Medication and Adrenal Insufficiency FAQs

Tapering

Question: If I have been updosing whilst following the Sick Day Rules, Surgical Guidelines or because I am on antibiotics, do I go straight back down to my usual replacement dose, or do I need to 'Taper' back down gradually?

Answer: This is dependent on the individual and how you feel.

If you are feeling back to your 'normal' self and have only increased your dose for a short amount of time, you can reduce straight back to your normal replacement dose.

If you have had a more severe or long-term illness, you may feel better gradually and therefore you can gradually taper down your increased dose of steroids, in line with feeling better, until you are back at your usual steroid replacement dosage. In these cases you shouldn't suddenly reduce to your normal dose in one go.

Everyone is different and you need to listen to your body. If you start to feel unwell when you lower your dose, updose again immediately and seek medical advice from your GP or endocrinology team

Visit our Sick Day Rules page for more support

Read our tapering guidance on page 15 in our Managing Addison's disease or adrenal insufficiency booklet

Antibiotics

Question: If I am prescribed a course of antibiotics, do I need to updose for the full length of the course? Am I updosing because of the infection or because of the antibiotics themselves?

Answer: We asked our Clinical Advisory Panel for more information and were given the clarification below:

1. The most serious one to get right is if you have TB and need to take rifampicin (often a 6-month course), then you will need to increase your hydrocortisone in line with Sick Day Rules for the full 6 months as the antibiotic accelerates the degradation of hydrocortisone.

2. For other antibiotics, the logic is that if you are sick enough to need an antibiotic, then you are sick enough to need to increase your hydrocortisone to ’sick day rules’ levels. For a regular course of antibiotics, this is only 5 or 7 days. If you feel perfectly back to normal before the end of the 5 or 7-day course, then it is appropriate to taper your dose back down to normal, however, they suggested that up-dosing for 5 to 7 days doesn’t seem unreasonable for most infections.

A suggested exception, where it is a case of a common-sense approach, may be something like a superficial skin infection where you feel fine throughout so do not feel it is necessary to updose.

3. There is a class of antibiotics known as macrolides, which includes clarithromycin and erythromycin. These inhibit the breakdown of hydrocortisone (ie the opposite of rifampicin in point 1,). As a result, taking increased doses of hydrocortisone for a long course of these antibiotics (eg 3 or 4 weeks) could, theoretically, lead to excess steroid side effects, although the consultant pointed out that he had not seen this in practice. For a standard course of these antibiotics (5-7 days) it is not a problem to follow Sick Day rules for the duration of the course.

Learn more on our medication page

Anti-nausea medication

Question: I read in the Living With Addison's Disease book that “Your GP will also prescribe anti-nausea tablets or suppositories as part of your emergency kit”. My GP hasn't prescribed these and I was wondering if I need to have them as part of my emergency kit? And if so, would I need my endocrinologist to prescribe these or should my GP be aware that these may be needed?

Answer: The anti-sickness tablets are probably of more use in preventing progression to adrenal crisis if patients can’t keep their medication down and/or take their usual steroids. If you are in crisis you would need to seek immediate treatment anyway and so would have any nausea and vomiting managed in that care setting.

Having some on hand would certainly be useful for admission avoidance, so you could explain this rationale to your GP in order to get a prescription. Read our GP practice page for more information on speaking with your GP.

Taking Ibuprofen (or other Non-Steroidal Anti-inflammatory Drugs - NSAIDS)

Question: I have Addison's disease and have read that there can be effects with using Ibuprofen alongside medication for my adrenal insufficiency. Can I use Ibuprofen for a short time to alleviate muscular pain, e.g. from sciatica?

Answer: Ibuprofen does not interfere directly with hydrocortisone. However ibuprofen and other NSAID drugs can cause fluid retention, and this has the potential to interact with fludrocortisone and salt balance. People with heart failure, taking diuretics or those with kidney failure (“CKD”) shouldn’t take them at all. Also, NSAIDs are not a good idea if people are taking an ACE inhibitor or AII-blocker (-pril or -sartan drug) for blood pressure or heart problems.

However, it would be fine for most people with Addison’s to take ibuprofen or other NSAIDs short-term, if necessary, e.g. a few days. Many people in our community take ibuprofen regularly (for example, period pains so monthly) and report no issues. However, if ankle or leg swelling develops, then you should stop them.

If you are unsure, paracetamol, topical NSAID gels, heat therapy, or physiotherapy may be alternatives to consider. Gentle exercise can also help.

Combining NSAIDs with steroids can increase the risk of stomach irritation, gastritis, or ulcers. This risk is higher if you’re on higher steroid doses, have a history of stomach problems, or take other medications like aspirin or blood thinners. So always take Ibuprofen as directed (often with food). You can also discuss with your healthcare professional if proton pump inhibitor (PPI) medication like Omeprazole may be suitable for you. This can help reduce the risk of stomach irritation, gastritis, or ulcers when taking ibuprofen alongside steroids. PPIs work by lowering stomach acid, which protects the stomach lining from irritation caused by NSAIDs and corticosteroids.

Covid Vaccination

Question: Am I eligible for the Covid-19 vaccination?

Answer: Definitions around who is eligible to receive Covid-19 vaccinations are updated annually. Spring 2025 eligibility, is as follows (Chapter 14a, page 32), updated on 17th March. The headline is that the majority of people under age 75 with adrenal insufficiency will not be eligible, but please see the information below to apply to your individual circumstances, and discuss it with your GP if you are unsure.

(Green book on Immunisation - chapter 14a COVID-19)

Spring 2025

The committee has recommended that those eligible for COVID-19 vaccination are:

● adults aged 75 years and over

● residents in a care home for older adults

● individuals aged 6 months and over who are immunosupressed (as defined in the "immunosuppression" row of table 3 and table 4 below)

Compared with the previous autumn campaigns, in the Spring 2025 campaign, those under the age of 75 with a clinical risk factor will no longer be eligible. Upon review of the data from the previous vaccination campaigns, it was found that a large proportion of those with risk factors were already eligible via the age based criteria, and that both uptake of the vaccine, and rate of severe outcomes from COVID-19 were much lower in younger individuals at risk than in older age groups. Therefore the benefit of continuing to vaccinate younger people with clinical risk factors other than immunosuppression is limited.

The table they refer to (Table 3) has the following information re immunosuppression, and mentions steroids but at a level of prednisolone 20mg equivalent, a significantly higher dose than most people will be taking for adrenal insufficiency alone.

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