Hisone

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What Is Hisone?

Hisone is an oral tablet manufactured by Samarth Pharma containing hydrocortison — the synthetic form of cortisol, the body's own primary stress hormone. Cortisol is produced by the adrenal cortex under the control of pituitary ACTH. It controls blood sugar, blood pressure, salt and water balance, the body's response to inflammation and infection, and the wake-sleep cortisol rhythm.

Hisone is Samarth Pharma's branded hydrocortisone tablet — the standard Indian-market oral hydrocortisone supplied across 5 mg, 10 mg and 20 mg strengths to allow flexible build-up of the typical 15–25 mg/day replacement dose. The three strengths are designed to be combined: a typical adult on 20 mg/day might take a 10 mg tablet on waking + 5 mg at midday + 5 mg in the late afternoon, mimicking the body's natural cortisol rhythm. Unlike prednisolone or methylprednisolone — which are used at supraphysiological doses to suppress inflammation and the immune system — hydrocortisone at replacement dose simply restores normal cortisol levels in patients whose adrenal glands no longer make enough on their own. The clinical goals, dosing rules, and monitoring strategy are completely different from the anti-inflammatory use of glucocorticoids.

How Does Hisone Work?

Hydrocortisone is identical to endogenous cortisol. After absorption it binds the intracellular glucocorticoid receptor (and, at higher doses, the mineralocorticoid receptor) and regulates the transcription of hundreds of genes. The clinically relevant effects at replacement dose are:

• Maintains blood glucose through gluconeogenesis — cortisol-deficient patients are prone to fasting hypoglycaemia.
• Supports vascular tone and blood pressure — cortisol enhances vascular sensitivity to catecholamines; deficiency causes orthostatic hypotension and shock during stress.
• Sodium and water balance — hydrocortisone has weak mineralocorticoid activity (about 1/300th that of aldosterone), enough to support sodium retention at higher doses but not enough to fully replace aldosterone in primary adrenal insufficiency (where fludrocortisone is added).
• Anti-inflammatory and immune-modulating effects at all doses, but at replacement dose these are physiologic, not therapeutic.
• Stress response — cortisol output rises sharply during illness, injury, surgery, and severe emotional stress. Replacement therapy must be increased proportionately (“stress dosing”).

Onset of action: 30–60 minutes after oral dose. Plasma half-life ~90 minutes; biological half-life 8–12 hours. The short biological half-life is why replacement is divided into 2–3 daily doses rather than once daily.

Toepassingen en Indicaties

Hisone is used for physiologic glucocorticoid replacement, not for short-course anti-inflammatory therapy (where prednisolone or methylprednisolone are preferred for once-daily dosing).

• Primary adrenal insufficiency (Addison's disease) — autoimmune, infectious (TB, HIV), bilateral adrenalectomy, congenital. Combined with fludrocortisone for mineralocorticoid replacement.
• Secondary adrenal insufficiency — pituitary tumour, post-pituitary surgery, hypopituitarism, isolated ACTH deficiency. Mineralocorticoid is preserved (driven by renin-angiotensin), so fludrocortisone is usually not needed.
• Tertiary adrenal insufficiency — suppression from prolonged exogenous steroid therapy. Replacement is needed during the months it takes for the HPA axis to recover.
• Congenital adrenal hyperplasia (CAH) — particularly classic 21-hydroxylase deficiency. Hydrocortisone is preferred in childhood because shorter-acting steroids cause less growth suppression.
• Adrenal crisis — emergency parenteral hydrocortisone (100 mg IV/IM stat, then 50–100 mg every 6 hours) is the first-line treatment. Oral hydrocortisone is restarted once stable.
• Stress cover for surgery, severe illness, or labour in any patient with known HPA suppression — double-to-triple replacement dose orally, or switch to IV/IM if oral route is unsafe.
• Anti-inflammatory or immunosuppressive use — rarely first-line; prednisolone or methylprednisolone are usually preferred because their longer half-life allows once-daily dosing and they have less mineralocorticoid effect at high anti-inflammatory doses.

Hisone is niet a substitute for prednisolone in routine asthma, RA, IBD, lupus or vasculitis flare. Use the right steroid for the right job: hydrocortisone for replacement; prednisolone (or methylprednisolone, dexamethasone) for therapeutic anti-inflammatory effect.

Hisone Dosage and How to Take

Hisone is supplied at 5 mg, 10 mg and 20 mg tablets. The 5 mg, 10 mg and 20 mg strengths allow flexible build-up of physiologic replacement doses.

Standard adult replacement dose

Sick-day rules — the most important thing to learn

Cortisol-deficient patients cannot mount their own stress response, so they must manually increase their dose during any acute illness, fever, injury or major stress. Failure to do so causes adrenal crisis — a life-threatening emergency.

• Mild illness with fever 37.5–39°C, flu-like illness, minor injury — double the daily dose for the duration of the illness, then return to baseline once recovered.
• Severe illness with fever > 39°C, vomiting and diarrhoea, major trauma, fracture — triple the daily dose, and call your endocrinology team.
• Vomiting, diarrhoea, or unable to keep tablets down — switch immediately to IM hydrocortisone 100 mg from the emergency injection kit, and seek medical care.
• Operatie — minor procedure (dental, cataract): take an extra dose 1 hour pre-op; major surgery: hospital-administered IV hydrocortisone before, during and after surgery, taper back to oral over 1–3 days.
• Labour and childbirth — double dose at onset of labour; IM/IV cover during delivery; double dose for 24–48 hours post-partum.
• Severe emotional stress (bereavement, marriage breakdown, exam, public speaking) — consider an extra 5–10 mg dose; usually no formal increase needed unless somatic symptoms develop.

How to Take Hisone Properly

1. Take the morning dose immediately on waking — do not delay until breakfast. The patient often feels weak and unwell on waking before the first dose absorbs.
2. Take with a small amount of food — reduces gastric irritation, but do not delay the morning dose for breakfast.
3. Slik de tabletten in hun geheel door met water. Tablets may be split if scored.
4. Avoid late-evening doses — doses after 18:00 disturb the natural cortisol rhythm and cause insomnia.
5. Never miss a dose. If a dose is missed by less than 4 hours, take it as soon as remembered. If missed by more than 4 hours, take it but be aware of possible mid-cycle wave of fatigue. Do not double up the next dose unless this was your sick-day plan.
6. Carry a Medic-Alert bracelet or steroid card at all times stating “adrenal insufficiency — needs hydrocortisone in emergency”. This is non-negotiable for replacement-therapy patients.
7. Carry the emergency hydrocortisone IM injection kit — the prescriber should ensure you and a family member know how to use it. The kit should be available at home, at work, and on travel.
8. Tell every healthcare provider that you take Hisone for adrenal insufficiency — including dentists, optometrists, alternative-medicine practitioners, anaesthetists, ED clinicians.
9. If primary Addison's, you will also be on fludrocortisone 0.05–0.2 mg/day for mineralocorticoid replacement — this is separate from Hisone and continues during sick days unchanged.

Why Hisone Is NOT Tapered Like Other Steroids

This is one of the most-misunderstood points about replacement therapy. When a patient is on prednisolone for asthma, RA flare or any anti-inflammatory indication, the dose must be tapered slowly because the patient is on supraphysiologic doses suppressing their own HPA axis.

Replacement-dose hydrocortisone is different: 15–25 mg/day of hydrocortisone is roughly the body's own daily output. The patient is REPLACING what their adrenals no longer make. There is no HPA suppression to recover from — the HPA axis is already broken (Addison's) or absent (post-pituitary surgery). Replacement is lifelong and not tapered. Stopping Hisone at any point in a patient with primary or secondary adrenal insufficiency causes adrenal crisis within hours to a day. The only time the dose changes is up (sick days, stress dosing) — not down.

The exception: patients tapering off long-term high-dose exogenous steroid therapy. As the daily dose of prednisolone is reduced below 5–7.5 mg/day equivalent, some clinicians switch to physiologic hydrocortisone replacement to allow the suppressed HPA axis to recover. In that case the hydrocortisone dose IS eventually tapered, but only after Synacthen testing confirms HPA recovery — usually months after the original steroid course ended.

Side Effects of Hisone

At physiologic replacement dose (15–25 mg/day), hydrocortisone causes few side effects — the patient is simply receiving what their body should make naturally. The classic Cushingoid side-effect profile of glucocorticoids only develops at supraphysiologic doses. The risk is predominantly under-replacement (fatigue, hypotension, hypoglycaemia, weight loss, hyperpigmentation in primary AI, eventual adrenal crisis) or overdosering (Cushingoid features, osteoporosis, diabetes, hypertension, mood disturbance).

Signs of under-replacement — need dose increase or different dose schedule:

• Persistent fatigue, especially in late afternoon/evening
• Postural dizziness, weakness
• Salt craving (suggests inadequate fludrocortisone in primary AI)
• Weight loss, anorexia, nausea
• Increased pigmentation in primary AI (high ACTH)
• Recurrent fasting or pre-dose symptoms

Signs of over-replacement — need dose reduction:

• Weight gain, central obesity
• Moon face, buffalo hump
• Easy bruising, skin thinning, abdominal striae
• Raised blood sugar, raised BP
• Insomnia, mood elevation, agitation
• Reduced bone density (especially with sustained doses > 25 mg/day)

Acute over-dosing (e.g. accidental sick-day dose with no underlying illness) for a few days has no significant adverse effect — this is what stress dosing is. Persistent over-replacement over months to years causes Cushingoid features.

Waarschuwingen en voorzorgsmaatregelen

• Never miss doses or stop without specialist input — adrenal crisis can develop within hours.
• Always carry a steroid card and Medic-Alert identification. Without it, an unconscious adrenal-insufficient patient may not be recognised or treated correctly.
• Always carry the emergency IM hydrocortisone injection kit when away from home.
• Diabetes — replacement-dose hydrocortisone has minimal effect on glucose; sick-day dosing causes transient rises.
• Hypertensie — usually no effect at replacement dose; over-replacement can raise BP.
• Osteoporose — long-term over-replacement raises fracture risk; aim for the lowest effective dose, screen with DEXA every 2–3 years.
• Zwangerschap — hydrocortisone is the preferred replacement glucocorticoid in pregnancy; placental 11β-hydroxysteroid dehydrogenase inactivates ~85% before reaching the fetus. Dose may need to be increased in the third trimester. Stress cover during labour is essential.
• Borstvoeding — safe at replacement doses; small amounts pass into milk but are clinically insignificant.
• Kinderen — hydrocortisone is preferred over longer-acting steroids in childhood replacement because of less growth suppression. Doses are calculated by body surface area (10–12 mg/m²/day).
• Ouderen — reduced replacement need; aim for the lower end of dose range.
• Levende vaccins — SAFE at replacement dose. The contraindication only applies at immunosuppressive doses (≥ 20 mg prednisolone equivalent for 2+ weeks). Replacement-dose hydrocortisone ≤ 25 mg/day = 6.25 mg prednisolone equivalent — not immunosuppressive.

Contraindications — Who Should NOT Take Hisone

• Known hypersensitivity to hydrocortisone or any tablet excipient
• Systemic fungal infection (unless concurrently treated and replacement is essential)
• Recent receipt of a live vaccine in patients on immunosuppressive doses (does not apply to replacement dose)

For a patient with confirmed adrenal insufficiency, the only effective contraindication is a true hypersensitivity reaction to hydrocortisone itself — in which case prednisolone or dexamethasone replacement is used instead. The disease is incompatible with not taking glucocorticoid replacement — so other contraindications are managed by treating the concurrent issue rather than withholding hydrocortisone.

Geneesmiddelinteracties

Bewaaradvies

• Bewaren bij kamertemperatuur, below 25°C, protected from light and moisture.
• Bewaar tabletten in de originele blisterverpakking tot gebruik.
• Bewaar niet in de badkamer — vocht verkort de houdbaarheid.
• Always carry at least 7 days’ supply when travelling, plus the emergency IM injection kit.
• Keep out of reach of children — even in adrenal-insufficient patients, paediatric overdose with adult tablets can cause significant illness.
• Do not use after the expiry date on the pack.

Gerelateerde alternatieven op MedsBase

Other medications used in anti-inflammatory and autoimmune care stocked alongside this product:

• Barinat (baricitinib 2 / 4 mg) — JAK1/2 inhibitor for RA
• Tofe (tofacitinib 5 mg) — JAK1/3 inhibitor for RA, UC, PsA
• Azoran (azathioprine 50 mg) — classic immunosuppressant DMARD
• Lefuheal (leflunomide) — oral DMARD for rheumatoid arthritis
• Conimune ME (cyclosporine) — calcineurin inhibitor
• Wysolone (prednisolone 5 / 10 / 20 mg) — oral corticosteroid
• Medrol (methylprednisolone 4 / 8 / 16 mg) — oral corticosteroid
• Predniheal (prednisolone) — oral corticosteroid
• Budez CR (budesonide) — gut-targeted corticosteroid for Crohn's
• Kenacort (triamcinolone) — systemic corticosteroid

Explore the full Ontstekingsremmende & Auto-immuunzorg category.

Veelgestelde vragen

Why hydrocortisone instead of prednisolone for replacement?

Hydrocortisone is identical to natural cortisol — same molecule, same receptors, same metabolism. Its short biological half-life (8–12 hours) allows the natural cortisol rhythm to be approximately mimicked with 2–3 daily doses. Prednisolone has a longer half-life and is harder to titrate to physiologic replacement; it also causes more growth suppression in childhood. Dexamethasone has an even longer half-life and is generally avoided for routine replacement, though it is sometimes used in CAH for its potency and once-daily dosing.

What is an adrenal crisis and how do I avoid it?

Adrenal crisis is acute, severe cortisol deficiency — the body cannot maintain blood pressure, blood sugar, sodium balance or vascular tone. Symptoms: severe weakness, abdominal pain, vomiting, low blood pressure, confusion, fever, hypoglycaemia. Untreated, it kills. Treatment: immediate IM/IV hydrocortisone 100 mg, IV fluids (saline or dextrose-saline), correction of electrolytes, treat the precipitating illness. The way to AVOID it: never miss your replacement dose, follow sick-day rules, carry the IM emergency injection kit, wear Medic-Alert ID, and tell every healthcare provider you have adrenal insufficiency.

When do I use the emergency hydrocortisone injection kit?

Use it (or have a partner/family member use it) immediately when: you are vomiting and cannot keep tablets down; you have severe diarrhoea; you have a fever above 39°C and feel very unwell; you have suffered major trauma; you are losing consciousness or feeling on the verge of collapse. The kit contains 100 mg hydrocortisone (Solu-Cortef or equivalent) for IM injection into the outer thigh. After using the kit, call emergency services and seek hospital review. Do NOT “wait and see” — using the kit when you didn't need it has no significant downside; failing to use it when you did is potentially fatal.

Can I take Hisone once a day instead of three times?

No — hydrocortisone's short biological half-life of 8–12 hours makes once-daily dosing impossible without long gaps of cortisol deficiency in the late afternoon and overnight. Many patients try to simplify dosing this way; it always leads to fatigue, weakness or under-replacement symptoms in the second half of the day. The 2–3 dose schedule (10/5/5 or 10/5/5 or 15/5 split) approximates the natural cortisol rhythm. Newer extended-release hydrocortisone (Plenadren, Chronocort) is designed for once-daily dosing but is not the same product as standard hydrocortisone tablets.

Do I need to take more Hisone before exercise?

Routine moderate exercise (jogging, gym, cycling, swimming) does not require an extra dose — the replacement dose covers normal activity. Strenuous exercise (long-distance running, prolonged hiking, competitive sport, heavy manual labour for several hours) may benefit from a small extra 5–10 mg dose 30–60 minutes before. Endurance events lasting hours may need a mid-event dose. Discuss with your endocrine team. There is no substitute for self-monitoring — if you regularly feel weak, dizzy or shaky during your usual exercise, your replacement plan needs review.

Can I drink alcohol on Hisone?

Moderate alcohol is generally safe at replacement dose. Heavy drinking is dangerous in adrenal insufficiency for two reasons: (1) hangover-related vomiting puts the patient at risk of missed doses and adrenal crisis; (2) hypoglycaemia from alcohol is more severe in cortisol-deficient patients. If you drink, eat with the alcohol, keep intake moderate, never miss your morning dose afterward, and have your IM kit available.

Can I have surgery on Hisone?

Yes, but you need stress-dose cover. For minor procedures (dental work, cataract, simple skin procedures): take an extra dose 1 hour pre-procedure and resume normal dosing afterward. For moderate surgery (laparoscopy, joint replacement): IV hydrocortisone 50–100 mg pre-induction, then 50–100 mg every 6–8 hours for 24 hours, then double oral dose for 1–2 days. For major surgery (cardiac, transplant, prolonged abdominal): IV hydrocortisone 100 mg pre-induction, infusion of 200 mg over 24 hours, then taper over 3–5 days. Always tell the anaesthetist and the surgical team about your adrenal insufficiency at every pre-operative review.

Can I have live vaccines on Hisone?

Yes — replacement-dose hydrocortisone (15–25 mg/day) is below the immunosuppressive threshold (which is ≥ 20 mg/day prednisolone equivalent = ~80 mg/day hydrocortisone). All live vaccines — MMR, varicella, yellow fever, BCG, live nasal flu, live Zostavax — are safe and recommended at replacement dose. Travel vaccinations should be planned ahead so you can stress-dose cover the response. Inactivated vaccines (annual flu, pneumococcal, COVID-19, recombinant Shingrix) are also safe and recommended.

How do I plan for travel?

Carry at least 2–3 weeks’ supply of Hisone plus the emergency IM kit in your hand luggage (not checked baggage). Carry a doctor's letter explaining your adrenal insufficiency and listing all your medications — useful for customs and emergency care abroad. Be aware that long-haul flights and time-zone changes can disrupt dosing rhythm; switch to local time on arrival. Travel insurance must be told about your adrenal insufficiency or it is invalid. Get all routine and travel vaccinations before departure with stress-dose cover.

Waarom bestellen bij MedsBase

Hisone is supplied through a WHO-GMP certified manufacturer with full COA documentation. We ship worldwide in plain, discreet packaging, and every order is covered by our Reshipment Assurance Policy. Uw betalingsbeschrijving bij betaling per kaart toont de gereguleerde betalingsverwerker (een gereguleerde kaartbetalingverwerker), nooit “MedsBase” of een medicijnnaam.

Other Anti-Inflammatory & Autoimmune Medications

If Hisone does not suit your situation, the following options are available in this category:

• Wysolone (Prednisolone 5/10/20 mg) — short anti-inflammatory courses
• Predniheal (Prednisolone 5/10/20/40 mg) — full strength range
• Medrol (Methylprednisolone 4/8/16 mg) — alternative for inflammation
• Kenacort (Triamcinolone 4 mg)
• Betnesol Tab (Betamethasone 0.5 mg) — long-acting fluorinated steroid

More options in Anti Inflammatory & Autoimmune Care

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