Hydrocortisone tablets

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 ibuprofen.

There's not enough information to say that complementary medicines and herbal remedies are safe to take with hydrocortisone. They're not tested in the same way as pharmacy and prescription medicines. They're generally not tested for the effect they have on other medicines.

Tell your doctor or pharmacist if you're taking any other medicines, including herbal remedies, vitamins or supplements.

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 higher doses of hydrocortisone by injection during childbirth.

If your doctor or midwife says your baby is healthy, you can take hydrocortisone tablets while you're breastfeeding.

Breast milk naturally contains hydrocortisone, but when you take hydrocortisone tablets, it's not known how much of it passes into breast milk. However, it's thought to be a small amount, and is unlikely to cause any side effects in your baby.

Your baby may need extra monitoring if you're taking a higher dose, or if you need to take it for a long time.

If you're taking hydrocortisone tablets for Addison's disease, it's important to carry on taking the medicine to keep you well. Breastfeeding will also benefit both you and your baby.

Talk to your health visitor, midwife, doctor or pharmacist or call 111 as soon as possible if you have any concerns about your baby. This includes if they:

• are not feeding as well as usual
• are not putting on weight as you would expect
• are being sick (vomiting) or having diarrhoea
• seem irritable or more tired than usual
• have skin reactions, such as rashes

There's no evidence that hydrocortisone tablets affect fertility in either men or women.

Tell your doctor if you're:

• trying to get pregnant
• pregnant
• breastfeeding

These common side effects of hydrocortisone happen in more than 1 in 100 people. There are things you can do to help cope with them:

If hydrocortisone makes 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, cycle, or use tools or machinery if you're feeling tired.

Do not drink alcohol as it will make you feel worse.

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 the headaches are severe or last longer than a week.

If you get unusual muscle ache that's not from exercise or other physical activity, talk to your doctor. You may need a blood test to find the cause.

Try taking your tablets with food. It may also help to 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.

Drink lots of fluids, such as 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.

If you take the combined contraceptive pill or the progestogen-only pill and you have severe diarrhoea for more than 24 hours, your contraception may not protect you from pregnancy. Check the pill packet for advice.

Get plenty of rest and raise your legs when you're sitting down. Try not to stand for a long time.

Speak to a doctor or pharmacist if the advice on how to cope does not help and a side effect is still bothering you or does not go away.

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.

Speak to a doctor if you get a puffy, rounded face and weight gain in your upper back or belly. This happens gradually and can be a sign of Cushing's syndrome.

Call a doctor or call 111 straight away if you:

• have a high temperature, chills, a very sore throat, ear or sinus pain, a cough, coughing up more mucus (phlegm) or a change in colour of your mucus, 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 have breath that smells like fruit – these can be signs of high blood sugar (hyperglycaemia)
• have a very upset stomach or vomiting, very bad dizziness or fainting, muscle weakness, mood changes, loss of appetite and weight loss or are feeling very tired – these can be signs of adrenal gland problems
• have muscle pain, weakness or cramps, or your heartbeats suddenly become more noticeable (heart palpitations) – 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
• get breathless
• have swelling in your arms or legs
• have changes in your eyesight
• have any bruising or bleeding that is not normal
• have red or black poo

• you have black or dark brown vomit or you're vomiting blood

Find your nearest A&E

Do not drive to A&E. Ask someone to drive you or call 999 and ask for an ambulance.

Bring all the medicines you take with you.

You may notice mood changes and mental health problems while taking hydrocortisone.

Talk to your doctor or call 111 if:

• you're feeling high, or have moods that go up and down
• you're feeling depressed
• you're feeling anxious
• you have problems sleeping
• you have difficulty in thinking, or are feeling confused and forgetting things
• you're feeling, seeing or hearing things that do not exist (hallucinations)
• you notice changes in the way you usually behave

The higher the dose, the more intense the mood changes can be.

• you have thoughts about harming yourself or ending your life

Find your nearest A&E

Do not drive to A&E. Ask someone to drive you or call 999 and ask for an ambulance.

Bring all the medicines you take with you.

It happens rarely, but it's possible to have a serious allergic reaction (anaphylaxis) to hydrocortisone tablets.

Call 999 now if:

• your lips, mouth, throat or tongue suddenly become swollen
• you're breathing very fast or struggling to breathe (you may become very wheezy or feel like you're choking or gasping for air)
• your throat feels tight or you're struggling to swallow
• your skin, tongue or lips turn blue, grey or pale (if you have black or brown skin, this may be easier to see on the palms of your hands or soles of your feet)
• you suddenly become very confused, drowsy or dizzy
• someone faints and cannot be woken up
• a child is limp, floppy or not responding like they normally do (their head may fall to the side, backwards or forwards, or they may find it difficult to lift their head or focus on your face)

You or the person who's unwell may also have a rash that's swollen, raised, itchy, blistered or peeling.

These can be signs of a serious allergic reaction and may need immediate treatment in hospital.

You may take hydrocortisone tablets for a long time, even for the rest of your life. Over time, 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 a good idea to take the following steps to stay as healthy as possible.

Exercise regularly 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.

Long-term side effects in children and teenagers

Hydrocortisone can cause slower growth in children and teenagers if they take it for a long time.

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.

These are not all the side effects of hydrocortisone tablets. For a full list see the leaflet inside your medicine packet.

Hydrocortisone tablets come as:

• standard tablets
• slow-release tablets
• slow-release capsules
• soluble tablets that you dissolve in water

They come in a range of strengths from 2.5mg to 20mg. Make sure you understand how to take the dose you've been prescribed.

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.

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're unwell with other health problems such as an infection, or if you need to have an operation or dental treatment.

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've been diagnosed with adrenal insufficiency you'll need to carry a red steroid emergency card with you (for adults) or an adrenal insufficiency card if the treatment is for a child. If you need emergency treatment, this will tell medical staff about your condition and how to treat you.

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 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

Slow-release (also known as modified release) 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, about half an hour before breakfast. Swallow them whole. Do not break or crush the tablets, as they will not work properly.

How to take soluble tablets

Dissolve soluble hydrocortisone tablets in at least 50ml of water then swallow the liquid immediately. Make sure you swallow all 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.

How long you take hydrocortisone depends on why you're taking it.

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.

Try to remember to take your tablets every day. Frequently missing doses can make you feel unwell.

If you forget to take a dose of hydrocortisone, take it as soon as you remember, unless it's nearly time for your next dose. In this case, skip the missed dose and take your next dose at the usual time.

Never take 2 doses at the same time. Never have an extra dose to make up for a forgotten one.

If you forget doses often, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicines.

Taking 1 or 2 extra hydrocortisone tablets 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.

• you take more than your prescribed dose of hydrocortisone and you have new symptoms, such as stomach pain or difficulty sleeping

Get help from 111 online or call 111. Call 111 if you need advice for a child under 5 years old

If you need to go to A&E, do not drive. Ask someone to drive you or call 999 and ask for an ambulance.

Bring the hydrocortisone packet or leaflet inside it, any remaining medicine, and any other medicines you take.

Do not stop taking hydrocortisone suddenly. It may cause your symptoms to come back.

You may also get 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. You'll need to reduce your dose gradually.

Most adults and children can take hydrocortisone tablets.

Hydrocortisone tablets are not suitable for some people. To make sure they're safe for you, tell your doctor 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
• have recently had, or are about to have, any vaccinations
• have ever had liver problems
• have ever had mental health problems, or a close family member has had mental health problems
• have any unhealed wounds
• have heart failure, or have recently had a heart attack
• have high blood pressure (hypertension)
• have diabetes
• have epilepsy
• have glaucoma
• have an underactive thyroid
• have osteoporosis (thinning bones)
• have ever had a stomach ulcer
• are pregnant, trying to get pregnant or breastfeeding

Hydrocortisone tablets are a type of medicine known as a steroid (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.