The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) agrees the following place in therapy for glucocorticoids in line with NG243 (Adrenal insufficiency: identification and management)

• Hydrocortidsone immediate release is the first choice glucocorticoid.
• Prednisolone is an alternative first line if multiple daily doses are not appropriate.
• Hydrocortisone modified-release is a 2nd line option
• Dexamethasone is a 2nd line option
• Fludrocortisone for mineralocorticoid replacement if needed (to normalise serum electrolytes and plasma renin, and reduce postural symptoms and salt craving)

See Formulary status and restrictions for individual formulations.

Dosing of glucocorticoids during acute illness - It is important for people with adrenal insufficiency to increase their corticosteroid doses at times of illness in order to reduce the risk of adrenal crisis. As a guide, for any moderate intercurrent illness (such as illness with fever, requiring bedrest, or requiring antibiotics), they should double their usual doses of Hydrocortisone until recovered, or if on Prednisolone, they should increase to a minimum dose of 10 mg daily (or follow specific advice as recommended by their specialist).

In order to allow patients to promptly increase their corticosteroid dose at times of need, and to avoid any risk from unexpected supply shortages, patients should ideally retain 2 months reserve supply at all times and should be reminded to renew their prescription in good time.