Cortef - Hydrocortisone (Oral)

What Is Cortef (Oral)?

Cortef (hydrocortisone) is an orally administered prescription medication used to reduce inflammation in the body and to raise the levels of steroid hormones in people with certain medical conditions, such as tuberculosis or rheumatoid arthritis (RA).

Cortef belongs to a class of drugs called corticosteroids, also known as glucocorticoids, or steroids. Corticosteroids work by altering your body’s immune response and reducing inflammation. 

Typically, the body’s adrenal gland naturally produces cortisol, a steroid hormone involved with numerous body functions. However, the body’s cortisol level of cortisol can be affected by various diseases, conditions, or medications. Cortisol levels that are too high or too low can adversely affect a person’s health. 

For example, in people with adrenal insufficiency, also called Addison’s disease, the body does not make enough cortisol. This lack of cortisol leads to symptoms such as fatigue, weight loss, joint or muscle pain, and skin pigmentation changes.

Cortef works by mimicking the effects of cortisol, helping to reduce or prevent related symptoms. 

Cortef contains the active ingredient hydrocortisone and is administered via oral tablets.

However, hydrocortisone is available as a generic drug administered in the form of oral tablets.

Additionally, other orally administered, brand-name medications contain the active ingredient hydrocortisone, such as Alkindi Sprinkle.

Drug Facts

Generic Name: Hydrocortisone

Brand Name(s): Cortef, Alkindi Sprinkle

Drug Availability: Prescription

Administration Route: Oral

Therapeutic Classification: Corticosteroid

Available Generically: Yes

Controlled Substance: N/A

Active Ingredient: Hydrocortisone

Dosage Form(s): Tablet, granular

What Is Cortef Used For?

The Food and Drug Administration (FDA) has approved Cortef to treat a variety of medical conditions, such as:

This is not a complete list of the wide variety of conditions that Cortef may be prescribed to treat. Therefore, consult your healthcare provider if you have questions regarding why you have been prescribed Cortef.

How to Take Cortef

Cortef should be taken by mouth according to the directions from your healthcare provider. In most cases, Cortef is recommended two to three times each day.

Your provider may have you take a higher dose in the morning and a lower dose in the afternoon and/or evening. This dosing schedule may help limit or avoid insomnia (trouble falling asleep or staying asleep), a possible side effect of Cortef.

During the first few weeks of Cortef treatment, changes in dose are common until your provider finds the right dose for you.

You should not stop taking Cortef without talking to a healthcare provider. If your provider decides to have you stop taking Cortef, they will have you decrease or taper your dose slowly as opposed to a sudden stop.

Cortef may cause stomach upset when taken on an empty stomach. Therefore, it's best to take each dose with food or milk.

Storage

Cortef tablets should be stored at room temperature (68 F to 77 F), and out of reach of children and pets. You’ll want to store the drug away from areas that might fluctuate in temperature (e.g., by a window) or areas susceptible to high levels of moisture, such as the bathroom.

How Long Does Cortef Take to Work?

Cortef begins to take effect within 30 minutes of taking the medication. During the first few weeks of Cortef treatment, changes in dose are common until your provider finds the right dose for you.

Because of these dose adjustments, you may not experience symptom improvement right away. Talk with your provider about what to expect while taking Cortef for your specific condition.

What Are the Side Effects of Cortef?

This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the FDA at www.fda.gov/medwatch or 800-FDA-1088.

Common Side Effects

Common side effects of Cortef may include:

Severe Side Effects

In rare cases, Cortef may cause severe side effects.

If you experience any of the following, contact your healthcare provider immediately or call 911 if you think you're having an emergency:

  • Adrenal gland suppression: Nausea, vomiting, diarrhea, headache, dizziness, or fatigue.
  • Eye problems, such as cataracts or glaucoma: Blurred vision, changes in vision, or pain in the eye area.
  • Severely high blood pressure: Intense headaches, chest pain, or shortness of breath.
  • Increased risk of serious infections: Fever, chills, body aches, fatigue, cough, congestion, or sore throat.
  • Osteoporosis, which may not cause symptoms, but can increase the risk of bone fracture.
  • Anaphylaxis (severe, systemic allergic reaction): Swelling of the face or throat, severe rash, urticaria (hives), or itching, or difficulty swallowing or breathing.

Long-Term Side Effects

Taking Cortef for an extended period of time, especially in high doses, could lead to changes in your metabolism as well as Cushing’s syndrome.

Cushing’s syndrome is a condition caused by excess steroid hormones (corticosteroids) in the body. Symptoms include weight gain, increased sweating, bruising or bleeding, skin atrophy (thinning), and “moon face” (rounding of the face).

Cushing’s syndrome typically goes away within a year of stopping Cortef.

Report Side Effects

Cortef may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your healthcare provider may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much Cortef Should I Take?

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The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (tablets):
    • Dose depends on medical condition:
      • Adults—At first, 20 to 240 milligrams (mg) per day. Your doctor may adjust your dose as needed.
      • Children—Use and dose must be determined by your doctor.
  • For oral dosage form (granules):
    • For adrenal problems:
      • Children—Dose is based on body surface area and must be determined by your doctor. Your doctor may adjust the dose depending on the age and symptoms. Dose is usually 0.5 to 1 milligram (mg) divided in 3 doses and given 3 times a day. Some patients may have their dose divided in 2 doses and given 2 times a day.

Modifications

Potential users should note the following before starting treatment with Cortef:

Severe allergic reaction: Avoid using Cortef if you have a known allergy to it or any of its ingredients. Ask your healthcare provider for a complete list of the ingredients if you're unsure.

Pregnancy: Since adequate human reproduction studies have not been done with corticosteroids, we don't know enough about the safety and effectiveness of Cortef in pregnant people and the unborn fetus. Therefore, discuss with your healthcare provider if you plan to become pregnant or are pregnant. They will help you weigh the benefits and risks of Cortef during your pregnancy.

Infants born of people who have received corticosteroids during pregnancy should be observed for signs of Addison's disease.

Breastfeeding: It's unlikely for Cortef to negatively affect nursing babies as a result of short-term breastfeeding, as steroids such as Cortef are not heavily expelled through breast milk.

Nonetheless, you may talk with your healthcare provider if you plan to breastfeed. They will help you weigh the benefits and harms of Cortef while nursing. They can also discuss the different ways available to feed your baby.

Older adults over 65: Older and younger adults are unlikely to experience any safety and effectiveness differences when using Cortef.

But in general, older adults with several medical conditions or who are taking several medications should use caution with Cortef. Older adults are typically more sensitive to side effects from medications.

Missed Dose

If you miss a dose of Cortef, take it as soon as you remember it. However, if you are about to take your next dose, skip the missed dose of Cortef. Do not take two doses at once to make up for a missed dose as this could lead to serious side effects.

Overdose: What Happens If I Take Too Much Cortef?

Taking too much Cortef may result in adrenal suppression.

Adrenal suppression occurs when your adrenal glands do not make enough steroid hormones. Specifically, symptoms associated with adrenal suppression include nausea, vomiting, diarrhea, headache, dizziness, muscle weakness, fatigue, and darkening of skin color.

What Happens If I Overdose on Cortef?

If you think you or someone else may have overdosed on Cortef, call a healthcare provider or the Poison Control Center (800-222-1222).

If someone collapses or isn't breathing after taking Cortef, call 911 immediately.

Precautions

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If you will be taking this medicine for a long time, it is very important that your doctor check you at regular visits for any unwanted effects that may be caused by this medicine. Blood or urine tests may be needed to check for unwanted effects.

Not giving enough or stopping Alkindi® Sprinkle, or switching from other hydrocortisone medicine may cause serious adrenal gland problems (eg, adrenal crisis). Check with your doctor right away if you have darkening of the skin, diarrhea, dizziness, fainting, joint pain, loss of appetite, mental depression, nausea, skin rash, unusual tiredness or weakness, or vomiting.

Using too much of this medicine or using it for a long time may increase your risk of having adrenal gland problems (eg, Cushing's syndrome). Talk to your doctor right away if you have blurred vision, dizziness or fainting, a fast, irregular, or pounding heartbeat, increased thirst or urination, irritability, or unusual tiredness or weakness.

If you are using this medicine for a long time, tell your doctor about any extra stress or anxiety in your life, including other health concerns and emotional stress. Your dose of this medicine might need to be changed for a short time while you have extra stress.

This medicine may cause you to get more infections than usual. Avoid people who are sick or have infections and wash your hands often. If you are exposed to chickenpox or measles, tell your doctor right away. If you start to have a fever, chills, sore throat, or any other sign of an infection, call your doctor right away.

Check with your doctor right away if blurred vision, difficulty in reading, eye pain, or any other change in vision occurs during or after treatment. These may be symptoms of eye or vision problems (eg, cataracts, glaucoma, central serous chorioretinopathy). Your doctor may want you to have your eyes checked by an ophthalmologist (eye doctor).

While you are being treated with hydrocortisone, do not have any immunizations (vaccines) without your doctor's approval. Hydrocortisone may lower your body's resistance and the vaccine may not work as well or you might get the infection the vaccine is meant to prevent. In addition, you should not be around other persons living in your household who receive live virus vaccines because there is a chance they could pass the virus on to you. Some examples of live vaccines include measles, mumps, influenza (nasal flu vaccine), poliovirus (oral form), rotavirus, and rubella. Do not get close to them and do not stay in the same room with them for very long. If you have questions about this, talk to your doctor.

This medicine may cause changes in mood or behavior for some patients. Tell your doctor right away if you have depression, mood swings, a false or unusual sense of well-being, trouble with sleeping, or personality changes while taking this medicine.

This medicine might cause thinning of the bones (osteoporosis) or slow growth in children if used for a long time. Tell your doctor if you have any bone pain or if you have an increased risk for osteoporosis. If your child is using this medicine, tell the doctor if you think your child is not growing properly.

Make sure any doctor or dentist who treats you knows that you are using this medicine. This medicine may affect the results of certain skin tests.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

What Are Reasons I Shouldn’t Take Cortef?

Cortef is not right for everyone. You should not take Cortef if:

  • You have a fungal infection, as Cortef will weaken your body’s ability to fight the infection.
  • You have had an allergic reaction to Cortef or hydrocortisone in the past.

What Other Medications Interact With Cortef?

Drug interactions occur when one drug affects how another drug works. Some interactions may be safely managed using dose adjustments by your healthcare provider, while others should be avoided.

Cortef is broken down in the liver before it is eliminated from the body. Medications that increase the activity of liver enzymes may decrease the body’s exposure to Cortef, such as Rifadin (rifampin), Dilantin (phenytoin), and Donnatal (belladonna/phenobarbital).

Medications that slow the activity of liver enzymes may increase the body’s exposure to Cortef, such as ketoconazole, Biaxin XL (clarithromycin), and Cardizem (diltiazem). 

As a result, a healthcare provider may need to adjust the dosage of Cortef to manage drug interactions such as these.

Blood thinning medications, such as Durlaza (aspirin) and Jantoven (warfarin), may interact with Cortef. If you need to take a blood thinner while taking Cortef, your healthcare provider may monitor you more closely.

In addition, live vaccines are not recommended while taking Cortef as the vaccine won’t be fully effective.

Other drug interactions are possible. During Cortef treatment, talk to your provider about all of your current medications, including prescription drugs, over-the-counter (OTC) medicines, vitamins, herbs, and other dietary supplements.

What Medications Are Similar?

Cortef is a type of steroid.

Examples of other drugs in this class include:

  • Prednisone has similar effects as Cortef, but its effects last longer in the body. Prednisolone is another steroid option that is very similar to prednisone. Cortef, however, is the preferred treatment for adrenal insufficiency because Cortef causes less severe side effects than prednisone and prednisolone.
  • Dexamethasone is another option within this drug class. It is considered more potent and longer-lasting than prednisone or prednisolone. However, providers do not usually prescribe dexamethasone to treat adrenal insufficiency because of the drug’s higher risk of Cushing’s syndrome.
  • Prednisone, prednisolone, or dexamethasone should not be taken at the same time as Cortef. When taken together, these agents could lead to excess hydrocortisone levels in the body, causing adverse effects.

Frequently Asked Questions

  • What is Cortef used for?

    Cortef is used to treat various disorders such as RA, psoriasis, Stevens-Johnson syndrome, and ulcerative colitis.

    Cortef is also used to treat adrenal insufficiency, a condition in which your adrenal glands can’t make enough cortisol.

  • How does Cortef work?

    Cortef serves as replacement therapy when the body does not naturally produce enough cortisol.

    Cortef works by regulating the immune system response and reducing inflammation throughout the body.

  • Are there any withdrawal side effects after stopping Cortef?

    Stopping Cortef abruptly may result in sudden adrenal insufficiency, with symptoms of nausea, vomiting, dizziness, and headache, among others. It’s important not to stop the drug unless you consult with your healthcare provider first.

    To avoid withdrawal, they’ll guide you on gradually decreasing your dose of Cortef before stopping it completely. Utilizing a slow taper, no withdrawal side effects should occur.

How Can I Stay Healthy While Taking Cortef?

Digestive side effects like nausea, vomiting, indigestion, and diarrhea are common when starting Cortef treatment. The good news is that taking each dose with a meal can prevent or lessen these symptoms.

If you experience other bothersome side effects or have signs of an infection while taking Cortef, tell your healthcare provider right away. It’s important not to stop treatment or reduce the dose on your own. Doing so may lead to severe withdrawal effects.

Side effects are often to blame when someone stops taking their medication. Open communication with your provider and taking steps to manage side effects are key steps to successful treatment.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended to replace medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Patricia Weiser, PharmD
Patricia Weiser, PharmD, is a licensed pharmacist and freelance medical writer. She has more than 14 years of professional experience.