Emergency Hydrocortisone Injection

If you are not able, for whatever reason, to give yourself the emergency injection, and no one can support you with it, then you must phone 999 and call for an ambulance, using the keywords 'adrenal crisis' and 'steroid-dependent'.

An adrenal crisis is a Category 2 call, which means it will be treated as an emergency.

Have your NHS Steroid Emergency Card ready to show the paramedics when they arrive so they know what treatment you need.

Yes, Hydrocortisone Sodium Succinate 100 mg Powder for Solution is an effective treatment for an adrenal crisis.  

This type of hydrocortisone is more stable at temperatures above 25ºC than the liquid form previously (but no longer) available.

The disadvantage of hydrocortisone sodium succinate is that it is a dried form that must be mixed with sterile water before injection.  This results in a lengthy and fiddly process of preparing the injection before administration, which is made more difficult when severely unwell with the symptoms of adrenal crisis.

Yes, we would strongly recommend that you have it accessible at all times.  This is because you do not know if/when you will experience an adrenal crisis trigger (ie, a physical or severe psychological stress).

Low cortisol symptoms can quickly worsen, and you must be able to urgently prevent or treat an adrenal crisis by administering a hydrocortisone injection.

Research by Dr Sofia Llahana in 2025 has shown that being able to self-administer an emergency injection in an adrenal crisis will reduce the risk of you being admitted into hospital.

Most people are given blue BD Eclipse Needles 23G x 1" (with Safeslip Technology) and, separately,  BD 2ml Luer Syringes by their endocrinology team or GP. 

These are most suitable for an intramuscular injection into the outer thigh, but can also be used to inject into the upper arm.

Children may be given an orange needle, and people with a high BMI may be given a green needle.

One needle or two?

Some endocrine teams provide 2 different types of needle: one to draw up the water and inject it into the vial of powder, and a second one to draw up the mixed solution and inject it into the body. 

It is not essential to have 2 separate needles for this, and in an emergency, it is quicker to use the same blue BD Eclipse needle to first draw up the water and inject it into the powder vial, and then to use the same needle to draw up the mixed solution for injection into the body.

You may be given a 'handful' of needles and syringes to use in your injection kits or just enough for the number of kits you have.

What does BD mean?

BD stands for Becton Dickinson, who manufactur the needles and syringes.

What is an all-in-one needle/syringe?

There are some all-in-one needle/syringe combos available, such as the Vanishpoint 3ml retractable syringe.  Having the needle and syringe all in one saves one step of the injection preparation process.

During 2025 and the first half of 2026, these Vanishpoint syringes have not been available in the UK, but they are due to be available again in the latter half of 2026 and will be available to purchase from the ADSHG online shop.

Shop Emergency Kits & Spare Needles/Syringes

Unfortunately, the intramuscular needles and syringes needed for your kit cannot be added to your repeat prescriptions, as they are not available on the 'drug tariff'.

They can be obtained from:

• Your endocrine team
• Potentially your GP (not all GPs are happy to provide them as they are not able to claim the cost of them back). The ADSHG are working with other stakeholders to try and get the needles and syringes put onto the drug tariff. Your GP would then be able to prescribe them for you.
• The ADSHG online shop.

Clinical best practice

Provision of a minimum of 2 kits to people with primary and secondary adrenal insufficiency is the advice given in:

• the NICE Guidelines for the Identification and Management of Adrenal Insufficiency
• the ADSHG Clinical Advisory Panel
• the Society for Endocrinology
• the NHS page for Addison's disease 

For people with a diagnosis of tertiary adrenal insufficiency, provision of an emergency injection kit is dependent on the consultant endocrinologist's assessment of the individual's need, and how likely they may be to experience an adrenal crisis.

What type of adrenal insufficiency do I have?

If you have a diagnosis of adrenal insufficiency and are refused a kit:

Addison's and adrenal insufficiency are rare.  With over 7,000 rare diseases, it isn't possible for your GP to be an expert on your condition. Providing them with information about your condition and your needs means they have the medical evidence they need to prescribe an injection kit.

• Write to your GP or endocrinologist to share the latest clinical guidance above. 
• Direct them to our pages for Medical Professionals, which clearly explain why an emergency injection kit is required.
• Provide your GP with a copy of the 'Caring for a Patient with Adrenal Insufficiency' leaflet, available to download for free or order in print from our online shop.

Buy a copy for your GP now

I have tried all this, and STILL they won't give me one...

If your endocrinologist or GP still refuse to provide you with an injection kit after you have shared the clinical guidance, ask them to put it in writing why they are going against best practice advice for the management of adrenal insufficiency. Let your GP know you intend to include their answer when writing formally to Patient Advice and Liaison Service (PALS) about their unsafe management of your Addison’s or adrenal insufficiency. 

Advanz Pharma permanently discontinued the manufacture of hydrocortisone sodium phosphate (liquid hydrocortisone) in May 2026.  You may still have some vials from a previous prescription that are safe to use in your kit if they are still in date.

In the UK, this currently leaves Hydrocortisone Sodium Succinate 100mg Powder for Solution as the only prescription medicine for the emergency injection.

The ADSHG are leading a campaign to push for the licensing of a product called Act-o-vial, where the hydrocortisone sodium succinate and water are stored in two separate chambers of a dual-chamber vial.  They are mixed at the press of a button, saving several steps in the preparation process for the injection.

This is still a 'stop-gap' solution until a pre-filled syringe or auto-injector becomes available.  For more information, read our 'Future of Emergency Injections' article (link below).

Future of Emergency Injections

Currently, ACT-O-VIAL® is only available in the UK using the unlicensed medication route. 

ACT-O-VIAL® is a dual-chamber vial containing pre-measured doses of the same hydrocortisone sodium succinate powder ('Solu-Cortef'') and sterile water in two separate chambers.  There are fewer steps in the emergency injection preparation process when using hydrocortisone powder packaged in this way.  This makes it quicker for some people to use.

It is currently not licensed in the UK, but is available through an 'unlicensed medicine' route, with the support of your prescriber.  The ADSHG are also working with Pfizer to apply for ACT-O-VIAL® to be licensed in the UK, through their lead role in the 'Real Story' multi-stakeholder group.

Read more information in our article on ACT-O-VIAL® and how you may be able to get it on prescription in the UK.    

Read more about the Real Story Working Group and how they are driving improvements for the adrenal insufficiency community.

The Real Story

I have heard that GPs will also prescribe anti-nausea tablets or suppositories as part of your emergency kit.  My GP hasn't prescribed these - do I need to have them as part of my emergency kit? And if so, would I need my endocrinologist to prescribe these or should my GP be aware that these may be needed?

The anti-sickness tablets are probably of more use in preventing progression to adrenal crisis if patients can’t keep their medication down and/or take their usual steroids. If you are in crisis, you would need to seek immediate treatment anyway, and so would have any nausea and vomiting managed in that care setting. 

Having some on hand would certainly be useful for admission avoidance, so you could explain this rationale to your GP in order to get a prescription. 

Read our Working with your GP page

Some endocrine teams provide you with a 'ready-made' injection kit in a sturdy case/box.  Others give you the 'contents', and you can choose a small sturdy box yourself.  

Here we help you create your own:

1. Request your emergency hydrocortisone prescription from your GP

2. Check that your hydrocortisone sodium succinate powder has come with water vials.  If not, ask your endocrinologist or GP.

3. Request needles & syringes from your GP or endocrine healthcare team.  You can also buy them from our online shop.

4. Don't forget to ensure you have a set of instructions inside the kit on how to give an injection, and make sure it is clearly labelled 'Emergency Injection Kit for Adrenal Crisis Treatment'

5. Optional 'amp snappers': You'll see from our videos and advice that snapping the tops off the glass water vials can be made easier with 'Amp Snaps' that can be purchased online and are included with the charity injection kits. Some people also use a piece of clean gauze, a clean tissue or place the top of the vial inside the plastic part of the syringe wrapper. 

6. Choose a sturdy, portable box or case for your kit. Everybody's different, as we often say; some of us carry a handbag and need something small and compact. Others like a larger container so they can add extra items like extra tablets or extra information.

The main thing is that your kit must be portable. When we ask members about their kits, they tell us how they've found just the right container - a small camera case, a pencil box, a nice plastic storage box. The choice is yours. 

7. Ideally, label your container so it is clear that there is an emergency injection kit inside, and use the words 'steroid-dependent' somewhere on the box too.  Make expiry dates for your medication or the needles/syringes visible/clear.

Other useful bits to keep with your kit:

• NHS Steroid Emergency Card
• Adrenal Insufficiency Action Plan OR Adrenal Crisis Guidelines
• Steroid-dependency hospital stickers
• Spare steroid-replacement medication

Steroid Emergency Cards, and all of our leaflets are available to purchase from the ADSHG online shop.

Explore the shop

Only your GP or endocrinologist can give you a repeat prescription for the hydrocortisone sodium succinate to go into your kit.  However, you have various options as to how you source the other kit contents.

Your endocrine team:

Your endocrinologist or endocrine nurse team are likely to provide you with a kit, in one form or another, when you are first diagnosed.

Your GP: 

Your GP may be able to provide you with the syringes and needles (but may not!)

The ADSHG online shop:

The ADSHG stocks both small and large, clearly labelled emergency injection kits.  NB: They do not contain the prescription medication.

Purchase an emergency injection kit

The following contents will have an expiry date: 

• Your hydrocortisone medication
• Your needles
• Your syringes

It is important to regularly #CheckYourKit to make sure they are all in date.  Having the expiry date taped to the container you use is a good way of reminding yourself of expiry dates.

Set a reminder in your diary to check your kit every 6 months.

Unfortunately, as mixing of hydrocortisone sodium succinate powder and sterile water would not be done in aseptic (sterile) conditions, there is a risk that microbes would be introduced into the mixture, which could grow during a period of storage. 

The Patient Information leaflet by Pfizer, who manufacture hydrocortisone sodium succinate, is very clear in its advice that after reconstitution, this product should be used immediately (see below).

They cannot guarantee the stability or recommend its use outside of these conditions.   We strongly recommend following the Patient Information leaflet instructions.   We understand that the process of mixing hydrocortisone sodium succinate and water whilst in adrenal crisis is very difficult, and as a charity are strongly campaigning for political support of recognition of the patient safety issues.

Read about our Advocacy Campaign to drive improvements

Schedule 19 of the Human Medicine Regulations 2012 states that;

any person who recognises someone is in adrenal crisis is permitted to administer the individual's prescribed emergency hydrocortisone injection for the purpose of saving life. 

They do not have to be a healthcare professional. The law is very clear and simple on this, because the emergency injection saves a life, and immediate action is required.