Patient leaflet - Hydrocortisone 20 mg tablets
What Hydrocortisone is and what it is used for
All patients taking hydrocortisone tablets for more than a few weeks should carry a steroid card, which is available from your doctor or pharmacist. This card shows the details of the medicine you are taking. Always keep it with you and show it to any doctor or nurse treating you. 1
In particular do not take this medicine and tell your doctor or pharmacist if you are taking any of the following:
Hydrocortisone tablets contain a medicine called hydrocortisone. Hydrocortisone belongs to a group of medicines called steroids. Their full name is corticosteroids. These corticosteroids occur naturally in the body and help to maintain health and well-being. Boosting your body with extra corticosteroid (such as hydrocortisone) is an effective way to treat various illnesses involving inflammation in the body.
- phenytoin, carbamazepine and barbiturates (antiepileptics)
- rifampicin and rifabutin (antitubercular drugs)
- herbal medicines containing St. John’s wort (Hypericum perforatum)
- efavirenz and nevirapine (HIV medicines)
- antifungal medicines (ketoconazole, itraconazole, posaconazole, voriconazole, amphotericin B)
Hydrocortisone reduces this inflammation, which could otherwise go on making your condition worse. You must take this medicine regularly to get maximum benefit from it.
- erythromycin, telithromycin, clarithromycin, fluoroquinolones (antibiotics)
- oestrogen products and oral contraceptives
- antihypertensive medication
- medicines that thin the blood (anticoagulants), e.g. warfarin
Hydrocortisone tablets are used for:
children and adolescents to replace hydrocortisone because part of the adrenal gland is not working properly
- acetyl salicylic acid (aspirin)
- medicines used to treat diabetes
- anticholinesterases (e.g. pyridostigmine)
emergency treatment of severe asthma, drug hypersensitivity reactions, serum sickness (hypersensitivity reaction to proteins), localised swelling of the skin and/or mucous membranes (angioedema) and life-threatening allergic reactions (anaphylaxis).
- “water tablets” (diuretics)
- cardiac glycosides (treatment of heart failure), e.g. digoxin
- theophylline and beta2 sympathomimetics e.g. bambuterol, fenoterol, formoterol, ritodrine, salmeterol, salbutamol, terbutaline (used to treat asthma or other breathing problems)
What you need to know before you take Hydrocortisone
- anti-inflammatory analgesics (i.e. NSAIDs), e.g. ibuprofen, diclofenac or naproxen
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- somatropin (growth hormone)
- mifepristone (termination of pregnancy)
Do not take Hydrocortisone if you:
- vaccines. Corticosteroids may reduce efficacy of vaccines and increase the risk of neurological complications. Vaccines containing live, attenuated viruses or bacteria should be avoided altogether (see also section ‘Do not take Hydrocortisone’).
- are allergic to hydrocortisone or any of the other ingredients of this medicine (listed in section 6)
have tuberculosis or any other acute or chronic bacterial, fungal, viral or parasitic infections without appropriate antimicrobial drug therapy.
Some medicines may increase the effects of Hydrocortisone and your doctor may wish to monitor you carefully if you are taking these medicines (including some medicines for HIV: ritonavir, cobicistat).
High doses of corticosteroid may weaken your immune system. If this is the case, you must not be given vaccines containing live, attenuated viruses or bacteria as this might cause you an infection.
Hydrocortisone with food and drink
Before you take Hydrocortisone tablets
Hydrocortisone tablets can be taken with or without food.
Check with your doctor first if
you have ever had severe depression or manic depression (bipolar disorder). This includes having had depression before or while taking steroid medicines like hydrocortisone
Avoid drinking grapefruit juice during treatment as this might raise blood hydrocortisone levels.
Pregnancy, breast-feeding and fertility
any of your close family has had these illnesses.
If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.
If either of these applies to you, talk to a doctor before taking hydrocortisone.
Warnings and precautions
Pregnancy
Talk to your doctor or pharmacist before taking Hydrocortisone if you have or have had:
Hydrocortisone crosses the placenta. Besides replacement therapy, other corticosteroid therapy affecting the whole body should be regarded with caution during pregnancy. If you have received hydrocortisone treatment during pregnancy, the newborn baby should be monitored for inadequate hormone production by the adrenal gland.
- diabetes
- stomach or bowel ulcers
- osteoporosis (thinning of the bones)
- glaucoma – increased eye pressure
- heart problems (heart failure, recent heart attack)
high blood pressure
Breast-feeding
kidney or liver problems
Hydrocortisone is excreted in breast milk. Prolonged use of high doses of hydrocortisone during breast-feeding may weaken the infant’s ability to produce adequate amounts of steroid hormones.
- epilepsy
- inflammatory bowel diseases
- recently undergone a surgery in which an artificial opening between two normally separate spaces is created (anastomosis)
mood disorder
Fertility
thyroid problems
Corticosteroids may affect fertility as they may impair semen quality and cause loss of menstrual periods (amenorrhoea).
- myasthenia gravis (a condition affecting the muscles) and are taking anticholinesterases
chickenpox, measles or shingles. Avoid contact with people who are infected or have chickenpox, measles or shingles. If you are exposed to these diseases, contact a doctor straight away
Driving and using machines
Hydrocortisone does not usually impair the ability to drive or use machines. However, in some patients steroids may cause a feeling of movement, even while you are still and this can cause you to feel dizzy (vertigo). Changes in your eyesight or muscle weakness may also happen. If you are affected you should not drive or operate machinery.
- an infection caused by gut worms (e.g. amebiasis or strongyloidiasis). Hydrocortisone may activate or exacerbate such infections
- tuberculosis
herpes simplex infection in the eye. Hydrocortisone may activate or exacerbate fungal and viral eye infections
Information you should carry while you are taking Hydrocortisone
- muscle weakness after taking steroids in the past.
Contact your doctor if you develop any new infections while taking Hydrocortisone tablets. Taking hydrocortisone for a long time and at high doses may increase the chances of getting infections as hydrocortisone treatment can hide the usual symptoms of infection.
If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicine.
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How to take Hydrocortisone
Always take this medicine exactly as your doctor or pharmacist has told you. Check with your doctor or pharmacist if you are not sure.
Dosage and duration of treatment will depend on your illness.
In replacement therapy, the first dose in the morning is usually higher than the other doses, to simulate the normal rhythm of corticosteroid secretion during a day.
The tablet can be divided into equal doses.
Swallow the tablets with some liquid, with or without meals.
If you feel that the effect of the treatment is too strong or too weak, discuss this with your doctor.
Adults for emergency treatment
- Take 60-80 mg (6-8 of the 10 mg or 3-4 of the 20 mg tablets) every 4-6 hours for 24 hours. Then gradually reduce the dose as instructed by your doctor over several days.
Children and adolescents (aged 1 month to 18 years) for replacement therapy
Hydrocortisone tablets can be used in children aged from 1 month to 18 years where the doses of 10 mg and 20 mg and tablet formulation are considered appropriate.
- Inherently increased number of adrenal gland cells (congenital adrenal hyperplasia): The doctor will determine an individual dose based on the patient’s height and weight. The daily dose is divided into 3 doses. The doctor will adjust the dose according to the patient’s response to the treatment.
- Inadequate production of steroid hormones by the adrenal gland (adrenal insufficiency): The doctor will determine an individual dose based on the patient’s height and weight. The daily dose is divided into 3 doses. The doctor will adjust the dose according to the patient’s response to the treatment: higher doses may be needed.
Use in special patient groups or special situations
Your doctor may want to change the dose or monitor your treatment carefully if you are elderly, have liver problems, problems with the adrenal glands, stress, injuries, infections or if surgery is planned for you.
If you take more Hydrocortisone than you should
Contact your doctor or emergency unit if you have taken more Hydrocortisone than your doctor has prescribed.
If a large overdose has been taken, activated charcoal can be administered as first aid. However a doctor must be contacted as soon as possible for other treatment.
If you forget to take Hydrocortisone
Skip the missed dose and then take the next dose as normal. Do not take a double dose to make up for a forgotten dose.
If you stop taking Hydrocortisone
You may only discontinue or stop the treatment following consultation with your doctor. It is dangerous to reduce your dose of
Hydrocortisone tablets too quickly. Your doctor will gradually reduce your dose.
Stopping Hydrocortisone tablets may leave you without enough steroid hormones in your body. If you suddenly stop taking Hydrocortisone, you may experience withdrawal symptoms like pains in muscles or joints, fever, weakness, feeling sick, raised pressure within the skull and low blood pressure.
If you have any further questions on the use of this medicine, ask your doctor or pharmacist.
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Possible side effects
Like all medicines, this medicine can cause side effects, although not everybody gets them.
Side effects may be stronger in elderly patients and in children.
People taking hydrocortisone to replace similar naturally occurring hormones, should be less likely to get side effects than people taking it for other illnesses. Your doctor will want to see you now and then to look out for these effects. Treatment with this medicine may sometimes cause serious side effects. Tell your doctor straight away if you notice any of these problems or if you think you are at increased risk of infection (e.g. you have been in contact with someone who has an infection):
- a possibly life-threatening allergic reaction which causes e.g. skin rash, swelling of the face or wheezing
- irregular or very fast or slow pulse, faintness
- in children, headaches with vomiting, listlessness and drowsiness. These are symptoms of pseudotumour cerebri that can raise pressure within the skull and usually occur after treatment is stopped
- burst or bleeding gut ulcers (indicated by stomach pain, especially if it seems to spread to your back, bleeding from the back passage, black stools or blood in your vomit)
- acute inflammation of the pancreas (abdominal pain, possibly accompanied by shock, i.e. low blood pressure with decreased output of urine and often loss of consciousness)
- a blood clot in a vein (thrombosis) in your leg, symptoms of which are a swollen, red, hot, tender muscle
- heart failure – problems with the pumping of your heart indicated by swollen ankles, chest pain, difficulty in breathing and palpitations or irregular beating of the heart, irregular or very fast or slow pulse; hypertension (high blood pressure, indicated by headaches or generally feeling unwell).
Serious effects: tell a doctor straight away
Steroids including hydrocortisone can cause serious mental health problems. These are common in both adults and children. They can affect about 5 in every 100 people taking medicines like hydrocortisone:
- feeling depressed, including thinking about suicide
- feeling high (mania) or moods that go up and down
- feeling anxious, having problems sleeping, difficulty in thinking or being confused and losing your memory
feeling, seeing or hearing things which do not exist. Having strange and frightening thoughts, changing how you act or having feelings of being alone.
If you notice any of these problems talk to a doctor straight away.
Other side effects reported with hydrocortisone:
Common: may affect up to 1 in 10 people
- high blood pressure
- increased susceptibility to infections, masked infection symptoms
- inadequate hormone secretion by the pituitary gland (adrenocorticotropin hormone, ACTH) and by the adrenal gland (cortisol) in long-term use
- round or moon-shaped face
- worsening or development of diabetes
- cramps and spasms due to the loss of potassium salts from your body. In rare cases, loss of potassium can lead to palpitations (an uneven beating of your heart that you become aware of)
- accumulation of sodium in the body
- thin or delicate skin, slow healing of cuts and wounds, scarring, red or purple spots, acne, stretch marks, bruising
- muscle weakness or wasting, osteoporosis (brittle bones - bones that break easily).
Uncommon: may affect up to 1 in 100 people
- increase in appetite
- mood changes, depression, mania (feeling high), psychoses (feeling, seeing or hearing things which do not exist, having strange and frightening thoughts, changing how you act or having feelings of being alone), sleeplessness
- changes in vision as a result of cataracts or glaucoma (increased eye pressure).
Rare: may affect up to 1 in 1,000 people
- convulsions
- breakdown of bone due to poor circulation of blood, torn muscle tendons (pain and/or swelling).
Not known: the frequency of side effects cannot be estimated from the available data
- increase in the number of white blood cells
- poor response to stress (like injury, surgery or illness)
- increase in blood sugar levels
- loss of potassium and calcium, loss of nitrogen due to breakdown of body protein stores, fluid retention
- mood disorders, behavioural problems, feeling irritated or anxious, having problems sleeping, difficulty in thinking (including being confused and losing your memory)
- vertigo, headache
- blurred vision, thinning of the surface of the eyes, bulging eyes
- rupture of the heart muscle following recent heart attack
- hiccups
- ulcerative inflammation of the gullet, bloating, indigestion, thrush in the gullet
- small round spots in the skin or mucous membranes, redness of the skin, permanent dilation of small blood vessels in the skin or mucous membranes, increased sweating, allergic skin inflammation, hives, increased hair on the body and face in women
- muscle disease caused by steroids, broken bones or fractures
- irregular or no periods in women
- weight gain, feeling sick, feeling of bodily discomfort and tiredness
thickening of the heart muscle (hypertrophic cardiomyopathy) in prematurely born babies
- weight increased.
Reporting of side effects
If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme Website: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.
By reporting side effects you can help provide more information on the safety of this medicine.
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How to store Hydrocortisone
Keep this medicine out of the sight and reach of children.
Do not use this medicine after the expiry date which is stated on the carton and blister after EXP. The expiry date refers to the last day of that month.
Do not store above 25°C. Store in the original package in order to protect from light.
Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment.
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Contents of the pack and other information
What Hydrocortisone tablets contains
- The active substance is hydrocortisone.
- The other ingredients are lactose monohydrate, maize starch, povidone K30, colloidal anhydrous silica and magnesium stearate.
What Hydrocortisone tablets looks like and contents of the pack
The 10 mg tablets are white, oval shaped tablets, with engraved “H10” on one side and bisect breakline on the other.
The 20 mg tablets are white, oval shaped tablets, with engraved “H20” on one side and bisect breakline on the other.
Hydrocortisone is available in blister packs of 30 and 100 tablets.
Not all pack sizes may be marketed.
Marketing Authorisation Holder
TEVA UK Limited, Eastbourne, BN22 9AG, UK
Manufacturer
TEVA Gyógyszergyár Zrt., Pallagi út 13, Debrecen, 4042, Hungary
This leaflet was last revised in August 2020
PL 00289/2035
PL 00289/2036
EAS1077c