Hydrocortisone alternative to Pred ?

Hi Shebob

It's good to hear from you again and that you have reduced down to as low as 5mgs. At this dose, I'm sure you will find that your hair will now stop thinning and will improve again. I can't understand how Prednisolone makes our hair on our heads thin but grow on our arms and chins :?

As far as intravenous steroids are concerned, I believe they are considered generally safer than Prednisolone for the body but they only tend to be given in more emergency situations similar probably to when you were in hospital or for people who have massive side effects with the oral steroids. Someone cleverer than me may come along with a better explanation (Eileen?!!!!).

Meanwhile, I should go for the hat option and treat yourself to a special hairdo :lol: !

MrsO

Hi Shebob!

To aid library research (!), when you were in hospital, how was the hydrocortisone given - i.v. obviously, but how often and for how long? How long did it take for the moonface to disappear and has it come back?

The hairy-effect of steroids will take some time to change as each current hair has to reach the end of its life-span and fall out and then the new hair has to grow again and, of course, luckily not all hair falls out at the same time unless you're on chemo. I think different hairy areas grow in length at different rates and head hair is about 1 cm a month so you can see it will take ages for a whole head of hair to improve (mine seems to grow faster and hasn't been affected too badly by the steroids).

EileenH

Hi Shebob,

Just to be going on with:

Hydrocortisone injections are used in acute situations as it has an effect within less than an hour whereas if you take a tablet is has to get into your gut and be dissolved there before it starts to get into your blood. The white non-coated prednisolone tablets get the steroid into the blood quicker than the enteric coated ones because the non-coated ones start to be absorbed from the stomach whilst the enteric-coated ones have to get much further down the gut before the digestive process works on them. Even so, since you always take the tablets with food this slows down the digestion process and with the enteric coated versions it can take 2 or 3 hours before the blood level starts to rise. The eventual level is the same, just takes longer - a bit like drinking and eating at the same time slows down the rate you absorb the alcohol but it still will get to the same level eventually.

So when you were in hospital the doctor wanted a quick effect so used an intravenous route to get it. That's fine for that but hydrocortisone has what is called a shorter half-life than prednisolone - that means that it is removed from the body quicker, within 12 hours, so the effect is shorter, whereas prednisolone continues to have an effect for up to 36 hours. This means that you have to take hydrocortisone more often to keep the anti-inflammatory effect going and you also have to take a much higher dose as it has a lower potency (it's not so strong).

Hydrocortisone is used for maintenance therapy for patients who have no or ineffective adrenal glands and they usually take 3 doses a day - but that's not for an anti-inflammatory effect, it's more like diabetics needing insulin because they don't make it themselves. Prednisolone is used for PMR because the effect is so much longer-lasting - they both have the potential for the same side-effects so there seems no point in using something you'd have to take much more of and more often. Hydrocortisone is more often used in arthritis patients to reduce pain and inflammation in a joint if just one or two joints are being very painful but using it often will damage the joint in the long term so that's not a good idea either. However, hydrocortisone CAN be used for maintenance if someone has too many problems with other steroid medications but it is quite unusual.

Another option that might help would be to try taking your prednisolone every other day - because what helped while you were in hospital might possibly have been that your body had breaks from the effect of the steroid. I started taking my prednisolone every other day at the beginning of March - double the daily dose one day, none the next - and my jaw is definitely more defined than it was although I don't think you could ever have said I had a moon-face. The abdominal fat is also starting to disappear (maybe moving somewhere else!) - I don't ever weigh myself so I don't know if I'm losing weight. When you use this Alternate Day Therapy you are taking a dose of steroid that achieves the anti-inflammatory effect you need in PMR which lasts for most of the 48 hours until the next dose. However, you have got rid of the steroid from your body within about 12-18 hours so your body has the rest of the 48 hours with no steroid influence so there is less potential for the side-effects to develop and it slowly starts to recover as well.

The ideal is to go onto the ADT as soon as possible once you have got down to a daily dose of 10mg but it's not essential. Some people will manage that within a few weeks (I did the first time) and by swapping to ADT then will never have any adrenal suppression and should get only a few minor side-effects if they're lucky. I've been on steroids for nearly a year now but I do feel good and have no side-effects from the prednisolone - that I can identify anyway. To swap over you take a slightly higher dose on day 1 and the same amount less on day 2 and repeat the p

Hi Eileen O and thanks for the info on Hydrocortisone. I was on 100 mg or ml morning and night intravenously. It gave a very strange sensation for a few seconds that the the nurses warned me about. Anyway you`ve answered a lot of my questions about it. I`m going to try the \"Alternate day \" idea. I`ll let you know how it goes ! Regards, Shebob :D

I meant Mrs O and Eileen H in my previous message !!!! I think my brain is going soft `cos I`m having more senior moments every day. Shebob xx