Source: European Medicines Agency (EU) Revision Year: 2026 Publisher: Immedica Pharma AB, 113 63 Stockholm, Sweden
Efmody is indicated in adolescents aged 12 years and over and adults for the:
Treatment should be initiated by physicians experienced in the management of AI and/or CAH.
As maintenance therapy the dose must be individualised according to the response of the individual patient. The lowest possible dose should be used.
Monitoring of the clinical response is necessary and patients should be observed closely for signs that might require dose adjustment, including changes in clinical status resulting from remissions or exacerbations of the disease, changes in electrolytes particularly hypokalaemia (see section 4.4) or hyponatraemia, individual responsiveness to the medicinal product, and the effect of stress (e.g. surgery, infection, trauma). As the treatment has a modified-release profile when blood tests are used to monitor clinical response in CAH; assessment of the evening dose should be done with a morning blood test and assessment of the morning dose should be done with an early afternoon blood test.
During excessive physical and/or mental stress it may be necessary to increase the dose of Efmody, and/or add additional immediate release hydrocortisone especially in the afternoon or evening.
Dose adjustments should be considered in case of concomitant use of potent CYP3A4 inducers or inhibitors (see section 4.5).
Recommended replacement doses of hydrocortisone are 10-15 mg/m²/day (CAH) and 8-10 mg/m²/day (other forms of AI) in adolescents aged 12 years and over who have not completed growth, and 15-25 mg/day in adolescents who have completed growth and adult patients with AI or CAH. In patients with some remaining endogenous cortisol production a lower dose may be sufficient.
At initiation the total daily dose should be split into two doses with two thirds to three quarters of the dose given in the evening at bedtime and the rest given in the morning. Patients should then be titrated based on their individual response.
Efmody can be taken with or without food (see section 5.2).
When changing patients from other oral hydrocortisone replacement therapy to Efmody, the identical total daily dose should be given, but the dose should be given in two doses with two thirds to three quarters of the dose given in the evening at bedtime and the rest given in the morning.
When changing patients from other glucocorticoids to hydrocortisone modified-release hard capsules an appropriate conversion factor should be used, and the patient monitored for response carefully.
Conversion to hydrocortisone modified-release hard capsules might elicit symptoms of adrenal insufficiency or overreplacement during dose optimisation.
A starting dose exceeding 40 mg per day of hydrocortisone is not recommended.
In severe situations, an increase in dose is immediately required and oral administration of hydrocortisone must be replaced with parenteral treatment (see section 4.4).
In less severe situations when parenteral administration of hydrocortisone is not required, during periods of physical and/or mental stress, additional immediate release hydrocortisone (IRHC) at the same total daily dose as Efmody should be given in three divided doses (i.e. a doubled total daily dose of hydrocortisone is given). Efmody should be continued with the usual regimen to allow for easy return to the normal replacement dose of hydrocortisone once additional hydrocortisone is no longer required.
In case of long-term increases in hydrocortisone daily dose due to prolonged periods of stress or illness, the additional hydrocortisone should be carefully weaned off.
If a dose of Efmody is missed, it is recommended that it be taken as soon as possible.
Limited clinical data on the safety and efficacy of Efmody are available in elderly patients (over the age of 65 years) with AI or with CAH. There are no data available in patients over the age of 75 years.
There is no need for dose adjustment in patients with mild to moderate renal impairment. In patients with severe renal impairment monitoring of the clinical response is recommended and adjustment of dose may be necessary (see section 4.4).
There is no need for dose adjustment in patients with mild to moderate hepatic impairment. In patients with severe hepatic impairment monitoring of the clinical response is recommended and adjustment of dose may be necessary (see section 4.4).
No clinical data on the safety and efficacy of Efmody are available in children aged below 12 years. Other hydrocortisone containing medicinal products are available for children below 12 years of age.
Limited clinical data on the safety and efficacy of Efmody are available in adolescents aged 12 to 18 years.
In the clinical development programme 2 patients ≤ 18 years of age have been treated with Efmody for CAH. Their response was comparable to that of patients > 18 years of age.
Oral use.
Patients should be advised to swallow the modified-release hard capsules with water to wash the capsules down.
The capsules should not be chewed as chewing the capsule could affect the release profile.
Reports of acute toxicity and/or deaths following hydrocortisone overdose are rare. No antidote is available. Treatment is probably not indicated for reactions due to chronic poisoning unless the patient has a condition that would render him/her unusually susceptible to ill effects from hydrocortisone. In which case, symptomatic treatment should be instituted as necessary.
3 years.
Store in the original package.
Keep the bottle tightly closed in order to protect from moisture.
This medicinal product does not require any special temperature storage conditions.
The capsules are provided in high-density polyethylene bottles with child resistant, tamper-evident polypropylene screw cap with integrated desiccant. Each bottle contains 50 modified-release hard capsules.
Pack size:
Carton containing 1 bottle of 50 modified-release hard capsules.
Carton containing 2 bottles of 50 modified-release hard capsules (100 capsules).
Not all pack sizes may be marketed.
Any unused medicinal product or waste material should be disposed of in accordance with local requirements.
© All content on this website, including data entry, data processing, decision support tools, "RxReasoner" logo and graphics, is the intellectual property of RxReasoner and is protected by copyright laws. Unauthorized reproduction or distribution of any part of this content without explicit written permission from RxReasoner is strictly prohibited. Any third-party content used on this site is acknowledged and utilized under fair use principles.