been reported after corticosteroid treatment has a whole body effect. In patients with suspected adrenal marrow tumors, the risk of adrenal tumor occurs before using corticosteroids.

The solution formed after the dried coastal powder of the hydrocortison injection with the solvent tube (2 ml) attached to the alcohol Benzylic with a concentration of 9 mg/ml. Therefore, it is not used for premature babies and babies. At the same time, it can cause toxic reactions and allergic reactions (anaphylactic reactions) in children and children up to 3 years old.

The ability to drive and operate machinery

has not been studied. However, when affected by any side effects of the drug: fainting (fainting), dizziness, convulsions (epilepsy), do not drive and operate the machine.

Pregnancy

corticosteroid has been shown to be teratogenic in many species when used in the same dose as a human dose. Animal studies when using corticosteroids for rats, rats and pregnant rabbits show an increase in the ratio of throat openings in the newborn.

There are no adequate studies and good control in pregnant women. Corticosteroids should only be used for pregnant women when the benefits are greater than the risk for the fetus. Newborns from mothers have used corticosteroids during pregnancy should be carefully monitored the signs of adrenal functional impairment.

The breastfeeding period

corticosteroids are used in sugar that has the effect of the system that appears in breast milk and can inhibit the development, interfere with endogenous corticosteroid production or cause other adverse effects. Because corticosteroids can cause serious adverse reactions in breastfed babies, decide to continue breastfeeding or stop using the drug depends on the importance of the drug with the mother.

Drug interaction

Aminoglutethimid

Aminoglutethimid can lead to reduced adrenal inhibition due to corticosteroids.

Amphoticin B injection drugs and potassium -lowering agents: When using Corticosteroids simultaneously with a decrease in potassium (such as amphotericin B, diuretics), patients need to be closely monitored on the progression of hypoglycemia. There are cases where it is reported when used simultaneously amphotericin B and hydrocortison leads to large heart and congestive heart failure.

Antibiotics

Macrolid antibiotics have been reported significantly reducing the clearance of corticosteroids.

Cholineseterase antagonists

Simultaneous use of antagonists and corticosteroids can cause severe weakness in patients with myastheniastick. If possible, cholinesterase antagonists should not be used for at least 24 hours before starting treatment with corticosteroids.

Anticoagulant drugs for oral use

Simultaneous use of corticosteroids and warfarin often leads to inhibition in response to warfarin, although there are some reverse reports. Therefore, blood clotting indicators should be monitored regularly to maintain the desired anticoagulant effect.

Hypoglycemic drugs

corticosteroids can increase blood glucose levels, so the appropriate medication should be adjusted.

Against drugs

The serum isoniazid concentration may be reduced.

cholestyramin

Cholestyramin may increase the clearance of corticosteroids.

cyclosporin

Increase the activity of both cyclosporin and corticosteroids that can occur when used simultaneously. Convulsions have been reported when using this combination therapy.

heart glycosides

Patients using cardiac glycosides may increase the risk of arrhythmia due to hypokalemia.

estrogen, including oral contraceptives

Estrogen can reduce metabolism in the liver of some corticosteroids, thus increasing the effect of the drug.

Liver enzyme induction (eg barbiturat, phenytoin, carbamazepin, rifampin)

Cytochrom P450 3A4 enzyme induction drugs may increase corticosteroid metabolism and therefore need to increase the dose of corticosteroids.

Liver enzyme inhibitors (for example ketoconazol, macrolide antibiotics such as erythromycin and troleandomycin)

Cytochrom P450 3A4 enzyme inhibitors have the ability to increase corticosteroid levels in plasma.

ketoconazole

Ketoconazole has been reported significantly reducing the metabolism of some corticosteroids by up to 60%, resulting in an increased risk of side effects due to corticosteroids.

Non -steroid anti -inflammatory drugs (NSAIDs)

Simultaneous use of aspirin (or other nonsteroidal anti -inflammatory drugs) and corticosteroids increase the risk of gastrointestinal side effects. Aspirin should be used carefully when combined with corticosteroids in reducing blood prothrombin. Salicylate's clearance may increase when used simultaneously with corticosteroids.

Skin tests

corticosteroids can inhibit the reaction of skin tests.

vaccine

Patients with long -term treatment with corticosteroids may decrease in response to toxins and live or inactivated vaccines due to antibody response inhibition. Corticosteroids also have the ability to increase the copy of some organisms in the vaccine to be reduced. If possible, the vaccine or toxin should be discontinued until stopped using corticosteroids.

Antid for hypertension

corticosteroid increases the need for anti -hypertension drugs.

anti -reducing muscle relaxants

corticosteroids may reduce the effect of anti -reducing muscle relaxants.

Storage

Store in a dry place, the temperature does not exceed 300C, avoiding light.

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