Hydrocortizone instead of prednisone?

Do you still have a dx of PMR?

If so, I think your endocrinologist needs a lesson on PMR - most would keep you on pred rather than use HC as they are both corticosteroids - but you need the pred to manage the PMR pain as the HC has a short lived effect. The pain specialist can't offer you pain relief for PMR - except the right dose of pred.

I certainly hope you are not considering listening to this quack. It is unethical for another doctor to supersede himself into another Physician's treatment. And bottom line, no one should ever stop prednisone without an appropriate taper and definitely not cold turkey. If you've been on 20 mg I'm assuming in this form you have a PMR diagnosis, you are throwing yourself into a dangerous tailspin. Janet

You all scare me now.  What should I do?  I thought it was a step foreward.  I will call the rheum. but she is not on the PMR band wagon, despite sympyoms because my inflammation isn't going down below 50 even on pred.

Why are you seeing an endocrinologist? It is well documented that stopping pred abruptly after taking it for a length of time is very dangerous and can make you very ill....

Dear Debbie,  I would not tell you to *run* but a couple of years ago I saw an endocrinologist for my thyroid.  It was a total and complete nightmare.  Never, ever again.  In my mind I 'fired' her and since then I've 'fired' a couple other doctors.  There are some who are not good fits.  All my life I've respected doctors, listened and considered there word 'law.'  I still respect them, but now understand that some are not experts in every area, nor are they expected to be.  We are our own best advocates.  This is why this list is SO valuable.

When my PMR was not responding, my very good rheumatologist upped my dose (as mentioned in other posts.)

I went from 20 to 60, back down to 10, was upped to 15 and am now to 10 again - holding.

My Dr. is 100% for  very slow withdrawal and everyone I've seen in the practice is amazing.  

I so hope you can get help.  The very thought of abruptly stopping prednisone scares me. When I was at 100mg (years ago with Behcet's) ..it took two years to get off, and that was an increase, reduce type of reduction.

If there is anything we learn about prednisone - it is to be respected.  My doctor told me, point blank, 'There is no other medication for PMR other than prednisone.  The other drugs given along side it, are to help us reduce it.  

I am no expert, only a participant in this tough journey.  There are some experts on this list and I'm reading all their posts.

Thinking of you.  These decisions are hard.  Please, let us know how you are doing.

MariGrace (70 - PMR for 1+ year.  Behcet's in remission, and Hashimotos.)

Debbie - I did a little Googe search on "Hydrocortisone vs Prednisone" and found quite a lot of information.  Below is a rather lengthy discussion on the topic. Please excuse the length of this, but I did not write it.  The author is none other than Eileen H, written some 8 years ago:

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

Everybody, I think Debbie is seeing an endocrinologist because her diagnosis of PMR has always been in doubt, because the expected relief of pain at a pretty high dose of Pred has not been forthcoming.  Debbie, correct me if I'm wrong.  

Debbie, I do hope that your various specialists are talking to one another so that your progress (or lack of it) can be observed by all concerned.  As Eileen says, the hydrocortisone is replacing the pred so concerns about the adrenal function should not be a problem.  But please double check, perhaps with the pharmacist, that the hydrocortisone dose (what do the three hydrocortisone tablets add up to in daily dosage?) is roughly equivalent to  what you've been getting of pred, and not a sudden drastic cut.  I have read elsewhere about people who didn't do well on pred managing better with hydrocortisone, although it's less convenient as it must be taken at more frequent intervals than once a day.

Good luck, and do let us know how you get on.  

It has been a bout 12 hours since I didn't take the pred. and I feel it bigtime.  Is that withdrawal or Poly?  My arms and legs are like cement with pain added into the mix.  I can't walk to the kitchen wihtout having to sit down.  My head aches and my neck, and the dogs want to be fed - haha.  So in desperation I just took 10mg of pred.  I hate being desperate.  Iwish one of you would come stay with me and fix me up!  Thnks for all the caring comments.  I am too dull right now to fix my typos!