Hisone (Hydrocortisone 20mg) Tablets

Hisone general information

What is Hisone used for?

The adrenal glands sit just above the kidney.  They are vital endocrine (hormone-producing) organs that regulate many body functions, including metabolism, blood pressure, our response to stress, and our immune system.  If the adrenal glands don’t produce enough hormones, this condition is known as adrenal insufficiency and can cause serious health problems.  Hisone tablets 20mg are used as hormone replacement therapy for treating adrenal insufficiency. 

Adrenal gland hormones

The hormones produced by the adrenal glands include cortisol, a glucocorticoid commonly known as the stress hormone that plays an essential role in metabolism.  Cortisol regulates the way the body uses fats, proteins, and carbohydrates, and increases blood sugar.  It is also a potent anti-inflammatory and has regulatory effects on blood pressure and bone formation.  The amount of cortisol released by the adrenal gland, is controlled by Adrenocorticotropic Hormone (ACTH}.  The pituitary gland in the brain is the control centre for many endocrine (hormone) systems.  It produces ACTH in response to low cortisol levels in the blood. 

Aldosterone is a mineralocorticoid hormone that regulates blood volume and salt content.  These are both important factors in regulating blood pressure. 

Adrenaline (epinephrine) and noradrenaline (norepinephrine) are catecholamines.  They trigger the flight or fight response and work by increasing heart rate, blood flow to the muscles and brain, and glucose metabolism to supply a rapid energy source.  

The adrenal glands also produce a precursor sex hormone (dehydroepiandrosterone or DHEA) that can be converted into oestrogen in the ovaries or androgens in the testes.

Adrenal insufficiency

Addison’s disease is the most common form of primary adrenal insufficiency.  It is an autoimmune disease, where the immune system attacks body tissues, mistaking them as foreign.  The adrenal cortex is the outer part of the adrenal gland and is where cortisol is produced.  The immune system gradually destroys the cells of the adrenal cortex, resulting in low cortisol levels.  Another common cause of adrenal insufficiency is when the pituitary gland does not produce enough ACTH to stimulate the production of cortisol by the adrenal gland.  This is known as secondary adrenal insufficiency.  It can be due to a pituitary tumour, some medications such as prednisone, or surgical removal of the pituitary. 

Other conditions affecting the production of cortisol include congenital adrenal hyperplasia, which is an inherited disease, where an essential enzyme for cortisol production is missing.  Also an infection and adrenal gland tumour.

Symptoms of adrenal insufficiency

Symptoms of adrenal insufficiency include abdominal pain, nausea, vomiting, weight loss, poor appetite, fatigue, muscle weakness and dizziness due to low blood pressure.  Another symptom of Addison’s disease is darkening of the skin.

Hisone tablets contain a steroid that is similar to cortisol, a naturally occurring steroid hormone produced by the adrenal glands.  Therefore, it can also be used as replacement therapy in endocrine (hormone) conditions caused by low cortisol levels. 

Other uses for Hisone

Aminoglutethimide is a medication used to treat breast or prostatic cancer, and it causes an increase in ACTH.  Hisone is used in conjunction with aminoglutethimide to inhibit ACTH secretion.

How does Hisone work?

Hisone tablets 20mg contain hydrocortisone, a synthetic corticosteroid hormone, that is used as hormone replacement therapy to substitute for low cortisol levels.  Hydrocortisone in Hisone tablets 20mg has similar properties to the naturally produced hormone cortisol, and works by binding to a specific glucocorticoid receptor that is expressed (made available) inside most cells of the body.  Interaction between hydrocortisone and its receptor regulates the transcription of particular genes (the process where DNA is converted into RNA, the template for protein synthesis).  These genes control many aspects of development, metabolism, and the immune response.  Hydrocortisone in Hisone tablets 20mg restores essential corticosteroid hormone levels to normal.  This helps relieve symptoms of adrenal insufficiency.

What does Hisone contain?

Hisone tablets 20mg contain the active ingredient hydrocortisone, used as hormone replacement therapy to increase low cortisol levels. 

What are the side effects of Hisone?

Most medications have some side effects, but they are not experienced by everyone.  Some side effects are commonly experienced when taking Hisone, but others are not so common, and you should discuss any problems or concerns with your primary care physician. 

Common side effects when taking Hisone include headache, gastrointestinal disorders (indigestion, ulcers, nausea), increased susceptibility to infection, muscle or bone aches and pains, weight gain, oedema (fluid retention in the tissues causing swelling), thinning of skin, bone demineralisation, slow wound healing, acne, redistribution of body fat creating the typical moon face, altered vision, menstrual problems.  Also, behavioural and mood disturbances such as depression, irritability, anxiety, sleep disturbances.

When should Hisone not be used?

Have a talk with your primary healthcare physician before taking Hisone tablets 20mg so that you have a full understanding of what this medicine is for and how to use it.  There are some reasons for not taking a medication; these are called contraindications, and for Hisone you should consider the following before taking Hisone:

• Have you ever had an unusual reaction or an allergy when taking Hisone?
• Are you pregnant or breastfeeding?
• Do you have any problems with your kidneys or your liver?
• Do you have a thyroid, stomach, or heart condition?
• Do you have high blood pressure, epilepsy, diabetes, glaucoma or osteoporosis?
• Do you have a mood disorder?
• Do you have any infectious disease, acute infection, systemic fungal infection, tuberculosis, or uncomplicated viral hepatitis?
• Have you had contact with anyone suffering from an infectious disease like chicken pox or measles?
• Are you due to receive a vaccination with a live virus vaccine?

What medications interact with Hisone?

Some medicines interact with Hisone tablets 20mg and may affect the way it works or are affected by Hisone or increase side effects; you should discuss possible interactions with your primary care physician.  These may include aspirin, anti-inflammatories such as diclofenac, ibuprofen, mefenamic acid, phenylbutazone or naproxen, barbiturates, antiepileptics like carbamazepine and phenytoin, antibiotics like clarithromycin, anti-infectives like rifampicin, antifungals like ketoconazole and itraconazole, anticoagulants like warfarin, diuretics like hydrochlorothiazide or frusemide, St John’s Wort for depression.  . 

If other medications may interact with Hisone, your doctor will discuss these with you. 

How should Hisone be taken and for how long?

You should take your Hisone tablets 20mg swallowed whole with a glass of water with or without food, two to three times daily.  The dose you take depends on what you are being treated for and your doctor’s recommendation.  You should continue to take your Hisone tablets 20mg for as long as recommended by your doctor.  When you are advised to stop taking Hisone, you should not do this suddenly, and your dose will gradually be reduced over a few weeks.

Missed dose of Hisone

If you miss a dose of Hisone tablets 20mg take it as soon as you remember, unless it is time to take the next dose, then skip the missed dose.  Do not take a double dose.

How should Hisone be stored?

You should store your Hisone tablets 20mg below 25°C in a cool dry place.