Hydrocortisone Enema Schedule (India)

Rectal

Hydrocortisone Enema Routes

Rectal

Hydrocortisone Enema Formulations

FormulationStrengths Available

Rectal enema (suspension)Hydrocortisone 100 mg/60 mL

Rectal foamHydrocortisone acetate 10% (limited availability — verify local supply)

Note: Foam formulations are not universally available across India; enema preparations are more commonly accessible.

Hydrocortisone Enema Adult indications

INDICATIONS + DOSING — FOR CLINICIAN USE ONLY

Primary Indications (Approved / Standard in India)

✦ Ulcerative Colitis — Distal Disease (Proctitis, Proctosigmoiditis, Left-sided Colitis)

Parameter Details

Starting dose 100 mg rectally (one enema) at bedtime

Titration Not applicable

Usual maintenance dose Not established for maintenance; therapy aimed at induction of remission followed by discontinuation or switch to 5-ASA maintenance

Maximum dose 100 mg/day (one enema daily)

Clinical Notes:

Rectal corticosteroids are indicated for mild-to-moderate distal ulcerative colitis

Enema reaches sigmoid and descending colon (up to splenic flexure); not effective for pancolitis

Duration of therapy: typically 2–4 weeks; assess response at 2–3 weeks

Instruct patient to retain enema overnight or for at least 1 hour for optimal mucosal contact

May be used as adjunct to oral 5-ASA or oral/systemic corticosteroids

Once remission achieved, transition to mesalamine rectal/oral for maintenance

For isolated proctitis (disease limited to rectum), suppositories or foam may be preferred if available

✦ Radiation Proctitis

Parameter Details

Starting dose 100 mg rectally (one enema) at bedtime

Titration Not applicable

Usual maintenance dose Not applicable; short-term therapy

Maximum dose 100 mg/day

Clinical Notes:

Duration: 2–4 weeks depending on symptom severity

Typically prescribed by gastroenterologist or radiation oncologist

May be combined with sucralfate enemas in refractory cases

Secondary Indications — Adults (Off-label, if any)

Indication Dose Duration Notes

Solitary Rectal Ulcer Syndrome (SRUS) 100 mg rectally at bedtime 2–4 weeks; rarely extended OFF-LABEL — Specialist only; evidence limited to case series and expert opinion in refractory cases

Hydrocortisone Enema Paediatric indications

PAEDIATRIC DOSING (Specialist Only)

Primary Indications (Approved / Standard in India)

✦ Ulcerative Colitis — Distal Disease (Proctitis, Left-sided Colitis)

Eligibility: Age ≥2 years; mandatory paediatric gastroenterology supervision

Age Group	Dose (mcg/kg/day)	Typical Total Daily Dose	Clinical Notes

2–6 years 25–50 mg rectally once daily at bedtime Use smaller volume preparations if available; may require compounding

6–12 years 50 mg rectally once daily at bedtime Increase to 100 mg if inadequate response after 2 weeks

12 years 100 mg rectally once daily at bedtime Adult dosing applicable

Dosing Parameters:

Parameter Details

Starting dose 25–50 mg rectally at bedtime (age 2–12 years); 100 mg for adolescents

Titration Not typically required; reassess clinical response at 2–3 weeks

Usual maintenance dose Not established; aim for discontinuation after remission induction

Maximum dose 100 mg/day (should not exceed adult dose)

Monitoring Requirements:

Height, weight, and growth velocity at baseline and during therapy

Monitor for signs of systemic steroid absorption (cushingoid features, hyperglycaemia)

Clinical response assessment at 2–3 weeks

Clinical Notes:

Enema retention may be challenging in younger children; parental/caregiver instruction essential

Duration: up to 4 weeks; taper or discontinue based on clinical improvement

Transition to rectal mesalamine for maintenance once remission achieved

Secondary Indications — Paediatric Doses (Off-label, if any)

No established off-label paediatric indications

Age Restriction Statement:

Not recommended below 2 years of age except under specialist paediatric gastroenterology supervision with documented benefit-risk assessment

Hydrocortisone Enema Renal Adjustments

No dose adjustment required

Systemic absorption from rectal route is minimal with short-term use

No specific concerns in patients with renal impairment

Hydrocortisone Enema Hepatic adjustment

Severity	Recommendation
Mild impairment (Child-Pugh A)	No dose adjustment required
Moderate impairment (Child-Pugh B)	Use with caution; systemic corticosteroid exposure may be increased if significant absorption occurs
Severe impairment (Child-Pugh C)	Use with caution; monitor for signs of systemic steroid effects with prolonged use

Hydrocortisone Enema Contraindications

Known hypersensitivity to hydrocortisone or any formulation component

Untreated local infections of the rectum (tuberculosis, herpes simplex, amoebiasis, fungal infections)

Systemic fungal infections

Recent intestinal anastomosis or bowel perforation

Obstruction, abscess, or fistula where enema administration is technically contraindicated

Peritonitis

Hydrocortisone Enema Cautions

Prolonged use (>4 weeks) may result in systemic corticosteroid effects including adrenal suppression

Concurrent systemic corticosteroid use — increased risk of HPA axis suppression

Diabetes mellitus — monitor blood glucose; systemic absorption may affect glycaemic control

Hypertension — fluid retention possible with systemic absorption

Osteoporosis — caution with prolonged use

Peptic ulcer disease

Immunocompromised patients — increased infection risk

May delay healing of rectal/colonic mucosal lesions

Elderly patients with multiple comorbiditi

Hydrocortisone Enema Pregnancy

Parameter Details

Safety Category Generally considered safe; rectal route has minimal systemic absorption

Preferred Alternative Hydrocortisone is preferred over fluorinated corticosteroids (betamethasone, dexamethasone) if systemic absorption anticipated

When May Be Used Use when benefit outweighs risk; appropriate for managing active distal UC in pregnancy

Monitoring Monitor fetal growth if prolonged use or significant systemic absorption suspected

Note: Uncontrolled IBD poses greater risk to pregnancy than short-term rectal corticosteroid use.

Hydrocortisone Enema Lactation

Parameter Details

Compatibility Compatible with breastfeeding

Drug Levels in Milk Low; minimal systemic absorption from rectal route

Preferred Alternative None required; hydrocortisone enema is acceptable during lactation

Infant Monitoring Monitor for rare signs of corticosteroid exposure (weight gain, GI upset, irritability) — unlikely with short-term rectal use

Hydrocortisone Enema Elderly

Parameter Recommendation

Starting Dose Standard adult dose (100 mg rectally at bedtime)

Titration Not applicable

Special Risks Slower mucosal healing; increased risk of local mucosal thinning with prolonged use; caution if comorbid diabetes, osteoporosis, or hypertension; monitor for systemic effects

Monitoring Blood glucose and blood pressure if prolonged therapy; assess skin and mucosal integrity

Hydrocortisone Enema Major drug interactions

Interacting Drug Mechanism/Effect Recommendation

Systemic CYP3A4 inducers (rifampicin, phenytoin, carbamazepine) May reduce corticosteroid efficacy if systemic absorption occurs Clinical significance low with short-term rectal use; monitor for reduced efficacy in prolonged therapy

Strong CYP3A4 inhibitors (itraconazole, ketoconazole, ritonavir) May increase systemic hydrocortisone exposure Caution if concurrent systemic corticosteroid therapy; monitor for steroid excess

Note: Drug interactions are generally not clinically significant with short-term rectal hydrocortisone use due to minimal systemic absorption.

Hydrocortisone Enema Moderate drug interactions

Interacting Drug Mechanism/Effect Recommendation

Potassium-depleting diuretics (furosemide, thiazides) Additive hypokalaemia risk if systemic absorption Monitor serum potassium with prolonged corticosteroid use

NSAIDs Additive risk of GI bleeding or ulceration Avoid concurrent use if possible; monitor for GI symptoms

Warfarin Variable effect on INR due to systemic corticosteroid absorption Monitor INR if prolonged rectal corticosteroid use

Oral hypoglycaemic agents / Insulin Corticosteroids may cause hyperglycaemia Monitor blood glucose; adjust antidiabetic therapy if needed

Hydrocortisone Enema Common Adverse effects

Rectal discomfort, burning, or irritation at application site

Tenesmus (feeling of incomplete evacuation)

Flatulence

Local pruritus

Increased bowel movements during initial use

Minor rectal bleeding (due to insertion technique)

Headache

Hydrocortisone Enema Serious Adverse effects

Adverse Effect Clinical Notes

Rectal mucosal thinning/ulceration May occur with prolonged use; discontinue if persistent local symptoms

Systemic corticosteroid effects Adrenal suppression, hyperglycaemia, cushingoid features, osteoporosis — with prolonged use (>4 weeks) or concurrent systemic steroids

Secondary infection Fungal overgrowth or bacterial superinfection; may require discontinuation

Hypersensitivity reaction Rare; discontinue immediately if occurs

Bowel perforation Risk increased if used in presence of severe colitis, diverticulitis, or recent anastomosis

Hydrocortisone Enema Monitoring requirements

Phase Parameters

Baseline Clinical assessment of rectal mucosa; blood glucose in diabetics; note concurrent steroid use

During Therapy (2–3 weeks) Assess clinical response (symptom improvement, endoscopic improvement if applicable); monitor for local adverse effects

Prolonged Use (>4 weeks) Monitor for systemic corticosteroid effects (blood glucose, blood pressure, signs of adrenal suppression); consider HPA axis assessment if extended use

Paediatric Growth velocity monitoring; watch for systemic steroid effects

Hydrocortisone Enema Brands in India

Brand Name Manufacturer Formulation

Cortenema Torrent Pharmaceuticals Enema 100 mg/60 mL

Rectocort Macleods Enema (Hydrocortisone acetate)

Note: Availability of rectal foam formulations is limited in India; verify local supply before prescribing. Some centres may require compounding for paediatric doses.

Hydrocortisone Enema Price range (INR)

Formulation	Approximate Price (per tablet)
Enema 100 mg/60 mL	₹80–150 per unit

Notes:

Not included in NLEM 2022

Available through private purchase only

Price varies by brand and region

Hydrocortisone Enema Clinical pearls

Enema reaches sigmoid and descending colon only: Not effective for extensive or pancolitis; use oral/systemic therapy for disease beyond splenic flexure

Combine with oral 5-ASA for optimal induction: Rectal corticosteroid + oral mesalamine is more effective than either alone in left-sided UC

Patient counselling on retention is critical: Instruct patients to retain enema for at least 1 hour, preferably overnight; lie on left side during instillation to enhance distribution

Avoid prolonged use beyond 4 weeks: Risk of systemic steroid effects and local mucosal atrophy increases with extended therapy; transition to rectal mesalamine for maintenance

Foam formulations may improve adherence: If available, foam is easier to retain than liquid enema and may be preferred for isolated proctitis — but availability in India is limited

Not a substitute for systemic therapy in moderate-severe disease: If inadequate response to rectal therapy within 2–3 weeks, escalate to oral/IV corticosteroids or biologics

Hydrocortisone Enema Tags

hydrocortisone enema; rectal corticosteroid; ulcerative colitis; proctitis; distal colitis; IBD; local steroid therapy; radiation proctitis; paediatric IBD; gastroenterology

Hydrocortisone Enema Version

RxIndia v1.1 — 27 Jan 2026

Hydrocortisone Enema Reference

CDSCO Product Information

Indian Pharmacopoeia / National Formulary of India (NFI)

NLEM 2022 (National List of Essential Medicines) — noted absence

API Textbook of Medicine

AIIMS Gastroenterology Clinical Protocols

Indian Society of Gastroenterology — IBD Management Recommendations

IAP Guidelines for Paediatric IBD

Goodman & Gilman's The Pharmacological Basis of Therapeutics

RxIndia

The Drug Registry

Hydrocortisone Enema