Increasing air travel means that many children and young people receiving hydrocortisone treatment or pituitary hormone replacement therapies have to face changes to their dosing schedule.
For travel within Europe, where there is a time difference of only one to three hours, this is not a serious problem.
Longer journey times do not pose a particular problem for medicines that are taken on a once-daily basis, such as thyroxine, growth hormone or oestrogen. There is quite a leeway with these medicines and gaps in therapy of eight to twelve hours make little difference. When treatments are taken more frequently, for instance, twice or three times each day, then some adjustment is going to be needed. This is particularly the case for hydrocortisone and DDAVP.
Holidays abroad are great fun. This section tells you how to adjust doses for different circumstances. Don’t forget that there are other potential risks from travel and we recommend that you discuss your plans with your consultant at an early stage. You might also need advice on additional vaccinations or tablets, so a call to the Travel Clinic (details below) is a good idea.
Things to remember before you travel
- Your child should wear his or her Medic-Alert bracelet or equivalent at all times.
- Take your child’s steroid or treatment card with you. This should be either the Department of Health Treatment Card, the Hydrocortisone Replacement Card from the Child Growth Foundation or the Congenital Adrenal Hypoplasia Therapy Card from the CAH Support Group. Make sure the card is filled in and up to date.
- Carry your child’s supply of hydrocortisone for emergency use in your hand luggage if possible. Make sure that it is in date, or ask for a new supply if it has expired. Useful doses are given below.
Intramuscular hydrocortisone doses for emergency use
| Age range (years) | Dose (mg) |
| 0 to 1 | 25 |
| 1 to 5 | 50 |
| Over 5 | 100 |
| | |
Emergencies
Most people do not get ill on holiday or become involved in an accident. However, if this does happen, you need to deal with it in the same way that you would at home.
Patients receiving hydrocortisone alone or with fludrocortisone
- If you think your child is ill, double or treble the steroid dose. If your child is also being sick, give the intramuscular hydrocortisone injection.
- Diarrhoea is a particular problem due to fluid loss. Use oral rehydration solution and make sure that your child is passing urine frequently. Seek medical advice early, especially if your child has a fever or blood in the diarrhoea, becomes confused or the diarrhoea does not stop within 24 hours. Do not use anti-diarrhoeal medicines.
- After you have given the intramuscular hydrocortisone injection, take your child to the nearest Accident and Emergency department as soon as possible. Give the attending doctor a detailed explanation, saying that emergency hydrocortisone has already been given. Your child should not be discharged until electrolyte and blood glucose concentrations have been measured. If there is any doubt, your child should be admitted for glucose, electrolyte and blood pressure monitoring.
- Remember to take your steroid or treatment card with you as this will help the local doctors.
- If there are problems, you can always contact the endocrine registrar at Great Ormond Street Hospital (GOSH) (details at the end of this information sheet).
Anterior and posterior pituitary hormone deficiencies
- In addition to the above, you should consider the following issues.
- If your child is unwell and has a combination of anterior and posterior pituitary defects, you should not give him or her any more DDAVP until plasma electrolytes have been checked at the local hospital. Water intoxication is difficult to treat and can be dangerous. It is usually safer to under-treat the diabetes insipidus at this stage and simply replace fluid loss as needed.
- Children with absent thirst and diabetes insipidus should go to the local hospital, even if they are only slightly ill, as fluid balance is difficult. All such patients should carry a letter explaining the management of this problem, preferably translated into the local language.
Medication changes during travel for twice daily hydrocortisone therapy
Hydrocortisone is used for cortisol deficiency resulting from anterior pituitary problems and in congenital adrenal hyperplasia (CAH). In CAH it is usually taken with fludrocortisone. No change to fludocortisone is needed as it is taken on a once-daily basis and this should be continued. However, children travelling to hot climates may need to boost their salt intake.
Europe
Journey to and from Europe
- Note: Within a one- to three-hour time shift, no change is required.
United States of America
Journey to USA
- Morning dose as usual.
- Half morning dose on arrival.
- Evening dose before going to bed.
- Normal dose schedule the following day.
Journey from USA
- Evening dose as usual.
- Normal dose schedule the following day.
Middle East or India
Journey to Middle East or India
- Evening dose as usual.
- Half morning dose on arrival.
- Normal dose schedule from the morning of arrival day.
Journey from Middle East or India
- Evening dose as usual.
- Repeat evening dose when boarding plane.
- Usual morning dose on arrival in UK.
- Normal evening dose.
- Normal dose schedule the following day.
Far East, Australia or New Zealand
Journey to and from Far East, Australia or New Zealand
- Note: For these journeys, it is better to switch to an eight-hourly treatment programme.
- Normal daily schedule up to departure.
- Switch to eight-hourly schedule for flight duration.
- Continue eight-hourly schedule until morning after arrival.
- Go back to normal dose schedule.
Medication changes during travel for three times daily hydrocortisone therapy
Hydrocortisone is used for cortisol deficiency resulting from anterior pituitary problems and in congenital adrenal hyperplasia (CAH). In CAH it is usually taken with fludrocortisone. No change to fludocortisone is needed as it is taken on a once-daily basis and this should be continued. However, children travelling to hot climates may need to boost their salt intake.
Europe
Journey to and from Europe
- Note: Within a one- to three-hour time shift, no change is required.
United States of America
Journey to USA
- Morning dose as usual.
- Usual second dose on arrival.
- Evening dose before going to bed.
- Normal dose schedule the following day.
Journey from USA
- Evening dose as usual.
- Normal dose schedule the following day.
Middle East or India
Journey to Middle East or India
- Evening dose as usual.
- Half morning dose on arrival.
- Normal dose schedule from the morning of arrival day.
Journey from Middle East or India
- Repeat evening dose on boarding plane.
- Usual morning dose on arrival in UK.
- Second dose late afternoon.
- Normal evening dose.
- Normal dose schedule the following day.
Far East, Australia or New Zealand
Journey to and from Far East, Australia or New Zealand
- Note: No significant changes as dose schedule is already eight-hourly.
Medication changes during travel for twice daily DDAVP therapy
DDAVP therapy needs careful observation of fluid intake, particularly when thirst is impaired, in which case, an individualised plan needs to be agreed with your doctor. As long as thirst is intact, it is probably better to slightly under-treat during travel, but remember that long flights can dehydrate the body so make sure that your child drinks enough and passes enough urine.
Europe
Journey to and from Europe
- Note: Within a one- to three-hour time shift, no change is required.
United States of America
Journey to USA
- Morning dose as usual.
- Half morning dose on arrival or approximately eight to 12 hours after the first dose.
- Half evening dose before going to bed or as late as possible. If within four hours of arrival dose, do not give but be prepared to give next morning dose earlier.
- Normal dose schedule the following day.
Journey from USA
- Evening dose as usual.
- Normal dose schedule the following day.
Middle East or India
Journey to Middle East or India
- Evening dose as usual.
- Half morning dose on arrival.
- Normal dose schedule from morning of arrival day unless within four to six hours of arrival dose, in which case delay dose.
Journey from Middle East or India
- Evening dose as usual.
- Usual morning dose on arrival in UK.
- Normal dose schedule the following day.
Far East, Australia or New Zealand
Journey to and from Far East, Australia or New Zealand
- Note: For these journeys it is better to switch to regular 10 to 12 hour dose schedule.
- Normal dose schedule up to departure.
- Switch to 10 to 12 hourly dose schedule for flight duration but make sure that there is a bit of a break.
- Continue 10 to 12 hourly dose schedule until morning after arrival but make sure that there is a bit of a break.
- Go back to normal dose schedule.
Medication changes during travel for three times daily DDAVP therapy
DDAVP therapy needs careful observation of fluid intake, particularly when thirst is impaired, in which case, an individualised plan needs to be agreed with your doctor. As long as thirst is intact, it is probably better to slightly under-treat during travel, but remember that long flights can dehydrate the body so make sure that your child drinks enough and passes enough urine.
Europe
Journey to and from Europe
- Within a one- to three-hour time shift, no change is required.
United States of America
Journey to USA
- Morning dose as usual.
- Normal second dose on arrival or approximately eight to 12 hours after the first dose.
- Half evening dose before going to bed or as late as possible. If within four hours of arrival dose, do not give but be prepared to give next morning dose earlier.
- Normal dose schedule the following day.
Journey from USA
- Evening dose as usual.
- Normal dose schedule the following day.
Middle East or India
Journey to Middle East or India
- Evening dose as usual.
- Half morning dose on arrival.
- Normal dose schedule from the morning of arrival day. May need to delay or omit morning dose if within four to six hours of arrival dose.
Journey from Middle East or India
- Evening dose as usual.
- Usual morning dose on arrival in UK.
- Normal dose schedule the following day.
Far East, Australia or New Zealand
Journey to and from Far East, Australia or New Zealand
- Note: For these journeys the usual 8-hourly dose schedule should not pose problems.
- Normal dose schedule up to departure.
- Take eight-hourly during flight but make sure that there is a bit of a break.
- Continue 10 to 12 hourly dose schedule until morning after arrival but make sure that there is a bit of a break.
- Go back to normal dose schedule.
Last reviewed by Great Ormond Street Hospital: October 2007
Ref: F070368 © GOSH Trust October 2007
Compiled by the London Centre for Paediatric Endocrinology in collaboration with the Child and Family Information Group.
Please read this information in conjunction with any patient information leaflet provided by the manufacturer. However, please note that this information explains about the use of medicines in children and young people so may differ from the manufacturer’s information.
Each person reacts differently to medicines so your child will not necessarily suffer every side effect mentioned. This information does not constitute health or medical advice and will not necessarily reflect treatment at other hospitals. If you have any questions, please ask your doctor. No liability can be taken as a result of using this information.
