Comprehensive medication guide to Solu-Cortef including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$0–$20 copay for generic hydrocortisone sodium succinate injection; typically Tier 1–2 on commercial plans; home emergency kits covered under pharmacy benefit (Part D for Medicare).
Estimated Cash Pricing
$25–$50 retail per 100 mg vial for brand-name Solu-Cortef; generic A-Hydrocort available for as low as $12.77 with a GoodRx coupon.
Medfinder Findability Score
62/100
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Solu-Cortef is the brand name for hydrocortisone sodium succinate for injection, USP, manufactured by Pfizer (Pharmacia & Upjohn Company LLC). It is an injectable corticosteroid — a synthetic form of the stress hormone cortisol — used when rapid IV or IM action is required. Effects are evident within one hour of IV administration.
The drug is available as a sterile powder reconstituted before injection. It comes in the ACT-O-VIAL single-dose system in four strengths: 100 mg/2 mL, 250 mg/2 mL, 500 mg/4 mL, and 1,000 mg/8 mL. A plain 100 mg vial without built-in diluent is also available. A generic equivalent, A-Hydrocort, is FDA-approved and therapeutically equivalent.
Solu-Cortef is used across a wide range of medical conditions including adrenal insufficiency, adrenal crisis, severe allergic reactions, autoimmune flares, septic shock, asthma exacerbations, inflammatory bowel disease, skin diseases, hematologic conditions, and many more. It is a cornerstone of emergency medicine and critical care. For patients with adrenal insufficiency or Addison's disease, the 100 mg ACT-O-VIAL is commonly prescribed as a home emergency kit for self-injection during an adrenal crisis.
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Hydrocortisone sodium succinate is a highly water-soluble ester of hydrocortisone (cortisol). Once injected, it is rapidly converted in the body to active hydrocortisone, which binds to glucocorticoid receptors inside cells throughout virtually every tissue. The drug-receptor complex enters the cell nucleus and modulates gene expression, producing powerful anti-inflammatory and immunosuppressive effects.
Hydrocortisone suppresses production of pro-inflammatory cytokines, prostaglandins, and leukotrienes, reducing redness, swelling, and pain. It also suppresses immune cell activity — including T-cells and macrophages — making it effective for autoimmune conditions. Unlike most other corticosteroids in clinical use, hydrocortisone also has significant mineralocorticoid activity: it binds to kidney receptors to promote sodium retention and potassium excretion, which helps maintain blood pressure and electrolyte balance.
This dual glucocorticoid and mineralocorticoid activity makes Solu-Cortef uniquely valuable for adrenal crisis — where both types of hormones are deficient. Other corticosteroids such as dexamethasone or methylprednisolone are more potent anti-inflammatory agents but lack mineralocorticoid activity, making them incomplete substitutes in adrenal replacement therapy.
100 mg/2 mL — ACT-O-VIAL (single-dose vial with diluent)
Most commonly prescribed for home emergency kits in adrenal insufficiency patients
250 mg/2 mL — ACT-O-VIAL (single-dose vial with diluent)
Hospital use for moderate-to-high dose corticosteroid therapy
500 mg/4 mL — ACT-O-VIAL (single-dose vial with diluent)
Hospital use for high-dose therapy in severe conditions
1,000 mg/8 mL — ACT-O-VIAL (single-dose vial with diluent)
Hospital use for very high-dose therapy; typically mixed in IV infusion bag
100 mg — Plain vial (no diluent)
Requires separate bacteriostatic water for injection for reconstitution
Solu-Cortef has a challenging findability profile. As primarily a hospital-distributed injectable, it is not universally stocked at retail pharmacies. The 100 mg/2 mL ACT-O-VIAL home emergency kit — prescribed for adrenal insufficiency patients — may be stocked at some retail chains, specialty pharmacies, and hospital outpatient pharmacies, but availability varies widely by location.
From a shortage history perspective, Solu-Cortef experienced a significant supply disruption in March 2023, with a secondary interruption in April 2025. As of October 2025, the ASHP confirmed that all Solu-Cortef presentations are available from Pfizer. No active FDA shortage is designated as of early 2026. However, the drug's repeated disruptions — combined with its specialized distribution channels — mean localized shortages remain possible.
Patients having trouble locating Solu-Cortef should use medfinder to find pharmacies near them that have it in stock — without having to call each pharmacy individually.
Solu-Cortef is not a controlled substance and does not require DEA scheduling. Any licensed prescriber may write a prescription without special DEA registration. The appropriate prescriber depends on the underlying condition:
Endocrinologists — primary specialists for adrenal insufficiency, Addison's disease, and congenital adrenal hyperplasia; manage long-term Solu-Cortef therapy and home kit prescriptions
Emergency Medicine Physicians — administer Solu-Cortef for adrenal crisis, anaphylaxis, severe asthma, and septic shock in the ER
Hospitalists and Intensivists (ICU) — prescribe in inpatient settings for critically ill patients
Rheumatologists — prescribe for autoimmune flares (lupus, inflammatory arthritis, vasculitis)
Allergists/Immunologists — administer for severe allergic reactions and anaphylaxis
Primary Care Physicians (PCPs), Nurse Practitioners (NPs), Physician Assistants (PAs) — can prescribe for established patients, refills of home emergency kits, and acute conditions
Telehealth options are available for established patients needing prescription refills — particularly for adrenal insufficiency home emergency kit renewals. Initial diagnosis and evaluation of acute symptoms require in-person evaluation. Platforms like Teladoc and MDLive, as well as health system virtual care programs, can prescribe for eligible established patients.
No. Solu-Cortef (hydrocortisone sodium succinate injection) is not a controlled substance under the DEA Controlled Substances Act. It is not assigned to any DEA schedule (I through V).
This means that any licensed prescriber — including physicians (MD/DO), nurse practitioners (NPs), and physician assistants (PAs) — can prescribe Solu-Cortef without the special DEA registration required for controlled substances. There are no restrictions on prescription quantity, no mandatory prescription drug monitoring program (PDMP) reporting, and no special pharmacy storage requirements beyond standard sterile injectable handling protocols.
While Solu-Cortef is not scheduled, it is a prescription-only medication. Obtaining or using it without a valid prescription is illegal and unsafe. Home emergency kits for adrenal insufficiency require a prescription from an endocrinologist, PCP, or other authorized prescriber.
Common side effects (more likely with higher doses or prolonged use):
Elevated blood sugar (hyperglycemia)
Fluid retention and edema
Elevated blood pressure
Mood changes, irritability, insomnia
Increased appetite and weight gain
Potassium loss
Increased infection risk (immune suppression)
HPA axis suppression / adrenal insufficiency on withdrawal
Cushing's syndrome (fat redistribution, stretch marks, thin skin) with prolonged use
Osteoporosis with long-term use
Cataracts and glaucoma with prolonged use
Cardiac enlargement with concomitant amphotericin B
Avascular necrosis of the hip with long-term use
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A-Hydrocort (hydrocortisone sodium succinate injection, generic)
Therapeutically identical to Solu-Cortef; preferred first substitute for cost savings or brand unavailability
Methylprednisolone Sodium Succinate (Solu-Medrol)
Potent glucocorticoid; preferred for extended high-dose therapy; lacks mineralocorticoid activity — not appropriate as sole substitute in primary adrenal insufficiency
Dexamethasone Sodium Phosphate
Long-acting potent glucocorticoid (half-life 36-72 hours); widely available; lacks mineralocorticoid activity — supplemental fludrocortisone required for primary adrenal insufficiency
Fludrocortisone (Florinef)
Synthetic mineralocorticoid used alongside glucocorticoids in primary adrenal insufficiency when hydrocortisone is unavailable and alternatives lacking mineralocorticoid activity are used
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Amphotericin B (IV)
majorConcomitant use associated with cardiac enlargement and congestive heart failure. Avoid unless clinically necessary; monitor cardiac function closely.
Live vaccines
majorContraindicated during immunosuppressive doses; can cause severe or fatal infections in immunosuppressed patients.
Mifepristone (Korlym, Mifeprex)
majorGlucocorticoid receptor antagonist; may reduce effectiveness of Solu-Cortef. Use with extreme caution in adrenal insufficiency patients.
NSAIDs (ibuprofen, naproxen)
moderateSignificantly increases risk of GI bleeding and ulceration when combined with corticosteroids.
Warfarin / anticoagulants
moderateVariable effect — both enhanced and diminished anticoagulant activity reported. Monitor INR closely when starting or stopping Solu-Cortef.
Azole antifungals (ketoconazole, fluconazole)
moderateInhibit CYP3A4 metabolism of hydrocortisone, potentially raising steroid levels and increasing Cushing's syndrome risk.
Rifampin / rifamycins
moderatePotent CYP3A4 inducer; dramatically reduces hydrocortisone levels. Higher Solu-Cortef doses may be needed.
Anti-seizure drugs (phenytoin, phenobarbital)
moderateInduce CYP3A4, reducing hydrocortisone blood levels. May require dose increases.
Potassium-depleting diuretics
moderateCombined potassium-wasting effect can cause significant hypokalemia. Monitor potassium; supplementation may be needed.
Insulin / diabetes medications
moderateHydrocortisone raises blood glucose, counteracting diabetes medications. Monitor blood sugar; dose adjustments may be needed.
Solu-Cortef (hydrocortisone sodium succinate) is a life-saving medication for patients with adrenal insufficiency and a critical tool in emergency medicine and critical care. Its recurring supply disruptions — most notably in 2023 and 2025 — underscore the importance of proactive access management for patients who depend on it. As of early 2026, supply has normalized, but patients should remain vigilant.
Patients with adrenal insufficiency should maintain an up-to-date home emergency kit, start refill searches 2-3 weeks before expiration, know their nearest ER, and wear medical alert identification. Cost-conscious patients should consider the generic A-Hydrocort and GoodRx coupons to reduce out-of-pocket expenses. For those with insurance barriers, patient assistance programs through Pfizer and the HealthWell Foundation may help.
When pharmacy inventory is the obstacle, medfinder simplifies the search by calling pharmacies near you and reporting which ones have your medication in stock — so you can focus on your health, not on hold music.
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