A B O U T Y O U R M E D I C I N E
|How does it work?|
|How do I take it?|
|What side effects can be expected?|
|Other medicines or substances which might interfere with your treatment|
|Advice for illness|
|What illnesses require extra replacement steroid?|
|What if a dose is missed by mistake?|
|Storing your medicine|
Available as tablets containing Hydrocortisone 10 mg and 20 mg supplied under the trade name HydrocortoneÒ .
An injection containing Hydrocortisone 100 mg is also available but rarely used for maintenance (replacement) therapy described below.
How does it work?
Hydrocortisone is one of the steroid hormones produced by the adrenal gland (adrenal cortex) which plays a complex role in regulating body functions and without which survival would not be possible. Hydrocortisone Tablets are taken as a replacement for the natural hormone where this is deficient either because there is a primary failure (or insufficiency) of Hydrocortisone production by the adrenal cortex gland (Addisons Disease) or adrenal failure (or insufficiency) results from a pituitary deficiency of ACTH (the hormone that stimulates production of Hydrocortisone by the adrenal gland). Replacement therapy is also required for people who have a congenital adrenal hyperplasia (a birth defect) or in cases where surgical removal of the gland (adrenalectomy) has been performed.
How do I take it?
High doses of Hydrocortisone administered by injection are required in the acute management of adrenal insufficiency in order to establish initial control. The following describes treatment once this has been achieved and refers to normal (maintenance) therapy.
In primary adrenal failure (or insufficiency) it is usual to attempt to mimic the normal secretion of Hydrocortisone by the adrenal cortex by giving a standard (physiological) dose twice a day in the morning and evening. The usual dose of 30 mg Hydrocortisone per day is split into 20 mg taken with breakfast and 10 mg taken with the evening meal.
Some patients feel better on hydrocortisone given three times per day i.e. 10mg with breakfast, 10mg with midday meal and 10mg with evening meal.Inthose with primary adrenal failure the hydrocortisone is given with fludrocortisone as this hormone is also deficient.
The above treatment strategy also applies in secondary adrenal failure (e.g. pituitary failure) but is not combined with fludrocortisone.
What side effects can be expected?
Other medicines or substances which might interfere with your treatment
Ideally, steroids used for replacement therapy mimic the natural release of Hydrocortisone from the adrenal gland and should not have any effect on other treatments. In practice, however, steroid medicines can interfere with treatments for high blood pressure and diabetes so requiring more careful control of these conditions.
When steroids are taken with anti-inflammatory pain killers such as BrufenÒ , Naproxen, Diclofenac/VoltarolÒ , etc. there is an increased likelihood of stomach problems such as indigestion and even peptic ulceration. If in doubt seek advice from your Doctor.
Some medicines used in the treatment of epilepsy can increase the metabolism of steroids so reducing their effect in the body. The concurrent use of the oral contraceptive, on the other hand, can increase the action of steroids. Any problems are easily overcome, however, by careful dosage adjustment.
The amount of potassium in the blood can be reduced by combinations of steroid and other medicines which lower potassium levels (e.g. diuretics or water tablets). The level of potassium in the blood requires to me maintained within an accepted range so that corrective measures may be necessary.
Advice for illness
If you become ill then the body naturally would increase the output of steroid from the adrenals. Therefore if you are on replacement steroid it is essential to mimic the natural response by doubling your dose of steroid until the illness is over.
What illnesses require extra replacement steroid?
2. Severe head cold
6. Dental surgery
7. Severe accidents
If you have diarrhoea or vomiting then you might not absorb your steroid even if you have doubled the dose so best to seek advice urgently from your GP or call at A+E. Remember you MUST see a doctor that day when you have diarrhoea or vomiting.
What if a dose is missed by mistake?
One dose missed is unlikely to cause a problem but missing two dosages could land you in hospital. Try to remember.
Storing your medicine
Hydrocortisone tablets should be stored at room temperature. Avoid exposure to excessive heat or moisture.
Ó NHS Tayside; 2006; version 1.0
Disclaimer; no liability whatsoever is accepted for information given and all such information, especially with regard to drug usage (UK version provided), must be checked with a persons health provider.