Drug shortage alert: injectable hydrocortisone This article was originally published in 2025. Hydrocortisone Sodium Phosphate has since been discontinued. Please read the latest update The Department of Health and Social Care (DHSC) has confirmed an upcoming shortage of hydrocortisone sodium phosphate for emergency injection kits from the end of February 2025, with supply expected to resume in May 2026. What does this mean for people with Addison’s and adrenal insufficiency? In some parts of the UK, your pharmacist may be able to locate remaining stock of hydrocortisone sodium phosphate (known to many as the 'pre-mixed' injection). However, this will not be the case in all areas, so you need to use an alternative form of hydrocortisone. Don't worry - alternative available The alternative injection medication, hydrocortisone sodium succinate 100mg powder, will work in exactly the same way in your body, but comes in a different format. Many of you will have used it before and be familiar with it. The alternative is called: ‘Hydrocortisone sodium succinate 100mg powder for solution for injection or infusion 1x2ml - vial with diluent’ (previously known as Solu-Cortef) Members outside the UK (Ireland, Europe and America) may also be able to obtain the 'Act-o-Vial preparation', containing hydrocortisone sodium succinate and water in a chambered ampoule. How do I get hold of the alternative form of hydrocortisone? Ask your GP for a prescription for the alternative form. For NHS prescriptions it is necessary to give the generic name which is: Hydrocortisone sodium succinate 100mg powder for solution for injection or infusion 1x2ml - vial with diluent - previously known as Solu-Cortef. EAN code: 5415062387238 PIP code: 540 0718 Guidance for GPs on what to prescribe can be found on our emergency injection page, GP Care leaflet and NICE Guidelines for adrenal insufficiency (section 1.3.10). How is it different to Hydrocortisone Sodium Phosphate? This alternative is prescribed in two parts: one is a powder and the other is a vial of water (dilutent). These need to be mixed together on the spot, prior to use, to make the injectable solution. Hydrocortisone sodium succinate (previously known as Solu-Cortef) is more stable in hot weather (above 25ºC) so it is a prudent choice for those planning a trip abroad. Can I use out-of-date Hydrocortisone Sodium Phosphate? In a crisis, and if you don't feel confident in using the hydrocortisone powder alternative option, it is still worth self-injecting with the out-of-date ampoule, rather than not injecting at all. Sealed in its glass ampoule, hydrocortisone sodium phosphate will usually remain safe to use for some months after its expiry date. It does not develop toxic by products, but it does lose a little of its potency. Don't delay, inject immediately Any situation where you are unable to absorb your regular oral medication could potentially become life-threatening, without timely injected hydrocortisone. Check the expiry date on your injection kit and remember to renew it in good time, well ahead of any planned trips away from home. Adrenal crisis - emergency information First-time users Ask your GP, practice nurse or Endocrine healthcare team to show you how to use the hydrocortisone sodium succinate powder injection. Bring a loved one or colleague to your training session so they can also learn. Some people need to ask for help in preparing the hydrocortisone injection syringe when they are unwell and, if needed, that person can support you in self-injecting or inject you themselves, and then ring 999. If a training session cannot be provided, don't worry, this is not uncommon and is due to limited NHS resource. Whilst it is the recommendation in the NICE Guidelines, many people in our community learn through watching our online injection videos with their loved ones, following along with our 'How To' picture leaflets, and then practise on an orange at home! Learn about the emergency injection Practice makes perfect! Why is this happening? How long will it go on for? In this instance, the disruption is due to manufacturing issues with the supplier, Advanz Pharma. It is anticipated stock will be used up by late February 2025, with anticipated resupply in May 2026. Therefore in some parts of the UK, your pharmacist may be able to locate remaining stock. A Medicine Supply Notification has been issued by the Department of Health and Social Care (DHSC) to NHS provider Trust pharmacy procurement teams and clinical teams. Communications have been added to the Specialist Pharmacy Services Medicines Supply tool, accessible to colleagues in the NHS. Why has this happened again? Due to the complexity of medicine supply chains, there are a number of reasons why supply can be disrupted. Previously, in 2021, it was reported demand outstripped existing supply, and in 2022, the disruption was due to global filtration issues. In this instance, the disruption is due to manufacturing issues with the supplier, Advanz Pharma. How are these shortages managed? The Department of Health and Social Care (DHSC) have a range of well-established processes and tools to manage them when they arise and mitigate risks to patients, including close and regular engagement with suppliers and patient support groups such as ourselves, The Pituitary Foundation, Living with CAH and Alex TLC - all whom support people living with steroid-dependency and are therefore affected. The DHSC also issue NHS communications to provide management advice and information on the issue to healthcare professionals including pharmacists, so they can advise and support their patients. Healthcare Professionals The DHSC's Medicine Supply Notification is available via the Specialist Pharmacy Services Medicines Supply tool, accessible to colleagues in the NHS. Enquiries in the first instance should be directed to your Specialist Pharmacy Service Regional Pharmacy Procurement Team, who will escalate to national teams if required, as the contact details on the Medicine Supply Notification. “Why don’t we have an EpiPen style injection for our hydrocortisone emergency injection?” An EpiPen like device for the administration of emergency hydrocortisone is in development! Read our latest research update from Julia Anthony, Founder and Chief Strategy Officer of SOLUtion Medical, who presented at our London Addison's Roadshow. In our article, she explains how their research and development has progressed since receiving the ADSHG research grant. 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