Hydrocortisone tablets: replacing cortisol safely

Hydrocortisone is a corticosteroid, but here it is used as hormone replacement. The NHS says it closely copies the effects of natural hormones produced in the adrenal glands, replacing the cortisol that is missing. It is used for conditions where the body does not produce enough cortisol, including Addison disease, after surgical removal of the adrenal glands, and in hypopituitarism.

Steroid doses for replacement are far lower than doses used to treat inflammation. The medicine in this guide is the tablet form; creams, injections and rectal foams have their own NHS pages.

The NHS lists three formulations. Standard tablets are taken two to three times a day with food. Slow-release tablets are taken once a day in the morning about half an hour before breakfast and must be swallowed whole. Soluble tablets are taken three times a day with food. NHS brand names for slow-release products are Plenadren and Efmody. Tablet strengths range from small to larger amounts, and the NHS says the usual replacement total is split into two doses with the larger dose in the morning. Your endocrinologist chooses the pattern and may adjust it during the first weeks.

Avoid grapefruit and grapefruit juice, the NHS says.

Your body normally releases extra cortisol under stress, so on replacement therapy you must raise your dose temporarily during illness, infection, surgery or dental treatment. The NHS says larger doses are needed at these times and that emergency high doses treat an adrenal crisis. Adults with Addison disease, adrenal insufficiency or pituitary disorders carry a red steroid emergency card; children carry an adrenal insufficiency card. A blue steroid card is given for use over three weeks or at high doses. Show the card to every clinician, including dentists and paramedics.

Tell your doctor of infection symptoms or a positive COVID-19 test. Severe diarrhoea lasting more than twenty-four hours can also reduce the effect of the contraceptive pill.

The NHS lists dizziness, weakness, tiredness, headaches, muscle ache, indigestion, nausea, diarrhoea and swollen ankles as common, with practical steps such as sitting or lying down if dizzy and taking tablets with food. Serious effects, which are rare, include Cushing-like changes (rounded face, weight gain on the upper back or belly), infection signs, high blood sugar, adrenal dysfunction, low potassium, pancreatitis and eye or bleeding problems. Call 999 for black or bloody vomit, severe allergic reaction or thoughts of self-harm.

Long-term effects can include bone thinning, uncontrolled diabetes, vision problems and slowed growth in children, which is why dose is kept at the lowest that restores health, with exercise, calcium, glucose monitoring and annual eye checks.

• Call 999: black or bloody vomit, throat or tongue swelling, thoughts of self-harm.

• Seek urgent advice: vomiting that stops you keeping tablets down, collapse or severe weakness.

The NHS says most adults and children can take hydrocortisone tablets. Tell your doctor if you have allergies to it, current infections including eye infections, recent contact with shingles, chickenpox or measles, vaccines due, liver problems, mental health issues, unhealed wounds, heart failure, recent heart attack, high blood pressure, diabetes, epilepsy, glaucoma, underactive thyroid, osteoporosis, stomach ulcers, pregnancy or plans to conceive or breastfeed.

Take a missed dose when you remember unless the next is nearly due; never double up. One or two extra tablets are unlikely to harm, but several days of excess could, so contact NHS 111 if new symptoms such as stomach pain or poor sleep appear. Do not stop hydrocortisone suddenly. Treatment for cortisol deficiency is generally lifelong, and any reduction is supervised.

The NHS says alcohol is allowed but may worsen dizziness. Do not drive, cycle or use tools until dizziness or tiredness passes. Live vaccines such as oral typhoid and BCG are unsuitable, while non-live flu, shingles and polio vaccines are safe options. Hydrocortisone tablets are prescription only. Suspected side effects can be reported through the Yellow Card scheme.