Hydrocortisone with Licorice Interaction Details
Brand Names Associated with Hydrocortisone
- Alkindi Sprinkle®
- Cortef®
- Cortisol
- Cortril®
- Hydrocortisone
- Hydrocortone®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Dec 03, 2023
Interaction Effect
Increased risk of corticosteroid adverse effects
Interaction Summary
Licorice component glycyrrhizine increased the area-under-the-curve (AUC) of prednisolone and decreased clearance in healthy subjects. The activity of topically administered hydrocortisone was potentiated by glycyrrhetinic acid in healthy subjects . The glycyrrhetinic acid component of licorice is metabolized to 3-monoglucuronyl-glycyrrhetinic acid (3MGA), which inhibits 11-beta-hydroxysteroid dehydrogenase and reduces cortisol breakdown, resulting in a hypermineralocorticoid effect .
Severity
Moderate
Onset
Delayed
Evidence
Probable
How To Manage Interaction
Caution is advised if licorice is used concomitantly with a corticosteroid. A lower corticosteroid dose may be required to avoid adverse effects.
Mechanism Of Interaction
Inhibition of corticosteroid metabolism by licorice
Literature Reports
A) Glycyrrhizin (licorice) significantly increased the area-under-the curve of free and total prednisolone in 6 healthy men. Subjects received glycyrrhizin 200 milligrams (mg) and prednisolone hemisuccinate 0.096 milligrams/kilogram (mg/kg) intravenously. Area-under-the curve (AUC) of free prednisolone increased (p less than 0.05) and clearance decreased (p less than 0.05). Total and free prednisolone concentration was increased at 6 and 8 hours after the prednisolone hemisuccinate infusion (p less than 0.05). Proposed mechanisms for the alteration of prednisolone pharmacokinetics by glycyrrhizin or its metabolites were (1) inhibition of protein binding, (2) inhibition of hydrolysis of prednisolone hemisuccinate to prednisolone, and (3) inhibition or metabolism of free prednisolone .
B) Oral glycyrrhizin significantly increased the area-under-the-curve (AUC) of prednisolone in 6 healthy men. Subjects received oral glycyrrhizin 200 milligrams (mg) prior to intravenous administration of prednisolone hemisuccinate 0.096 milligrams/kilogram (mg/kg). AUC of both total and free prednisolone increased significantly (p less than 0.05). Clearance of both total and free prednisolone decreased significantly (p less than 0.05). Total and free prednisolone concentration was increased at 6 and 8 hours post-prednisolone infusion (p less than 0.05). Volume of distribution was not significantly altered, suggesting that oral glycyrrhizin increases prednisolone concentrations by inhibiting metabolism, not by affecting distribution .
C) A licorice-containing herbal combination (Saiboku-to) significantly increased the area-under-the-curve (AUC) of prednisolone in an open, cross-over study of 9 subjects. Subjects received a single oral dose of prednisolone 10 milligrams (mg) and Saiboku-To, a formula of ten herbs including Glycyrrhiza glabra (licorice), three times daily for 3 days. The area under the curve (AUC) of prednisolone increased while the clearance decreased (p less than 0.01). The Saiboku-To preparation provided glycyrrhizin 63.5 mg daily. The AUC ratio of prednisone to prednisolone decreased significantly (p less than 0.01), indicating inhibition of 11-beta-hydroxysteroid dehydrogenase .
Hydrocortisone Overview
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Hydrocortisone is used alone or with other medications to treat the symptoms of low corticosteroid levels (lack of certain substances that are usually produced by the body and are needed for normal body functioning). Hydrocortisone is also used to treat other conditions in patients with normal corticosteroid levels. These conditions include certain types of arthritis; severe allergic reactions; lupus (a disease in which the body attacks many of its own organs); and certain conditions that affect the lungs, skin, eyes, kidneys, blood, thyroid, stomach, and intestines. It is also sometimes used to treat the symptoms of certain types of cancer. Hydrocortisone is in a class of medications called corticosteroids. It works to treat patients with low levels of corticosteroids by replacing steroids that are normally produced naturally by the body. It works to treat other conditions by reducing swelling and redness and by changing the way the immune system works.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.