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6.3.1 Replacement therapy


Formulary choices

Replacement therapy

(Mineralocorticoid) – Fludrocortisone tablets 100 micrograms

(Glucocorticoid) –Hydrocortisone tablets 10mg

Prescribing Notes

  • In Addison’s disease (primary adrenal failure) hydrocortisone (glucocorticoid) and fludrocortisone (mineralocorticoid) are given in combination.
  • Addison’s Disease Self-Help Group supply patient leaflets with clear instructions and pictures on how to administer intramuscular hydrocortisone in an emergency.
  • In secondary adrenal failure (hypopituitarism) hydrocortisone is given alone as a mineralocorticoid is not usually required.
  • Patients deficient in glucocorticoids do not respond adequately to stress and should be advised to double the replacement dose of hydrocortisone for several days if significantly unwell. They should all be encouraged to wear a Medi-Alert bracelet. More serious illnesses or gastro-intestinal disturbances necessitate prompt parenteral hydrocortisone.
  • A Steroid Emergency Card for Northern Ireland has been developed in response to a National Patient Safety Alert issued in August 2020. The alert highlights the dangers associated with adrenal insufficiency for patients taking corticosteroid medication and recommends that all eligible patients prescribed (or initiated on) steroids are assessed and where necessary issued with a Steroid Emergency Card. Community pharmacies and GP practices can order these from

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