Improved medication safety

BijnierNET: successful campaign in response to patients’ wishes

There is specially customised medication available for people with an adrenal disorder who are dependent on hydrocortisone. In the Netherlands, the preparation of this customised medication is the domain of specialised compounding pharmacies. In 2015, BijnierNET (AdrenalNET) held several meetings with a number of the larger compounding pharmacies in an effort to examine how the two sides could work together for their mutual benefit. During these meetings, BijnierNET was able to explain to the pharmacies exactly what problems the patients face in terms of their medication, in particular with regard to hydrocortisone.

Colour and size

The precise amount of hydrocortisone a patient needs to take has to be very carefully calculated. This is what is meant by ‘medication safety’, and with that aim in mind agreement has been reached about graduations in the colour and size of capsules. The capsule with the lightest colour and the smallest size contains the lowest dosage of hydrocortisone, and the largest capsule and the darkest colour contains the highest dosage of hydrocortisone per capsule.

Safer use of medication

Lobbying on behalf of patients with adrenal disorders and their healthcare providers, BijnierNET suggested that a standardised national colour coding should be used for these capsules. That calls for a carefully coordinated approach, and is not something that can be achieved overnight. The pharmacists at two of the large compounding pharmacies acknowledged that colour coding would help improve medication safety. They reviewed their entire relevant range of products and set to work with gusto. From 1 June 2016, hydrocortisone will be available in capsules of different colours and different sizes in the Netherlands: the larger and darker coloured capsules contain more hydrocortisone.


Dutch pharmacies and physicians can order these capsules through Fagron and Pharmaline. Capsules can be supplied in strips or in a pot. The capsules that are ordered from Fagron are prepared by DAB, a GMP-certified compounding pharmacy.

Since all the capsules have a unique numerical code (in the Netherlands, this is known as the ZI code), they can easily be ordered by pharmacists through their pharmacy information system.
Other compounding pharmacies may well join this initiative, but most of BijnierNET’s patients are already covered by the two parties mentioned above.

Tablets or capsules?

Just to be clear: capsules must only be supplied instead of tablets if they have been specifically prescribed by the healthcare provider. There is no reason why the many patients who are being treated satisfactorily with tablets should switch to taking capsules. Tablets are just as effective as capsules and there are in fact some disadvantages to switching to capsules.

-Unique index no. Name and party responsible for compounding
16225309 HYDROCORTISONE CAPSULE WHITE 1MG                                            DAB
16253493 HYDROCORTISONE CAPSULE WHITE 1MG                                            PHL
16225317 HYDROCORTISONE CAPSULE YELLOW 2MG                                         DAB
16253507 HYDROCORTISONE CAPSULE YELLOW 2MG                                         PHL
16225570 HYDROCORTISONE CAPSULE ORANGE 5MG                                        DAB
16253515 HYDROCORTISONE CAPSULE ORANGE 5MG                                        PHL
16225325 HYDROCORTISONE CAPSULE RED 10MG                                               DAB
16253523 HYDROCORTISONE CAPSULE RED 10MG                                               PHL

DAB = De Ad hoc Bereider (Fagron)
PHL = Pharmaline

Where do we go from here?

The next step is to create more differentiation in the various dosages and in the recognisability of the hydrocortisone TABLETS. This is more difficult from a technical point of view, but BijnierNET is continuing its discussions with the compounding pharmacies in this respect.

“This collaboration is a successful example of demand-driven healthcare. Medication safety is being improved thanks to the wishes expressed by patients and their healthcare providers.”
Gerben Klein Nulent, Chairman, Royal Dutch Pharmaceutical Society (KNMP)

Further information

For further information about the capsules that can be ordered via Fagron, pharmacists and physicians are invited to get in touch with Fagron’s Customer Service by telephone, or by sending an email to

Pharmacists and physicians can also get in touch with Pharmaline by telephone or by email: