Hydrocortisone Tablets

Hydrocortisone tablets can be taken by adults and children. Hydrocortisone tablets are not suitable for some people. Tell your doctor before starting the medicine if you:

• have ever had an allergic reaction to hydrocortisone or any other medicine
• have an infection (including an eye infection)
• have recently been in contact with anyone with shingles, chickenpox or measles (unless you are sure you are immune to these infections)
• have recently had, or are about to have, any vaccinations
• have had liver problems in the past
• or a close family member have ever had mental health problems
• have any unhealed wounds
• have heart failure, high blood pressure or you have recently had a heart attack 
• have diabetes or epilepsy 
• have glaucoma 
• have an underactive thyroid 
• have osteoporosis (thinning bones)
• have or have ever had a stomach ulcer 
• are pregnant, trying to get pregnant or breastfeeding

Hydrocortisone tablets and pregnancy

Hydrocortisone tablets can be taken in pregnancy. Your doctor will only prescribe them if the benefits of the medicine outweigh the risks.

If you are taking hydrocortisone tablets for Addison’s disease, it is important to carry on taking the medicine throughout pregnancy. Sometimes, your dose may need to increase and it is usual to receive high doses of hydrocortisone by injection during childbirth.

Hydrocortisone tablets and breastfeeding

You can take hydrocortisone tablets while you are breastfeeding. Hydrocortisone does get into breast milk, but in amounts that are usually too small to harm your baby. If you are taking a total dose of more than 160mg of hydrocortisone each day for a long time, your baby may need extra monitoring.

If you notice that your baby is not feeding as well as usual, or if you have any other concerns about your baby, talk to your health visitor, midwife or doctor as soon as possible

Hydrocortisone tablets come as standard or slow-release tablets. They are also available as a soluble tablet that you dissolve in water before use. Your pharmacist or doctor will tell you which type of hydrocortisone tablets you are taking and how to take them. Always follow the instructions that come with your medicine.

Dosage

Hydrocortisone comes as 5mg, 10mg and 20mg tablets.

If you take hydrocortisone tablets for hormone replacement the usual dose is 20mg to 30mg a day, split into 2 doses. The first dose in the morning may be larger than the second dose in the evening. If you have an infection, or if you need to have dental treatment or an operation, you will probably need to take a higher dose for a while.

How to take standard tablets

Standard tablets start to release the medicine into your body as soon as you swallow them.

You will usually take them 2 or 3 times a day. Take the tablets with or just after a snack or meal. This is so they do not upset your stomach.

How to take slow-release tablets

Some hydrocortisone tablets are slow release (also known as modified release). These tablets release the medicine into your body gradually throughout the day.

You will usually take slow-release tablets once a day.

Take them in the morning, around half an hour before breakfast. Swallow them whole. Do not break or crush the tablets, as they will not work properly. Do not eat grapefruit or drink grapefruit juice while you are being treated with hydrocortisone tablets. Grapefruit can change the way hydrocortisone works and increases the risk of side effects.

How to take soluble tablets

Some hydrocortisone tablets need to be dissolved in at least 50ml of water immediately before swallowing. Make sure you swallow all of the liquid, otherwise you may not get all of the dose. The hydrocortisone starts to be absorbed as soon as the liquid is swallowed.

You will usually take soluble tablets 3 times a day. Take the tablets with or just after a snack or meal. This is so they do not upset your stomach.

Like all medicines, Hydrocortisone tablets can cause side effects although not everyone gets them. Hydrocortisone is not a strong steroid so you are unlikely to get side effects. It as 4 times weaker than another widely used steroid called prednisolone. 

Common side effects

These common side effects happen in more than 1 in 100 people. Keep taking the medicine, but tell your doctor if the side effects bother you or do not go away:

• feeling dizzy, weak or tired
• headaches
• muscle ache
• indigestion or feeling sick (nausea)
• diarrhoea
• swollen ankles

Serious side effects

Serious side effects are rare and happen in less than 1 in 1,000 people. You are more likely to get serious side effects if you take high doses of hydrocortisone over many months.

Contact your doctor straight away if you:

• are depressed (including having suicidal thoughts), feeling high, mood swings, feeling anxious, seeing or hearing things that are not there or having strange or frightening thoughts – these can be signs of mental health problems
• have a high temperature, chills, a very sore throat, ear or sinus pain, a cough, more saliva or a change in colour of your saliva, pain when you pee, mouth sores or a wound that will not heal – these can be signs of an infection
• are sleepy or confused, feeling very thirsty or hungry, peeing more often than usual, flushing, breathing quickly or breath that smells like fruit – these can be signs of diabetes or complications of diabetes
• have a “moon face” (puffy, rounded face), weight gain in your upper back or belly – this happens gradually and can be a sign of Cushing’s syndrome 
• have a very upset stomach or vomiting, very bad dizziness or fainting, muscle weakness, feeling very tired, mood changes, loss of appetite and weight loss – these can be signs of adrenal gland problems
• have muscle pain or weakness, muscle cramps, or a heartbeat that does not feel normal – these can be signs of low potassium levels
• have severe stomach pain, severe back pain, a severe upset stomach or vomiting – these can be signs of pancreas problems
• have swelling or throbbing in your arms or legs, or if you feel breathless or have chest pain – these can be signs of a deep vein or blood clot
• have changes in your eyesight
• have any unusual bruising or bleeding, black poo, black or dark brown vomit or vomiting blood – these can be signs of a bleeding ulcer

Side effects can happen at different times. An upset stomach or mood changes can happen straight away. Other side effects, such as getting a rounder face, happen after weeks or months.

Children and teenagers

If your child or teenager takes hydrocortisone tablets for more than a year or so, it can slow down their normal growth. Your child’s doctor will monitor their height and weight carefully for as long as they are having treatment with hydrocortisone. This will help them spot any slowing down of your child’s growth and change their treatment if needed.

Even if your child’s growth slows down, it does not seem to have much effect on their overall adult height. Talk to your doctor if you are worried about your child taking hydrocortisone tablets.

How to cope with side effects of hydrocortisone

What to do about:

• feeling dizzy, weak or tired – if you feel dizzy, weak or tired, stop what you are doing and sit or lie down, or have a rest, until you feel better. Do not drive, ride a bike, or use tools or machinery. It is a good idea to avoid alcohol too as it will make you feel worse.
• headaches – make sure you rest and drink plenty of fluids. Do not drink too much alcohol. Ask your pharmacist to recommend a painkiller. Talk to your doctor if headaches last longer than a week or are severe.
• muscle ache – if you get unusual muscle ache, which is not from exercise or other physical activity, talk to your doctor. You may need a blood test to find the cause.
• indigestion or feeling sick (nausea) – try taking your tablets with food. It may also help if you avoid rich or spicy food. Tell your doctor if it does not get better or you get severe indigestion or stomach pain. They may be able to prescribe an extra medicine to protect your stomach
• diarrhoea – drink plenty of water or squash to avoid dehydration. Signs of dehydration include peeing less than usual or having dark, strong-smelling pee. Do not take any other medicines to treat diarrhoea without speaking to a pharmacist or doctor.
• swollen ankles – get plenty of rest and raise your legs when you are sitting down. Try not to stand for a long time.

Protecting yourself from long-term effects

You may take hydrocortisone tablets for a long time, even for the rest of your life. Over many years hydrocortisone can have several harmful effects on your body. It can lead to:

• weak or fragile bones 
• poorly controlled diabetes 
• eyesight problems
• slower growth in children and teenagers

If you have to take hydrocortisone tablets for a long time, it is worth taking these steps to stay as healthy as possible:

• take regular exercise and make sure you get enough calcium in your diet to help strengthen your bones. Milk, cheese and leafy greens contain lots of calcium. To check your bones, your doctor may arrange for you to have an occasional bone scan
• if you have diabetes, you may need to check your blood sugar (glucose) more often. Your doctor can advise you about this
• to reduce the chances of eyesight problems, visit an optometrist every 12 months to check for high pressure in your eye and cataracts 
• make sure that children and teenagers have their height monitored regularly by a doctor so that any slowing of growth is spotted quickly and their treatment changed if necessary

Cautions with other medicines

There are many medicines that can affect the way hydrocortisone tablets work. It is important to ask your doctor or pharmacist if a medicine is safe to take with hydrocortisone tablets before you start taking them. This includes prescription medicines and ones that you buy such as paracetamol and ibuprofen.  

How do Hydrocortisone tablets work?

The adrenal glands sit on top of your kidneys. They produce 2 hormones called cortisol and aldosterone. If your adrenal glands are not making enough cortisol, hydrocortisone tablets work by replacing the hormone and bringing your levels up to normal.

What happens if I stop taking Hydrocortisone tablets?

If you stop taking hydrocortisone tablets suddenly it may cause your symptoms to come back. You may also get dangerous withdrawal symptoms including:

• severe tiredness
• weakness and feeling unwell
• body aches including stomach ache
• feeling dizzy
• joint and muscle pain

If you need to stop taking hydrocortisone, your doctor will reduce your dose gradually to prevent these side effects.

Important

Do not stop taking hydrocortisone tablets without talking to your doctor.

Why do I need to be careful of infections?

Taking hydrocortisone tablets can affect your immune system, so you are more likely to catch the flu, the common cold, and chest infections. Keep away from people with an infectious disease, especially chicken pox, shingles or measles. If you have never had these illnesses they could make you very ill.

Tell your doctor straight away if you come into contact with someone who has chickenpox, shingles or measles. Your doctor may be able to prescribe a medicine to protect you.

Will it affect my fertility?

There is no clear evidence that hydrocortisone tablets will affect the fertility of men or women.

Will it affect my contraception?

Hydrocortisone tablets do not affect any contraception including the comboned pill or emergency contraception. If you start taking the combined pill your dose of hydrocortisone may need adjusting.

Is there any food or drink I need to avoid?

Do not eat grapefruit or drink grapefruit juice while you are taking hydrocortisone tablets. Grapefruit can change the way hydrocortisone works and increases the risk of side effects.

Are there other steroid tablets available?

There are other steroid tablets available such as: deflazacort, dexamrthasone, methylprednisolone, and prednisolone. 

These steroids are very similar to high dose (more than 100mg) hydrocortisone tablets. However, they are not usually used as replacement treatment, for example in Addison’s disease, because they are too strong and can cause more side effects.