Hydrocortisone: uses, dosing, side effects & brands
Hydrocortisone is a corticosteroid sold in the U.S. under 14 brand and generic names, for adrenal insufficiency, congenital adrenal hyperplasia and ulcerative colitis. Below: what the FDA label says, every product that contains it, what the pills look like, and its recall record.
Key facts
- Drug class
- Corticosteroid
- Treats (across its forms)
- Adrenal Insufficiency, Congenital Adrenal Hyperplasia and Ulcerative Colitis
- Available as
- Enema · Injectable · Tablet · Topical · Powder · Spray/Inhaler · Solution · Suspension
- Sold as
- 14 products — Cortenema, Hydrocortone and Nutracort, and others
- Prescription?
- Prescription only
- Generic available?
- Yes
- Half-life
- about 1.5 hours
- What the pharmacy pays
- about $0.15 per gm — not your price
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How Alkindi Sprinkle is dosed
From the FDA label for Alkindi Sprinkle (application NDA213876). Other hydrocortisone products — different forms, different strengths — are dosed differently. Follow the label for the one you were prescribed.
Individualize the dose, using the lowest possible dosage. (2.1) • The recommended starting replacement dosage is 8 to 10 mg/m2 daily. Higher doses may be needed based on patient’s age and symptoms of the disease. Use of lower starting doses may be sufficient in patients with residual but decreased endogenous cortisol production. (2.1) • Round the dose to the nearest 0.5 mg or 1 mg. More than one capsule may be needed to supply the required dose. (2.1) • Divide the total daily dose in 3 doses and administer 3 times daily. Older patients may have their daily dose divided by 2 and administered twice daily. (2.1) • When switching from other oral hydrocortisone formulations, use the same total daily hydrocortisone dosage. If symptoms of adrenal insufficiency occur, increase total daily dosage. (2.2) • ALKINDI SPRINKLE are oral granules contained within capsules. Do not swallow the capsule. Do not chew or crush the granules. (2.3) • See the Full Prescribing Information for detailed administration instructions. (2.3) 2.1 Dosage Information Individualize the dose for each patient, using the lowest possible dosage. The recommended starting replacement dosage is 8 to 10 mg/m 2 /day daily. Higher doses may be needed based on patient’s age and symptoms of the disease. Use of lower starting doses may be sufficient in patients with residual but decreased endogenous cortisol production.…
Everything below is the FDA label for Alkindi Sprinkle (powder). Hydrocortisone is also sold as enema, injectable, tablet, topical, spray/inhaler, solution and suspension, and those are different medicines to take — follow the label for the one you were prescribed.
Alkindi Sprinkle side effects
The following serious adverse reactions are described here and elsewhere in the label: Adrenal Crisis [see Warnings and Precautions ( 5.1 )] Immunosuppression and Increased Risk of Infection with Use of a Dosage Greater Than Replacement [see Warnings and Precautions ( 5.2 )] Growth Retardation [see Warnings and Precautions ( 5.3 )] Cushing’s Syndrome Due to Use of Excessive Doses of Corticosteroids [see Warnings and Precautions ( 5.4 )] Decrease in Bone Mineral Density [see Warnings and Precautions ( 5.5 )] Psychiatric Adverse Reactions [see Warnings and Precautions ( 5.6 )] Ophthalmic Adverse Reactions [see Warnings and Precautions ( 5.7 )] Gastrointestinal Adverse Reactions [see Warnings and Precautions ( 5.8 )] Risk of Kaposi's Sarcoma with Use of Dosage Greater Than Replacement [see Warnings and Precautions (5.9)] Vaccinations [see Warnings and Precautions (5.10)] Common adverse reactions for corticosteroids include fluid retention, alteration in glucose tolerance, elevation in blood pressure, behavioral and mood changes, increased appetite and weight gain. ( 6 ) To report SUSPECTED ADVERSE REACTIONS, contact Eton Pharmaceuticals, Inc. at 1-855-224-0233 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch . 6.1 Clinical Trials Experience Because clinical studies are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug…
Who shouldn’t take Alkindi Sprinkle
ALKINDI SPRINKLE is contraindicated in patients with hypersensitivity to hydrocortisone or to any of the ingredients in ALKINDI SPRINKLE. Anaphylactic reactions have occurred in patients receiving corticosteroids [see Adverse Reactions ( 6.2 )] . Hypersensitivity to hydrocortisone or to any of the ingredients in ALKINDI SPRINKLE. ( 4 )
Alkindi Sprinkle drug interactions
Table 2 Drug Interactions with ALKINDI SPRINKLE CYP3A4 Inhibitors Clinical Impact: Hydrocortisone is metabolized by cytochrome P450 3A4 (CYP3A4). Concomitant administration of inhibitors of CYP3A4 may lead to increases in serum concentrations of ALKINDI SPRINKLE and increase the risk of adverse reactions associated with the use of excessive doses. Intervention: Concomitant use of CYP3A4 inhibitors may require a decrease in the ALKINDI SPRINKLE dose. Examples: Anti-fungals: itraconazole, posaconazole, voriconazole Antibiotics: erythromycin and clarithromycin Antiretrovirals: ritonavir Grapefruit juice CYP3A4 Inducers Clinical Impact: Hydrocortisone is metabolized by cytochrome P450 3A4 (CYP3A4). Concomitant administration of inducers of CYP3A4 may lead to decreases in serum concentrations of ALKINDI SPRINKLE and increase the risk of adverse reactions, including adrenal crisis. Intervention: Concomitant use of CYP3A4 inducers may require an increase in the ALKINDI SPRINKLE dose. Examples: Anticonvulsants: phenytoin, carbamazepine and oxcarbazepine Antibiotics: rifampicin and rifabutin Barbiturates: phenobarbital and primidone Antiretrovirals: efavirenz and nevirapine Estrogen and Estrogen Containing Products Clinical Impact: Oral estrogen and estrogen-containing oral contraceptives may interact with hydrocortisone by increasing serum cortisol-binding globulin (CBG) concentration. Concomitant use may reduce the efficacy of ALKINDI SPRINKLE by binding and delaying or preventing absorption. Intervention: Concomitant use of estrogen/estrogen containing products may require an increase in the ALKINDI SPRINKLE dose. Antidiabetic Agents Clinical Impact: Corticosteroids in supraphysiologic doses may increase blood glucose concentrations. Intervention: Use of ALKINDI SPRINKLE in supraphysiologic doses may require a dose adjustment of antidiabetic agents. Anticoagulant Agents Clinical Impact: Concomitant use of warfarin and corticosteroids usually results in inhibition of response to warfarin, although there have been some conflicting reports. Intervention: Monitor coagulation indices in patients receiving ALKINDI SPRINKLE and concomitant warfarin to maintain the desired anticoagulant effect. Cyclosporine Clinical Impact: Increased activity of both cyclosporine and corticosteroids may occur when the two are used concurrently. Convulsions have been reported with concurrent use. Intervention: Monitor patients receiving ALKINDI SPRINKLE and concomitant cyclosporine. Nonsteroidal Anti-inflammatory Drugs (NSAIDs) Clinical Impact: Concomitant use of NSAIDs and corticosteroids increases the risk of gastrointestinal adverse reactions. Aspirin should be used cautiously in conjunction with corticosteroids in hypoprothrombinemia. The clearance of salicylates may be increased with concurrent use of corticosteroids; this could lead to decreased salicylate serum levels or increase the risk of salicylate toxicity when corticosteroid is withdrawn. Intervention: Monitor patients receiving ALKINDI SPRINKLE and concomitant NSAIDs. CYP3A4 Inhibitors : concomitant administration may require a decrease in the ALKINDI SPRINKLE dose. ( 7 ) CYP3A4 Inducers : concomitant administration may require an increase in the ALKINDI SPRINKLE dose. ( 7 ) Estrogen and Estrogen Containing Products : concomitant administration may require an increase in the ALKINDI SPRINKLE dose. ( 7 ) Antidiabetic agents: excessive doses may increase blood glucose concentrations. Dose adjustment of antidiabetic agents may be required. ( 7 ) NSAIDs: concomitant administration increases risk of gastrointestinal adverse reactions. ( 7 ) See 17 for PATIENT COUNSELING INFORMATION and FDA-approved patient labeling (Medication Guide). Revised 04/2026
Every hydrocortisone product we track (14)
Same active ingredient — different manufacturer, form, price and FDA recall record. That last one is what our independent score measures.
| # | Drug | Rating | Type | Form | Generic? | Pharmacy pays | |
|---|---|---|---|---|---|---|---|
| 1 | 70/100 | Prescription | Enema | Generic | $0 | View → | |
| 2 | 70/100 | Prescription | Injectable | Generic | $0 | View → | |
| 3 | 70/100 | Prescription | Topical | Generic | $0 | View → | |
| 4 | 64/100 | Prescription | Tablet | Generic | $0 | View → | |
| 5 | 62/100 | Prescription | Topical | No data | — | View → | |
| 6 | Not yet rated | Prescription | Topical | Generic | $0 | View → | |
| 7 | Not yet rated | Prescription | Powder | Generic | $0 | View → | |
| 8 | Not yet rated | Prescription | Topical | Generic | $0 | View → | |
| 9 | Not yet rated | Prescription | Tablet | Generic | $0 | View → | |
| 10 | Not yet rated | Prescription | Topical | Generic | $0 | View → |
Combination products containing hydrocortisone
A combination is a different drug — different dosing, different warnings. It is listed here so you can find it, not so you can substitute it.
Hydrocortisone recalls
From the FDA Enforcement database. A recall covers specific lots — not the drug as a whole.
How long hydrocortisone keeps
No hydrocortisone label we read sets a separate limit for after opening, but they do specify how it must be stored — and the stability behind any date assumes those conditions.
Does hydrocortisone expire? The in-use limits and storage rules from its labelsHydrocortisone and breastfeeding
From LactMed, the US National Library of Medicine’s Drugs and Lactation Database — quoted, not rewritten.
Full LactMed record for hydrocortisone: levels in milk, effects in breastfed infants, and the drugs it would consider insteadHydrocortisone (cortisol) is a normal component of breastmilk, but it has not been studied in milk after exogenous administration in pharmacologic amounts. Although it is unlikely that dangerous amounts of hydrocortisone would reach the infant, a better studied corticosteroid might be preferred. Maternal use of hydrocortisone as an enema would not be expected to cause any adverse effects in breastfed infants. Local maternal injections, such as for tendinitis, would not be expected to cause any adverse effects in breastfed infants. Medium to large doses of corticosteroids given systemically or injected into joints or the breast have been reported to cause temporary reduction of lactation. See also Hydrocortisone, Topical.
National Institute of Child Health and Human Development, record revised March 15, 2026. LactMed states its information is not a substitute for professional judgement.
What people report to the FDA about hydrocortisone
The FDA Adverse Event Reporting System (FAERS) collects reports from patients and clinicians. It holds 82,950 reports naming hydrocortisone, and the FDA flagged 83% of those reports as serious. The effects reported most often — leaving out reports about overdose, misuse or the condition being treated, which dominate the raw list for common medicines:
- fatigue8,427 reports
- rash7,255 reports
- nausea6,661 reports
- diarrhoea6,003 reports
- arthralgia5,942 reports
- dyspnoea5,920 reports
- headache5,915 reports
- pyrexia5,447 reports
Read these as a signal, not a rate. A report does not mean hydrocortisone caused the effect — anyone can file one, and many describe people taking several medicines for several conditions. Crucially there is no denominator: FAERS does not record how many people took the drug, so these counts cannot be turned into “X% of patients” — a bigger number often just means a more widely used or more talked-about drug. Duplicates exist, and publicity drives reporting. For what is actually established, read the FDA label section above.
Source: openFDA drug/event (FAERS), retrieved August 25, 2026.
How long hydrocortisone stays in your system
The elimination half-life of hydrocortisone is about 1.5 hours. This is the plasma (terminal) elimination half-life; the FDA label states "The terminal half-life of hydrocortisone is about 1.5 hours following intravenous and oral dosing of hydrocortisone tablets" in healthy adults, so roughly 90% of a dose clears within about 8 hours and nearly all within ~12 hours. Hydrocortisone is not a prodrug, but its half-life measures how fast the drug leaves the blood, not how long its effects last: as a short-acting glucocorticoid its biological (tissue) effect on the body persists well beyond blood clearance, and this short plasma half-life is why oral replacement is usually dosed 2-3 times a day. Because hydrocortisone is metabolized in the liver, significant liver impairment can slow clearance; the label does not give a specific half-life adjustment for age, kidney, or liver function. Half-life is not the same as a drug-test detection window.
ALKINDI SPRINKLE (hydrocortisone) oral granules — FDA prescribing information, DailyMed ↗Half-life is how long the body takes to clear half a dose. It is not the same as how long a drug test can detect it, and it varies with age, kidney and liver function.
Related calculators
Frequently asked questions
What is Alkindi Sprinkle?
Alkindi Sprinkle (Hydrocortisone) is a corticosteroid used to treat Adrenal Insufficiency, Congenital Adrenal Hyperplasia, Ulcerative Colitis, Contact Dermatitis.
What kind of drug is hydrocortisone?
The FDA classifies hydrocortisone as a corticosteroid. Corticosteroids mimic the body's natural stress hormone cortisol: they enter cells and bind a glucocorticoid receptor that switches off genes for inflammatory chemicals, calming swelling, redness, and an overactive immune response. If you are checking whether it is safe to combine with something else, the class is what matters — two drugs from the same class usually should not be stacked.
How long does hydrocortisone stay in your system?
The elimination half-life of hydrocortisone is about 1.5 hours — that is how long the body takes to clear half of a dose. This is the plasma (terminal) elimination half-life; the FDA label states "The terminal half-life of hydrocortisone is about 1.5 hours following intravenous and oral dosing of hydrocortisone tablets" in healthy adults, so roughly 90% of a dose clears within about 8 hours and nearly all within ~12 hours. Hydrocortisone is not a prodrug, but its half-life measures how fast the drug leaves the blood, not how long its effects last: as a short-acting glucocorticoid its biological (tissue) effect on the body persists well beyond blood clearance, and this short plasma half-life is why oral replacement is usually dosed 2-3 times a day. Because hydrocortisone is metabolized in the liver, significant liver impairment can slow clearance; the label does not give a specific half-life adjustment for age, kidney, or liver function. Half-life is not the same as a drug-test detection window. Half-life is not the same as how long a drug test can detect the drug, and it varies with age, kidney and liver function.
Can you take hydrocortisone with other medicines?
It depends on the medicine. We check it against the FDA labels rather than guessing: our interaction checker searches each drug's own label for the other and quotes what it says, naming the section it came from. Run hydrocortisone against whatever else you take — and remember that a label not naming a drug is not the same as that combination being safe.
What brand names is hydrocortisone sold under?
We track 14 hydrocortisone-containing products in the U.S.: Cortenema, Hydrocortone, Nutracort, Cortril, Hydrocortisone Valerate, Acticort, Alkindi Sprinkle and Cort-Dome, and 6 more. They are the same active ingredient; they differ in form, manufacturer, price and FDA recall record.
What forms does hydrocortisone come in?
Across the brands we track, hydrocortisone is currently marketed as enema, injectable, tablet, topical, powder, spray/inhaler, solution and suspension, per the FDA's National Drug Code Directory. Each form is dosed differently — follow the label for the exact product you were prescribed.
Is there a generic hydrocortisone?
Yes. Our catalog lists 4 generic hydrocortisone products alongside the brand versions. A generic has the same active ingredient and must meet the FDA's bioequivalence standard; it usually costs less. Ask your pharmacist which one your plan covers.
Has hydrocortisone been recalled?
The FDA's Enforcement database lists 1 recall record whose product description mentions hydrocortisone. The most recent: Hydrocortisone 1% & Acetic Acid 2% Otic Solution (Aug 7, 2024). A recall applies to specific lots, not to the drug as a whole — check the record for the affected lot numbers.
Cite this page
- APA
- pharmaranks. (2026, July 24). Hydrocortisone: uses, dosing, side effects & brands. https://pharmaranks.com/drugs/hydrocortisone
- MLA
- “Hydrocortisone: uses, dosing, side effects & brands.” pharmaranks, 24 July 2026, https://pharmaranks.com/drugs/hydrocortisone.
We summarise public FDA and NIH sources — for a clinical claim, cite the primary source we link to as well.
Sources: FDA openFDA drug label, National Drug Code Directory, and Enforcement (recall) database. This page reproduces public FDA data and is not medical advice. Dosing is set by your prescriber.
Read the full FDA label for hydrocortisone on DailyMed (NIH) ↗.