Q: How important is it to take my tablets rigorously at the same time every day? Generally I try to stick to 8.00 a.m. and 4.30 p.m. every day.

A: It is very important to take the tablets of hydrocortisone at regular times each day. I advise my patients that they should take their morning dose of hydrocortisone before they get out of bed in the morning on waking. They do not need to take these tablets which are for simple replacement therapy with food simply with a little water whatever the bottle containing the tablets says. For those on hydrocortisone my advice is for them to take the second dose of tablets later in the day with their evening meal but not later than 7pm. Sometimes they have to have a dose also in the middle of the day and this should be taken with lunch. Fludrocortisone should be taken twice a day in the morning and the evening with the hydrocortisone. The reason for taking the dose of hydrocortisone on an empty stomach before getting out of bed is that normally the circulating hydrocortisone (cortisol) levels rise to their maximum value about twenty minutes after waking. They then fall through the day. By taking the morning dose of tablets fasting on an empty stomach with just a little water the normal pattern of secretion is reflected most accurately. If the tablets are taken later in the day after breakfast the absorption is very slow, circulating levels of the hormone remain low for many hours and many patients feel tired and unwell early in the morning and take a long time to "get going".