Biocort Special Precautions

Hydrocortisone should only be used asystematically with great caution. In the presence of heart failure, recent myocardial infarction or hypotension, in patients with diabetes mellitus, epilepsy, glaucoma, hypothyroidism, hepatic failure, osteoporosis, peptic ulceration, psychoses or severe affective disorder or renal impairment. Children may be at increased risk of some adverse effects, in addition, hydrocortisone may cause growth retardation and prolonged administration is rarely, justified. The elderly too may be greater risk from adverse effects.
The risk of chicken pox and probably of severe herpes zoster are increased in nonimmune patients receiving therapeutic doses of hydrocortisone and patients should avoid close personal contact with either infection. Passive immunization is recommended for nonimmune patients who have come into contact with chickenpox. Similar precautions apply to measles. Live vaccines should not be given to patients receiving high doses of systemic corticosteroid therapy for atleast 3 months onwards; killed vaccines or toxoids may be given although the response may be attenuated.
During prolonged courses of corticosteroid therapy, patients should be examined regularly. Sodium intake may need to be reduced and calcium and potassium supplements may be necessary. Monitoring of the fluid intake and output and daily weight records may give early warning of fluid retention. Back pain may align osteoporosis. Children are at special risk from raised intracranial pressure. Patients should carry cards (and preferably also wear bracelets) giving full details of corticosteroid therapy; they and their relatives should be fully conversant with the implications of their therapy and the precautions to be taken.
Measures to compensate for the adrenal's inability to respond to stress include increasing the dose to cover minor intercurrent illness or trauma eg, surgery.