prednisolone to hydrocortisone ?

[FarmerJacks]

I've been steadily reducing my prednisolone, currently down to 8mg (started on 93mg). Now I have received a letter from an "endocrinologist" which suggests I convert to hydrocortisone (20mg morning, 10mg lunchtime, 10mgs evening initially). It doesn't really explain why, etc.

I am assuming hydrocortisone is another type of steroid but why change to this (at higher doses) ? I don't really understand the logic behind this. Can anyone offer some advice.

[SofiaDeo]

Well, 5mg prednisolone is equivalent to 20mg hydrocortisone in terms of "steriod" potency. So this is actually a "lower equivalent " steroid dose. And the side effect potential for the two are different, as well as the amount of time they generally act/are hanging put in your body. Prednisolone has more "immune suppressing" activity than hydrocortisone, and is considered "intermediate acting" in terms of how long it acts/remains in your system. Hydrocortisone is "short acting" and has less suppressant effect on the immune system. Are you being weaned off long term steroids? Are you having side effects from the prednisolone? Sometimes patients react strongly to attempts to "just stop" long term steroids, or have "glucocorticoid" side effects as opposed to "mineralocorticoid" effects. Have you ever seen this endocrinologist, is this something your GP asked them to do? I can see a switch from an intermediate acting one, to a lower dose equivalent shorter acting one, to finally stopping in certain patients. Also, are you referring to "prednisolone" or "methylprednisolone"? In the US prednisolone comes more often as 5mg increments, and methyprednisolone is in 4mg ones. But IDK anything about UK medication doses.

ncbi.nlm.nih.gov/pmc/articl...

Table from the attached reference article

[FarmerJacks in reply to SofiaDeo]

Thanks for that - really explains things. It is prednisolone and I have just changed Haematologist. Dr number 1 wanted to keep me forever on a low level of prednisolone. This new Dr seems to want to get me off steroids completely. I have had some bad times coming off the prednisolone so I'm a little worried about the initial switch from 8mg prednisolone to 20mg (5mg potency) hydrocortisone.

[SofiaDeo in reply to FarmerJacks]

What exactly has happened that's "bad" when you have tried to come off steroids before? FWIW even if you truly need steroids & your body won't want you/let you to be off them, the attempt to switch from the "more immune suppressing" one to the "less immune suppressing one" is understandable. Some docs will try yearly to wean/decrease patients on certain meds. You may be one of those who needs a longer, slower decrease time.

I'll also mention that with the stresses of the pandemic/other life events, many are likely having some effect on their adrenal glands. Hydrocortisone offers some support in adrenal insufficiency compared to prednisolone.