Endocrine
Medicines for Addison's disease
A condition in which the adrenal glands no longer make enough of their own hormones — treated with lifelong steroid replacement that must be increased during illness, never stopped suddenly, and backed up by an emergency injection.
Education and reference only. This explains which medicines are used and why, in plain language — it deliberately contains no doses and is not a substitute for advice from your doctor or pharmacist. Always discuss your own treatment with a qualified clinician, and check the BNF and the product labelling for prescribing detail.
Quick answer
What is Addison's disease?
Addison's disease, also called primary adrenal insufficiency, is a condition in which the adrenal glands — two small glands that sit on top of the kidneys — gradually stop making enough of their key hormones. The most important of these is cortisol, a hormone that helps the body cope with stress, control blood pressure and balance blood sugar; the glands also usually fail to make enough aldosterone, which helps the body manage salt, water and blood pressure.
- How it is treated: Addison's disease is treated by replacing the hormones the adrenal glands can no longer make, and this replacement is taken for life.
- Self-care: Learning the 'sick day rules' is the single most valuable thing you can do, so ask your specialist team to teach you and anyone close to you exactly when and how to increase your steroid during illness, fever, injury or before procedures, and what to do if you are being sick.
- When to seek help: See your GP or specialist team if your usual symptoms are not well controlled, if you are losing weight, feeling persistently tired or dizzy, or if you are unsure how to adjust your steroid when unwell — and always ask to be shown the 'sick day rules'.
What it is
Addison's disease, also called primary adrenal insufficiency, is a condition in which the adrenal glands — two small glands that sit on top of the kidneys — gradually stop making enough of their key hormones. The most important of these is cortisol, a hormone that helps the body cope with stress, control blood pressure and balance blood sugar; the glands also usually fail to make enough aldosterone, which helps the body manage salt, water and blood pressure. Because the hormones fall slowly, symptoms often build up over months and can be vague at first: persistent tiredness and weakness, loss of appetite and weight, low blood pressure that can cause dizziness on standing, and a craving for salt. A characteristic clue is a gradual darkening of the skin, often most noticeable in skin creases, on scars and on the gums. The most common cause in the UK is the immune system mistakenly attacking the adrenal glands. The condition is lifelong, but with hormone replacement most people are able to live full and active lives — provided they understand how to adjust their treatment when unwell.
How it is treated
Addison's disease is treated by replacing the hormones the adrenal glands can no longer make, and this replacement is taken for life. It is important to understand that this is replacement of the body's own missing hormones to restore normal levels — it is not the same as the high-dose steroid treatment used to damp down inflammation in other conditions. Cortisol is usually replaced with a steroid called hydrocortisone, taken to mimic the body's natural daily pattern, and the missing aldosterone is replaced with a second tablet, fludrocortisone, which helps control salt, water and blood pressure. Two safety principles sit at the very heart of living with this condition. The first is the 'sick day rules': because a healthy body makes extra cortisol during illness, injury, surgery or other stress, someone on replacement must temporarily increase their steroid dose at these times, as the body cannot do this for itself. The second is that the medicine must never be stopped suddenly, as doing so can be dangerous. If steroid cannot be kept down — for example because of vomiting or severe diarrhoea — or if the person collapses, an emergency hydrocortisone injection is needed and emergency help must be called. Care is usually overseen by a specialist endocrine team, and everyone with the condition should carry a steroid emergency card and have access to an emergency injection kit.
For this condition, these medicines
Medicine classes used for Addison's disease
Each links to a full, dose-free guide — what it is, how it works, who can and cannot use it, side effects, interactions and FAQs.
Symptom checker
Symptoms that can point to Addison's disease
Addison's disease can be one cause of these symptoms. Each guide explains the other possible causes and the red-flag warning signs that mean you should get urgent help:
By active ingredient
Specific medicines used for Addison's disease
Dose-free guides to individual active ingredients used in addison's disease — what each is, how it works, how to take it, and its advantages and disadvantages:
Beyond medication
Lifestyle and self-care
Learning the 'sick day rules' is the single most valuable thing you can do, so ask your specialist team to teach you and anyone close to you exactly when and how to increase your steroid during illness, fever, injury or before procedures, and what to do if you are being sick. Always carry your steroid emergency card and your emergency hydrocortisone injection kit, and make sure family, friends or colleagues know where these are and how to use the injection in an emergency. Wearing a medical alert bracelet or pendant means that, even if you are unable to speak, others know you depend on steroids. Never run out of your medicines: keep a spare supply, order repeats in good time, and take your tablets regularly as advised. Tell any healthcare professional — including dentists and surgeons — that you have adrenal insufficiency before any treatment, so they can plan extra steroid cover. Otherwise, aim for a normal, balanced diet (you do not usually need to avoid salt), stay well, and keep your regular specialist reviews.
When to get help
When to see a doctor
See your GP or specialist team if your usual symptoms are not well controlled, if you are losing weight, feeling persistently tired or dizzy, or if you are unsure how to adjust your steroid when unwell — and always ask to be shown the 'sick day rules'. Some situations are emergencies. An adrenal (Addisonian) crisis can develop quickly during illness, injury or stress, or if doses are missed, and is life-threatening: warning signs include sudden severe weakness, feeling faint or collapsing, severe vomiting or diarrhoea, severe abdominal, back or leg pain, confusion or drowsiness. If you cannot keep your steroid tablets down because of vomiting, if you collapse, or if you suspect a crisis, use your emergency hydrocortisone injection if you have one and call 999 straight away — tell the ambulance crew you have adrenal insufficiency and need hydrocortisone.
Not sure how urgent it is? It is always OK to call NHS 111 for advice, day or night.
Answers
Addison's disease: frequently asked questions
What medicines are used for Addison's disease?
Treatment replaces the hormones the adrenal glands can no longer make, and is taken for life. Cortisol is usually replaced with a steroid called hydrocortisone, taken to mimic the body's natural daily rhythm, and the missing aldosterone is replaced with a separate tablet, fludrocortisone, which helps control salt, water and blood pressure. This is replacement of your own missing hormones to restore normal levels — not the same as the high-dose steroids used to treat inflammation. Two rules are vital: the dose must be temporarily increased during illness or stress ('sick day rules'), and the medicine must never be stopped suddenly. Everyone should also carry a steroid emergency card and an emergency hydrocortisone injection.
What are the 'sick day rules' and why do they matter?
A healthy body automatically makes extra cortisol when it is under stress — during a fever, infection, injury, surgery or another illness. In Addison's disease the adrenal glands cannot do this, so the body relies on you to supply the extra steroid yourself. The 'sick day rules' are simple guidance from your specialist team on when and how much to increase your steroid at these times, and what to do if you are vomiting and cannot keep tablets down. Following them prevents a dangerous drop in cortisol that could lead to an adrenal crisis. Ask your team to teach the rules to you and to the people close to you, and keep a written copy where you can find it.
What is an adrenal (Addisonian) crisis?
An adrenal crisis is a life-threatening emergency that happens when the body runs critically short of cortisol — often triggered by an illness, injury or stress when the steroid dose has not been increased, by vomiting that stops tablets being absorbed, or by suddenly stopping the medicine. Signs include sudden severe weakness, collapse or feeling faint, severe vomiting or diarrhoea, severe abdominal, back or leg pain, and confusion or drowsiness. It needs immediate treatment with an emergency hydrocortisone injection and a 999 call. This is why everyone with Addison's disease should carry an emergency injection kit and a steroid card, and make sure those around them know how to act.
Can I ever stop my steroid medicine?
No — the steroid replacement in Addison's disease is taken for life and must never be stopped suddenly. Unlike steroids given for a short course to treat inflammation, this medicine is replacing hormones your body simply cannot make, so going without it allows cortisol to fall to dangerously low levels and can trigger an adrenal crisis. Always keep a spare supply, order repeat prescriptions in good time, and never run out. If you are having difficulty taking your tablets — for example because of vomiting — do not just go without; use your emergency injection if you have one and seek urgent help. Any changes to your treatment should only be made with your specialist team.
Keep reading
Related articles
Sources
Where this is drawn from
- NICE CKS: Addison's disease.
- Society for Endocrinology
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