What is the difference between hydrocortisone and hydrocortisone acetate

Question: What are the differences between hydrocortisone, cortisone acetate, prednisone, and dexamethasone? Are there any guidelines as to when one is used versus another?

Answer: These compounds are all adrenal steroid analogs; specifically, they are called glucocorticoids. Glucocorticoids affect carbohydrate, protein, and fat metabolism, bone metabolism, and immune and inflammatory functions. In contrast, the mineralocorticoid aldosterone, also secreted by the adrenal, regulates sodium and potassium metabolism and fluid balance. The glucocorticoid that is produced by the body is cortisol, also known as hydrocortisone. Cortisone acetate is the glucocorticoid cortisone with an ester group attached that makes it soluble in water. Cortisone is biologically inactive and is rapidly converted to cortisol by the liver so that it can exert its effects. Hydrocortisone and cortisone acetate are both short-acting glucocorticoids. They are given once daily, in the early morning, to patients who are recovering from Cushing’s syndrome or are being tapered off pharmacological dosages of glucocorticoids to allow their hypothalamic -pituitary-adrenal axis to recover. These are the only circumstances in which I prescribe hydrocortisone, and I do not use cortisone acetate.

Prednisone and dexamethasone are also synthetic glucocorticoids. Prednisone is 4 to 5 times more potent than hydrocortisone and has a longer duration of action, perhaps 12 hours or more. Dexamethasone is 40 to 50 times more potent than hydrocortisone and even longer-acting, 18 to 24 hours. Both of these glucocorticoids are given when a prolonged action is desired. This includes replacing cortisol in patients with permanent adrenal insufficiency (Addison’s disease) or suppressing ACTH secretion in patients with congenital adrenal hyperplasia. In such cases, the medication is taken at bedtime, thus the patient awakens with appropriate levels of steroid. Very rarely, these medications cause insomnia if taken at night. These longer acting glucocorticoids are also used to suppress inflammation or immune rejection, and both are less expensive than hydrocortisone.

If a patient with permanent adrenal insufficiency is doing well on hydrocortisone replacement, usually split between two or three doses, the largest taken in the morning, I usually do not change the medication. However, if the patient is not doing well, I will change the medication to dexamethasone or prednisone. Some of my patients have reported remarkable improvements in their quality of life on these longer acting medications. The longer acting glucocorticoids have been reported to have greater catabolic activity on bone, but there is no evidence that they act differently than cortisol. Rather, it is probably because they are used in inappropriately high dosage.

The usual replacement dosages of these glucocorticoids are : hydrocortisone about 25 mg/day, cortisone acetate about 37.5 mg/day, prednisone about 5 mg/day, and dexamethasone about 0.5 mg/day. Glucocorticoid replacement in any patient must be carefully monitored and individualized.

By Dr. David Orth MD (November, 1996)

Cortisone and hydrocortisone are both corticosteroids (often shortened to "steroids"). Hydrocortisone is an anti-inflammatory drug that mimics the natural hormone cortisol, which is known as the stress hormone. Cortisone, however, must be processed by the liver to produce anti-inflammatory properties in the immune system. It is converted to hydrocortisone by the body to produce these effects.

Corticosteroids treat many different conditions, but cortisone and hydrocortisone, while similar, are not the same thing. Read on to learn more about the differences between cortisone and hydrocortisone, and when to use each.

What Is Hydrocortisone?

Hydrocortisone in a topical form is a mild corticosteroid medication that relieves pain, redness, itching, and inflammation on the skin. It does this by activating natural substances in the skin that suppress immune system responses. It can also be injected or given orally in pill form when prescribed by a healthcare provider.

What Is Hydrocortisone Used For?

Hydrocortisone is used for a number of conditions. When used topically as an anti-itch cream or lotion, it can help stop the itch or allergic reactions of many conditions, including:

• Insect bites
  
• Eczema
• Psoriasis
• Diaper rash
• Heat rash
• Poison ivy and poison oak
• Genital and anal area itching (external only)

In oral or injectable form, hydrocortisone is used to treat other conditions like autoimmune diseases and infections, and can alleviate nausea from chemotherapy. These forms of hydrocortisone are only available through a healthcare provider.

Hydrocortisone Side Effects

Over-the-counter (OTC) hydrocortisone topicals, which contain 1% or less hydrocortisone, typically have mild side effects. The side effects of prescription-strength hydrocortisone topicals can be more significant.

Common topical hydrocortisone side effects include:

• Stinging or burning
• Irritated or dry skin
• Thinning skin when overused
• Acne

Oral hydrocortisone can have additional side effects, including:

• Edema (swelling)
• Insomnia
• Mood swings
• Nausea or vomiting
• Possible infection
• Weight gain
• Weakness

There are other, more serious side effects of oral hydrocortisone, but these are rare. Contact your healthcare provider if you experience any of the following side effects from prescription-strength hydrocortisone, which include:

• Signs of infection (like fever)
• Severe headache
• Visual disturbances
• Muscle weakness
• Seizures

What Is Cortisone?

Cortisone is a naturally occurring, inactive corticosteroid that must be processed by the liver into hydrocortisone before it becomes active in immune system suppression, which controls inflammation and other symptoms. It is available by prescription only.

What Is Cortisone Used For?

Cortisone can be used to treat the following:

• Inflammation and pain from certain autoimmune diseases
• Asthma
• Some blood cancers
• Severe allergic reactions
• To supplement low adrenal hormones
• Loss of appetite during chemotherapy
• Nausea during chemotherapy
• Some inflammatory eye diseases
  

Cortisone Side Effects

Cortisone can cause a variety of side effects, including:

• High blood pressure
• Muscle pain or weakness
• Insomnia
• Mood changes
• Headache
• Lethargy (lack of energy)

Because cortisone suppresses the immune system, it makes you more prone to infection. Therefore, you may be given instructions on how to avoid exposure to infection.

Seek emergency medical treatment if you have signs of an allergic reaction to cortisone, such as:

• Blurred vision
• Severe headache
• Shortness of breath
• Blood in stool
• Severe pains in your stomach or legs

Hydrocortisone is often used on the skin as a topical anti-itch medication for conditions like rashes or bug bites. Both cortisone and hydrocortisone are given as oral medications (pills) to treat inflammatory autoimmune diseases and other health conditions.

Corticosteroids and Anabolic Steroids

Corticosteroids are not the same thing as anabolic steroids. Anabolic steroids are synthetic hormones that act like testosterone, used to build muscle. They can be used for weight gain, but they can also be abused and lead to both mental and physical damage.

What Forms Do Corticosteroids Come In?

Some forms of hydrocortisone are available over-the-counter, while other corticosteroids are prescription only.

Topical hydrocortisone comes in the form of:

• Ointments
• Creams
• Sprays
• Gels

Other corticosteroids come in the form of:

• Inhalation mists
• Tablets
• Injections
• Eye drops
• Nasal sprays

Do They Differ in How They Work?

Corticosteroids are fast-acting medications that suppress the immune system, but they act in different ways.

Topical hydrocortisone works on the skin by suppressing the immune system response that causes itching and rashes from bug bites, eczema, or other skin conditions. It is shorter acting than cortisone. It is usually applied in a cream or lotion. Hydrocortisone pills or injections are also available by prescription to treat more severe inflammation or other conditions.

Cortisone also suppresses the immune system, but it must be metabolized (processed) in the liver and converted to hydrocortisone. It comes in oral form and can be delivered in higher strengths than topical hydrocortisone medications.

When to Use Each

Cortisone

• Severe rash or allergy

• Autoimmune disease

• Inflammatory eye disease

• Some blood cancers

• Supplemental hormone

Topical Hydrocortisone

• Insect bites

• Poison ivy or poison oak

• Eczema

• Psoriasis

• Anal itching (external)

Summary

Hydrocortisone and cortisone are both corticosteroids, which are manufactured hormones that suppress the immune system response. Topical hydrocortisone can be purchased over the counter (without a prescription) and is used on the skin as a cream or ointment. It also comes in the form of a pill or injectable, which is only available by prescription.

Cortisone is an oral medication that must be processed by the liver to become active in treating autoimmune diseases, other inflammatory conditions, certain cancers, and other health conditions.

A Word From Verywell

Corticosteroids can be effective in treating a wide range of symptoms, but they should always be used carefully to avoid side effects, some of which can be serious. If you are taking prescription corticosteroids, follow the directions carefully as outlined by your healthcare provider.

Frequently Asked Questions

• Is Cortizone 10 a hydrocortisone?

  Yes, Cortizone 10 is a mild hydrocortisone treatment that is sold over-the-counter as an anti-itch medication.

• When should you not use hydrocortisone cream?

  Don't use hydrocortisone cream if you have signs of a fungal infection like thrush or athlete's foot. Don't use it for diaper rash without checking with a healthcare provider. Don't use it on your face without your provider's permission. Don't use it if you have an infection, have had an allergic reaction to corticosteroids, or are pregnant or breastfeeding.

• Which steroid cream is strongest?

  The strongest steroid creams or topicals you can buy over the counter are hydrocortisone 1%. Stronger topical concentrations are available by prescription only.

By Nancy LeBrun
In addition to her extensive health and wellness writing, Nancy has written about many general interest topics for publications as diverse as Newsweek, Teen Vogue, abcnews.com, and Craftsmanship Quarterly. She has authored a book about documentary filmmaking, a screenplay about a lost civil rights hero, and ghostwritten several memoirs.

Thanks for your feedback!

What is hydrocortisone acetate for?

How strong is hydrocortisone acetate?

What is the strongest prescription hydrocortisone cream?