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Hydrocortisone oral standard release


Oral formulations of hydrocortisone.

Drugs List

  • hydrocortisone 10mg dispersible tablet sugar-free
  • hydrocortisone 10mg tablets
  • hydrocortisone 15mg tablets
  • hydrocortisone 2.5mg tablets
  • hydrocortisone 20mg dispersible tablet sugar-free
  • hydrocortisone 20mg tablets
  • hydrocortisone 5mg dispersible tablet sugar-free
  • hydrocortisone 5mg tablets
  • HYDVENTIA 10mg tablets
  • HYDVENTIA 20mg tablets
  • Therapeutic Indications


    Adrenal insufficiency - cortical
    Congenital adrenal hyperplasia
    Hypersensitivity: emergency treatment



    Replacement therapy
    20mg to 30mg daily in two divided doses. Give larger doses in the morning and smaller doses in the evening.

    Acute Emergencies
    60mg to 80mg every 4 to 6 hours for 24 hours. Gradually reduce the dose over several days.


    Replacement therapy
    10mg to 30mg daily in two divided doses. Give larger doses in the morning and smaller doses in the evening.

    The following alternative dosing schedule may be suitable:

    Replacement therapy
    0.4mg/kg to 0.8mg/kg daily in two or three divided doses. Titrate to response.

    Adrenal hypoplasia, Addison's disease, chronic maintenance or replacement therapy
    8 to 10mg/square metre daily, given in three divided doses. Higher doses may be required.
    Give larger doses in the morning and smaller doses in the evening.

    Congenital adrenal hyperplasia
    9 to 15mg/square metre daily, given in three divided doses. Titrate to response.

    Additional Dosage Information

    Hydrocortisone Withdrawal
    Gradual withdrawal of therapy will be required in patients who have received more than physiological doses of systemic corticosteroids (approximately 30mg hydrocortisone) for greater than 3 weeks. Determine how dose reduction is to be carried out based on the likelihood of disease relapse on withdrawal and likelihood of hypothalamic-pituitary-adrenal (HPA) suppression. If disease is unlikely to relapse but hypothalamic-pituitary adrenal suppression is uncertain the dose may be reduced rapidly to physiological doses. Once a daily dose equivalent to 30mg hydrocortisone is reached, dose reduction should be slowed down to allow the HPA-axis to recover.

    Abrupt withdrawal of systemic hydrocortisone treatment which has continued up to 3 weeks is appropriate if it is considered that the disease is unlikely to relapse. Abrupt withdrawal of doses of up to 160mg daily of hydrocortisone for 3 weeks is unlikely to lead to clinically relevant HPA-axis suppression in the majority of patients.

    In the following patient groups gradual withdrawal of systemic corticosteroid therapy should be considered even after courses lasting 3 weeks or less:
    Patients who have had repeated courses of systemic corticosteroids, especially if taken for greater than 3 weeks,
    When a short course has been prescribed within one year of cessation of long term therapy (months or years),
    Patients receiving doses greater than 160mg hydrocortisone,
    Patients repeatedly taking doses in the evening.


    Uncontrolled systemic infection

    Precautions and Warnings

    Children under 18 years
    Family history of diabetes mellitus
    Family history of glaucoma
    Chronic nephritis
    Congestive cardiac failure
    Corneal damage
    Diabetes mellitus
    Epileptic disorder
    Gastrointestinal anastomosis
    Glucose-galactose malabsorption syndrome
    Hepatic impairment
    History of severe affective disorders
    History of steroid myopathy
    History of steroid-induced psychosis
    History of tuberculosis
    Lactose intolerance
    Myasthenia gravis
    Ocular herpes simplex infection
    Peptic ulcer
    Recent myocardial infarction
    Renal impairment
    Severe affective disorders
    Thromboembolic disorder
    Ulcerative colitis

    Administration of live vaccines is not recommended
    Consider reintroducing steroids temporarily during illness/trauma/surgery
    Disease reactivation may occur in patients with latent TB
    Exposure to measles may require prophylaxis with normal immunoglobulin
    May activate latent amoebiasis
    May mask symptoms or signs of infections
    Patients with diabetes may experience fluctuations in blood glucose
    Temporary increase in dose may be needed during illness, trauma or surgery
    Advise ability to drive/operate machinery may be affected by side effects
    Consider prophylactic anti-tuberculosis therapy if appropriate
    Passive immunisation of chicken pox / herpes zoster may be required
    Premature infants: Perform cardiac evaluation and monitoring
    Some formulations contain lactose
    Frequent review needed to titrate dose to disease activity
    If visual disturbances occur, perform ophthalmic evaluation
    Monitor blood pressure regularly
    Monitor regularly the height of children receiving prolonged treatment
    Pregnancy: Monitor closely patients with pre-eclampsia or fluid retention
    Prolonged or high dose may lead to adrenal suppression
    Psychological changes may occur during initiation & withdrawal of treatment
    Supervise patient closely during drug withdrawal
    Adrenal cortical atrophy may persist for years after stopping drug
    Antibody response to vaccines may be reduced
    Corticosteroids may cause growth retardation in children under 18 years
    May cause activation of latent psychosis
    May cause posterior subcapsular cataracts and glaucoma in long term use
    Oversuppression of immune system may increase susceptibility to infection
    Patient should report worrying psychological changes esp. suicidal thoughts
    Potassium supplements may be required
    May affect results of some laboratory tests
    Sudden withdrawal may be inadvisable -see product information/SPC
    Withdraw gradually after long-term use
    Maintain treatment at the lowest effective dose
    Advise patient not to take St John's wort concurrently
    Dietary salt restriction may be necessary
    Advise patient to avoid exposure to measles
    Advise patient to seek urgent medical attention if exposed to measles
    Advise those on systemic corticosteroids to avoid chickenpox/H zoster
    Ensure patient receives Steroid Treatment/Steroid Emergency Card
    If exposed to chickenpox or Herpes zoster seek urgent medical attention

    Patients (or parents of children) without a definite history of chicken pox should be advised to avoid close personal contact with chicken pox or herpes zoster and seek urgent medical attention if exposed as chicken pox can prove fatal in immunocompromised patients. If exposed while on dexamethasone or within three months of previous use, passive immunisation with varicella/zoster immunoglobulin (VZIG) should be administered within 10 days of the exposure. If chicken pox occurs, treat urgently under specialist care. Do not stop dexamethasone therapy, an upwards dosage adjustment may be required.

    Treatment of elderly patients, particularly if long term, should be planned bearing in mind the more serious consequences of the common side effects of corticosteroids in old age, especially osteoporosis, diabetes, hypertension, hypokalaemia, susceptibility to infection and thinning of the skin. Close clinical supervision is required especially during long term therapy.

    Pregnancy and Lactation


    Use hydrocortisone with caution during pregnancy.

    The manufacturer notes that this medication should only be considered if the expected benefit to the mother is greater than any risk to the foetus. If corticosteroids are considered essential, patients with normal pregnancies may be treated as though they were in the non-gravid state.

    Hydrocortisone readily crosses the placenta. Schaefer and Briggs suggest there is inconclusive evidence that corticosteroids result in an increased incidence of congenital abnormalities however, a possible association with clefts cannot excluded. When administered for long periods or repeatedly during pregnancy, corticosteroids may increase the risk of intrauterine growth retardation. Hypoadrenalism may occur in the neonate following prenatal exposure but usually resolves spontaneously following birth and is rarely clinically important.

    Closely monitor patients with pre-eclampsia or fluid retention.


    Use hydrocortisone with caution during breastfeeding.

    The manufacturer notes that breastfed infants of mothers taking higher doses may have a degree of adrenal suppression but the benefits of breastfeeding are likely to outweigh any theoretical risk.

    Corticosteroids are excreted in small amounts in breast milk, and both Schaefer and Briggs report that there are no reports to date of the use of hydrocortisone during lactation. Schaefer recommends that prednisolone and methylprednisolone are the systemic corticosteroids of choice during breastfeeding.

    Side Effects

    Abdominal distension
    Acute pancreatitis
    Aggravation of schizophrenia
    Allergic dermatitis
    Angioneurotic oedema
    Aseptic necrosis
    Avascular osteonecrosis
    Behavioural disturbances
    Changes in mood
    Cognitive impairment
    Congestive cardiac failure
    Corneal thinning
    Cushingoid changes
    Emotional lability
    Exacerbation of diabetes
    Exacerbation of epilepsy
    Exacerbation of ophthalmic fungal disease
    Exacerbation of ophthalmic viral disease
    Fluid retention
    Gastro-intestinal perforation
    Hypersensitivity reactions
    Hypokalaemic alkalosis
    Increased appetite
    Increased calcium excretion
    Increased intra-ocular pressure
    Increased susceptibility and severity of infections
    Increased sweating
    Inflammatory bowel disease
    Irregular menstruation
    Muscle weakness
    Myocardial rupture following recent myocardial infarction
    Negative calcium balance
    Negative protein balance
    Oesophageal candidiasis
    Opportunistic infections
    Peptic ulceration with perforation and haemorrhage
    Posterior subcapsular cataracts
    Precipitation of diabetes
    Proximal myopathy
    Psychiatric disorders
    Raised intracranial pressure
    Recurrence of dormant tuberculosis
    Reduced carbohydrate tolerance
    Reduced muscle mass
    Scleral thinning
    Sleep disturbances
    Sodium retention
    Suicidal tendencies
    Suppression of growth in children and adolescents
    Suppression of reactions to skin tests
    Suppression of the hypothalamic-pituitary-adrenal axis
    Tendon rupture
    Thinning of skin
    Ulcerative oesophagitis
    Vertebral and long bone fractures
    Visual disturbances
    Weight gain
    Wound healing retarded

    Effects on Laboratory Tests

    False negative results may occur with the nitroblue tetrazolium test for bacterial infection.

    Withdrawal Symptoms and Signs

    Too rapid a reduction of corticosteroid dosage following prolonged treatment can lead to acute adrenal insufficiency, hypotension and death. A `withdrawal syndrome' may also occur including fever, myalgia, arthralgia, rhinitis, conjunctivitis, painful itchy skin nodules and weight loss.


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: April 2019

    Reference Sources

    Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 3rd edition (2015) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

    Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.

    Summary of Product Characteristics: Hydrocortisone 2.5mg/5mg/15mg tablets. Activcase Pharmaceuticals Ltd. Revised May 2021.

    Summary of Product Characteristics: Hydrocortisone 10mg tablets. Teva UK Limited. Revised June 2017.

    Summary of Product Characteristics: Hydrocortisone 20mg tablets. Teva UK Limited. Revised June 2017.

    Summary of Product Characteristics: Hydrocortisone 5mg Dispersible tablets. Morningside Healthcare Ltd. Revised December 2021.

    Summary of Product Characteristics: Hydrocortisone 10mg Dispersible tablets. Morningside Healthcare Ltd. Revised December 2021.

    Summary of Product Characteristics: Hydrocortisone 20mg Dispersible tablets. Morningside Healthcare Ltd. Revised December 2021.

    Summary of Product Characteristics: Hydventia 10mg tablets. Resolution Chemicals Ltd. Revised March 2019.

    Summary of Product Characteristics: Hydventia 20mg tablets. Resolution Chemicals Ltd. Revised March 2019.

    NICE Evidence Services Available at: Last accessed: 13 July 2022

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