Maximum dose of IV hydrocortisone for exacerbations in COPD (adult)

Based on Product leaflets:

• 100-500mg (or more), depending on the severity of the condition
• Doses can be repeated at an interval of 2-6 hours
• Some products claim can use 100mg – 8g daily

By indications (only those related to this case):

COPD

• Severely ill patients or those who are unable to swallow can initially be given 100-200 mg of intravenous hydrocortisone (TDS-QID)

ASTHMA

• Hydrocortisone 50 mg 4 times a day for 48 hours, followed by oral prednisone, was as effective as 200 mg or 500 mg of hydrocortisone followed by high dose prednisone
• 1-2 mg/kg/dose every 6 hours for 24 hours, then maintenance of 0.5-1 mg/kg every 6 hours

LIFE THREATENING SHOCK

• 50 mg/kg by direct IV injection initially and repeated in 4 hours and/or every 24 hours if needed
• Alternatively, 0.5–2 g by direct IV injection initially and repeated at 2- to 6-hour intervals as required
• In such cases, administer by direct IV injection over a period of one to several minutes
• Continue high-dose therapy only until the patient’s condition has stabilized and usually not beyond 48–72 hours

 REFERENCE:

1. Acute Exacerbations. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1489228/
2. Management of Acute Exacerbations of COPD. http://www.nhsforthvalley.com/__documents/qi/ce_guideline_copd/13-6.2-management-of-acute-exacerbation-copd-1.pdf
3. http://www.drugs.com/monograph/hydrocortisone-sodium-succinate.html
4. www.uptodate.com