Hydrocortisone Tablets and an Issue of Concern

Hydrocortisone

Recently I came across an interesting conversation regarding problems with Adrenal Insufficiency medication in the UK. After giving some serious thought I decided the Issue needed to be addressed here on the blog.

A person with Adrenal Insufficiency cannot produce their own Cortisol which is a natural steroid in the body and “Stress Hormone”. As a result we become “Steroid dependent” and have to medication- usually Hydrocortisone replacement therapy 3 times a day.

For myself I am currently on 20mg of Hydrocortisone per day. You cant take the medication in one fowl swoop as Hydrocortisone does not last more than 4-6 hours in the blood stream depending on how fast an individual clears their medication.

My medication is split up into 3 times a day. I take 10mg at 8am which is when a cortisol producing or healthy adult would have the most cortisol for their body. I then take 5mg at 12pm and 5mg at 5pm.

I have been on several doses from 60mg which was way to much down to 30mg and 25mg and with each dose I have had the same problem, my tablets do not come in any dose smaller than 10mg.

Hydrocortisone in the UK is manufactured by Auden McKenzie Pharma Division. They produce the tablets in 20mg and 10mg only.

So how do the 8,000 patients in the UK deal with incorrect doses? We have to cut our tablet in half. For myself I am expected to split a 10mg tablet in half and take half at lunch time and half at dinner time.

The tablet does have grooves but it is physically difficult to cut my tablets in half accurately be it using my fingers or a tablet cutter. Half the time the tablet is uneven and some of the medication crumbles into dust.

What does this mean for me? When I am very Cortisol sensitive and if I need 5mg at 12pm and 5mg at 5pm then I need that exact amount not 4.5 because the tablet is uneven or some has crumbled.

The solution of course would be for the Manufacturer to actually make tablets in 5mg and even 2.5mg for those of us taking smaller doses. It seems unfair to me that the correct dose is not available. It is hard enough to replace cortisol at the correct amount, never mind potentially taking the incorrect amounts.

Not having the correct amount of Cortisol in the body can cause many symptoms and place someone at risk of Adrenal Crisis.

The one thing I did not realise however was that when a tablet is released from it’s sealed package and broken in half, as mine are each day the quality of the tablet deteriorates.

In fact, I discovered that quite a few people on Hydrocortisone are told to split the 10mg in half the best they can and then throw the other 5mg away because the 5mg cant be expected to work properly after being out of the packaging and exposed tot he elements for a number of hours.

I however have always been expected to split my tablet and save the other half to take 5 hours later. Could this be why I am always so unwell in the evenings? Is my quality of mediation not so good at 5pm because my 5mg tablet has been exposed to the elements and deteriorated in quality.

The question both myself and others are raising is this?

How effective is a 10mg hydrocortisone tablet which has been cut in half and left exposed for 5 hours? 

Will this kind of dosing strategy cause an Adrenal Insufficient to be under-dosed and at risk of Adrenal Crisis? 

If thousands of Adrenal Insufficient patients are being told by Endocrinologist to cut the 10mg tablets in half and throw the other way away, how much NHS money is being wasted? 

Lets do the maths?

In order for me to take my medication from a sealed packet at the correct times, I would need 3 packets of 10mg Auden Hydrocortisone which costs 3x £80. My monthly medication cost will be £240.

If I had my medication in 5mg then I would only need the equivalent of 2 10mg boxes or 4 5mg boxes which would be 2x £80. This would cost only £180 per month.

As Adrenal Insufficiency is a life threatening illness, the medication is covered by the NHS. this is my opinion is fair. It would be wrong to deny people life saving medication and so I agree that the NHS cover the cost.

However, if 8,000 people are spending £80 more than need to because they cant get 5mg tablets and cant use the second half of a 10mg tablet without placing themselves at risk then how much is the NHS  wasting?

Lets work that out? 8000 patients x £80 a month = £640,000 per month wasted!

How much is this in a year?  £7,680,000

How much in 5 years? 38,400,000

Wow what a waste of NHS money!

Would it not be cheaper to create a 5mg hydrocortisone and 2.5mg hydrocortisone tablet?

This is food for thought and I wish to credit Alison Jones for raising the issue.

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