H

ydrocortisone cream

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• Readily available as an over-the-counter anti-itch cream
• Cream, not ointment, because ointments do not absorb as well
• Use topically, do not ingested
• For physiologic replacement dosing and/or stress dosing
• One milliliter (ml) of 1% hydrocortisone (HC) cream = 10 mgs oral HC
• Use when fasting for anesthesia, digestive issues, stress dosing
• Absorption may be limited in some people
• Use with small (no more than 3 ml) dosing syringe (instructions below)
• Rub onto thighs, abdomen, buttocks, upper arms for daily use
• Rub onto neck or wrists for quick absorption when stress dosing
• Rotate sites to avoid thinning the skin
• Hydrocortisone acetate formula is not recommended as it metabolizes
too quickly; check ingredients before you buy

Using a syringe
A 3 ml (or cc) plastic syringe is available from pharmacies or farm/pet
stores. This is a needleless syringe. Make sure it is a manual
syringe, not one designed to be used with a “gun”.
• A daily dose of 25 mg of HC equates to 2.5 ml of 1% HC cream.
• If your cream is 0.5% strength (in Canada), 25 mg is 5 ml
• If you have 2% strength (usually Rx), 25 mg is 1.25 ml
3 ml syringes are marked in 0.1 ml increments, each of which would be
equivalent to 1 mg HC in pills. Using the syringe to provide a
physiological replacement dose of HC requires adjusting the dosing, so
each is rounded to the nearest 0.1 ml.
 
Example for using cream equivalent to 25 mg oral HC would be:
waking, use 1 ml HC cream (equivalent to 10 mg oral HC)
+4 hours, 0.8 ml cream (8 mg)
+4 hours, 0.5 ml cream (5 mg)
bedtime at lights out, 0.2 ml cream (2 mg)

Filling a syringe
Assemble
• 3 ml/cc size syringe
• Tube of HC cream
• Small (snack-sized) zip-lock bag with a piece of cardboard longer
than the filled syringe; the cardboard will help prevent the plunger from
being inadvertently pressed, and the bag will contain any mess.

For method 2
• Small container with tight-fitting lid

Method 1
• Take the plunger out of the syringe
• Open the tube of HC cream and gently squeeze out any air so the
cream just starts to come out of the tube
• Put the opening of the HC tube at the plunger end of the syringe.
• Very gently squeeze cream into the syringe. The slower you go, the
fewer air bubbles there are likely to be. Slightly overfill the amount you
need for a day's dosing of HC
• Put the plunger back into the syringe, very gently so as not to
squeeze out any cream
• Squeeze out any excess air from the HC tube again, without letting
any cream come out
• Put the tip of the syringe to the opening of the HC cream and very
slowly squeeze any excess HC cream back into the tube while gently
letting the pressure off the tube so that the excess HC cream will be
sucked back into the tube
• Examine the syringe to see if there are any other air bubbles. If so,
you may need to squirt out cream to get to the bubble, squirt out the
bubble, and refill to make sure your dosing is accurate
• Put filled syringe in zip-lock bag

Method 2
• Squirt contents of a tube of HC cream into small jar with tight-fitting
lid, making as tall a glob as possible
• Making sure the plunger is all the way into the syringe, put the tip of
the syringe into the cream
• Pull back on the plunger very slowly so that cream is sucked into the
syringe without any air
• As needed, use a spoon to mound the cream so you can continue to
fill the syringe without air bubbles
• When finished, cap the jar tightly
• Put filled syringe in zip-lock bag