How does this medication work? What will it do for me?

Hydrocortisone enema is used to treat diseases caused by inflammation of the colon and rectum, such as certain types of ulcerative colitis, ulcerative proctitis, regional enteritis with left side involvement, proctitis, proctocolitis, and proctitis caused by radiation. It is usually used in combination with other medications. It works within the colon and rectum to decrease inflammation.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are being given this medication, speak to your doctor. Do not stop using this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to use this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

Cortenema® is available as enema suspension.

Each single-dose unit contains 100 mg of hydrocortisone USP in 60 mL of an aqueous suspension. Nonmedicinal ingredients: carboxypolymethylene, polysorbate 80, methylparaben, purified water, and sodium hydroxide.

How should I use this medication?

The usual adult dose of hydrocortisone enema is one 60 mL enema daily for 2 or 3 weeks, and every second day after that.

It is to be used in the evening before going to bed, as directed by your doctor.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are using the medication without consulting your doctor.

To use the medication:

  • Lie on your left side, shake the bottle well, and grasp the bottle at the neck where it is most rigid.
  • Expose the lubricated tip of the bottle by removing the protective sheath.
  • Carefully insert the lubricated tip into the rectum in the direction of the back of the hips.
  • Slowly squeeze the container until empty.
  • Remain in the same position for at least 30 minutes to allow distribution of the medication in the colon.

Hydrocortisone retention enema should be retained in the colon or rectum for at least 1 hour, preferably all night.

Improvement of the condition being treated usually occurs within 5 to 7 days. If you do not notice improvement within 2 to 3 weeks, or if your condition worsens, call your doctor.

It is important to use this medication exactly as prescribed by your doctor. If you miss a dose, use it as soon as possible (if you have the time to follow the instructions thoroughly), and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not use a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not use hydrocortisone enema if you:

  • are allergic to hydrocortisone or any of the ingredients of the medication
  • are pregnant, unless expected benefits outweigh risks
  • have a conditions of the intestine that involves obstruction, abscess, perforation, peritonitis, fresh intestinal anastomoses, extensive fistulas, or sinus tracts
  • have one of the following medical conditions, unless expected benefits outweigh risks: peptic ulcer, acute glomerulonephritis, myasthenia gravis, osteoporosis, diverticulitis, thrombophebitis, psychic disturbances, diabetes, hyperthyroidism, acute coronary disease, high blood pressure, or limited heart reserve
  • has tuberculosis, fungal, or viral infections

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent. The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

  • dizziness
  • dry, scaly skin
  • increased appetite
  • increased sweating
  • lightened skin colour
  • sensation of spinning
  • thin, fragile skin
  • thinning hair on scalp
  • unusual weight gain

Although most of these side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

  • abdominal or stomach pain
  • acne
  • burning and itching of skin
  • chills
  • diarrhea
  • false sense of well-being
  • fever
  • filling or rounding out of the face
  • infection
  • menstrual irregularities
  • mood swings
  • osteoporosis or bone fractures
  • painful, red or itchy, pus-containing blisters in hair follicles
  • personality changes
  • rectal bleeding, burning, dryness, itching, or pain not present before treatment
  • sensation of "pins and needles"
  • signs of depression (e.g., poor concentration, changes in weight, changes in sleep, decreased interest in activities, thoughts of suicide)
  • slow healing of wounds
  • stabbing pain
  • stunting of growth (in children)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Diabetes: Corticosteroids such as hydrocortisone may cause an increase in blood sugar levels. People with diabetes may find it necessary to monitor their blood sugar more frequently while using this medication. If you have diabetes or are at risk for developing diabetes, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

General precautions: Advise all doctors involved in your care that you have been using this medication.

Glaucoma: Corticosteroids such as hydrocortisone may cause glaucoma to worsen. If you have glaucoma or are at risk for developing glaucoma, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Medical conditions: Corticosteroid therapy may aggravate a large number of medical conditions, including peptic ulcer, acute glomerulonephritis, myasthenia gravis, osteoporosis, diverticulitis, thrombophebitis, psychic disturbances, diabetes, hyperthyroidism, high blood pressure, and certain types of heart disease. If you have any of these conditions, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Severe bowel disease: People with severe ulcerative disease should be cautious about using this medication because they are predisposed to perforation of the bowel wall. If you have severe ulcerative disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Stopping medication: Stopping this medication suddenly may cause symptoms of the illness to return. Do not stop using this medication abruptly without checking with your doctor first.

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: This medication may pass into breast milk. If you are a breast-feeding mother and are using hydrocortisone retention enema, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The active ingredient in this medication, hydrocortisone, belongs to the family of medications known as corticosteroids. Children may be more likely to experience the side effects encountered by using large amounts this class medication for long periods of time (e.g., slowing down of growth, delayed weight gain). The use of this medication by children should be limited to the smallest amount that will be effective. Discuss with your doctor the risks and benefits of the use of this medication by children.

What other drugs could interact with this medication?

There may be an interaction between hydrocortisone enema and any of the following:

  • aldesleukin
  • ceritinib
  • deferasirox
  • hyaluronidase
  • other medications being applied to the area being treated

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.