ential requires that the possible benefits of the drug be weighed against the potential hazards to the mother and embryo or fetus. neonates born of mothers who have received substantial doses of corticosteroid during pregnancy should be carefully observed for signs of hypoadrenalism. average and large doses of hydrocortisone or cortisone can cause elevation of blood pressure, salt and water retention, and increased excretion of potassium. these effects are less likely to occur with the synthetic derivatives except when used in large doses. dietary salt restriction and potassium supplementation may be necessary. all corticosteroids increase calcium excretion. while on corticosteroid therapy, patients should not be vaccinated against smallpox. other immunization procedures should not be undertaken in patients who are on corticosteroids, especially on high dose, because of possible hazards of neurological complications and a lack of antibody response. persons who are on drugs which suppress the immune system are more susceptible to infections than healthy individuals. chicken pox and measles, for example, can have a more serious or even fatal course in non-immune pediatric patients or adults on corticosteroids. in such pediatric patients or adults who have not had these diseases, particular care should be taken to avoid exposure. how the dose, route and duration of corticosteroid administration affects the risk of developing a disseminated infection is not known. the contribution of the underlying disease and/or prior corticosteroid treatment to the risk is also not known. if exposed to chicken pox, prophylaxis with varicella zoster immune globulin (vzig) may be indicated. if exposed to measles, prophylaxis with pooled intramuscular immunoglobulin (ig) may be indicated. (see the respective package inserts for complete vzig and ig prescribing information.) if chicken pox develops, treatment with antiviral agents may be considered. if corticosteroids are indicated in patients with latent tuberculosis or tuberculin reactivity, close observation is necessary as reactivation of the disease may occur. during prolonged corticosteroid therapy, these patients should receive chemoprophylaxis.

rticoid secretion may be impaired, salt and/or a mineralocorticoid should be administered concurrently. there is an enhanced effect of corticosteroids on patients with hypothyroidism and in those with cirrhosis. corticosteroid should be used cautiously in patients with ocular herpes simplex because of possible corneal perforation. the lowest possible dose of corticosteroid should be used to control the conditions under treatment, and when reduction in dosage is possible, the reduction should be gradual. psychic derangement may appear when corticosteroids are used, ranging from euphoria, insomnia, mood swings, personality changes, and severe depression, to frank psychotic manifestations. also, existing emotional instability or psychotic tendencies may be aggravated by corticosteroids. aspirin should be used cautiously in conjunction with corticosteroids in hypoprothrombinemia.

fails to occur within 2 or 3 weeks after starting hydrocortisone rectal suspension, usp, discontinue its use. symptomatic improvement, evidenced by decreased diarrhea and bleeding; weight gain; improved appetite; lessened fever; and decrease in leukocytosis, may be misleading and should not be used as the sole criterion in judging efficacy. sigmoidoscopic examination and x-ray visualization are essential for adequate monitoring of ulcerative colitis. biopsy is useful for differential diagnosis. patient instructions for administering hydrocortisone rectal suspension, usp are enclosed in each box. it is recommended that the patient lie on their left side during administration and for 30 minutes thereafter, so that the fluid will distribute throughout the left colon. every effort should be made to retain the enema for at least an hour and preferably, all night. this may be facilitated by prior sedation and/or antidiarrheal medication, especially early in therapy when the urge to evacuate is great.

cal: convulsions; increased intracranial pressure with papilledema (pseudo-tumor cerebri) usually after treatment; vertigo; headache. endocrine: menstrual irregularities; development of cushingoid state; suppression of growth in pediatric patients; secondary adrenocortical and pituitary unresponsiveness, particularly in times of stress, as in trauma, surgery or illness, decreased carbohydrate tolerance; manifestations of latent diabetes requirements for insulin or oral hypoglycemic agents in diabetics. ophthalmic: posterior subcapsular cataracts; increased intraocular pressure; glaucoma; exophthalmos. metabolic: negative nitrogen balance due to protein catabolism.