Home Drug Guide Hydrocortisone Butyrate

Drug Guide

Generic Name

Hydrocortisone Butyrate

Brand Names Locoid, Locoid Lipocream

Classification

Therapeutic: Anti-inflammatory, corticosteroid

Pharmacological: Topical glucocorticoid

FDA Approved Indications

Inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses

Mechanism of Action

Hydrocortisone Butyrate exerts anti-inflammatory, antipruritic, and vasoconstrictive effects by inducing synthesis of proteins that stabilize cell membranes, reduce inflammation, and suppress immune responses.

Dosage and Administration

Adult: Apply a thin film to affected area 2-4 times daily as directed by a physician.

Pediatric: Use with caution; consult specific pediatric guidelines and monitor for potential systemic absorption.

Geriatric: Use renal and hepatic functions to guide dosage; monitor for systemic effects.

Renal Impairment: No specific adjustment necessary, but caution advised.

Hepatic Impairment: No specific adjustment necessary; monitor for systemic effects.

Pharmacokinetics

Absorption: Minimal when used topically on intact skin; increased if applied to broken skin.

Distribution: Primarily localized; systemic absorption is low.

Metabolism: Metabolized in the liver.

Excretion: Excreted mainly in urine as metabolites.

Half Life: Approximately 1.5-2 hours once absorbed systemically.

Contraindications

Hypersensitivity to hydrocortisone butyrate or any component of the formulation.
Fungal or viral skin infections.
Vaccine sites where immunization is active.

Precautions

Use with caution in compromised skin, skin infections, or in children due to potential for systemic absorption. Avoid long-term or extensive use; monitor for signs of adrenal suppression. Use during pregnancy only if clearly needed; safety data are limited.

Adverse Reactions - Common

Burning, itching, or dryness at application site (Common)
Skin atrophy, striae (Less common)

Adverse Reactions - Serious

Hypothalamic-pituitary-adrenal (HPA) axis suppression (Rare)
Secondary infections (Rare)
Contact dermatitis or allergic reactions (Rare)

Drug-Drug Interactions

Potent topical or systemic corticosteroids
Immunosuppressants

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Assess skin condition before and during therapy. Monitor for signs of irritation, skin atrophy, or systemic absorption.

Diagnoses:

Risk for skin atrophy
Impaired skin integrity

Implementation: Apply thin layer over affected area, avoiding surrounding healthy skin, eyes, and mucous membranes. Do not occlude unless directed.

Evaluation: Monitor skin improvement, adverse effects, and signs of systemic corticosteroid effects.

Patient/Family Teaching

Use as prescribed, avoid covering with occlusive dressings.
Do not use on large areas, broken skin, or for prolonged periods without medical advice.
Report signs of skin thinning, growth disturbances in children, or systemic symptoms.

Special Considerations

Black Box Warnings:

Long-term use of topical corticosteroids can cause hypothalamic-pituitary-adrenal (HPA) axis suppression.
Extended or excessive use may lead to skin atrophy and secondary infections.
Children are especially susceptible to systemic effects.

Genetic Factors: Patients with defective skin barriers or impaired healing may have altered absorption.

Lab Test Interference: May alter results of skin tests or immune function tests.

Overdose Management

Signs/Symptoms: Signs of systemic corticosteroid overdose include adrenal suppression, Cushingoid features, growth retardation in children.

Treatment: Discontinue use, provide supportive care, and monitor adrenal function. In severe cases, corticosteroid replacement therapy may be necessary.

Storage and Handling

Storage: Store at room temperature, 20-25°C (68-77°F). Keep container closed when not in use.

Stability: Stable for the shelf life indicated by the manufacturer.