Hydrocortisone

Hydrocortisone (HC) is a steroid hormone produced by the adrenal gland. It plays a complex role in regulating body functions
and is essential for survival.

Hydrocortisone is taken as a replacement for the natural hormone where this is deficient, either because there is a failure of hydrocortisone production by the adrenal gland (Addison’s disease/primary adrenal insufficiency), or pituitary deficiency (secondary adrenal insufficiency) of ACTH (the hormone that stimulates the production of hydrocortisone by the adrenal gland).
Replacement therapy is also required for people who have congenital adrenal hyperplasia, which is a birth defect. Hydrocortisone is available as tablets under the trade name Hydrocortisone, containing 10mg or 20mg. Prednisolone may be prescribed to individual patients instead of hydrocortisone and works in the same way as hydrocortisone. Prednisolone is available as tablets under the trade name Deltacortril® containing 2.5mg or 5mg or Prednisolone 1mg or 5mg. 

Plenadren is a novel, once daily hydrocortisone modified-release tablet, designed to better mimic the body’s natural cortisol production compared to standard treatment. The Plenadren tablet is available in 5 and 20 mg strengths. The immediate release outer coating provides physiological cortisol concentrations within 20 minutes of intake; the extended release core provides a smooth serum cortisol level with reduced exposure in the late afternoon and over the 24-hour period.

An injection containing 100mg Hydrocortisone is available for emergency situations for those on hydrocortisone or prednisolone. For children, there are lower dose emergency injections available.

How do I take it?

The usual dose for hydrocortisone is 15-20mg by mouth, split over two or three times daily, and depending on your individual endocrinologist’s recommendations. For example: 10mg before getting out of bed in the morning, 5mg at mid-day and 5mg no later than 6pm. Hydrocortisone should ideally be taken with water and is better absorbed if taken before food. The usual dose for prednisolone is 5-7mg by mouth, split over two times daily.

When would I need to take more hydrocortisone?

If you become ill then the body would naturally increase the output of steroid from your adrenals. Therefore, if you are taking replacement steroid (hydrocortisone) it is essential, to mimic the natural response by increasing your dose appropriately after hydrocortisone or prednisolone.

For Plenadren, the dose must be increased temporarily and your doctor may advise you to use other hydrocortisone tablets instead of, or in addition to Plenadren. Please discuss this with your doctor and follow the instructions on how to act in these situations.

The daily dose of Plenadren may have to be doubled or tripled in milder conditions such as a mild infection or stress. You should then take the second dose of Plenadren 6 to 10 hours after the morning dose. If it is not enough to double the daily dose, you should take a third dose 6 to 10 hours after the second dose (6-10 hours intervals between doses). When your illness is over, return to your normal maintenance dose of Plenadren. 

Please read our Hydrocortisone advice for the pituitary patient for sick day rules and recommendations on increasing your dose.

Peak Timings ImageWhen do I know that I would need an emergency injection?

If you cannot absorb your tablets, or your usual replacement wasn’t sufficient for an acute shock or illness, then gradually or perhaps quite quickly, you would feel weak, sickly and light headed. The cortisol clock gives approximate times of need for emergency medical help and replacement.

How to give an emergency injection of hydrocortisone

How To Give Emergency Injection Solucortef 1

Emergency Injections 2

Liquid version Efcortesol preparation and administration videos

How can I let others know I take replacement hydrocortisone?

When you are prescribed your medication you will be given a ‘blue steroid card’ from the hospital to carry. The Pituitary Foundation suggests that you purchase and wear a medical necklace or bracelet, such as MedicAlert® to show your cortisol replacement therapy. Further, we can provide you with a Pituitary Foundation Patient Care Card which is small enough to fit in your bag, or pocket and displays your hydrocortisone needs and information on emergency replacement should you need this.

Emergency injections - should I have these at home?

The Pituitary Foundation does recommend all patients taking hydrocortisone (or prednisolone) to have a 100mg injection kit in their home for emergency use only. If you don’t have one of these already, you can ask your GP or endocrinologist if they will prescribe this for you. Please check regularly that these preparations are not expired.