Hydrocortisone Injection Changes in the UK: What It Means for Aspergillosis Patients

Last reviewed: March 2026
Audience: Patients, carers, and non-specialist healthcare professionals

Table of contents

• Overview
• Why hydrocortisone matters in aspergillosis
• What has changed in the UK
• What this means in practice
• Potential concerns and risks
• Practical steps for patients and carers
• Common questions
• When to seek medical help
• References

Overview

Hydrocortisone is a steroid hormone used as cortisol replacement in people whose bodies cannot produce enough cortisol, a condition known as adrenal insufficiency.

Some patients with aspergillosis may be affected by this change because:

• long-term steroid use can suppress the body’s natural cortisol production
• adrenal function may be reduced during or after treatment
• some patients may already have adrenal insufficiency or need emergency steroid cover

In emergencies, hydrocortisone injections can be life-saving.

Why hydrocortisone matters in aspergillosis

Patients with aspergillosis may encounter adrenal-related issues for several reasons. For example, some people with allergic bronchopulmonary aspergillosis (ABPA) have needed prolonged courses of steroid treatment. Over time, this can reduce the body’s own cortisol production.

There can also be concerns about drug interactions, especially where antifungal medicines and steroid medicines affect the way the body handles hormones. Not every aspergillosis patient will be affected, but for some people this is an important part of their wider treatment plan.

If cortisol levels are too low during illness, injury, vomiting, or other physical stress, this can lead to an adrenal crisis, which is a medical emergency.

What has changed in the UK

Previously, some patients were supplied with a ready-made liquid hydrocortisone injection. This was already in solution and could be given more quickly.

This ready-to-use product is no longer available in the UK.

Most patients who need emergency hydrocortisone injection are now supplied with a preparation that includes:

• a vial containing hydrocortisone powder
• a liquid for mixing
• a syringe and needle for drawing up and giving the injection

The medicine itself is still hydrocortisone and remains standard treatment. What has changed is the practical process: it now needs to be prepared before it can be injected.

Diagram: preparing hydrocortisone injection

Preparing a hydrocortisone injection (Video) : https://www.youtube.com/watch?v=NXXB3w1ADcI

What this means in practice

For many patients, this change is manageable with training and practice. However, it does change the experience of using emergency medication.

Compared with a ready-made solution, there are now more steps involved. In a calm situation, that may not seem significant. In an emergency, it can feel much harder.

This is especially relevant if the person is:

• very unwell
• vomiting
• dizzy or confused
• trying to guide a family member or carer through the process

For some patients, this could potentially cause a delay in giving the injection. That does not mean the current treatment is ineffective or unsafe, but it does mean that confidence, familiarity, and training matter even more.

Potential concerns and risks

1. More steps may mean more delay

The current injection usually has to be mixed before use. That means opening the kit, preparing the medicine, drawing it up, and then giving the injection. In an emergency, even a short delay may feel important.

2. Stress makes practical tasks harder

Patients and carers are often being asked to act quickly during a frightening situation. Even people who have previously been shown what to do may lose confidence if they rarely need to use the injection.

3. Training may vary

Not everyone receives the same level of teaching or refresher support. Some people may feel very confident. Others may feel unsure, especially if their kit has changed.

4. Aspergillosis patients may already be managing a lot

Some patients are already coping with breathlessness, fatigue, infections, multiple medicines, and complex follow-up. Adding a more complicated emergency injection process can feel like an extra burden.

It is important to keep this concern in proportion. Many patients and carers do use mixed hydrocortisone kits successfully. The key issue is not that the medicine no longer works, but that the loss of a ready-made formulation may make emergency use less straightforward.

Practical steps for patients and carers

If you have been prescribed emergency hydrocortisone, it may help to:

• check that you know exactly which product you have been given
• ask for a demonstration of how to prepare and inject it
• ask for a refresher if you are not confident
• make sure family members, carers, or trusted friends also know what to do
• keep the emergency kit somewhere accessible and check expiry dates regularly
• carry any steroid emergency information you have been given, such as a steroid card

These steps cannot remove all risk, but they may reduce hesitation and confusion if the injection is ever needed urgently.

Common questions

Has hydrocortisone been withdrawn completely?

No. Hydrocortisone is still widely used. The main issue is that a ready-to-use liquid injectable form is no longer available in the UK.

Is the current injection less effective?

No. The medicine remains hydrocortisone. The change is in the formulation and the preparation steps, not in the intended effect of treatment.

Why does this matter so much?

In an emergency, simple treatments are often easier to use correctly and quickly. A preparation that needs mixing may be more difficult for some patients or carers under pressure.

Does this affect every aspergillosis patient?

No. This is mainly relevant to people who have adrenal insufficiency, adrenal suppression, or a clear plan from their clinical team to keep emergency hydrocortisone available.

Should patients be worried?

Patients should not panic, but it is reasonable to recognise this as a practical concern. If you rely on emergency hydrocortisone, it is sensible to make sure you understand your current kit and feel as confident as possible using it.

When to seek medical help

Seek urgent medical help if there are symptoms suggesting a possible adrenal emergency, especially if there is:

• severe weakness
• collapse or near-collapse
• confusion or marked drowsiness
• vomiting or inability to keep medicines down
• sudden severe illness or infection

If an emergency hydrocortisone injection has been prescribed, follow the instructions given by your clinical team and seek urgent medical care immediately.

References

• British National Formulary (BNF): hydrocortisone medicinal forms
• Society for Endocrinology guidance on adrenal crisis and emergency steroid treatment
• NHS information on steroids, steroid emergency cards, and urgent care
• UK endocrine and Addison’s patient group communications on hydrocortisone supply changes

---