Prednisone vs hydrocortisone

[Simba1992]

I would very much like to hear your experiences of hydrocortisone. It seems like everyone on steroids is on predisone. Have understood that hydrocortisone has less side effects and is more a " normal" steroid for your body.

[Hidden]

My understanding of hydrocortisone is that it’s useful for dermatology - for which it is excellent. I’m therefore assuming that it’s not possible to formulate it in a way that helps inflammatory internal conditions.

For example, Hydroxychloroquine caused me the most intense itching - which is an allergic response. I have that sort of skin anyway, so had some hydrocortisone cream, which did not help. I also had some Pred, which after taking advice from the pharmacist, I did use, and that ultimately did help with these random itching attacks.

Hope that helps, cheers Deb

[Simba1992 in reply to Hidden]

Thank you for your response. I have come accross hydrocortisone use by many with RA who want to choose a less taxing steroid for their bodies. Those with adrenal insufficiency usually take this.

[Hidden in reply to Simba1992]

I’ve just done some research. If you look at the treatment regimes, you need to take more hydrocortisone than prednisone to achieve the same effect - I suspect, you end up taking the same amount of the base component. The potential side effects are the same. Here is a link from what appears to be a reputable source.

csrf.net/doctors-answers/st...

[Simba1992 in reply to Hidden]

Done the same research. This however is not correct. The effect of corresponding dose of hydrocortisone does different things in your body. What I find strange is that real information on biochemical facts are not to be found anywhere on the internet. Asked a rheumy here in Spain about it. She just brushed it aside saying it's not strong enough ( the corresponding dose ?!).

[Hidden in reply to Simba1992]

Well, that was my interpretation. I’ll ask you a question. If hydrocortisone could be prescribed and be safe, don’t you feel that Rheumatologists would be prescribing it? The stuff has been around for donkeys years. Both types are man made, the difference would appear to be about how much of each you’ve got to swallow. The side effects appear to be identical, cheers

[Simba1992 in reply to Hidden]

But it is not true that the side effects are the same. Evidently the half life is shorter and that makes it safer but also less efficient. Hydrocortisone is prescribed for a number of illnesses often longterm. Functional integrated medical doctors do in fact often prescribe hydrocortisone to their RA patients. It's really not a question of it not being safe but more that it does not have the same longstanding effect as pred. The question however remains that do RA patients that have a combination of Mtx and steroids or just steroids, always need pred or would the safer hydrocortisone be enough in less aggressive RA at least. Interesting question I think. When I get back to France I will try the hydrocortisone alternative. Will report how it turns out.

[helixhelix]

Like everything else i think it's quite individual. Yes it's more normal/natural but i think also slower acting - which could be a good thing for adrenal insufficiency, I have problems with prednisone and prednisalone, but am totally fine with methylprednisalone. I had hydrocortisone once and as i recall it did nothing.

[Simba1992 in reply to helixhelix]

Thank you HH, I just don't really understand how these steroids work. When did some research it said that as an example 5mg prednisone would correspond to 20mg hydrocortisone. The antiinflammatory effect of hydrocortisone is 1 whereas in pred 4-5. Dexametazone having the strongest anti-inflammatory effect of 20-25. So would think that Dexa would be the most efficient. Not so, tried it, corresponding to pred dose. Hope you have some thoughts on this. Tried my doc. Had no answer. 🤔Simba

[AgedCrone in reply to Simba1992]

If you look on the NICE website you will find lists of different ..hydro, cortico,Glucocorticoid...steroids.....boring enough to put you to sleep for a week!!!

[Simba1992 in reply to AgedCrone]

😊

[Barrister]

Hydrocortisone is relatively short acting and is cleared out of the body within 4-6 hours so needs to be taken regularly throughout the day whereas Prednisolone is longer acting.

Clemmie

[Simba1992 in reply to Barrister]

Well here is something that makes sense. So taking the corresponding amount would be cleared faster and in this way your body gets a rest ( if you can stay with 1 dosing ). This also means that the normal adrenal function is spared. Thank you Barrister. x Simba

[Tillytop]

Thanks for raising this - I’m really interested reading what has been said because I have recent experience of both. I have been on Pred for Rheumatoid continuously for 15+ years at doses varying between 1mg and 60 mg daily. I have other autoimmune conditions too, a benign - but troublesome pituitary tumour, and steroid induced diabetes and osteoporosis. There is suspicion of adrenal insufficiency and I was told by the endocrinologist that in order for them to carry out the relevant tests I would have to reduce my Prednisolone to 5mg daily as a max. At which point he could switch me to Hydrocortisone instead. He said after a couple of months he could do the necessary tests. But after trying and trying to reduce the pred it was just not doable below 8mg daily and now I’m barely coping on 18mg. When I saw Endo recently and explained he said though it was possible to swap my pred for Hydrocortisone now, it would be very big dose and not something they would usually consider for that reason. He said it was shorter acting so needed to be taken as a split dose and taken regularly ie timing was important. That was fine for me because I was splitting my pred dose anyway. My 15mg pred equated to 60mg Hydrocortisone. He told me I may have a “lag” when I stopped pred and started Hydrocortisone because it would take a while to become effective. I managed 9 days on Hydrocortisone before I had to give up and go back to pred. It made me feel truly dreadful. My head state was all over the place, I was suicidal, (to be fair I am struggling anyway but not to that extreme) I was in pain and I just felt so ill in ways I don’t know how to describe. Obviously that means I won’t be able to have the adrenal insufficiency tests now. But I know that, in my case, whatever the differences between them, Hydrocortisone isn’t for me. Though I don’t know for sure, I have the impression that steroids of whatever variety are not overall good for anybody, though their “miracle like” effect (in my case anyway) makes them hard to manage without. I’m not sure there is much to choose between them in terms of risks etc and as others have commented, if Hydrocortisone was generally a safer - or even a more appropriate med in some cases - than pred then it would be more widely prescribed. I will continue to read this thread with interest xxx

[Simba1992 in reply to Tillytop]

Thank you for your reply that was very informative and also confusing. I wonder if the doctors even really know what these steroids do. My sister in law switched to hydrocortisone from pred and all her side effects disappeared, moon face included. Don't exactly know what dose she was on. Your reaction to the swap was really scary. So what in the world caused this? That is really a million dollar question. I think I will also try to find more info. xSimba

PS. One thing I know though is a safer way to take pred is the alternate day regieme, where you take double dose one day and the next day none and so on. It is however very hard to change your every day dosing, so you should start with alternate days with your pred from the beginning.

[Tillytop]

Thanks Simba for your reply v interesting about you Sister in Law and I’m so pleased for her. I did just type a proper reply but it’s “disappeared” and I don’t have the energy to type it all again. But thanks again for starting the thread and I will continue to read with interest xxx

[Simba1992 in reply to Tillytop]

Found this. What I still cannot understand why Dexametazone isn't used if it has a antiinflammatory effect that is so much stronger than pred.?

csrf.net/doctors-answers/st...

The same as YanniBach posted above.

[nablur]

I had never heard of hydrocortisone used for anything but dermatology. Then I found this from a discussion group:

Hydrocortisone injections are used in acute situations as it has an effect within less than an hour whereas if you take a tablet is has to get into your gut and be dissolved there before it starts to get into your blood. The white non-coated prednisolone tablets get the steroid into the blood quicker than the enteric coated ones because the non-coated ones start to be absorbed from the stomach whilst the enteric-coated ones have to get much further down the gut before the digestive process works on them. Even so, since you always take the tablets with food this slows down the digestion process and with the enteric coated versions it can take 2 or 3 hours before the blood level starts to rise. The eventual level is the same, just takes longer - a bit like drinking and eating at the same time slows down the rate you absorb the alcohol but it still will get to the same level eventually.

So when you were in hospital the doctor wanted a quick effect so used an intravenous route to get it. That's fine for that but hydrocortisone has what is called a shorter half-life than prednisolone - that means that it is removed from the body quicker, within 12 hours, so the effect is shorter, whereas prednisolone continues to have an effect for up to 36 hours. This means that you have to take hydrocortisone more often to keep the anti-inflammatory effect going and you also have to take a much higher dose as it has a lower potency (it's not so strong).

Hydrocortisone is used for maintenance therapy for patients who have no or ineffective adrenal glands and they usually take 3 doses a day - but that's not for an anti-inflammatory effect, it's more like diabetics needing insulin because they don't make it themselves. Prednisolone is used for PMR because the effect is so much longer-lasting - they both have the potential for the same side-effects so there seems no point in using something you'd have to take much more of and more often. Hydrocortisone is more often used in arthritis patients to reduce pain and inflammation in a joint if just one or two joints are being very painful but using it often will damage the joint in the long term so that's not a good idea either. However, hydrocortisone CAN be used for maintenance if someone has too many problems with other steroid medications but it is quite unusual.

Another option that might help would be to try taking your prednisolone every other day - because what helped while you were in hospital might possibly have been that your body had breaks from the effect of the steroid. I started taking my prednisolone every other day at the beginning of March - double the daily dose one day, none the next - and my jaw is definitely more defined than it was although I don't think you could ever have said I had a moon-face. The abdominal fat is also starting to disappear (maybe moving somewhere else!) - I don't ever weigh myself so I don't know if I'm losing weight. When you use this Alternate Day Therapy you are taking a dose of steroid that achieves the anti-inflammatory effect you need in PMR which lasts for most of the 48 hours until the next dose. However, you have got rid of the steroid from your body within about 12-18 hours so your body has the rest of the 48 hours with no steroid influence so there is less potential for the side-effects to develop and it slowly starts to recover as well.

The ideal is to go onto the ADT as soon as possible once you have got down to a daily dose of 10mg but it's not essential. Some people will manage that within a few weeks (I did the first time) and by swapping to ADT then will never have any adrenal suppression and should get only a few minor side-effects if they're lucky. I've been on steroids for nearly a year now but I do feel good and have no side-effects from the prednisolone - that I can identify anyway. To swap over you take a slightly higher dose on day 1 and the same amount less on day 2 and repeat the p

[Simba1992 in reply to nablur]

Thank you nalbur. Not so straight forward the info on steroids and. their effect on us. Lots of contradicting info. Hydrocortisone is in fact used for milder RA by functional medicine doctors. Have followed a page on alternative treatments where many RA patients take oral hydrocortisone but I think the inflammation in these cases is pretty low and you can just take one dose daily. The dose corresponding to 5mg predisone is often the case.In RA we do have a cortisone deficiency. This is why we cannot not stop the inflammation like a healthy immunesystem does. If we can give our body the ammount of cortisone it physiologically needs then the problem would be solved, but the steroids we take are unfortunately not capable of doing this. I believe perhaps with hydrocortisone you have a better chance finding your physological need.

I tried to swap over to ADT when on 7mg pred. Tried for two weeks and the pred free days were too hard so went back to every day dosing. There is a protocol for how you gradually swap, think I'll have a try with that. One safer way to take steroids anyway! xSimba

[HansLog]

You can't be sure it would have less side effects. It can effect everyone individually. Yes, if we compare side effects on canadadrugsdirect.com we can see that the list is shorter, but still, they are pretty similar.