1. About hydrocortisone tablets
Hydrocortisone tablets are a type of medicine known as a steroid (or corticosteroid). Corticosteroids are not the same as anabolic steroids.
Hydrocortisone tablets work as a hormone replacement for a natural hormone called cortisol.
You may take hydrocortisone tablets if your body does not make enough cortisol – for example if you have Addison's disease or if you've had your adrenal glands taken out.
They can also be prescribed for hypopituitarism, a rare condition affecting the pituitary gland.
Hydrocortisone tablets come as standard tablets, slow-release tablets and soluble tablets. These are only available on prescription.
Other types of hydrocortisone
There are different types of hydrocortisone, including skin treatments and injections.
2. Key facts
- The most common side effects of hydrocortisone tablets are feeling dizzy, headaches, swollen ankles and feeling weak or tired.
- Taking hydrocortisone tablets can affect your immune system so you’re more likely to get infections. Tell your doctor if you get an infection, such as coronavirus (COVID-19), or if you come into contact with anyone who has chickenpox, shingles or measles.
- Tell anyone who is giving you medical or dental treatment that you're taking hydrocortisone tablets. You may need a higher dose of hydrocortisone for a while. Your body will be unable to produce a hormone normally produced in stress situations such as being unwell or receiving dental treatment.
- Hydrocortisone tablets can cause extra side effects if you stop taking them suddenly. Do not stop taking the medicine if you've been taking it for more than a few weeks.
- If you take hydrocortisone tablets because you have been diagnosed with Addison’s disease or adrenal insufficiency, you will need to carry a steroid emergency card.
3. Who can and cannot take 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're 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've 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
4. How and when to take hydrocortisone tablets
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're taking and how to take them. Always follow the instructions that come with your medicine.
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'll 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’ll 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’ll 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're 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’ll 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.
What if I forget to take a tablet?
Try to remember to take your tablets every day. Regularly missing doses can make you feel unwell.
If you forget to take a dose, take it as soon as you remember. If you do not remember until the next dose is due, skip the missed dose.
Never take 2 doses to make up for a forgotten one.
If you often forget to take your tablets, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to remember your medicine.
Will the dose I take go up or down?
Your doctor may increase or decrease your dose of hydrocortisone during the first weeks or first month of your treatment until your health problem is stable.
You may need a bigger dose for a while if you are unwell with other health problems such as an infection, or if you need to have an operation.
You may need a short, very high dose of hydrocortisone if you have Addison's disease and your cortisol levels drop suddenly. This is a medical emergency called an adrenal crisis.
If you have been diagnosed with adrenal insufficiency you will need to carry a steroid emergency card with you. If you need emergency treatment, this will tell medical staff about your condition and how to treat you.
What if I take too much?
Taking too many hydrocortisone tablets as a one-off is unlikely to harm you. If you're worried, talk to your doctor or pharmacist.
If you take too much hydrocortisone for more than a few days, it could harm your health. Talk to your doctor as soon as possible.
5. Side effects
Like all medicines, hydrocortisone tablets can cause side effects although not everyone gets them.
Hydrocortisone is not a strong steroid so you're unlikely to get side effects. It's 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 don't go away:
- feeling dizzy, weak or tired
- muscle ache
- indigestion or feeling sick (nausea)
- swollen ankles
Serious side effects
Serious side effects are rare and happen in less than 1 in 1,000 people.
You're 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 aren't 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 thrombosis (DVT) 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're 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're worried about your child taking hydrocortisone tablets.
Serious allergic reaction
It's extremely rare to have an allergic reaction (anaphylaxis) to hydrocortisone tablets but if this happens to you, contact a doctor straight away.
Immediate action required: Call 999 or go to A&E now if:
- you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
- you're wheezing
- you get tightness in the chest or throat
- you have trouble breathing or talking
- your mouth, face, lips, tongue or throat start swelling
You could be having a serious allergic reaction and may need immediate treatment in hospital.
These are not all the side effects of hydrocortisone tablets. For a full list see the leaflet inside your medicine packet.
You can report any suspected side effect using the Yellow Card safety scheme.
6. 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're 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’s 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're 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 (osteoporosis)
- poorly controlled diabetes
- eyesight problems
- slower growth in children and teenagers
If you have to take hydrocortisone tablets for a long time, it's 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 (glaucoma) 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
7. Pregnancy and 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're taking hydrocortisone tablets for Addison's disease, it's important to carry on taking the medicine throughout pregnancy. Sometimes, your dose may need to increase and it's usual to receive high doses of hydrocortisone by injection during childbirth.
Hydrocortisone tablets and breastfeeding
You can take hydrocortisone tablets while you're breastfeeding. Hydrocortisone does get into breast milk, but in amounts that are usually too small to harm your baby.
If you’re 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
For safety, tell your doctor if you're trying to get pregnant, are already pregnant or if you're breastfeeding.
For more information about how hydrocortisone can affect you and your baby during pregnancy, read this leaflet on steroids on the Best Use of Medicines in Pregnancy (BUMPs) website.
8. Cautions with other medicines
There are many medicines that can affect the way hydrocortisone tablets work.
It's 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.
Important: Medicine safety
Tell your doctor or pharmacist if you're taking any other medicines, including herbal medicines, vitamins or supplements.
9. Common questions about hydrocortisone tablets
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.
How long will I take hydrocortisone tablets for?
This depends on why you’re taking them.
If you take hydrocortisone tablets because your body cannot make enough cortisol (if you have Addison’s disease, for example), you’ll usually need to take them for the rest of your life.
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.
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’re more likely to catch the flu, coronavirus (COVID-19), the common cold and chest infections. Tell your doctor if you get symptoms of an infection or test positive for COVID-19.
Keep away from people with an infectious disease, especially chickenpox, shingles or measles. If you've 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.
Can I have vaccinations?
If you need any vaccinations, mention to your nurse or doctor that you're taking a steroid.
It's possible that if you have a "live" vaccine when you are taking hydrocortisone tablets, your immune system might not be strong enough to handle it. This could lead to you getting an infection.
Live vaccines include:
- shingles vaccine
- BCG (tuberculosis) vaccine
- yellow fever vaccine
- MMR (measles, mumps and rubella) vaccine
- nasal spray flu vaccine
Inactive vaccinations, like the injected flu vaccine, are safe.
Do I need to carry a steroid card?
If you've been taking hydrocortisone tablets for longer than 3 weeks, or if you've been prescribed a high dose, your doctor or pharmacist will give you a blue steroid card. Carry this with you all the time.
The card is the size of a credit card so it fits into your wallet or purse. It gives advice on how you can reduce the risks of side effects. It also gives details of your doctor, how much hydrocortisone you take and how long your treatment will last for.
If you're having long-term treatment with hydrocortisone tablets and you do not have a blue steroid card, ask your doctor for one.
If you need any medical or dental treatment, show your steroid card to the doctor or dentist.
If you have been diagnosed with adrenal insufficiency you will also need to carry a steroid emergency card. If you need emergency treatment, this will tell medical staff about your condition and how to treat 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 combined pill or emergency contraception.
If you start taking the combined pill your dose of hydrocortisone may need adjusting.
Can I drink alcohol with it?
Yes, you can drink alcohol while taking hydrocortisone tablets.
However, if hydrocortisone tablets make you feel dizzy, it’s a good idea not to drink alcohol as it will make you feel worse.
Is there any food or drink I need to avoid?
Do not eat grapefruit or drink grapefruit juice while you’re 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:
These steroids are very similar to high dose (more than 100mg) hydrocortisone tablets. However, they're not usually used as replacement treatment, for example in Addison's disease, because they are too strong and can cause more side effects.