From the Guidelines
For patients with Addison's disease, the recommended dosage of hydrocortisone is 15-25 mg total daily dose, divided into 2-3 doses with the largest portion given in the morning, as stated in the most recent and highest quality study 1. This dosing regimen mimics the body's natural cortisol rhythm, with higher levels in the morning and lower levels in the evening.
- The typical distribution is 10-15 mg in the morning, 5 mg in the early afternoon, and sometimes 2.5-5 mg in the early evening.
- Dosing should be individualized based on clinical response, with adjustments made according to symptoms of under-replacement (fatigue, nausea, hypotension) or over-replacement (weight gain, insomnia, hypertension). Some key points to consider when managing patients with Addison's disease include:
- During times of illness, injury, or significant stress, patients need to increase their dosage, typically doubling or tripling their usual dose for several days, as recommended by 1 and 1.
- Patients should always carry emergency hydrocortisone for injection and wear medical identification indicating their condition to ensure proper treatment during emergencies, as advised by 1 and 1. It is essential to note that the management of Addison's disease requires a comprehensive approach, including patient education on stress dosing, emergency injections, and medical alert systems, as well as collaboration with endocrinologists and other healthcare professionals, as recommended by 1, 1, and 1.
From the FDA Drug Label
The initial dosage of hydrocortisone tablets may vary from 20 mg to 240 mg of hydrocortisone per day depending on the specific disease entity being treated. IT SHOULD BE EMPHASIZED THAT DOSAGE REQUIREMENTS ARE VARIABLE AND MUST BE INDIVIDUALIZED ON THE BASIS OF THE DISEASE UNDER TREATMENT AND THE RESPONSE OF THE PATIENT
The recommended dosage of hydrocortisone for a patient with Addison's disease is not explicitly stated in the provided drug label. However, it is mentioned that the initial dosage may vary from 20 mg to 240 mg per day, and that dosage requirements are variable and must be individualized based on the disease and patient response 2.
- The dosage should be adjusted until a satisfactory response is noted.
- Constant monitoring is needed to adjust the dosage as necessary.
- It is recommended to withdraw the drug gradually if it is to be stopped after long-term therapy.
From the Research
Recommended Dosage of Hydrocortisone for Addison's Disease
The recommended dosage of hydrocortisone for a patient with Addison's disease varies, but several studies provide guidance on this topic.
- The starting dose of hydrocortisone should be 15-20 mg, divided into two or three doses, and preferentially weight-adjusted 3.
- Another study recommends a daily starting dose of 20 mg for hydrocortisone, divided into two or preferably three doses 4.
- A more recent guideline suggests that hydrocortisone (15-25 mg/d) or cortisone acetate replacement (20-35 mg/d) should be applied in two to three daily doses in adults 5.
Mineralocorticoid Replacement
In addition to glucocorticoid replacement, patients with Addison's disease also require mineralocorticoid replacement.
- The recommended dose of fludrocortisone is 0.05-0.20 mg once daily 3.
- Another study recommends a dose of 0.05-2.0 mg/day for fludrocortisone 4.
- A more recent guideline suggests a median dose of 0.1 mg for fludrocortisone 5.
New Treatment Modalities
There are also new treatment modalities being developed for Addison's disease, including timed-release hydrocortisone tablets and continuous subcutaneous hydrocortisone infusion 3, 6.
- These new approaches aim to simulate the physiological serum cortisol rhythm more closely and may offer improved patient health and quality of life in the future 6.