'slow release' compound pharmacy drugs

[eeso]

Ok I'm guessing this 'slow release' stuff is a load of bollucks.

I started on 15mg SR cortisol in the morning about 1.5 weeks ago but for the last few days I've been waking up wheezing and asthmatic, progressively getting worse.

What I assume is happening is that I take the pill in the morning and I use up the whole 15mg relatively quickly, which then leaves me even further depleted for the rest of the day/night. So by the time the next morning comes around I have very low cortisol levels and I get woken up very early not able to breathe.

I am currently on 15mg SR Cortisol and 50mg SR DHEA both taken in the morning. Unfortunately I gave my last HC to a mate who took it overseas so I'll have to see the docs about changing my script.

What do you guys think about 10mg SR Cortisol taken twice daily, morning and afternoon?

Should I also have my 50mg DHEA split into two doses such as 30mg morning and 20mg afternoon?

I would like to avoid having to dose more than twice a day because it all gets too troublesome. I tried doing Isocort then HC every 4 hours but it just became a pain in the ass, and I could really feel it every 4 hours when I needed a new dose. I do believe SR is working better for me, but it's not slow enough to do once a day.

Oh also, the good thing about using compounding chemists is that they can combine medications into the same SR pill. So when I've worked out all my different doses, I can have cortisol, dhea, armour and arimidex all in the same pill. When you're cutting down 4 different meds to 1 pill it really does make a huge difference and you also don't feel like such a sicko with all these bottles of meds and pills everywhere.

 

[JanSz]

Ok I'm guessing this 'slow release' stuff is a load of bollucks.

I started on 15mg SR cortisol in the morning about 1.5 weeks ago but for the last few days I've been waking up wheezing and asthmatic, progressively getting worse.

What I assume is happening is that I take the pill in the morning and I use up the whole 15mg relatively quickly, which then leaves me even further depleted for the rest of the day/night. So by the time the next morning comes around I have very low cortisol levels and I get woken up very early not able to breathe.

I am currently on 15mg SR Cortisol and 50mg SR DHEA both taken in the morning. Unfortunately I gave my last HC to a mate who took it overseas so I'll have to see the docs about changing my script.

What do you guys think about 10mg SR Cortisol taken twice daily, morning and afternoon?
Should I also have my 50mg DHEA split into two doses such as 30mg morning and 20mg afternoon?

I would like to avoid having to dose more than twice a day because it all gets too troublesome. I tried doing Isocort then HC every 4 hours but it just became a pain in the ass, and I could really feel it every 4 hours when I needed a new dose. I do believe SR is working better for me, but it's not slow enough to do once a day.

Oh also, the good thing about using compounding chemists is that they can combine medications into the same SR pill. So when I've worked out all my different doses, I can have cortisol, dhea, armour and arimidex all in the same pill. When you're cutting down 4 different meds to 1 pill it really does make a huge difference and you also don't feel like such a sicko with all these bottles of meds and pills everywhere.

Some time ago I used your four point cortisol levels and calculated distribution of pills during day so you would have support when your adrenals are low.

Latter I found opinion from Genova Diagnostics that recomended supporting adrenals only twice daily, morning and at noon. The reson given was, to preserve circadian rhytm.

After I posted that opinion, Phil (I think) said that at STTM board the consensus is to support adrenals thru out the whole day.

So, there are all kind of opinions, pick one and run with it, or try and see which system makes you feel better.

My calculation is here:
Invalid Link Removed

This is how my calculated 4 pills distibution looks like.
For 4pill=20mg Cortef version
take 1.5 pills 7AM
take 1.5 pills 11AM
no pills
take 1 pill 7PM

 

[SPE]

Why don't you look into methylprednisolone? Those who use up cortisol too fast, usually do much better on the longer acting methylpred.

Also, your dose is probably too low. The majority of people don't really start to feel well again until they reach 25mg of cortef (or 5mg of methylpred).

 

[eeso]

JansZ - much appreciate your help. I found dosing HC 4 times a day was just too troublesome. Having to carry around a little bag of white pills and getting strange looks when i pull a pill out of my wallet etc...

I figured that if I use the compound chemist's slow-release version I could get away with only twice a day, because the cortisol should last more than the 4 hours that HC does.

From what you guys have said it sounds like it's worthwhile trying 2x10mg in slow release, taken morning and early afternoon.

I'll split my DHEA 25mg morning, 25mg early afternoon too.

 

[RPHMark]

As long as the pharmacist is following correct procedure and formula, which is relatively simple, the the slow release technology is very reliable. There simply is not much to go wrong. The slow release mechanism is due to a cellulose derivative which slowly hydrates from the outside in, so the medication is only released from the outside of the "lump". This is referred to lovingly as the "lumpy gravy theory". If you know gravy then you know that if the flour lumps then the lumps take forever to go away (unless you mash them) the outside of the lump is wet while the center is dry. The technology has been lab tested in realistic conditions many times and has always shown to work.

 

[eeso]

After doing some tests I'm actually sure it does work, I just don't think it works for 12 hours which is the problem. Up at 5:30am right wheezing. Damn I wish I hadn't given my HC away because that is instant relief. Even if I bust open a SR cap and take some powder it doesnt work quickly because of the SR.

 

[love_en]

If you need a stress dose of HC and nothing else is available, HC cream ie. Cortaid wil work. 1/4 teaspoon rubbed into the thin skin of a forearm is 10 mg applied, 30-40% is absorbed. There have been many times this has saved me. Adrenal failure is nothing to fool with, yet it is something commonly disregarded by doctors and ER.

 

[eeso]

What I've been doing is cutting open the SR cortisol and dhea and just getting the powder out, and guessing how much to take at a time. Not ideal, but haven't been able to see doc or get new meds yet.

Anyway, I've realised SR is not ideal for cortisol anyway - at least not the morning dose. It's too slow release in the morning so you can't get a good boost when you get up. You don't get a good "hit" which you need to get your levels up for the start of the day.

However using SR cortisol + HC might work well for sustaining the release through the day, as the SR is good during the day as I don't feel so over hyped on it like I did on HC. I think I use up HC much too quick as I can really feel it when I take it, then 4 hours later I really feel it's worn off completely.

For example something like this:

Morning: 5mg HC + 5mg SR
Midday: 5mg SR
Afternoon: 5mg SR

 

[love_en]

20 mg HC per day is not enough. Either replace or do not replace. Underdosing only burns out the adrenals more. Especially if you are primary.

 

[eeso]

20mg not enough? I thought 20mg was pretty standard for everyone around here?

I've managed to have my script for 15mg caps changed to 5mg, and i got half slow release and half non-slow release so im pretty free to dose how i want.

I was of the understanding that 20-30mg was the usual dose for adrenal insufficiency with most on 20. I'm trying to support my adrenals enough so I can get onto armor...

 

[love_en]

20 mg is adequate if you are a petite female not subject to any physical or mental stress at any time. If you are male, and physically active, that is barely enough. I am a very small man, but because of my level of activity, 30 mg is a maintenance dose for me. By doing this, I rest and preserve what remaining adrenal function I have. This might not hold true for those who are secondary. I am primary adrenal insufficient and probably have been for most of my life. I had a very mediocre response to an ACTH stim test. Started with what could be considered a high baseline, but did not double it or go to 50+. I still do not understand how stimming to 37 is a pass. I consider that alive but no adrenal reserves. Heaven help me if I should be injured or seriously ill.

 

[JanSz]

20 mg is adequate if you are a petite female not subject to any physical or mental stress at any time. If you are male, and physically active, that is barely enough. I am a very small man, but because of my level of activity, 30 mg is a maintenance dose for me. By doing this, I rest and preserve what remaining adrenal function I have. This might not hold true for those who are secondary. I am primary adrenal insufficient and probably have been for most of my life. I had a very mediocre response to an ACTH stim test. Started with what could be considered a high baseline, but did not double it or go to 50+. I still do not understand how stimming to 37 is a pass. I consider that alive but no adrenal reserves. Heaven help me if I should be injured or seriously ill.

Consider metal wrist band, wery tight so there is no way to take it out.
Engrave instructions on the outside surface of the band.

 

[cpeil2]

Ok I'm guessing this 'slow release' stuff is a load of bollucks.

I started on 15mg SR cortisol in the morning about 1.5 weeks ago but for the last few days I've been waking up wheezing and asthmatic, progressively getting worse.

What I assume is happening is that I take the pill in the morning and I use up the whole 15mg relatively quickly, which then leaves me even further depleted for the rest of the day/night. So by the time the next morning comes around I have very low cortisol levels and I get woken up very early not able to breathe.

I am currently on 15mg SR Cortisol and 50mg SR DHEA both taken in the morning. Unfortunately I gave my last HC to a mate who took it overseas so I'll have to see the docs about changing my script.

What do you guys think about 10mg SR Cortisol taken twice daily, morning and afternoon?

Should I also have my 50mg DHEA split into two doses such as 30mg morning and 20mg afternoon?

I would like to avoid having to dose more than twice a day because it all gets too troublesome. I tried doing Isocort then HC every 4 hours but it just became a pain in the ass, and I could really feel it every 4 hours when I needed a new dose. I do believe SR is working better for me, but it's not slow enough to do once a day.

Oh also, the good thing about using compounding chemists is that they can combine medications into the same SR pill. So when I've worked out all my different doses, I can have cortisol, dhea, armour and arimidex all in the same pill. When you're cutting down 4 different meds to 1 pill it really does make a huge difference and you also don't feel like such a sicko with all these bottles of meds and pills everywhere.

i would be afraid that taking the SR HC in the afternoon would interfere with your sleep.

 

[MacDonnell]

Why don't you look into methylprednisolone? Those who use up cortisol too fast, usually do much better on the longer acting methylpred.

Also, your dose is probably too low. The majority of people don't really start to feel well again until they reach 25mg of cortef (or 5mg of methylpred).

Bump! Did anyone read what SPE wrote above? Eeso, have you thought about taking prednisone instead? Dr. Mariano has me on 5 mg/day. I take it in the morning, it lasts for most of the day, and then lets you get sleep.

 

[eeso]

Bump! Did anyone read what SPE wrote above? Eeso, have you thought about taking prednisone instead? Dr. Mariano has me on 5 mg/day. I take it in the morning, it lasts for most of the day, and then lets you get sleep.

I actually have a bottle of prednisolone here which my father was prescribed for something that he no longer needs. However prednisolone half-life is only 2-3 hours - i assume it's the methylprednisolone i need which has a half life of 18-26hours?

 

[love_en]

In most cases, both prednisone and prednisolone are active for 18 + hours. However, they are hard for the liver to process. I think full replacement on either of those is a total of 7.5 mg per day. You also have less mineralcorticoid effect as well, so if your aldosterone is not adequate, Florinef may be needed.

 

[coz]

Even for some methlyprednisolone can be metabolised faster. I'm currently taking 7mg & I split it 3mg am, 3mg afternoon, 1mg night. If I take it all in the morning - I feel worn out by afternoon/early evening.

 

[eeso]

I definitely feel better on slow release than I do on standard, as I got some 5mg standards now. I'm going to try some 5mg SR's

on standards i get too hepped up then just plummet a few hours later. SR is much more consistent and smoother.

 

[Sypher7]

I relise this is an old thread but I too have just started hydrocortisone a couple of months ago and am having awful trouble with dosing. It wears off in me within two hours! Sometimes i get away with 3, moreso in the afternoon/night.

I've just got onto SR cortisol aswell from a compounding pharmacist. The problem with it as eeso mentions is that it seems weak.. many people with adrenal insufficiency as I have say the same. I've found so far I need to use normal HC along WITH the SR.

I currently take 40mg a day sometimes even up to 50mg. This is because my problem is far from simple.. i have had severe CFS/Fibro, multiple chemical sensitivities etc for many years now. Therefore my body is generally more stressed than others, also i seem to metabolise HC much too fast. I've been on a seriously bad rollercoaster for the last 2 months trying to get it right. Apparently some people take a long time to find their dose / steroid type that works best for them.

I have 10mg SR cortisol caps, but have only had them for about a week so trying to find a good way to use them. In the moming i find it better to take normal HC, and I'm up to 25mg usually by midday. Then i take a 10mg SR at the same time, which lasts through most of the afternoon, but I usually still need a couple of 2.5 mg doses late arv and night time.

I've also considered prednisolone (prednisone is terrible on the liver, and my liver is very sluggish so i wouldnt try that), but prednisolone is already 'liver converted' so its much easier on it. Just as cortisone acetate is not liver ready and has to be converted, but HC doesn't.

I'll see how this SR schedule goes for a while.. but i'm still pretty up and down and it's frustrating, so i may have to try the solone.

There is a new drug coming out, which they say is true 'once daily' hydrocortisone therapy. It's called Duocort. There is 2 layers to the tablet, the first layer is quick release (about twice as fast as current HC tabs apparently), and the second layer of the tab is sustained release, apparently releasing all the way until night time. check it out at duocort.com

Interested to see how anyone here is going with similar experiences..

~Chris.