Comprehensive medication guide to Hydrocortisone including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$0–$20 copay for generic on most plans; generic hydrocortisone is Tier 1–2 on most formularies. Covered by most Medicare Part D plans. Brand-name Cortef may require prior authorization or step therapy due to active shortage.
Estimated Cash Pricing
$20–$80 retail for generic hydrocortisone tablets for a 30-day supply; as low as $6.80–$15 with GoodRx or SingleCare coupons. Brand-name Cortef runs $50–$150+ without insurance.
Medfinder Findability Score
45/100
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Hydrocortisone is the pharmaceutical form of cortisol — the body's primary stress hormone, produced naturally by the adrenal glands. It belongs to the glucocorticoid (corticosteroid) drug class and is used both as hormone replacement therapy and as an anti-inflammatory and immunosuppressive agent.
The brand-name version of oral hydrocortisone tablets is Cortef (Pfizer). Injectable hydrocortisone is marketed as Solu-Cortef. A pediatric sprinkle capsule formulation is available as Alkindi Sprinkle (or Khindivi) in doses of 0.5 mg, 1 mg, 2 mg, and 5 mg for children with adrenal insufficiency.
Hydrocortisone oral tablets are FDA-approved to treat adrenal insufficiency (Addison's disease, congenital adrenal hyperplasia), inflammatory and autoimmune conditions (arthritis, lupus), severe allergic reactions, asthma, inflammatory bowel disease, and certain skin conditions when given systemically. Topical hydrocortisone (0.5%–2.5%) is used for eczema, psoriasis, contact dermatitis, and other localized inflammatory skin conditions.
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Hydrocortisone is a steroid hormone that is fat-soluble, allowing it to cross cell membranes and bind to glucocorticoid receptors (GRs) inside the cell's cytoplasm. The hydrocortisone-receptor complex then moves into the cell nucleus, where it binds to glucocorticoid response elements (GREs) on DNA. This activates or suppresses specific genes, altering the production of proteins that mediate inflammation, metabolism, and immune function.
As an anti-inflammatory, hydrocortisone suppresses pro-inflammatory cytokines (TNF-alpha, IL-1, IL-6), stabilizes immune cell membranes, reduces vascular permeability (swelling), and inhibits phospholipase A2 — the enzyme that produces inflammatory prostaglandins and leukotrienes. As hormone replacement in adrenal insufficiency, it restores circulating cortisol levels, regulating metabolism, blood pressure, immune function, and the hypothalamic-pituitary-adrenal (HPA) axis feedback loop.
Hydrocortisone has both glucocorticoid effects (anti-inflammatory, metabolic, immune suppression) and mineralocorticoid effects (sodium retention, potassium excretion, blood pressure regulation) — making it unique among corticosteroids. This dual activity is why hydrocortisone is the preferred replacement therapy for primary adrenal insufficiency. It has a plasma half-life of approximately 1.5–2 hours and biological effects lasting 8–12 hours.
5 mg — tablet
Lowest commercially available oral tablet strength; often most affected by shortage
10 mg — tablet
Mid-range oral tablet; frequently prescribed for adrenal replacement
20 mg — tablet
Highest oral tablet strength; can be split for lower doses
0.5 mg, 1 mg, 2 mg, 5 mg — sprinkle capsule
Alkindi Sprinkle / Khindivi — pediatric formulation for children with adrenal insufficiency
100 mg, 250 mg, 500 mg, 1000 mg — injectable
Solu-Cortef — for IV or IM use in emergencies and hospital settings
0.5%, 1%, 2.5% — topical cream/ointment
For skin conditions; 0.5% and 1% available OTC; 2.5% requires prescription
Hydrocortisone oral tablets (5 mg, 10 mg, 20 mg) have been on the FDA's official drug shortage database since April 2, 2020 — making this one of the longest-running drug shortages in the United States. The shortage was triggered when Amneal Pharmaceuticals discontinued all hydrocortisone tablet presentations in 2020, combined with COVID-19 pandemic supply chain disruptions. The remaining manufacturers — primarily Pfizer (Cortef brand and Greenstone generic) and Vensun Pharmaceuticals — have been unable to fully meet demand.
As of 2026, the shortage persists. Availability varies significantly by pharmacy, geographic region, and which tablet strength you need. Brand-name Cortef has generally maintained better availability than generics. The injectable Solu-Cortef shortage (2023) was largely resolved by late 2025. Topical hydrocortisone products are unaffected by the shortage.
To find a pharmacy near you with hydrocortisone in stock, use medfinder. medfinder contacts pharmacies on your behalf, checks current availability, and texts you the results — saving hours of phone calls. Both chain and independent pharmacies are checked.
Hydrocortisone is not a controlled substance, so any licensed healthcare provider with prescribing authority can write a prescription. There are no DEA registration requirements, no prescription monitoring program (PMP) obligations, and no limits on quantity or refills. The type of prescriber you see depends primarily on your underlying condition.
Endocrinologists — Primary prescribers for adrenal insufficiency (Addison's disease, CAH), pituitary disorders
Primary care physicians (PCPs) — Can prescribe for a wide range of conditions, including maintenance therapy for established patients
Rheumatologists — For rheumatoid arthritis, lupus, vasculitis, and other autoimmune conditions
Pediatricians / Pediatric Endocrinologists — For children with congenital adrenal hyperplasia (CAH)
Pulmonologists — For asthma and COPD exacerbations requiring systemic corticosteroids
Gastroenterologists — For inflammatory bowel disease (rectal and oral formulations)
Dermatologists — For prescription-strength topical hydrocortisone 2.5%
Nurse Practitioners (NPs) and Physician Assistants (PAs) — Licensed to prescribe in most states; often the most accessible prescribers in primary care settings
Hydrocortisone can also be prescribed via telehealth in all 50 states, since it is not a controlled substance. This is especially helpful for patients who need prescription renewals but cannot see their regular provider in person, or for patients in rural areas without nearby specialists. For complex conditions like Addison's disease or CAH, ongoing in-person specialist care with an endocrinologist is still recommended.
No. Hydrocortisone is not a controlled substance and is not scheduled under the DEA's Controlled Substances Act. It can be prescribed by any licensed physician, nurse practitioner, or physician assistant without special DEA registration or prescription monitoring requirements.
There are no restrictions on the number of refills or quantity that can be prescribed. Prescriptions can be called in to pharmacies, sent electronically, or written on paper without any controlled substance special requirements. Telehealth providers can prescribe hydrocortisone in all 50 states, making remote access to prescriptions straightforward.
The main access challenge for hydrocortisone is not the prescription — it is finding a pharmacy with the medication in stock given the ongoing supply shortage.
Common side effects with short-term or physiological replacement doses:
Mood changes (irritability, increased energy, anxiety)
Increased appetite and weight gain
Elevated blood sugar (hyperglycemia)
High blood pressure (hypertension)
Fluid retention (edema)
Insomnia (especially when dosed late in the day)
Stomach upset or GI irritation
Osteoporosis (bone density loss)
Adrenal suppression / adrenal crisis on abrupt discontinuation
Cushingoid features (moon face, buffalo hump, stretch marks)
Increased susceptibility to infections
Cataracts and glaucoma
Avascular necrosis (bone death, typically hip)
Low potassium (hypokalemia)
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Prednisone
Most commonly available alternative; 5 mg prednisone ≈ 20 mg hydrocortisone; once-daily dosing; widely available at virtually all pharmacies
Prednisolone
Active form of prednisone; preferred for liver disease patients; available as liquid for children; same potency as prednisone
Methylprednisolone (Medrol)
4 mg methylprednisolone ≈ 20 mg hydrocortisone; slightly more potent; minimal mineralocorticoid activity; available oral and injectable
Dexamethasone
0.75 mg dexamethasone ≈ 20 mg hydrocortisone; longest-acting (18-36 hr); very potent; no mineralocorticoid activity; generally not preferred for long-term adrenal replacement
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Warfarin (Coumadin)
majorHydrocortisone unpredictably alters warfarin's anticoagulant effect — both increased and decreased INR have been reported. Monitor INR closely when starting or stopping hydrocortisone.
NSAIDs (Ibuprofen, Naproxen, Aspirin)
majorCombined use significantly increases risk of gastrointestinal ulcers and bleeding. Use acetaminophen if possible; if NSAIDs required, add PPI protection.
Live Vaccines (MMR, Varicella, Yellow Fever)
majorContraindicated at immunosuppressive corticosteroid doses. Immune suppression can prevent vaccine response and risk vaccine-strain infections.
Rifampin, Phenytoin, Phenobarbital
moderateCYP3A4 inducers that accelerate hydrocortisone metabolism, reducing drug levels. Patients with adrenal insufficiency may need significantly higher doses. Critical to monitor.
Ketoconazole and Azole Antifungals
moderateCYP3A4 inhibitors that slow hydrocortisone metabolism, increasing drug levels and potential side effects.
Cyclosporine / Tacrolimus
moderateMutual inhibition of metabolism; may increase levels of both drugs. Monitor drug levels and side effects closely.
Potassium-Wasting Diuretics (Furosemide, HCTZ)
moderateCombined use increases risk of hypokalemia. Monitor potassium levels.
Diabetes Medications (Insulin, Metformin)
moderateHydrocortisone raises blood glucose. Diabetes medication doses may require adjustment when starting or changing hydrocortisone.
St. John's Wort
moderatePotent CYP3A4 inducer that significantly reduces hydrocortisone blood levels. May compromise adrenal replacement in insufficiency patients. Avoid combination.
Hydrocortisone is one of the most essential medications in modern medicine. For patients with Addison's disease, congenital adrenal hyperplasia, or other conditions requiring cortisol replacement, it is a life-sustaining therapy with no real alternative. The ongoing FDA shortage of oral tablets — now in its sixth year — is a genuine crisis for this patient population.
Strategies for managing the shortage include: seeking brand-name Cortef (which has had better availability), working with compounding pharmacies (especially for pediatric CAH patients), and building an emergency buffer supply when medication is available. Talk to your endocrinologist about stress dosing protocols and ensure you have an emergency injection kit on hand.
When you need to find hydrocortisone in stock near you, medfinder is your fastest solution. medfinder contacts pharmacies near you on your behalf to check which ones have your specific medication and dose in stock, and texts you the results. Stop spending hours on hold — let medfinder find your pharmacy.
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