Heat & Hydration

Supporting you to manage your adrenal insufficiency when the temperatures rise. Remember to store your medication according to instructions to ensure it continues to work as it should.

For people with Addison's, who do not produce the steroid hormone, aldosterone, learn how to manage your salt/fluid balance.

Storing your medication in the heat

Managing your salt and fluid balance

Keeping cool

Storing medication in the heat

High temperatures (above 25°C) can affect the efficacy of your medication, so it is important to ensure you store it correctly in hot conditions.

Be particularly vigilant with medication stored in emergency injection kits that you would usually store in the car, where temperatures may get high.

If your medicine has changed colour, developed an unusual smell, changed texture or looks different, this could signal heat damage. Order replacements and discard the degraded medication when you have new stock available.

Preventing heat damage

Check the manufacturer's instructions to see if your medication needs to be kept at a certain temperature. Solid medicines (tablets and capsules) are usually stable for a short time above 25°C – store them somewhere cool, dark and shaded.
In extreme heat, some medicines may need to be refrigerated to keep cool. In the short term, blister packaging should protect from the risk of any moisture damaging the medication. Refrigeration can help during heatwaves, though we wouldn't recommend it long-term. Be aware of any change to your medication.
Check how your medication should be stored (e.g. in a sealed container to block out light). Cool bags or pouches designed for items like insulin can also help keep medication cool in summer, and are available online or speak with your pharmacist for advice.
Emergency injection medication: Hydrocortisone sodium succinate (previously known as Solu-Cortef) is more stable in hot weather than hydrocortisone sodium phosphate (liquid hydrocortisone, which was discontinued in the UK in May 2026), so it is a good option for when going abroad.

If you are still worried, you may be able to contact individual manufacturers for additional and specific advice on your situation.

Managing your Salt/Fluid Balance

This is common sense for anyone spending time in high temperatures. For people with Addison's disease (primary adrenal insufficiency), it is an essential part of managing your health.

In hot temperatures, where you are sweating, you will lose both water and salts.

People with Addison's disease (primary adrenal insufficiency) are more vulnerable to dehydration/salt imbalance as they do not produce the hormone aldosterone, which is involved in the body effectively maintaining its fluid balance.

They take fludrocortisone daily to replace missing aldosterone.

It is therefore important to follow the guidelines below:

Be guided by your thirst and stay well hydrated by drinking plenty of water. Be aware that bottled water may be low in sodium and other minerals, so can just go straight through you.
If you are feeling symptoms of dehydration, e.g. light-headness, feeling 'washed-out', muscle cramps and persistent headaches, the quickest way to address this is, alongside drinking plenty of water, to keep your salt levels up by enjoying salty foods such as soup or salty snacks. You can also consider rehydration fluids or salts (available in most chemists).

Read our 'Why Salt' article

Increases to fludrocortisone take at least a couple of days before they impact symptoms of fluid/salt imbalance, so adjusting fludrocortisone doses is not a 'quick fix'. When you are spending an extended period of time in high temperatures that cause increased sweating, then daily fludrocortisone intake can be increased by 50micrograms. People with high blood pressure or a heart condition should speak to their endocrinologist before increasing their fludrocortisone dose. Indeed, the ideal is that everyone would first discuss their proposed medication change with their endocrinologist.
Follow Sick Day Rules if you are unwell and experiencing low cortisol symptoms.

Please note that there is little clinical evidence regarding this, so this advice is based on the experience and consensus advice of experts.

Stay cool and listen to your body

Stay cool and keep out of the sun.
Dress sensibly – long, light, loose clothes and a hat in direct sunshine.
Hot weather on holiday: It is easy to want to do everything when you’re travelling: You want to pack all the sights and experiences in, with early starts and late nights. Addison's and adrenal insufficiency have a knack of catching up with us when we overdo things, so watch for the signs that you need a rest, or for low cortisol symptoms that signal a need to updose.

Thank you to Matthew Heppel, endocrinology pharmacist and Clinical Advisory Panel member, for clarifying the guidance on medication storage.

Why Salt

Professor Simon Pearce explains the connection between aldosterone, fludrocortisone and why you should always listen to your salt cravings.

Translated Adrenal Crisis Guidelines

Heading abroad? Ensue you get the best care when you need it - print off adrenal crisis guidelines in the language you need.

Managing Travel & Holidays

Read our advice on how to best manage your adrenal insufficiency, including Addison's, when you are on holiday or travelling.

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