Hydrocortisone-Richter

2024 Author: Rachel Wainwright | [email protected]. Last modified: 2023-12-15 07:39

Hydrocortisone-Richter: instructions for use and reviews

1. Release form and composition
2. Pharmacological properties
3. Indications for use
4. Contraindications
5. Method of application and dosage
6. Side effects
7. Overdose
8. Special instructions
9. Application during pregnancy and lactation
10. Use in childhood
11. Use in the elderly
12. Drug interactions
13. Analogs
14. Terms and conditions of storage
15. Terms of dispensing from pharmacies
16. Reviews
17. Price in pharmacies

Latin name: Hydrocortisone-Richter

ATX code: H02AB09

Active ingredient: hydrocortisone (Hydrocortisone) + lidocaine (Lidocaine)

Manufacturer: Gedeon Richter (Hungary)

Description and photo updated: 30.11.2018

Prices in pharmacies: from 181 rubles.

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Suspension for intra-articular and periarticular administration of Hydrocortisone-Richter

Hydrocortisone-Richter is a glucocorticoid agent with anti-inflammatory action.

Release form and composition

The dosage form is a suspension for intra-articular and periarticular administration: almost white or white, with a characteristic odor (5 ml each in colorless glass bottles, 1 bottle in a cardboard box and instructions for use of Hydrocortisone-Richter).

Composition of 1 ml of suspension:

active substances: hydrocortisone acetate - 25 mg, lidocaine hydrochloride - 5 mg;
auxiliary components: water for injection, N, N-dimethylacetamide, sodium chloride, sodium dihydrogen phosphate, sodium phosphate, methyl parahydroxybenzoate, polysorbate 80, povidone, propyl parahydroxybenzoate.

Pharmacological properties

Pharmacodynamics

Hydrocortisone-Richter is a combination drug, the effect of which is due to the properties of active substances.

Hydrocortisone is a glucocorticosteroid (GCS) with anti-inflammatory activity. The mechanism of its action is explained by the ability to inhibit the release of cytokines (interleukins and interferon) from lymphocytes and macrophages, to inhibit the release of inflammatory mediators by eosinophils, to reduce the synthesis of prostaglandins and the metabolic rate of arachidonic acid. Hydrocortisone activates steroid receptors. Promotes the formation of lipocortins, which have an anti-edema effect. Reduces inflammatory cell infiltration, prevents the migration of leukocytes and lymphocytes at the site of inflammation. When used in high doses, it inhibits the development of connective and lymphoid tissue. Reduces the number of mast cells, thereby reducing the formation of hyaluronic acid. Helps reduce capillary permeability. Suppresses hyaluronidase. With intra-articular administration, the therapeutic effect develops after 6-24 hours and lasts for several days or even weeks.

Lidocaine is a local anesthetic with a membrane stabilizing effect.

Pharmacokinetics

Hydrocortisone after intraarticular and periarticular administration enters the systemic circulation. More than 90% of the dose is bound to plasma proteins. Penetrates the placental barrier.

Lidocaine is absorbed to a large extent, binds well to plasma proteins. Penetrates through the blood-brain and placental barriers, into breast milk.

Both substances are metabolized in the liver, hydrocortisone - with the formation of tetrahydrocortisone and tetrahydrocortisol, which are excreted by the kidneys in conjugated form.

The half-life of lidocaine is 1–2 hours.

Indications for use

epicondylitis;
humerus periarthritis;
rheumatoid arthritis;
bursitis;
rheumatic diseases accompanied by arthritis, including osteoarthritis in the presence of synovitis (with the exception of purulent, gonorrheal, tuberculous and other infectious arthritis);
tenosynovitis.

Contraindications

Absolute:

Achilles tendon diseases;
an infection in the joints;
systemic infection without specific treatment;
tendency to thrombus formation;
Itsenko-Cushing's syndrome;
I trimester of pregnancy;
hypersensitivity to any component of Hydrocortisone-Richter.

Intra-articular administration is also contraindicated in the following cases:

intraarticular bone fracture;
pronounced periarticular osteoporosis;
osteoarthritis without synovitis (the so-called dry joint);
aseptic necrosis of the epiphyses of the bones that form the joint;
unstable joint;
severe bone destruction and deformation of the joint (significant narrowing of the joint space, ankylosis);
infectious (septic) arthritis or periarthricular infection (including a history);
transferred arthroplasty;
pathological bleeding (endogenous or caused by anticoagulants);
a common infectious disease.

Relative contraindications for the use of Hydrocortisone-Richter (the drug should be used with caution, after assessing the balance of benefits and risks):

osteoporosis;
diabetes mellitus (including family history);
peptic ulcer of the stomach and duodenum;
chronic heart failure;
epilepsy;
steroid myopathy;
glaucoma;
a history of tuberculosis;
chronic psychotic reactions;
arterial hypertension;
herpes simplex (including eyes);
measles;
II – III trimesters of pregnancy;
lactation period;
age over 65.

Hydrocortisone-Richter, instructions for use: method and dosage

Suspension Hydrocortisone-Richter is administered intra- or periarticularly, no more than 3 joints in one day. Repeated injections are given at intervals of 3 weeks.

The introduction of the drug directly into the joint can have a negative effect on the hyaline cartilage, therefore, injections into the same joint are allowed no more than 3 times a year.

When treating tendonitis, it is forbidden to inject the drug directly into the tendon; injections are made in the tendon sheath.

For adults, Hydrocortisone-Richter is prescribed 5-50 mg, depending on the severity of the disease and the size of the joint, for children - 5-30 mg per day in several injections.

With periarticular administration, a single dose for children, depending on age, is:

6-14 years old - 50-75 mg;
1–6 years old - 25–50 mg;
3-12 months - 25 mg.

Side effects

local reactions: pain and swelling of tissues at the injection site (they pass on their own a few hours after injection), increased pain in the joint when Hydrocortisone-Richter is injected into the joint, burning, paresthesia, numbness at the injection site; in case of accidental injection into the deltoid muscle - atrophy of the skin and subcutaneous tissue; rarely - scarring at the injection site, necrosis of surrounding tissues;
from the nervous system: anxiety, dizziness, disorientation, headache, agitation, irritability, hallucinations, euphoria, insomnia, delirium, increased intracranial pressure with swelling of the optic nerve papilla, depression, mental disorders, pseudotumor of the cerebellum, paranoia, exacerbation of manic-depressive psychosis, epileptiform seizures;
on the part of the endocrine system: steroidal diabetes mellitus, manifestation of latent diabetes mellitus, decreased glucose tolerance and an increase in the need for a hypoglycemic drug; with prolonged use of Hydrocortisone-Richter - growth retardation in children and adolescents, inhibition of adrenal function, Itsenko-Cushing's syndrome;
on the part of the musculoskeletal system: osteoporosis, growth retardation and ossification processes in children (due to premature closure of the epiphyseal growth zones); very rarely - steroid myopathy, arthralgia, rupture of tendons and muscles, pathological bone fractures, decreased muscle mass, aseptic necrosis of the head of the humerus and femur;
from the digestive system: hiccups, nausea, flatulence, increased appetite, vomiting, bleeding and perforation of the gastrointestinal tract, esophagitis, peptic ulcer, pancreatitis; rarely - increased activity of hepatic transaminases and alkaline phosphatase;
on the part of the cardiovascular system: when using lidocaine in high doses - conduction disturbance, peripheral vasodilation; when using hydrocortisone in high doses - increased blood pressure, thromboembolism, hypokalemia and its characteristic changes in the electrocardiogram, heart failure;
from the immune system: local and generalized hypersensitivity reactions (itching, skin rash, anaphylactic shock), delayed wound healing, exacerbation of latent tuberculosis, opportunistic infections, a tendency to exacerbate infections, the development of candidiasis and pyoderma (especially with simultaneous vaccination or the use of immunosuppressive drugs);
on the part of metabolism: increased sweating, negative nitrogen balance, weight gain;
on the part of the organ of vision: exophthalmos, trophic changes in the cornea, glaucoma, secondary bacterial fungal and viral eye infections, posterior capsular cataract (more likely in children), corneal ulceration, increased intraocular pressure with possible damage to the optic nerve;
on the part of the skin: striae, steroid acne, folliculitis, telangiectasia, ecchymosis, petechiae, hirsutism, hyper- and hypopigmentation;
others: leukocytosis, leukocyturia, malaise, withdrawal syndrome (arthralgia, myalgia, fever, adrenal insufficiency), effects caused by the mineralocorticoid activity of Hydrocortisone-Richter, - hypernatremia, hypokalemia (fatigue, increased weakness, muscle spasm, myalgia) sodium and fluid retention with the formation of peripheral edema.

With prolonged use of Hydrocortisone-Richter in high doses, it is possible to develop systemic undesirable effects inherent in hydrocortisone and lidocaine.

In elderly patients, the likelihood of side effects is higher.

Overdose

If doses are exceeded and / or prolonged use of Hydrocortisone-Richter, it is possible to suppress its own production of glucocorticoids, exacerbate chronic infections, increase blood pressure, develop arthralgia and Itsenko-Cushing's syndrome, ulcerative bleeding from the gastrointestinal tract.

There is no specific antidote. Overdose treatment is symptomatic.

special instructions

Suspension Hydrocortisone-Richter is administered aseptically to avoid bacterial contamination.

During the period of therapy, it is recommended to follow a diet that limits sodium intake, containing a sufficient amount of protein and an increased amount of potassium. Blood pressure, diuresis, blood clotting, blood glucose concentration, and the patient's body weight should be periodically monitored.

With a latent form of tuberculosis and during the bend of tuberculin tests, it is necessary to carefully monitor the patient's condition, if necessary, carry out chemoprophylaxis.

The use of Hydrocortisone-Richter, especially in high doses, is a contraindication to any vaccination, which is explained by the high probability of insufficient antibody synthesis.

Relative adrenal insufficiency may persist for several months after discontinuation of hydrocortisone. In this regard, in stressful situations, it is recommended to resume hormonal therapy with the simultaneous administration of mineralocorticoids and salts.

Application during pregnancy and lactation

In the first trimester of pregnancy, Hydrocortisone-Richter is contraindicated, since there are no data on its safety in this period. In the II-III trimesters, the drug can be used only if the expected benefit outweighs the potential risks. Neonates who have been exposed to intrauterine hydrocortisone should be monitored for adrenal insufficiency.

The active substances of the drug penetrate into the mother's milk. Hydrocortisone-Richter should be used with extreme caution during lactation, or breastfeeding should be abandoned.

Pediatric use

Hydrocortisone-Richter is used in pediatrics according to indications. It is recommended to use the lowest effective doses for the shortest possible period. Care must be taken and careful observation of children and adolescents is required, since the drug can cause growth retardation and ossification processes.

Use in the elderly

In patients over 65 years of age, Hydrocortisone-Richter is used with caution.

Drug interactions

inhibitors of steroid synthesis (including mitotane): the effect of hydrocortisone decreases (an increase in dose may be required);
barbiturates, phenytoin, theophylline, ephedrine, rifampicin and other inducers of microsomal liver enzymes: the effect of hydrocortisone decreases;
thyroid hormones: increased clearance of hydrocortisone;
paracetamol: the risk of developing its hepatotoxic effect increases (due to the induction of liver enzymes and the formation of a toxic metabolite of paracetamol);
acetylsalicylic acid: its excretion is accelerated, the concentration of salicylates in the blood decreases (when Hydrocortisone-Richter is canceled, the content of salicylates in the blood and the risk of side effects increase);
estrogens (including oral estrogen-containing contraceptives): the clearance of hydrocortisone decreases, its half-life increases, the therapeutic and toxic effects increase;
other glucocorticoids, antipsychotics, azathioprine and carbutamide: the risk of developing cataracts increases;
tricyclic antidepressants: it is possible to increase the severity of depression caused by hydrocortisone (if depression develops against the background of the use of Hydrocortisone-Richter, tricyclic antidepressants are contraindicated);
coumarin derivatives: the anticoagulant effect is enhanced;
immunosuppressants: the risk of developing infections, lymphoma and other lymphoproliferative disorders associated with the Epstein-Barr virus increases;
oral hypoglycemic drugs: their effect decreases;
cardiac glycosides: their toxicity increases (the risk of developing arrhythmias due to hypokalemia);
ethanol, nonsteroidal anti-inflammatory drugs: the likelihood of ulceration of the gastrointestinal tract mucosa and bleeding increases;
indomethacin: the risk of developing its side effects increases;
other glucocorticoids, carbonic anhydrase inhibitors, thiazide diuretics, amphotericin B: hypokalemia may develop;
sodium-containing drugs: edema and increased blood pressure may occur;
somatropin: its effect decreases (in the case of high doses of Hydrocortisone-Richter);
isoniazid, mexiletine: their metabolism increases, due to which plasma concentrations decrease;
ketoconazole: the toxicity of hydrocortisone increases;
vitamin D: its effect on calcium absorption in the intestinal lumen is weakened;
carbonic anhydrase inhibitors, amphotericin B: the risk of osteoporosis increases;
nitrates, m-anticholinergics (including antihistamines, tricyclic antidepressants): intraocular pressure increases;
steroid hormonal drugs (androgens, estrogens, anabolic steroids, oral contraceptives): acne and hirsutism may appear;
muscle relaxants: it is possible to increase the duration and severity of muscle blockade induced by them due to hypokalemia caused by hydrocortisone;
live (attenuated) vaccines and other types of immunizations: the risk of viral activation and the development of infections increases.

Analogs

Analogs of Hydrocortisone-Richter are: Betaspan-Depo, Budenofalk, Hydrocortisone, Dexazon, Dexamethasone, Depo-Medrol, Diprospan, Ivepred, Kenalog, Lemod, Metipred, Prednisol, Prednisolone, Solu-Cortef, Solu-Medrol, etc. Flosterone

Terms and conditions of storage

Store at temperatures from 15 to 30 ° C out of reach of children, protected from light.

Shelf life is 2 years.

Terms of dispensing from pharmacies

Dispensed by prescription.

Reviews of Hydrocortisone-Richter

Reviews of Hydrocortisone-Richter are positive: the drug quickly and effectively relieves the inflammatory process in the joint, reduces pain and swelling. There are also many good messages from patients who were recommended by the doctor to use Hydrocortisone-Richter topically for other diseases not described in the instructions, including otitis media, inflammatory skin lesions, dermatitis, laryngospasm.

Price for Hydrocortisone-Richter in pharmacies

The approximate price for Hydrocortisone-Richter for a 5 ml bottle is 175–245 rubles.

Hydrocortisone-Richter: prices in online pharmacies

Drug name

Price

Pharmacy

Hydrocortisone-Richter 25 mg + 5 mg / ml suspension for intraarticular and periarticular administration 5 ml 1 pc.

RUB 181

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Anna Kozlova Medical journalist About the author

Education: Rostov State Medical University, specialty "General Medicine".

Information about the drug is generalized, provided for informational purposes only and does not replace the official instructions. Self-medication is hazardous to health!