Steroid sick day rules

This applies to you if:

  • You suffer from Addison’s disease (also called primary adrenal insufficiency)
  • You have taken, or will take, steroid replacement therapy for 4 or more weeks (i.e. more than 3mg prednisolone or more than 10mg hydrocortisone daily)
  • You have taken, or will take (because of, e.g. recurrent exacerbations of asthma or COPD) 3 or more short courses of oral steroids per 12 months

If you are on any other form of long-term steroid, please get in touch with your doctor for further information.

Adrenal insufficiency: Taking regular oral steroids for more than 4 weeks consecutively can temporarily reduce your adrenal gland producing a hormone called cortisol. This is called adrenal insufficiency. Since your oral steroids are similar to cortisol, this is not a problem when you are otherwise well.

When your body is under major stress however, such as with a severe infection or surgery, you will need extra doses of steroids to help maintain your blood pressure and let your body deal with the stress.

Adrenal Crisis: If you are usually on oral steroids and do not take extra doses during a major illness, you can go into adrenal crisis. This is a life-threatening condition that requires immediate hospitalisation. The symptoms include severe dizziness, lightheadedness, fever, shivering, feeling very cold, extreme fatigue, feeling sick or vomiting, drowsiness, confusion, aching muscles and joints, stomache aches, and severe diarrhoea.


Preventing an adrenal crisis: ensure you know the sick rules below and that you have a month’s supply of extra steroids at home to take if unwell. Do not skip steroid doses and do not stop without input from a medical professional. If you feel unwell after stopping steroids, contact your GP.

Sick Day Rule 1

There is no need to increase steroid dose if you only have a mild illness with no fever. But IF YOU ARE UNWELL WITH A FEVER, INCREASE YOUR ORAL STEROID DOSE until you are completely better.

  • If you take less than 10mg prednisolone daily: take double your normal dose
  • If you take 10mg to 19mg prednisolone daily: increase to 20mg
  • If you take 20mg or more daily: no need to increase your dose
  • If you take more than 10mg daily of hydrocortisone: take 20mg immediately and then 10mg every 6 hours until you recover

Sick Day Rule 2

SEEK MEDICAL ADVICE URGENTLY IF ANY OF THE FOLLOWING HAPPEN, since you will require steroid injections:

  • Severe diarrhoea or vomiting lasting more than a day
  • If you have a major injury
  • If you are due to undergo major surgery
  • If you need to take bowel prep prior to colonoscopy

Special Situations

Pregnancy: continue normal doses. You will need a steroid injection at the onset of labour and then double your normal oral dose for 48 hours after giving birth.

Minor dental surgery: Discuss with your dentist. A typical regime would be

  • Prednisolone: take 5mg one hour before the procedure, double your usual dose for 24 hours after the procedure, and then back to your usual dose
  • Hydrocortisone: take 20mg one hour before the procedure, double your usual dose for 24 hours after the procedure, and then back to your usual dose

Major dental surgery: discuss in advance with your dentist; you might require steroid injections.

COVID (confirmed, or suspected by a medical professional):

  • Prednisolone: take 10mg twice daily until you recover
  • Hydrocortisone: take 20mg every 6 hours until you recover

What to do now

  1. Ensure you have a steroid emergency card with you at all times; the NHS Steroid Emergency Card was launched in August 2020 to improve patient safety for those with adrenal insufficiency. Find more information here: PMRGCA UK | The Pituitary Foundation
  2. Keep these instructions with you to show your healthcare professional.
  3. If you are on long term steroids please ensure that you have at least a one-month supply of your medication left at any time. This will allow you to increase the dose in accordance with sick day rule 1 if required.  Please talk to your GP or our practice pharmacy team if additional supplies are needed for this.
  4. You can self-register with the ambulance service so you are highlighted as potentially needing steroid injections in an emergency (Registering with Your Local Ambulance Service | Addison’s Disease Self-Help Group)

See also:

Steroid emergency card

Last modified: July 12, 2022