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Hydrocortisone muco-adhesive buccal tablets continue to be used for the treatment of adrenal insufficiency in children in the UK
  1. Meera Shaunak1,
  2. Indraneel Banerjee2,
  3. Justin Huw Davies1
  1. 1 Department of Paediatric Endocrinology, Southampton General Hospital, Southampton, UK
  2. 2 Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester, UK
  1. Correspondence to Dr Meera Shaunak, Department of Paediatric Endocrinology, Southampton General Hospital, Southampton SO16 6YD, UK; meera.shaunak{at}

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Adrenal insufficiency (AI) is caused by inadequate cortisol production by the adrenal glands and is a life-threatening disorder in children and young people. It is important to ensure good adherence to hydrocortisone prescribed as cortisol replacement in AI. Several hydrocortisone preparations are available, with wide variation in prescribing practices.1 However, not all preparations are recommended for regular therapy of AI; recently, the Medicines and Healthcare products Regulatory Agency (MHRA) issued a safety alert recommending against the off-label use of hydrocortisone muco-adhesive buccal (buccal-HC) tablets, citing insufficient cortisol absorption and consequent risk of life-threatening adrenal crisis.2

Since the MHRA safety alert, the British …

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  • Contributors MS drafted the initial manuscript and revised the manuscript. IB and JHD reviewed and revised the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.