People with Addison's disease and adrenal insufficiency carry emergency injectable hydrocortisone to treat or prevent an adrenal crisis.
Since liquid hydrocortisone (hydrocortisone sodium phosphate), was discontinued in May 2026, the only form of hydrocortisone available in the UK is hydrocortisone sodium succinate powder which must be reconstituted with sterile water before injecting.
These medications come in separate vials (shown left). The process to prepare the injection is fiddly, with multiple steps.
Our community have been asking us about ACT-O-VIAL® hydrocortisone (shown right) as an alternative. It isn't currently licensed in the UK, though it is licensed in the EU. Its main advantage is that it is generally considered quicker to prepare than the standard UK hydrocortisone sodium succinate injection, which can make a life-saving difference in a time-critical adrenal crisis.
Here we explain what ACT-O-VIAL® is, what "unlicensed medicine" means, and how it may be prescribed in the UK. This article is intended to support informed discussions between patients and their healthcare teams.
What is Act-O-Vial®?
What does "unlicensed medicine" mean?
Can Act-O-Vial® be prescribed in the UK?
How is Act-O-Vial® prepared?
What does it cost, and how quickly can it be supplied?
Next steps
Frequently Asked Questions
What is ACT-O-VIAL®?
ACT-O-VIAL® contains:
- Hydrocortisone sodium succinate
- Sterile water for injection
The active medicine, hydrocortisone sodium succinate, is the same effective form of hydrocortisone used currently in the UK for the treatment of adrenal crisis.
The difference is in the design.
Instead of a separate powder vial and water ampoule, both are held together in one dual-chamber vial.
You simply press a plastic activator to release the water into the powder, mix, and draw up the dose. This means fewer steps to prepare an emergency injection, which can make a real difference if you're unwell, in pain, alone, or have difficulty with dexterity.
ACT-O-VIAL® is used in a number of countries but does not currently hold a UK medicines licence (Marketing Authorisation).
What does "unlicensed medicine" mean?
An unlicensed medicine is a medicine that does not currently have a UK Marketing Authorisation.
This does not mean that the medicine is unsafe, experimental, or unavailable elsewhere. ACT-O-VIAL® is a well-established product, already licensed for use in the EU and elsewhere. It simply doesn't yet have its own licence (Marketing Authorisation) in the UK.
However, UK regulations allow healthcare professionals to prescribe unlicensed medicines when they believe this is necessary to meet the clinical needs of an individual patient, and this cannot be met by a licensed alternative.
The use of unlicensed medicines is a normal and established part of NHS practice. Doctors across the NHS prescribe unlicensed medicines every day, in fields like children's medicine, palliative care, and rare diseases - whenever they judge it's the right thing for a particular patient.
Can ACT-O-VIAL® be prescribed in the UK?
Potentially, yes, but the decision rests with the healthcare professional responsible for your care, for example, your endocrinologist or GP. Factors that may be relevant to discuss with your healthcare professional include:
- Difficulty preparing the current multi-step emergency injection during an adrenal crisis
- Reduced hand strength or dexterity
- Arthritis or tremor
- Visual impairment
- Past experience of adrenal crisis and hospital admissions
- Concerns about being able to prepare an injection when acutely unwell, particularly for those who live alone
Everyone with adrenal insufficiency and at risk of adrenal crisis would benefit from a simpler emergency injection process. But people in the groups above may have a particularly strong case to discuss with their clinician.
Research supports that patients who inject themselves early, rather than waiting for paramedics or A&E, are less likely to need a hospital admission. This shows the benefits not only in health outcomes and confidence for the patient and those who support them, but also for the NHS in terms of costs related to preventable hospital admissions.
How is ACT-O-VIAL® prepared?
One of the reasons many patients prefer ACT-O-VIAL® is that the sterile water and hydrocortisone powder are stored together in a dual-chamber vial.
With the current UK process, you need to remove the powder bottle cap, snap open the water ampoule, draw up the water, mix it into the powder, and draw up again to inject. ACT-O-VIAL® simplifies this - pressing the plastic activator releases the diluent straight into the powder bottle. Once mixed, you simply draw up the solution and inject. This means fewer steps overall compared with the standard UK hydrocortisone sodium succinate preparation.
Watch our YouTube video demonstrating how to give an emergency injection of hydrocortisone using an ACT-O-VIAL® bottle and a retractable safety syringe in the event of an adrenal crisis.
It is narrated by Professor John Wass, Chair of our Clinical Advisory Panel, with injection demonstration performed by consultant endocrine nurse, Phillip Yeoh.
What does it cost, and how quickly can it be supplied?
Because it's imported, ACT-O-VIAL® currently costs more than the standard UK-licensed hydrocortisone sodium succinate powder and diluent presentation, and has a longer procurement (supply) time.
Indicative supplier pricing obtained by ADSHG in 2026 suggests a cost of approximately £84.20 per pack of 10 × 100mg ACT-O-VIAL® (equivalent to around £8.42 per vial), with additional delivery charges potentially applying to smaller orders. Supply is typically arranged through specialist importers and may require a lead time of approximately 7–10 days, depending on availability in the source country.
Prescribers should balance procurement and cost considerations against the individual clinical needs of the patient and any difficulties the patient may experience with the preparation of the standard emergency injection.
Two importers we have reached to; Genetech Healthcare and Target Healthcare, who have confirmed they are able to source ACT-O-VIAL® for UK prescribers.
Costs and availability are subject to change, and prescribers or pharmacies should obtain current pricing directly from the supplying importer before prescribing.
Next steps: What should I do if I'm interested?
1. Talk to your healthcare team. This can be your endocrinologist, endocrine nurse or GP.
2. Explain your situation. Let them know why ACT-O-VIAL® may better meet your needs, bearing in mind the priority groups mentioned above. Highlight any concerns about preparing an injection during an adrenal crisis, as well as your previous experiences of adrenal crisis.
3. Your healthcare professional considers your request. They will decide whether there is sufficient clinical justification for prescribing an unlicensed medicine. They may provide the prescription during your appointment, or they may seek advice from:
- Hospital pharmacy teams
- Medicines optimisation teams
- Endocrinology colleagues
- Local prescribing advisers
- This is a normal part of the process.
4. The prescription is provided. This can be done by your GP or endocrinologist. It will appear as: "Solu-Cortef ACT-O-VIAL® 100mg powder and solvent for solution for injection vials (imported)", on their system. They will decide with you how many vials to prescribe.
5. The medicine is sourced. It can be helpful if, at the time of prescribing, your healthcare professional notes on the prescription for your pharmacy that confirmed importers include Genetech Healthcare, Target Healthcare, and Alcatia Pharma. Your pharmacy will then liaise with these importers (more details below).
How is Act-O-Vial® obtained?
The Department of Health and Social Care has advised that specialist importers have previously confirmed that they can source unlicensed hydrocortisone sodium succinate ACT-O-VIAL®, including:
Target Healthcare: Currently importing from Australia. Available within around 7 days from order. Can be ordered as 1 vial or more. Costs not shared at the time of publishing.
Genetech Pharmaceuticals: Currently importing from Canada. Available within 7-10 days. Costs quoted as £84.20 per pack of 10 × 100mg Act-O-Vials at the time of publishing (Aug 2026).
Availability can change over time and may depend on supply in countries where the product is licensed. Your prescriber and pharmacist will identify the most appropriate route for obtaining the medicine.
Your pharmacy may not have used these importers before, so they may have to open a new account with them. They may need to get approval within their own business to do this, which may make the process longer.
Summary
ACT-O-VIAL® offers a simpler, faster way to prepare emergency hydrocortisone, something that can make a real difference in a time-critical adrenal crisis. If you think it could help you, the first step is to speak to your endocrinologist or GP about whether prescribing this unlicensed medicine would meet your clinical needs.
When making that decision, prescribers should weigh procurement and cost considerations against your individual clinical needs, including any difficulties that you may have preparing standard emergency injection kits.
We'll continue to update this page as availability, pricing, and guidance evolve.
This article is intended for information only and does not replace personalised medical advice. Patients should always discuss treatment decisions with their healthcare professional.
FAQs
Read more about the topics raised in this article:
Discontinuation of liquid hydrocortisone
Emergency hydrocortisone injection
Adrenal crisis emergency management
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