CHANGING FROM PRED TO HYDROCORTISONE

[sallie1804]

Morning , 3 weeks ago my rheumy changed me from 5mg of pred to 20mg a day of hydrocrtisone so tomorrow l can have a short synacthen test . Within days of the change l started to feel awful , aches ,pains , hot sweats , fatigue etc. I am also on methatrexate as l cant get below 5mg of pred . Has anyone else had the same problem or know if once l have had the test l can go back on pred ? Thanks

[SheffieldJane]

I declined hydrocortisone in your situation because I feared that it would be like this. It also felt retrograde to go on to 25 mgs of another drug after getting down to 5 mgs and I was still symptomatic ( PMR). It turned out that my difficulties were undiagnosed GCA rather than Adrenal deficiency. My second short Synacthen Test had normalised after I decreased to 3 mgs. My Rheumatologist arranged for me to have a head neck and armpit (specialised) ultrasound scan. They found the signs of LV-GCA in my left armpit. I am now being treated with a combination of low dose Pred ( with a view to tapering to zero) and Tocilizumab.

[sallie1804 in reply to SheffieldJane]

Thanks for your reply . In hindsight l wish l had stayed as l was ! Will get the test done tomorrow and hopefully then go back on to pred .

[PMRpro Ambassador]

Typical adverse effects of hydrocortisone - some people don't do as well on HC as on pred despite both being corticosteroids. It isn't really to do with the dose - that's just numbers. The antiinflammatory effect doesn't last as long so it doesn't control the PMR as well but it is supposed to stimulate the adrenal gland function better.

But yes, no reason for you not to go back to pred - unless the rheumy thinks keeping you on HC longer will stimulate the return of adrenal function better. But if it makes you feel unwell that should be taken into account and your wishes listened to.

[sallie1804 in reply to PMRpro]

Thanks for your reply . This site is so helpful with advice but also to know we are not alone . Will get the test done tomorrow and then hopefully get back on to pred .

[piglette]

I had extra hydrocortisone after a recent hip op as they were hoping to increase my blood pressure. I had about two lots of 100mg by drip and in that time I started to be affected by it. Not for me.

[MrsNails in reply to piglette]

They normally give Hydrocortisone during & Post Operatively as it’s quicker acting than Prednisolone, for our PMR or GCA it’s not really suitable as it has to be taken three times a day. My Mum was on it after many years of Prednisolone as she developed adrenal insufficiency.....

[piglette in reply to MrsNails]

I think I had the normal dose for the op bit, then extra for the low blood pressure problem as that was a couple of days after the op.

[MrsNails in reply to piglette]

I had to have additional Hydrocortisone during the night as l was vomiting for England, as well as during Surgery but back on Prednisolone the following day, increased by an additional 2.5mg for two weeks.....

[piglette in reply to MrsNails]

I never actually went off pred but had it doubled by the anaesthetist, although the orthopaedic surgeon was against it.

[MrsNails in reply to piglette]

Yes l stayed on my normal dose too but they rang my Rheumatologist the next day for her advice on any additional cover Post Operatively & she said to increase to 10mg per day for two weeks l was on 7.5mg at the time.

[PMRpro Ambassador in reply to piglette]

My German GP recommended prosecco as better than any medication for low BP ...

[piglette in reply to PMRpro]

Sounds a much better idea.

[Tiredcat in reply to PMRpro]

Now that's interesting!!!

[tangocharlie]

I had the same problem - couldn't get below 5 Pred - about 5 years ago. I wish I'd just stayed on 5 for ever because trying to get below was a disaster. I got switched to Hydrocortisone to have adrenal tests, but basically the problem was that despite what the doctors told me, I still had PMR (and still do have another 3 years later). If you still have PMR you still need Pred, I don't know why doctors don't get that? They read in the text books that PMR goes in 2 years and believe that. HC only substitutes for lack of cortisol, it doesn't have much of an anti-inflammatory effect, nor does methotrexate much, so you now have nothing controlling the inflammation and it'll be building up. Trying to reduce just made things worse for me and now I need a higher dose of steroids. You could ask your doctor about depo-medrone steroid injections, I wrote a post on it, and one on adrenal problems.

[powerwalk]

Goood luck with test. Let us know how it goes. I may be facing similar issue after recent rheumy discussion!

[sallie1804]

Thanks everyone for your replies . The test itself was fine ,just strange times in hospital at the moment . My consultant is ringing me with the results on wednesday morning .