Hydrocortisone tablets for cortisol replacement (Plenadren)

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Hydrocortisone belongs to a class of medicines known as corticosteroids (more commonly called steroids).

Your pharmacist will give you a blue 'Steroid Treatment Card'. Carry this with you at all times.

If you need any medical treatment, make sure the person treating you knows that you are taking hydrocortisone. This is because your dose may need to be increased for a short while.

Type of medicineA corticosteroid medicine
Used forCortisol replacement treatment in people with Addison's disease or following surgical removal of the adrenal glands
Also calledPlenadren® (these are modified-release tablets)
Available asTablets and modified-release tablets

Hydrocortisone belongs to a group of medicines called corticosteroids. It is sometimes referred to simply as an oral steroid. It is used as a replacement treatment for people whose adrenal glands are not producing as much of the steroid hormones (such as cortisol) as they normally do. This can happen in a condition known as adrenal insufficiency, or Addison's disease. It also happens in people who have had surgery to remove their adrenal glands and who therefore no longer make their own natural steroid hormones. These hormones are vital for your body and if you do not have enough of them, you can become very unwell.

Hydrocortisone is usually prescribed alongside another replacement medicine called fludrocortisone. Fludrocortisone is a substitute medicine for one of the other vital hormones that are no longer being made in people with adrenal insufficiency.

Some medicines are not suitable for people with certain conditions, and sometimes a medicine can only be used if extra care is taken. For these reasons, before you start taking hydrocortisone it is important that your doctor knows:

  • If you have high blood pressure.
  • If you have had a heart attack, or if you have any other heart problems.
  • If you have any problems with the way your liver works, or if you have any problems with the way your kidneys work.
  • If you (or a close family member) have either sugar diabetes or an eye condition called glaucoma.
  • If you have any of the following conditions: an underactive thyroid, 'thinning' of the bones (osteoporosis), epilepsy, a condition causing muscle weakness (called myasthenia gravis), a stomach ulcer, or an inflammatory bowel disorder.
  • If you have ever had a mental health problem.
  • If you are pregnant or breast-feeding. (Oral steroids like hydrocortisone can be taken while you are expecting or breast-feeding; however, it is important that your doctor knows about the baby.)
  • If you have any kind of infection at the moment, or if you have ever had tuberculosis (TB).
  • If you have ever had an unwanted blood clot in an artery or a vein.
  • If you have recently had, or are about to have, any vaccinations.
  • If you are taking other medicines, including those available to buy without a prescription, herbal and complementary medicines.
  • If you have ever had an allergic reaction to a medicine, or if you have ever developed muscle pain after taking a steroid medicine.
  • Before starting the treatment, read the manufacturer's printed information leaflet from inside the pack and any additional information you are given by your doctor. These will give you more information about hydrocortisone and will also provide you with a full list of side-effects which you could experience from taking it.
  • Your doctor or pharmacist will tell you how many tablets to take and when to take them. This information will also be printed on the label of the packet of tablets to remind you about what was said to you. It is important that you take hydrocortisone exactly as your doctor tells you to. As a guide:
    • If you are taking immediate-release tablets (called simply 'Hydrocortisone tablets'), it is likely that you will be prescribed two or three doses to take each day. It is usual for your morning dose to be larger than the other doses. Take the tablets just after eating a meal, or alternatively with a snack.
    • If you have been prescribed a brand of tablet called Plenadren®, this is a tablet which releases hydrocortisone to your body throughout the day. It is usual to take one dose a day, 30 minutes before your breakfast. Swallow the tablet whole (this means do not break, crush, or chew it), with a drink of water. Do not drink grapefruit juice if you are taking Plenadren® because it will interfere with the way the tablets work.
  • Try to take your doses at the same time of day each day, as this will help you to remember to take hydrocortisone regularly. If you forget to take a dose, take it as soon as you remember (unless it is nearly time for your next dose, in which case leave out the missed dose). Do not take two doses together to make up for a forgotten dose.
  • Continue to take hydrocortisone tablets regularly each day - it is vital for your well-being. Hydrocortisone replacement treatment is almost always lifelong.
  • You will be given a 'Steroid Treatment Card' which says that you are on steroids and contains some important advice for you. It is important that you read this card and carry it with you at all times. It also contains details about your dose, how long you have been taking hydrocortisone and who prescribed it for you. Please make sure that this information is kept up to date. If you are due to have an operation or dental treatment, or if you are having any treatment for an injury, please tell the person carrying out the treatment that you are taking hydrocortisone and show them your treatment card.
  • Try to keep your regular appointments with your doctor. This is so your doctor can check on your progress. Your doctor will want you to have tests from time to time to make sure you remain free from some of the unwanted side-effects of treatment.
  • It is important that if you become ill you make an appointment to see your doctor straightaway. Also, if you come into contact with anyone who has measles, shingles or chickenpox (or anyone who suspects they might have them), you should contact your doctor for advice as soon as possible.
  • Make sure you get your next supply of tablets well in advance so that you never run out. People with Addison's disease are entitled to free prescriptions.
  • Some vaccines are not suitable for you while you are being treated with hydrocortisone. If you need any immunisations, make sure you mention that you are taking hydrocortisone.
  • If you buy any medicines 'over the counter', please check with a pharmacist that they are suitable for you to take alongside hydrocortisone.

Along with its useful effects, hydrocortisone can cause unwanted side-effects which your doctor will discuss with you. The benefits of taking hydrocortisone usually outweigh the side-effects; however, they can sometimes be troublesome. Although not everyone experiences side-effects, and some will improve as your body adjusts to the new medicine, speak with your doctor or pharmacist if you become concerned about any of the following:

Common hydrocortisone side-effectsWhat can I do if I experience this?
Fluid retention causing swollen feet and anklesWhenever possible, sit with your feet up
Tummy (abdominal) pain, indigestion, feeling sickEat little and often. Stick to simple or bland foods. If you are sick and there is blood present, you must speak with your doctor straightaway
Muscle weakness or feeling tiredIf this happens, do not drive or use tools or machines until you feel more awake
Mood or behavioural changes, especially at the beginning of treatmentIf you become confused, irritable or start having worrying thoughts about harming yourself, speak with your doctor straightaway
Difficulties sleeping, headache, increased weight, and irregular periods in womenIf any of these become troublesome, speak with your doctor
Increased risk of getting an infectionIf you become ill, make an appointment to see your doctor straightaway
Long-term treatment with hydrocortisone may cause other unwanted effects

If you have any symptoms which cause you concern, you should arrange to see your doctor for advice

For more information about side-effects which are possible when hydrocortisone is taken long-term, please see the separate leaflet called Oral Steroids.

  • Keep all medicines out of the reach and sight of children.
  • Store in a cool, dry place, away from direct heat and light.

Never take more than the prescribed dose. If you suspect that you or someone else might have taken an overdose of this medicine, go to the accident and emergency department of your local hospital. Take the container with you, even if it is empty.

This medicine is for you. Never give it to other people even if their condition appears to be the same as yours.

Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you.

If you have any questions about this medicine ask your pharmacist.

Further reading & references

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.

Original Author:
Helen Allen
Current Version:
Peer Reviewer:
Dr Adrian Bonsall
Document ID:
619 (v26)
Last Checked:
21/01/2016
Next Review:
20/01/2019
The Information Standard - certified member

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