Adding hydrocortisone to prednisone dosage

I don't see the point either. There are guidelines that suggest using hydrocortisone in the lower stages of the reduction because it is felt that using it rather than pred makes it easier for your adrenal system to get back into working properly. It is, however, something I have not yet come across. One lady in New Zealand uses hydrocortisone alone for her probable PMR/GCA diagnosis because she can't take pred but seems to be OK on hydrocortisone.

I found this on a "doctors reply" site, it's a bit complicated:

"Question: What are the differences between hydrocortisone, cortisone acetate, prednisone, and dexamethasone? Are there any guidelines as to when one is used versus another? 

Answer: These compounds are all adrenal steroid analogs; specifically, they are called glucocorticoids. Glucocorticoids affect carbohydrate, protein, and fat metabolism, bone metabolism, and immune and inflammatory functions. In contrast, the mineralocorticoid aldosterone, also secreted by the adrenal, regulates sodium and potassium metabolism and fluid balance. The glucocorticoid that is produced by the body is cortisol, also known as hydrocortisone. Cortisone acetate is the glucocorticoid cortisone with an ester group attached that makes it soluble in water. Cortisone is biologically inactive and is rapidly converted to cortisol by the liver so that it can exert its effects. Hydrocortisone and cortisone acetate are both short-acting glucocorticoids. They are given once daily, in the early morning, to patients who are recovering from Cushing’s syndrome or are being tapered off pharmacological dosages of glucocorticoids to allow their hypothalamic -pituitary-adrenal axis to recover. These are the only circumstances in which I prescribe hydrocortisone, and I do not use cortisone acetate.

Prednisone and dexamethasone are also synthetic glucocorticoids. Prednisone is 4 to 5 times more potent than hydrocortisone and has a longer duration of action, perhaps 12 hours or more. Dexamethasone is 40 to 50 times more potent than hydrocortisone and even longer-acting, 18 to 24 hours. Both of these glucocorticoids are given when a prolonged action is desired. This includes replacing cortisol in patients with permanent adrenal insufficiency (Addison’s disease) or suppressing ACTH secretion in patients with congenital adrenal hyperplasia. In such cases, the medication is taken at bedtime, thus the patient awakens with appropriate levels of steroid. Very rarely, these medications cause insomnia if taken at night. These longer acting glucocorticoids are also used to suppress inflammation or immune rejection, and both are less expensive than hydrocortisone.

If a patient with permanent adrenal insufficiency is doing well on hydrocortisone replacement, usually split between two or three doses, the largest taken in the morning, I usually do not change the medication. However, if the patient is not doing well, I will change the medication to dexamethasone or prednisone. Some of my patients have reported remarkable improvements in their quality of life on these longer acting medications. The longer acting glucocorticoids have been reported to have greater catabolic activity on bone, but there is no evidence that they act differently than cortisol. Rather, it is probably because they are used in inappropriately high dosage.

The usual replacement dosages of these glucocorticoids are : hydrocortisone about 25 mg/day, cortisone acetate about 37.5 mg/day, prednisone about 5 mg/day, and dexamethasone about 0.5 mg/day. Glucocorticoid replacement in any patient must be carefully monitored and individualized."

My question would be what does she expect to gain from a single dose of a short-acting corticosteroid in addition to a longer acting one.

I see you are located in the USA, a small group of people, all located in the states are all now emailing each other and have some plans in hand.

If you want to be in contact with the, send a pm with your name and email address and I will forward the information to them and their information to you.   Has to be by a PM, we cannot put links on this site.

By the way, since I have so many side effects from the prednisone, I surely don't want to take another medication that has the exact same side effects listed. 

I smiled, this is exactly the reason why I refused anything except pred, no steroid sparing agents  - all offered and politely turned down.  I reasoned that with all the side effects of pred, my body had enough to cope with, without adding more.  I also said, 'Will it cure', knowing full well it would not as there is no cure. 

I do not recommend this practice, it is always a very personal decision and the patient must decided for themselves in conjuction with their medics.    My medics sharp gave up.

 

I find it very strange that here and there a Rhuemy or GP will strike out with their own different plan of attack against a well known disease as if all the other practisioners have been wasting their time and don't know the real breakdown of chemicals and dosage. I'm sure there is plenty left to be done in this field, but in the meantime it is wiser to use what is working with the least problems.