COVID-19 :New UK steroid guidance issued Advice... - AMN EASIER

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COVID-19 :New UK steroid guidance issued Advice for patients who take replacement steroids


COVID-19 : New UK steroid guidance issued

Advice for patients who take replacement steroids (hydrocortisone, prednisolone, dexamethasone or plenadren) for pituitary/adrenal insufficiency.

9 Replies

Thanks Chris! Ever since my diagnosis of Addison's 31 years ago, I was advised 3x3, whereby, I triple my dose for 3 days. Is double the medication standard fare?

in reply to SongStream

I don't know I'm afraid. Don't take it. Maybe someone else knows?

When I was first diagnosed 2002 I was told to double but I've learned that it's not enough and I take x3 or x4 sometimes!

All the best


in reply to SongStream

Hi, I don‘t know if it helps, but in this article, Site 18/24, „Crisis Management“, they write about to double if ... triple if ... (it‘s in the blue box on the lower right corner):

On Site 20/24 they write about the dosages for certain surgeries.

There are also some interesting information about dosing corticosteroids:

More information from this google search of, when we should double dosage:

And in general looking for more information:

Ok, this article (cahisus) is probably not really answering the question you asked, and is more adressing (pre-)adolescents and their families, but I thought, it is interesting as well as the following one:

I have this last two links from this site:

I think, the link of was written by a pediatrician, but it is still interesting. He writes, it could be better for some to take Hydrocortisone four times a day, to better mimic circadian rhythm, but I‘m not sure if he wrote about it in the provided paper; I saw two of his.

Another, interesting stuff: Plenadren (I didn‘t heard so much good about this tough) and Chronocort (the last med is probably not approved for Addison‘s at present) — I think, Chronocort could give us more of a cortisol curve like a healthy person would have; Cortisol rises in the early morning hours when we sleep, with Chronocort one takes something like an extended releasing Hydrocortisone preparation before sleeping, as I understand it, that imitates this rising and peaks when we wake up and then declines during the day, another different Chronocort pill would mimic these daytime curve — falling gradually.

More information about Chronocort:

The link explains it way better than I could and it is always possible that I didn’t understand it right!

The dosage, I think, mainly depends on our metabolism/ metabolic rate, height, weight; I think it would be better, if they took a more individual approach in treating people than just putting us „into boxes“ that could fit, like if we were just a data point on some years ago calculated curve. I think, that is also what this pediatrician wrote in one of his works, we are generally either over- or under-replaced, I mean no one knows how much cortisol our adrenal cortex would have excreted at a day or night — they are just taking established average dosages, measured/established by healthy people, who certainly didn‘t had delayed puberty and growth failure and are a hormonal mess, like me :)), but it might be not that important, so what do I know.

Sorry, for always editing my posts, I make mistakes every time.

Thanks, Chris. My brother is steroid dependent. He also increases his dosage when he needs it.

This is partially incorrect. It says in Adrenal sufficiency it recommended to get vaccines. This is counter indicated.

in reply to bluejadedwho

I don't understand exactly what you are saying. Is it about the recommendation to get a flu vaccination? What is the counter-indication?

Every year, I am advised to get the flu vaccine. We are at high risk and of having an Addisonian crisis as a result.

in reply to SongStream

If I understand you correctly, you are saying that flu vaccine is dangerous to those with adrenal insufficiency? That's something I hadn't heard. If that's what you are saying, have you checked with your AMN metabolic consultant? I can check with mine.

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