Hydrocortisone tablets for cortisol replacement

About hydrocortisone tablets

Hydrocortisone belongs to a group of medicines called corticosteroids. It is sometimes referred to simply as an oral steroid. It is used as a replacement treatment for people whose adrenal glands are not producing as much of the steroid hormones (such as cortisol) as they normally do. This can happen in a condition known as adrenal insufficiency, or Addison's disease. It also happens in people who have had surgery to remove their adrenal glands and who therefore no longer make their own natural steroid hormones. These hormones are vital for your body and if you do not have enough of them, you can become very unwell.

Hydrocortisone is usually prescribed alongside another replacement medicine called fludrocortisone. Fludrocortisone is a substitute medicine for one of the other vital hormones that are no longer being made in people with adrenal insufficiency.

Before taking hydrocortisone tablets

Some medicines are not suitable for people with certain conditions, and sometimes a medicine can only be used if extra care is taken. For these reasons, before you start taking hydrocortisone it is important that your doctor knows:

• If you have high blood pressure.

• If you have had a heart attack, or if you have any other heart problems.

• If you have any problems with the way your liver works, or if you have any problems with the way your kidneys work.

• If you (or a close family member) have either diabetes (diabetes mellitus) or an eye condition called glaucoma.

• If you have any of the following conditions: an underactive thyroid gland, 'thinning' of the bones (osteoporosis), epilepsy, a condition causing muscle weakness (called myasthenia gravis), a stomach ulcer, or an inflammatory bowel disorder.

• If you have ever had a mental health problem.

• If you are pregnant or breastfeeding. (Oral steroids like hydrocortisone can be taken while you are expecting or breastfeeding; however, it is important that your doctor knows about the baby.)

• If you have any kind of infection at the moment, or if you have ever had tuberculosis (TB).

• If you have ever had an unwanted blood clot in an artery or a vein.

• If you have recently had, or are about to have, any vaccinations.

• If you are taking other medicines, including those available to buy without a prescription, as well as herbal and complementary medicines.

• If you have ever had an allergic reaction to a medicine, or if you have ever developed muscle pain after taking a steroid medicine.

How to take hydrocortisone tablets

• Before starting the treatment, read the manufacturer's printed information leaflet from inside the pack and any additional information you are given by your doctor. These will give you more information about hydrocortisone and will also provide you with a full list of side-effects which you could experience from taking it.

• Your doctor or pharmacist will tell you how many tablets to take and when to take them. This information will also be printed on the label of the packet of tablets to remind you about what was said to you. It is important that you take hydrocortisone exactly as your doctor tells you to. As a guide:

  • If you are taking immediate-release tablets (called simply 'Hydrocortisone tablets'), it is likely that you will be prescribed two or three doses to take each day. It is usual for your morning dose to be larger than the other doses. Take the tablets just after eating a meal, or alternatively with a snack.

  • If you have been prescribed a brand of tablet called Plenadren®, this is a tablet which releases hydrocortisone to your body throughout the day. It is usual to take one dose a day, 30 minutes before your breakfast. Swallow the tablet whole (this means do not break, crush, or chew it), with a drink of water. Do not drink grapefruit juice if you are taking Plenadren® because it will interfere with the way the tablets work.

• Try to take your doses at the same time of day each day, as this will help you to remember to take hydrocortisone regularly. If you forget to take a dose, take it as soon as you remember (unless it is nearly time for your next dose, in which case leave out the missed dose). Do not take two doses together to make up for a forgotten dose.

• Continue to take hydrocortisone tablets regularly each day - it is vital for your well-being. Hydrocortisone replacement treatment is almost always lifelong.

Getting the most from your treatment

• You will be given a 'Steroid Treatment Card' which says that you are on steroids and contains some important advice for you. It is important that you read this card and carry it with you at all times. It also contains details about your dose, how long you have been taking hydrocortisone and who prescribed it for you. Please make sure that this information is kept up to date. If you are due to have an operation or dental treatment, or if you are having any treatment for an injury, please tell the person carrying out the treatment that you are taking hydrocortisone and show them your treatment card.

• Try to keep your regular appointments with your doctor. This is so your doctor can check on your progress. Your doctor will want you to have tests from time to time to make sure you remain free from some of the unwanted side-effects of treatment.

• It is important that if you become ill you make an appointment to see your doctor straightaway. Also, if you come into contact with anyone who has measles, shingles or chickenpox (or anyone who suspects they might have them), you should contact your doctor for advice as soon as possible.

• Make sure you get your next supply of tablets well in advance so that you never run out. People with Addison's disease are entitled to free prescriptions.

• Some vaccines are not suitable for you while you are being treated with hydrocortisone. If you need any immunisations, make sure you mention that you are taking hydrocortisone.

• If you buy any medicines 'over the counter', please check with a pharmacist that they are suitable for you to take alongside hydrocortisone.

Can hydrocortisone cause problems?

Along with its useful effects, hydrocortisone can cause unwanted side-effects which your doctor will discuss with you. The benefits of taking hydrocortisone usually outweigh the side-effects; however, they can sometimes be troublesome. Although not everyone experiences side-effects, and some will improve as your body adjusts to the new medicine, speak with your doctor or pharmacist if you become concerned about any of the following:

For more information about side-effects which are possible when hydrocortisone is taken long-term, please see the separate leaflet called Oral Steroids.

How to store hydrocortisone tablets

• Keep all medicines out of the reach and sight of children.

• Store in a cool, dry place, away from direct heat and light.

Important information about all medicines