Dexamethasone versus prednisone

[Nap1]

I have been trying to get my Endocrinologist to adjust the dose of prednisone so that I can take a steroid that is better for my adrenals.

Since I have been taking between 8.5 and 9 mg of prednisone I am now to take 6.5 mg of prednisone and 1/2 of 0.5 mg of Dexamethasone. Which to me is 0.25 of dexamethasone. So here is my problem. I do not trust the dose to equal my present dose of prednisone. I know I am supposed to have confidence but I have been knocked around so badly that I no longer trust any doctors.

PRO Do you know how the proper dose is determined? I wish I could be comfortable with what I am told but I am not. I do have good reason not to trust. When one of the best rheumatologists in the US takes me off steroids so quickly that I have the vilest and most dangerous relapse plus no adrenal function...I lost all faith.

[Nap1]

Don’t know how to continue posting this so I am adding a reply to my own post. Found out the conversion is 3.33 of dexamethasone to 1 mg the prednisone. So when it is converted doctor is looking for me to take 6.5 prednisone +1.16 of dexamethasone which is 1/2 tablet of 0.5 making it 0.25,which does not equal the amount of steroids I am taking now 8.5 mg. It would equal out better if I took 5 mg of prednisone and .05 mg of dexamethasone. It would be closer to when I am taking now which is 8.5. I am concerned about reducing steroids by 1 mg when my adrenals are not working. Opinion please

[HeronNS in reply to Nap1]

But isn't the dexamethasone long lasting so it will remain in your bloodstream far longer than the pred? Would that make a difference?

[Nap1 in reply to HeronNS]

HeronNS I found conversion which was 3.3 mg of dexamethasone to 1 mg of prednisone. Please take a look at my post again because I replied to myself and did the calculations tell me what you think.

[HeronNS in reply to Nap1]

I saw that post and I wondered if the fact that the dexa stays in the bloodstream longer than pred accounts for it? Or you could be right and the doctor has miscalculated. You may have to wait for PMRpro to wake up tomorrow but I'm sure she'll have an answer for you.

[DorsetLady PMRGCAuk volunteer in reply to Nap1]

Not addressing health queries..others have done that, but if you want to add/amend original post you can do so by editing it.

Just tap on the downward arrow (at the end of post), and it will bring up option to edit. It then takes you back to the original post page- do whatever necessary and then post again. New replaces old!

[HeronNS]

med.umkc.edu/docs/em/Cortic...

[SheffieldJane]

I have nothing intelligent to add to your post. Are you saying that you have Adrenal insufficiency and this is why your doctor has added Dexamethasone to your existing dose of Prednisalone, so that you don’t have to take as much?

Are you further saying that your Adrenals are in this state because the same doctor took you off them so quickly?

Has the rationale for your treatment been explained to you?

[HeronNS]

I found this article which describes how the various steroids are used for adrenal insufficiency. It says prednisone is 4 to 5 times more potent than hydrocortisone, and dexamethasone 40 to 50 times more potent and longer acting.

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

The item was published in 1996 but I don't suppose much has changed.

[PMRpro Ambassador]

Sorry - but I am a bit confused as to what you mean by "a steroid that is better for your adrenal glands". Also why an endocrinologist is giving you dexamethasone if he wants to stimulate your adrenal gland function (I'm not a medic so maybe he knows something I don't).

Normally hydrocortisone (HC) would be used to provide a better stimulus because it is far shorter-lasting than prednisolone and there needs to be less in the body before the adrenal glands are stimulated to produce any. It is mentioned in some guidelines about switching patients to HC once they are down to about 5mg and some rheumatologists do do that when they are aware of it. Dexamethasone stays in the body far longer - so I would have assumed it provides LESS of trigger to the adrenal glands.

I'm also not clear whether you have NO adrenal function or just poor adrenal function because an ignoramus reduced your steroid dose too fast to allow your body to catch up - in which case you may have potential adrenal function but it didn't get a chance to reestablish.

And frankly - who classifies the person as "one of the best rheumies in the USA"? Self-praise has always been said to be no recommendation

[Soraya_PMR]

“I have been trying to get my Endocrinologist to adjust the dose of prednisone so that I can take a steroid that is better for my adrenals.”

Just a slowly slowly slowly reduced dose of pred surely?

[30048]

I was put on it in the hospital. It is much stronger than prednisone. I was told in the 4 to 5 range. It also does last longer. It was too strong for me...it made me dizzy and unstable. I had two bad falls. It did work....I am now on prednisolone which is so far working. I did try alternating the dexamethasone one day ...and then prednisone the next. You need to work out your dosage based on your side effects.. good luck😊