1. About hydrocortisone tablets
Hydrocortisone tablets are a type of medicine known as a corticosteroid or 'steroid'. Corticosteroids are not the same as anabolic steroids.
Hydrocortisone tablets work as a hormone replacement for a natural 'steroid' hormone called cortisol.
You may take hydrocortisone tablets if your body doesn't make enough cortisol - for example if you have Addison's disease - or if you've had your adrenal glands taken out in an operation.
Hydrocortisone tablets are only available on prescription.
Other types of hydrocortisone
Hydrocortisone comes in different ways, including skin creams, injections and foam.
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 mean you're more likely to get infections. Tell your doctor if you come into contact with infectious illnesses like chickenpox, shingles or measles. These infections can make you very ill.
- 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.
- 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.
- Hydrocortisone tablets are also called by the brand name Plenadren.
3. Who can and can't have hydrocortisone tablets
Hydrocortisone tablets can be taken by adults and children.
Hydrocortisone tablets aren't suitable for some people. Tell your doctor before starting the medicine if you have:
- had an allergic reaction to hydrocortisone or any other medicine in the past
- an infection (including an eye infection)
- recently been in contact with someone with shingles, chickenpox or measles (unless you're sure you are immune to these infections)
- recently had, or are about to have, any vaccinations
- had liver problems in the past
- had mental health problems in the past (either you or close family members)
- any unhealed wounds
- heart failure or you've recently had a heart attack
- high blood pressure
- an eye condition called glaucoma
- an underactive thyroid
- osteoporosis (thinning bones)
- a stomach ulcer
Also, tell your doctor if you're trying to get pregnant, are already pregnant or if you're breastfeeding.
4. How and when to take them
It's important to take hydrocortisone tablets as your doctor has asked you to.
Try to take them at the same time every day.
How much to take
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.
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 them
Most hydrocortisone tablets release the medicine into your body as soon as you swallow them. It's usual to take them 2 or 3 times a day. Take the tablets with or just after a snack or meal so they don't upset your stomach.
Slow release tablets
Some hydrocortisone tablets are slow release (also known as modified release). These tablets release the medicine into your body slowly throughout the day. It's usual to take them once a day. Slow release hydrocortisone tablets also come with the brand name Plenadrin.
If you're taking slow release hydrocortisone tablets swallow them whole in the morning - about half an hour before breakfast. Do not break or crush the tablets or they won't work.
It's important that you do not eat grapefruit or drink grapefruit juice while you're on slow release hydrocortisone tablets. Grapefruit can change the way hydrocortisone works and increases the risk of side effects.
Your pharmacist or doctor can tell you which type of hydrocortisone tablet you're taking and how to take them.
What if I forget to take a tablet?
Try to remember to take your tablets every day. Missing doses can make you feel unwell.
If you forget to take a dose, take it as soon as you remember. If you don't remember until the next dose is due, skip the missed dose.
Never take a double dose of hydrocortisone tablets 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 at the start 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.
What if I take too much?
Accidentally taking too many hydrocortisone tablets only once 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.
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 isn't a strong steroid (it's 4 times weaker than another widely used steroid, prednisolone) so you're unlikely to get side effects.
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 weak or tired
- muscle ache
- stomach problems, 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.
Tell your doctor straight away if you get:
- 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
- a fever (temperature above 38C), 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 won't heal - these can be signs of an infection
- 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 high blood sugar
- weight gain in your upper back or belly, a moon face, a very bad headache and slow wound healing - these can be signs of Cushing's syndrome
- 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
- muscle pain or weakness, muscle cramps, or a heartbeat that doesn't feel normal - these can be signs of low potassium levels
- severe stomach pain, severe back pain, or a severe upset stomach or vomiting - these can be signs of pancreas problems
You should also call a doctor straight away if you get:
- swelling in your arms or legs
- changes in your eyesight
- any bruising or bleeding that isn't normal
- black poo
- black or dark brown vomit or vomiting blood
Side effects can happen at different times during treatment. Stomach upset 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 watch their growth carefully while they are having hydrocortisone tablets. That way they will be able to see quickly if your child is growing more slowly and can change their treatment if necessary.
Talk to your doctor if you're worried about your child taking hydrocortisone tablets.
Serious allergic reaction
In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to hydrocortisone tablets.
Urgent advice: Contact a doctor straight away 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
These are warning signs of a serious allergic reaction. A serious allergic reaction is an emergency.
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 to the UK safety scheme.
6. How to cope with side effects
What to do about:
- feeling dizzy - if you feel dizzy, stop what you're doing and sit or lie down until you feel better
- 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.
- feeling weak or tired - make sure that you get plenty of rest. Do not drive or use tools or machinery if you're feeling tired. Do not drink alcohol as it will make you feel worse.
- muscle ache - if you get unusual muscle ache, which isn't from exercise or hard work, talk to your doctor. You may need a blood test to find the cause.
- stomach problems, feeling sick (nausea) - try taking your tablets with food. It may also help if you avoid rich or spicy food while you're taking hydrocortisone tablets. If it carries on or you get severe indigestion or stomach pain, tell your doctor. They may be able to prescribe an extra medicine to protect your stomach
- diarrhoea - drink plenty of water or other fluids 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 the 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 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 are generally thought to be safe to take in pregnancy and while breastfeeding.
If you're taking hydrocortisone tablets for Addison's disease, it's important to carry on taking the medicine throughout pregnancy. Sometimes, the dose may need to increase in pregnancy and it's usual to receive high doses of hydrocortisone by injection during childbirth.
If you're on a high dose of hydrocortisone tablets, your newborn baby may need to be monitored for signs of side effects.
Hydrocortisone tablets and breastfeeding
You can take hydrocortisone tablets while you're breastfeeding. Hydrocortisone gets into breast milk, but in amounts that are too small to harm the baby.
For safety, tell your doctor if you're trying to get pregnant, are already pregnant or if you're breastfeeding.
8. Cautions with other medicines
There are many medicines that interfere with the way hydrocortisone tablets work.
It's very important to check with your doctor or pharmacist that a medicine is safe to mix with hydrocortisone tablets before you start taking it. This includes prescription medicines and ones that you buy over the counter like aspirin, paracetamol and ibuprofen. It also includes herbal remedies and supplements.
Tell your doctor or pharmacist before stopping or starting any other medicines and before taking any herbal remedies, vitamins or supplements.
9. Common questions
How do hydrocortisone tablets work?
Hydrocortisone tablets mimic the effects of hormones that your body naturally makes in your adrenal glands. The adrenal glands sit on top of your kidneys.
If your adrenal glands aren't making enough natural hormone, as in Addison's disease, taking hydrocortisone tablets will bring your hormone levels up to normal.
When will I feel better?
This will vary depending on your health problem. Ask your doctor what to expect.
How long will I take hydrocortisone tablets for?
This varies depending on your health problem.
If you take hydrocortisone tablets as hormone replacement, the treatment is almost always 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 can also get potentially dangerous withdrawal symptoms including:
- severe tiredness
- weakness and feeling unwell
- body aches including stomach ache
- joint and muscle pain
Your doctor will probably want to reduce your dose gradually over several weeks 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?
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 the healthcare professional 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.
If you need any vaccinations, check with the nurse or doctor that they are safe for you.
Do I need a blue 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 steroid card. Carry this with you all the time.
The card is usually blue and 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 don't 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.
Will it affect my fertility?
Hydrocortisone tablets have no effect on the fertility of men or women.
Can I drink alcohol with it?
Yes, you can drink alcohol while taking hydrocortisone tablets.
Is there any food or drink I need to avoid?
Do not eat liquorice while you're taking hydrocortisone tablets. It can increase the amount of hydrocortisone in your body and also increase the risk of low potassium.
Also, if you're taking slow release hydrocortisone tablets (Plenadrin), do not eat grapefruit or drink grapefruit juice. 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.