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6.3.1 Replacement therapy

Formulary choices

(Mineralocorticoid) –
Fludrocortisone tablets 100 micrograms

Usual dose 50-300 micrograms daily

(Glucocorticoid) –
Hydrocortisone tablets 10mg, 20mg

15-30mg daily in divided doses

Prescribing Notes

  • In Addison’s disease (primary adrenal failure), hydrocortisone (glucocorticoid) and fludrocortisone (mineralocorticoid) are given in combination.
  • In acute adrenocortical insufficiency, intravenous hydrocortisone sodium succinate 100mg is given every 6-8 hours in sodium chloride intravenous infusion 0.9%.
  • 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 the National Patient Safety Alert that was 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