The drug Cortef

[Chris0808]

Has anyone taken the drug Cortef as a replacement for Prednisone?? Do you know anything about it?

[SheffieldJane]

It seems to be a brand name for Hydrocortisone which a number of us have been prescribed. It is weaker than Prednisalone, with a shorter lasting action and replaces the body’s natural cortisol in a way that mimics the body’s own production of it. It can be useful in encouraging the body to produce its own Cortisol towards the end of treatment rather than Prednisalone. Reportedly, it it is less good at controlling the pain and stiffness from PMR/GCA. My Endocrinologist was keen on it for me when I got a poor Synacthen test result ( testing the body’s potential to produce its own cortisol after its having been switched off during steroid treatment). I didn’t switch from Prednisalone and my Adrenals recovered when I reduced Pred further. I was still issued with a hydrocortisone emergency kit in the event of an Adrenal crisis which can be life threatening. Thankfully this was never needed. In conclusion it is useful the support the adrenal system but less good at controlling our symptoms.

[Chris0808 in reply to SheffieldJane]

Thank you for the reply. Ok good to know it was a health food source that recommended it and basically she said exactly what you did. She felt that it was a good way to try coming down on pred. I wonder how it would be if you stayed on the pred and tried to start going down to a lower dose and took Cortef in addition to the pred??

[PMRpro Ambassador in reply to Chris0808]

It is very unlikely to help you reduce the pred - you need the amount of antiinflammatory effect you need. Hydrocortisone is weaker then pred in that sense. And it is still a corticosteroid.

[Chris0808 in reply to PMRpro]

Thank you!

[PMRpro Ambassador]

Cortef is a brand name for hydrocortisone - and it isn't usually used for PMR since to get control of the symptoms you would almost certainly need 3x daily dosing and that isn't encouraging for patient compliance! It is a corticosteroid, very similar to the naturally produced cortisol, so used for problems with the adrenal production, but with similar adverse effects (plus others). Its anti-inflammatory effect is much lower than that of pred.

Is it being suggested for you or are you just looking for alternatives to pred?

[Chris0808 in reply to PMRpro]

I haven't asked the rheumatologist yet it doesn't sound like he would be into the cortef.The source person that recommended it has been managing a health food store for over 30 years and of course studies more what she calls "natural drugs" or drugs which may be less intrusive on the body. She has had some customers that seemed to do well under the cortef. She did mention that you take more of it but she liked the fact that you could control the amounts that you were taking as things got better or worse. Interesting that you bring up dexamethasone for Covid as before my diagnosis when I was in such pain my neurologist gave me Dexamethasone for a couple of months. When I tried to wean myself off of it (before I was diagnosed) I had such excruciating pain that is when I knew I really had a problem and went to a Rheumatologist. He took me off of the Dexamethasone and put me on Prednisone. . . . . and so the circle goes!

[PMRpro Ambassador in reply to Chris0808]

Oh yes, the health food salesperson who has done all the medical training and research!I've explained the use of pred rather than dexamethasone in my other response.

[piglette]

Like pred it is a corticosteroid but used for other things as not really suitable for PMR. There are a severalcorticosteroids on the market that are available. In fact they have been using dexamethasone for Covid.

[Chris0808 in reply to piglette]

Sorry I answered above regarding the dexamethasone. I guess the big question is of all of the steroids which has the best result and the most safe? It seems as though I should just stay on Pred alone and eventually wean myself down to a lower dose. I am currently at 10 mg a day which I have been told is not bad, but my doctor does not like it!!!! Of course he doesn't have PMR. I think unless you have it yourself it is very hard to be directing a patient especially when there is definitely real pain involved! I so appreciate everyones feedback this is all so helpful!

[PMRpro Ambassador in reply to Chris0808]

In general - pred, whether prednisone or prednisolone. It doses ideally (1x daily) and allows a choice of doses that make it possible to taper. Dexamethasone is difficult to taper accurately enough to find an ideal low dose.

It's no coincidence it is the first line option.

[Chris0808 in reply to PMRpro]

So are you saying that I should just take the pred once a day instead of splitting it to morning and night. I do have a hard time sleeping at night and I am assuming that it is the pred keeping me up. Maybe I should switch to taking the full dose once in the morning?

[PMRpro Ambassador in reply to Chris0808]

The recommended dosing for PMR and GCA is 1x per day, all in the morning usually. Once you have got things fairly much under control there are ways to tweak it to make it better if you aren't standard but for most people 1x daily dosing works fine and it is always where you should start. The earlier in the day you have taken the pred, the more likely it is that your sleep will improve though some people struggle unti lthe dose is down a bit. Doesn't bother me at all at PMR doses.

[DorsetLady PMRGCAuk volunteer in reply to Chris0808]

More sensible option - as explained by PMRpro. With PMR or GCA unless there is a very good reason, it’s better to take Pred as recommended by manufacturers - one dose per day in the morning.