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Check this out about hydrocortisone doses

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I read this on the Addison's site I'm on the other day and I've tried it for two days now. My swelling is completely gone and tonight I'm down two pounds from Tuesday morning (and usually I don't weigh at night so tomorrow morning might even be better.) My rings are falling off of me. So I was taking 15/2.5/2.5 hydro with 0.1/0.05 Florinef in between the hydro doses. Now I take 10/5/5 and still the same fludro dose. I know it's a lot of times to remember but it is so far working for me. Here is the source of my lunacy! LOL!

 

HC Dose Frequency Effects on Urinary Cortisol

http://toxnet.nlm.nih.gov/cgi-bin/sis/search/r?dbs+hsdb:@term+@rn+50-23-7

 

Absorption, Distribution & Excretion:

We investigated the influence of dose distribution in hydrocortisone replacement therapy on urine free cortisol excretion. To this end, we measured 24-hr urine free cortisol (24-hr UFC) in 13 patients with hypocortisolism.

The patients took 25 mg hydrocortisone/day according to the following schedules:

either a single 25 mg hydrocortisone dose at 8:00 a.m.,

or 15 mg hydrocortisone at 8:00 a.m. and 10 mg hydrocortisone at 2:00 p.m.,

or 5 mg hydrocortisone at 8:00 a.m., 10:00 a.m., 2:00 p.m., 6:00 p.m. and 10:00 p.m.

 

24-hr UFC decreased significantly with increasing division of the daily 25 mg hydrocortisone dose.

 

When taking 25 mg hydrocortisone in a single morning dose, the mean 24-hr UFC was 649 + or - 52 nmol/day (mean + or - SEM).

 

When the daily dose was divided into doses of 15 mg and 10 mg hydrocortisone, 24-hr UFC was reduced by 28 % to 466 + or - 39 nmol/day (p < 0.002).

 

After division into five doses of 5 mg, 24-hr UFC was reduced by 42.8 % to 371 + or - 36 nmol/day (p < 0.001) compared to the single 25 mg dose.

 

These data demonstrate that consideration of the dose distribution in hydrocortisone replacement therapy when analysing 24-hr UFC is of clinical importance.

[bliesener N et al; Exp Clin Endocrinol Diabetes 111 (7): 443-6 (2003)] **PEER REVIEWED** PubMed Abstract

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An assessment of optimal hydrocortisone replacement therapy

Howlett TA.

 

Leicester Royal Infirmary, UK.

Clin Endocrinol (Oxf). 1997 Mar;46(3):263-8.

Clin Endocrinol (Oxf). 1997 Mar;46(3):269-70.

 

OBJECTIVE: To assess the management of hydrocortisone replacement therapy in one institution, and derive recommendations for optimum starting and maintenance replacement therapy with hydrocortisone.

 

DESIGN: Retrospective survey of clinical management using a clinical information system and the patient case notes.

 

PATIENTS: Using the department's clinical information system, 210 patients were identified who had been treated with hydrocortisone. Case notes were reviewed and 130 patients were identified whose records contained the results of at least one valid hydrocortisone day curve. Data on 174 day curves performed on these patients (65 on twice daily and 109 on thrice daily hydrocortisone regimes) formed the basis of this analysis.

 

METHODS: Hydrocortisone day curves had been performed as part of routine clinical management: patients collected a 24 h urine for free cortisol on the day prior to the test and took their morning hydrocortisone at the normal time, at home, on wakening. During a day-case attendance serum cortisol was then measured at 0900 h, 1230 h (prior to any lunchtime dose) and 1730 h (prior to the evening dose).

 

'Optimal replacement' was arbitrarily defined as that dose which achieved a UFC and 09:00 h cortisol within the reference range for the normal population (to avoid over-replacement) combined with 1230 h and 1730 h cortisol above 50 nmol/l, and ideally above 100 nmol/l (to avoid under-replacement).

 

Raw data from all hydrocortisone day curves was analysed in an Excel spreadsheet to determine the effect of different dose regimens on the percentage of patients achieving each and all of these 4 criteria, and on an overall 'quality score' (comprising 1 point for each of the 4 criteria attained).

 

RESULTS: Patients on twice daily hydrocortisone regimes achieved optimal replacement in 15% of cases compared to 60% on thrice daily regimes (P < 0.001 by chi 2); mean overall 'quality scores' for these regimens were 2.72 and 3.49 respectively (P < 0.001 by t-test).

 

Of individual dose regimens with sufficient cases for valid comparison, a dose of 10 mg/5 mg/5 mg (rising/lunch/evening) achieved optimal replacement in 66% and mean 'quality score' of 3.62 (n = 53), compared to 50% and 3.32 for 10 mg/ 10 mg/5 mg (n = 28) and 10% and 2.48 for 20 mg/-/10 mg (n = 29).

 

CONCLUSIONS: The use of arbitrary, but logical, criteria to assess the quality of hydrocortisone replacement regimens indicates that optimal replacement is achieved with thrice daily hydrocortisone regimens, and that the traditional twice daily regime results in a 0900 h cortisol above normal in one-third, and late afternoon cortisol below 50 nmol/l in one-half of patients thus treated. An appropriate starting dose of hydrocortisone of 10 mg/5 mg/5 mg (rising/lunch/evening) is suggested, with subsequent individual adjustment based on simple hydrocortisone day curves.

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Wow, I am totally tempted to try this. Thanks for posting it. I wonder if it would be safe for me to divide up the times being only seven weeks out from pit. surgery? I am currently doing 20 mg at 8 am and 6.125 at 2 p.m. What times are you taking yours, Kristin?

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That makes sense, your tissues aren't overwhelmed with a big dose, and you're getting closer to a biological release that way.

 

It still depends on the person. I know some of us are doing very well with just low doses of Prednisone to spread throughout the day.

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I take 10 mg at 0530 and 5 mg at 1300 and 5 mg at 1800. I would call your doc and see if you can split yours first to 12.5/7.5/5. That is 25 mg though so you would be 1.125 less than you are used to. I couldn't wrap my brain around how you were taking 6.125 and couldn't divide it up right. You know what I mean though. Let us know what your doctor says.

 

Hugs,

Kristin

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That's 'cause I messed it up--it should say 6.25 mg (a 5 mg tablet divided in four parts, then add one part to a 5 mg tablet for a total of 6.25 mg). Sorry--I've got Cushie brain. Thanks!

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I've always split my doses into 3 - that's the advice given by endo's as standard over here in the UK. I always found it odd that in the US you usually take 2 doses a day, it worries me because I can't help thinking all of you that are on 2 doses must feel awful for a big chunk of the day! I take 10/2.5/2.5 at waking, then around 12 and last dose around 5pm and though the dose has altered several times I still stick to the same time scale. :)

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When I was first out of surgery, I did the 3 doses thing. I eventually went to 2 doses, because it didn't seem any different than 3, when I got low on my hydro. I'm only on 10 mg. total, with my BLA. I split it by 7.5 at 7AM and 2.5 at 2PM. If I went back to 3 doses, I'd do 5/2.5/2.5. I think it's easier for me to take 2 doses, and then I'm done with it. LOL!

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I think I will try it to see if it helps me get out of this stall. I switched to Prednisone - 2.5 a day, which is equivelent to 12.5 of hydro a day. I just take it all in the morning because I was always forgeting my second dose....hell, even now I forget it in the morning sometimes....I am so bad with meds.

 

I just broke my tiny tiny little half a pred pill into crumbles...so I have no idea how much I'm actually getting with each peice of crumble...but we'll see how it goes.

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That is great info! Thanks for sharing Kristin!

 

I started my hydro in two doses but quickly moved it to three. I feel better on three---now I know why!

 

love,

melly

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This is great info! So glad the docs in the UK are looking at this kind of information because the docs in the US don't do the "day curve" test which I think is ashame. Although after reading how they did this I suppose I could talk to my doc about doing this as an outpatient in terms of going to the lab 3x's in one day while doing a 24hr UFC.

 

I have played around with my dosing schedule several times and have found that 3 x's a day works best for me. Though I still seem to crash every day around the 5-7pm time frame. It's very hard if not impossible for me to stay awake during that time.

 

I actually decided that today I would try and take 10mg in the am vs. 12.5mg which I had been doing to move my dose schedule from 12.5/5/5 to 10/7.5/5 to see if I feel a difference.

 

I'm so greatful that the UK has such good info on Addison's!!

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I've taken mine in 3 doses for quite a while. I feel more even and I found out that I was one of those that needed a later dose if I was to sleep that night. I take 3.75/1,25/1,25 for a whopping 6.25 daily dose which is currently working for me. I've lost weight and anxiety, and mostly feel pretty good so I don't think I'm dealing with rest tissue as much as just being really sensitive to too much cortisol. I take it on waking (around 6 now that I'm back at work), noon, and 5pm. I use the alarm feature on my cell phone to help me keep on time for my doses or I'd be lost. I do know that I certainly can tell if I've missed or been really off in taking it.

 

Barb

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I have been on addisonssupport.com and they are super nice. This is where I found this information. However, there aren't as many people on there and it takes quite a while to get a response. I don't think that there is a view new content feature so you have to cruise around the boards to see new stuff. What others have you all found?

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Thanks for sharing this insight. I may be in this boat with ya'll soon, so I am glad to hear this. I take my thyroid split into 3 doses - though I do forget. But, I think I could do this especially with a phone alarm. Good idea!

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If I'm reading that right, it means we are actally absorbing/using more of the cortisol we take when split into more doses. So we might be able to take less. Right? Obviously, if it isn't being passed out of the body, we are absorbing it. Am I seeing that right?

 

Interesting!

Robin

 

 

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I think I will try it to see if it helps me get out of this stall. I switched to Prednisone - 2.5 a day, which is equivelent to 12.5 of hydro a day. I just take it all in the morning because I was always forgeting my second dose....hell, even now I forget it in the morning sometimes....I am so bad with meds.

 

I just broke my tiny tiny little half a pred pill into crumbles...so I have no idea how much I'm actually getting with each peice of crumble...but we'll see how it goes.

 

 

Since prednisone has such a long half-life, I don't know if this will work for you. It may keep you up all night. Let us know, ok?

 

Hugs,

Robin

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If I'm reading that right, it means we are actally absorbing/using more of the cortisol we take when split into more doses. So we might be able to take less. Right? Obviously, if it isn't being passed out of the body, we are absorbing it. Am I seeing that right?

 

Interesting!

Robin

 

Robin,

 

I think that makes sense to me. All I know is that I just switched and I have shifted out of the lull I was in losing weight/inches/symptoms. Now I'm on track again. Plus it will be easier to wean when I have to on this 10/5/5 instead of 15/2.5/2.5. I'm not one that can compare what three doses does as opposed to two though, just what happens when you are more balanced instead of taking a huge dose in the morning. How is work going? School has been back in for a while, are you coping well?

 

Hugs,

Kristin

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This is another reason I think pushing for a clinical trial of the cortisol pump among BLAers would be an amazing thing to do for one of our docs.

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I've got an OK from Dr. F for a cortisol pump, but it's pretty much going to be a no go due to cost. The only way to get one is to get in a trial, but no one is going to run one, so we're stuck. They don't believe in the technology and the ones that are thinking about it are waiting on the results of the Norway/Sweden trial being conducted right now, which probably won't have results for another 4+ years based on the fact it's slated to go through 2012.

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A cortisol pump is just an insulin pump filled with liquid hydro. The hydro is delivered using a sub-q catheter. The pump is programmable so you can set it to dose you. It would be really nice to have, but at this point, unfortunately, a real long shot. Why oh why don't I live in Norway or Sweden? Sigh.

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