Hydrocortisone injections

Hydrocortisone injections, also called corticosteroid injections, are used to treat swollen or painful joints, or muscle pain. You may get this type of pain after an injury.

They're also used to treat painful tendons and bursitis (when the fluid-filled sacs that cushion a joint become swollen).

Hydrocortisone injections usually help relieve pain and swelling to make movement easier. The benefits can last for 2 to 3 months.

Hydrocortisone is a type of medicine known as a steroid (or corticosteroid). Corticosteroids are not the same as anabolic steroids.

Hydrocortisone injections are only available on prescription. They're usually given by a specially trained doctor in a GP surgery or hospital clinic.

Most adults and children, including babies, can have hydrocortisone injections.

Hydrocortisone injections are not suitable for some people. To make sure it's safe for you, tell your doctor before starting the medicine if you:

• have ever had an allergic reaction to hydrocortisone or any other medicine
• or any of your close family have ever had depression or manic depression (bipolar disorder)
• have an infection (including an eye infection)
• are trying to get pregnant, are already pregnant or you're breastfeeding
• have recently been in contact with someone with chickenpox, shingles or measles
• have recently had, or you're due to have, any vaccinations

Hydrocortisone injections can make some health problems worse so it's important that your doctor monitors you.

Make sure your doctor knows if you have:

• any unhealed wounds
• high blood pressure
• an eye problem called glaucoma
• weak or fragile bones (osteoporosis)
• type 1 or type 2 diabetes

If you have diabetes and monitor your own blood sugar, you'll need to do this more often. Hydrocortisone injections can affect your blood sugar control.

Your dose of hydrocortisone depends on the size of your joint or tendon.

The amount of hydrocortisone you need could go up or down if you have a follow-up injection. It depends on how well the previous injection worked, how long the benefits lasted and whether you had any side effects.

You'll usually get your injection from a specialist doctor at your GP surgery or a hospital clinic.

If the injection is for pain, it may contain a local anaesthetic. You may be given a local anaesthetic by spray or injection to numb the skin before the hydrocortisone injection.

The hydrocortisone is injected directly into the soft tissue around your painful joint or tendon. You can go home after the injection, but you may need to rest the joint that was treated for a few days.

Hydrocortisone injections usually help with pain and swelling for around 2 months. They can also make movement easier.

If the pain and swelling gets better after a single hydrocortisone injection, you may not need another injection.

The number of injections you can have depends on the area being treated and how strong the dose is.

If you have a short-term injury, an injection will often help you start to move again so that your body can heal itself.

If you have a long-term problem and your hydrocortisone injections are working well, you can carry on having them. For long-term pain, an injection may help for a few months.

The most common side effect of hydrocortisone injections is intense pain and swelling in the area where the injection was given. This usually gets better after a few days.

You may also get some bruising where the injection was given. This should go away after a few days.

It helps to rest the joint for 24 hours after the injection and avoid heavy exercise. It's safe to take painkillers such as paracetamol or ibuprofen.

In rare cases, if hydrocortisone gets into your blood, it can travel around your body and cause serious side effects.

If you're having repeat doses of hydrocortisone injections, or you're also taking other steroid medicines or tablets for fungal infections or HIV, you may get underactive adrenal glands as a side effect. Ask your doctor if you need to carry a red steroid emergency card (for adults), or an adrenal insufficiency card if the treatment is for a child.

Speak to a doctor if you get a puffy, rounded face, and weight gain in the upper back or belly. This happens gradually and can be a sign of Cushing's syndrome.

Call a doctor or call 111 now if you get:

• a high temperature, chills, a very sore throat, ear or sinus pain, a cough, coughing up more mucus (phlegm) or a change in colour of your mucus, pain when you pee, mouth sores or a wound that will not heal – these can be signs of an infection
• sleepy or confused, very thirsty or hungry, a need to pee more often than usual, flushing, breathing quickly or breath that smells like fruit – these can be signs of diabetes or complications of diabetes
• any changes to your eyesight
• breathlessness
• swelling or throbbing in your arms or legs

• you have black or dark brown vomit or you're vomiting blood

Find your nearest A&E

Do not drive to A&E. Ask someone to drive you or call 999 and ask for an ambulance.

Bring all the medicines you take with you.

You may notice mood or mental health changes while having hydrocortisone injections.

Talk to your doctor or call 111 if:

• you're feeling high, or have moods that go up and down
• you're feeling depressed
• you're feeling anxious
• you have problems sleeping
• you have difficulty in thinking, or are feeling confused and forgetting things
• you're feeling, seeing or hearing things that do not exist (hallucinations)
• you notice changes in the way you usually behave

Serious allergic reaction

It's possible to have a serious allergic reaction (anaphylaxis) to hydrocortisone injections.

Call 999 now if:

• your lips, mouth, throat or tongue suddenly become swollen
• you're breathing very fast or struggling to breathe (you may become very wheezy or feel like you're choking or gasping for air)
• your throat feels tight or you're struggling to swallow
• your skin, tongue or lips turn blue, grey or pale (if you have black or brown skin, this may be easier to see on the palms of your hands or soles of your feet)
• you suddenly become very confused, drowsy or dizzy
• someone faints and cannot be woken up
• a child is limp, floppy or not responding like they normally do (their head may fall to the side, backwards or forwards, or they may find it difficult to lift their head or focus on your face)

You or the person who's unwell may also have a rash that's swollen, raised, itchy, blistered or peeling.

These can be signs of a serious allergic reaction and may need immediate treatment in hospital.

In rare cases, if your child or teenager has hydrocortisone injections over many months or years, it can slow down their normal growth.

Your child's doctor will monitor their height and weight carefully for as long as they're having treatment with hydrocortisone. This will help them spot any slowing down of your child's growth and change their treatment if needed.

Even if your child's growth slows down, it does not seem to have much effect on their overall adult height.

Talk to your doctor if you're worried. They'll be able to explain the benefits and risks of giving your child hydrocortisone injections.

These are not all the side effects of hydrocortisone injections. For a full list, see the leaflet inside your medicine packet.

Hydrocortisone injections can be used in pregnancy.

Most of the hydrocortisone stays in the same area around the joint, and only a small amount enters your blood, so it will not harm your baby.

You can have hydrocortisone injections if you're breastfeeding.

It's not known how much hydrocortisone passes into breast milk, but because most of it stays in your joint, it's likely to be a tiny amount. It's unlikely to cause any side effects in your baby.

If you notice that your baby is not feeding as well as usual, is not putting on weight as you would expect, or if you have any other concerns about your baby, talk to your health visitor, midwife, pharmacist or doctor as soon as possible.

Hydrocortisone injections do not affect fertility in either men or women.

• you're breastfeeding and you want to have hydrocortisone injections

Some medicines can affect how hydrocortisone injections work and can increase the risk of side effects.

Tell your doctor or pharmacist if you're using any other medicines before having a hydrocortisone injection. This includes prescription medicines and ones that you buy like ibuprofen and aspirin.

There's not enough information to say that complementary medicines and herbal remedies are safe to take if you're having hydrocortisone injections. They're not tested in the same way as pharmacy and prescription medicines. They're generally not tested for the effect they have on other medicines.

Tell your doctor or pharmacist if you're taking any other medicines, including herbal remedies, vitamins or supplements.