To the Editor: I concur with Professor Stockigt’s recent article1 outlining the shortcomings of product information (PI) for thyroid-related drugs. I often need to contradict incorrect or even hazardous PI advice given to patients.

An example is the consumer medicine information (CMI) available on the MIMS website, the “myDr” service.2 Although Hysone (hydrocortisone, Alphapharm) is often used for cortisol replacement, rather than as anti-inflammatory therapy, much of the CMI makes no distinction between these two uses. This may, in part, underlie the potentially dangerous advice: “Do not take Hysone if you have any infections that are not being treated or are not responding to treatment”.2 This instruction implies that patients should stop taking Hysone when they have an infection; this may be disastrous for those with adrenal insufficiency because it could lead to an adrenal crisis.3 It is necessary to increase replacement dosages in the event of an infection, intercurrent illness or surgery.3

The CMI for Cortate (cortisone acetate, Aspen Pharmacare), the alternative glucocorticoid replacement drug, has similar information: “Do not take CORTATE if you have an uncontrolled infection”.4

In the editorial accompanying Stockigt’s article,5 Dowden acknowledges that PI needs to be kept up to date, but I think that PI and CMI will remain inadequate without expert professional review, in addition to that currently mandated by the Therapeutic Goods Administration.

Patients with adrenal insufficiency need reliable information about the replacement medications they take long term. The CMI for these two drugs is in need of urgent revision in the interests of patient safety.