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.

It can also be prescribed for hypopituitarism, a rare condition affecting the pituitary gland.

Hydrocortisone tablets are only available on prescription.

Other types of hydrocortisone

Hydrocortisone comes in different ways, including skin creams, injections and foam.

Find out more about other ways you can use hydrocortisone to treat different health problems.

• 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.

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
• diabetes
• epilepsy
• 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.

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 Plenadren.

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.

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'.

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.

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:

• dizziness
• headaches
• feeling weak or tired
• muscle ache
• stomach problems, feeling sick (nausea)
• diarrhoea
• 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:

• breathless
• 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.

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

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.

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.

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.