Information for patients taking long-term oral steroid medication (such as Prednisolone, Hydrocortisone, Dexamethasone)

Your adrenal glands (which sit on top of your kidneys) produce a natural steroid hormone called cortisol. Cortisol has a very important role in helping your body cope with illness/physical stress. When you are sick, your body needs more cortisol. If you are taking regular steroid tablets, your body may not be able to produce enough cortisol when you are unwell. This can lead to an adrenal crisis which is a life-threatening emergency. This can be prevented by following the ‘sick day rules’ outlined below.

When you are sick, you need to adjust your steroid dose temporarily to prevent an adrenal crisis

🚨Symptoms of an adrenal crisis🚨

Feeling exhausted

Feeling lightheaded/dizzy

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Nausea/vomiting

Very low blood pressure

Muscle weakness

Joint pain

What are sick day rules and when do they apply?

• If you have a minor illness (such as the common cold) without a fever and feel well enough to continue most of your usual activities, you can continue taking your steroid medication at the usual prescribed dose.
• If you are unwell with a fever, please follow the guidance in the table below until you feel well again, and seek medical advice if you are feeling worse or not feeling better within 48 hours.
• If you are extremely unwell, take an extra 20mg of prednisolone OR 50mg of hydrocortisone and seek immediate medical advice.
• If you are vomiting, you may not be absorbing your medication. Take an extra 5mg of prednisolone OR 20mg of hydrocortisone immediately, and if you continue to vomit after this you must seek immediate medical advice, by calling 111/999/going to your nearest emergency department.

If you are ever in doubt about what to do with your steroid medication when unwell then please contact the GP surgery or 111 out-of-hours.

A few other important points

⚠️ You must never stop taking your steroids abruptly.

⚠️     Carry your NHS steroid emergency card with you at all times – if you have lost yours, please speak to reception. You can read more about the steroid emergency card and download an electronic version here: https://themuswellhillpractice.co.uk/steroid-emergency-card 

⚠️  If you are unsure about any of the information in this leaflet, you can speak with your GP.

⚠️ If you have a dental procedure planned, speak with your dentist beforehand regarding what to do with your steroid dose.

Reference: https://www.endocrinology.org/media/atsfelcr/ai-leaflet-final-9th-july-2025.pdf