Should you take Hydrocortisone when you are taking Prednsone?
Posted , 10 users are following.
My (now) 77 year old husband George reduced his Pred to 5 mgs by last September, and he has continued (without trouble except tiredness) with that dose for 6 months.
He saw his rheumatologist here in France last week. She's given him a new prescription, for Pred at 4 and a half mg, and now also Hydrocortisone at 10 mg . He is to continue another 6 months with these 2 drugs - but to gradually reduce the Pred further.
As he's got bad arthritis in one knee, she gave him an injection of cortisone in the knee.
We're concerned that he's suddenly having a lot of steroids. Please can you tell us if this sounds ok?
0 likes, 14 replies
Mrs_Hobbles Amanda4567
Posted
Hi Amanda, I hope you're both doing ok. I don't know anything about the Hydrocortisone but the injection into the knee is site specific, as in will only stay in the knee area, and doesn't affect the amount of steroids he is on, so that's fine and hopefully he'll get some relief from his knee pain with that. Some people can get up to a years relief, some much shorter, but to my mind, worth trying. I would be concerned that the doctor only prescribed 4.5 mgs of Pred, as this doesn't allow for the DSNS system of reducing, which at that level would be very important to do, going straight to 4.5mg could cause problems, he needs a bit of wriggle room, maybe a phone call to the doctor to at least send an amended prescription of 5mgs. At this level he shouldn't be rushing his reduction. Take care and stay safe.
rick00953 Mrs_Hobbles
Posted
While cortizone injection in knee is site specific, my doc said it also has a systemic effect. Was my doc correct or not?
sfazal rick00953
Posted
the cortisone shot is site specific, but it will also have some systemic effects as well. The doctor was right
Amanda4567 Mrs_Hobbles
Posted
Thank you, yes, I believe you're right about the 4.5..
Michdonn rick00953
Posted
Rick, 18 months ago while on around 10 -12 mg of Prednisone I had Hydrocortisone shot in my hip and back. It screwed up my taper and caused a flare. I increased and reduced in a matter of days.
Anhaga Amanda4567
Posted
Hydrocortisone is not nearly as strong as prednisone so it's not as much as it looks like. But why does the doctor feel it's necessary to gradually substitute in the hydrocortisone?
Amanda4567 Anhaga
Posted
I don't think I managed to explain very well, it was late last night ! -
The hydrocortisone 10mg has been prescribed in addition to the Pred - and the two medications to be taken together for the next 6 months.
Last September 2019 George had succeeded in reducing from 15 mg in, October 2018, to 5 mg of pred . Since last September he's stayed on the 5mg till now.
The rheumy has now asked George to gradually reduce the Pred , as well, in half mg steps month by month.
I 've got Eileen's chart for final tapering and I was thinking George would be following that by now.
We're not sure now whether he should try what the rheumy says in reducing the Pred, or go more slowly. And, we don't understand why the hydrocortisone is required as well, because it just sounds like more steroids at a time when he's trying to reduce them.
EileenH Amanda4567
Edited
The 10mg hydrocortisone is only the same as 2.5mg pred. HC isn't as effective for PMR as pred because it lasts less time in the body. I'm sure it may work to prod the adrenal glands into life better than just on pred - but it isn't they way I would go about it! Has she told him to take it together or at different times?
Amanda4567 EileenH
Posted
French rheumy prescribed hydrocortisone 10mg one in the morning, and one mid day - and we think it is to help adrenals, but didn't really understand.
George is to continue with the Pred in the mornings - he's down to 4.5 mg now - for a month - then reduce again.
It is puzzling us that he will be taking additional steroids at a time when he's trying to taper down. Also, I thought hydrocortisone was a topical treatment.. something to put on the skin, or inject..?
He's been taking lower, 4.5mg of Pred for nearly one week now. He says he feels ok.. but falls asleep even more often, and gets really knocked-out by any exercise.
You say you would go about it a different way - could you tell us how, perhaps..?
EileenH Amanda4567
Posted
I wouldn't have added HC to raise the total dose at this point - I would have waited for him to continue reducing the pred slowly, 1/2mg a month, until the fatigue got to be a problem. Then I might have considered replacing the pred with the equivalent dose of pred - because by giving him the HC instead of the pred it would have stimulated the adrenals better. HC is more like cortisol, the natural corticosteroid, and so using that instead of pred means the adrenals experience something more like normal. But why he's putting them together I just don't understand. Too tired to explain more just now.
Amanda4567 EileenH
Posted
Eileen, thank you for this help.
I think you live in Italy, you say you are tired, I hope you are not ill with this thing. Good wishes.
EileenH Amanda4567
Posted
No - I needed my bed!!!!
Amanda4567 EileenH
Edited
What a relief!
catherine34621 Amanda4567
Posted
Amanda4567 Hi, I have been taking Pred. and Hydrocortisone since last year, I started on 1x10mgs. am. 1x5mgs. at lunchtime, and 1x5mgs mid afternoon. They stopped the mid afternoon pill (Hydro.) as it was affecting my sleep, I also take 5mgs. of Pred. I also inject Tocilizumab every week. I seem to be o.k. so far.