HC dosing suggestions

[Guest guest]

I don't present any of this as " the bible " ...just some thoughts to

consider for those who are on (or are considering) low-dose HC

therapy:

1. My doctor prescribed 20 mg/day of HC in 2 divided doses. In

general, I think people would do better on 4 divided doses per day

rather than 2. The half-life of cortisol is supposed to be about 4

hours so two doses per day (morning and evening) will likely be a

little bit too drawn out for most people.

2. I don't think I would make them equal doses. Your body should

produce the most cortisol in the morning, and the least at

night...so a 20 mg/day dosage should probably follow something like

a 10/5/2.5/2.5 approach rather than 5/5/5/5.

3. Don't assume that you'll feel dramatically better in a few days

or even a few weeks. I would suggest starting small...perhaps just

10 mg/day and then bumping it up by maybe 5 mg each week until you

find relief. Don't exceed 35 or 40 mg/day without carefully

consulting someone knowledgeable. 40 mg/day is generally considered

to be the amount needed by a person with no adrenal functioning at

all, which does not hold true for those who have some functioning,

such as those of us with AF. I have heard several reports of people

taking at least a month to feel effects. I can't explain the

mechanism for this...perhaps it has something to do with reserves as

opposed to just the hour-by-hour needs of the body.

4. If you have been on cortisol for more than 3 days, do not

discontinue abruptly. It has been recommended elsewhere that

tapering should be no more than 2.5 mg every two weeks. Monitor

your symptoms closely and do not make other changes (such as

starting or stopping other meds) while tapering...that way, you'll

know if any changes in symptoms are due to the HC or not. If you

are at very high doses (30 mg) you can perhaps taper a bit more

aggressively until you reach 20 mg/day, but should then taper more

gradually. There are different ways to taper. For example, if you

are at 20 mg, tapering to 17.5, you might take 15 mg one day, and 20

the next. Or you might simply take 17.5 each day. The key is to go

slow, monitor your symptoms, and change only one thing at a time so

you'll have some basis for cause/effect.

--Steve

[Guest guest]

Hi Steve,

So, even though your docotr prescribed 20 mg/day of HC, you have decided to

wean off of the HC.

What motivated you to not follow your doctor's advice?

Also, if I wanted to do a cortisol test, I need to take 2 months to wean off

of the HC (2.5 every two weeks), correct? I have never been tested and now I am

concerned if it really is the correct medication for me. Is there any way of

telling the HC isn't necessary WITHOUT doing the saliva tests?

Thanks,

Pamela

Steve wrote:

I don't present any of this as " the bible " ...just some thoughts to

consider for those who are on (or are considering) low-dose HC

therapy:

1. My doctor prescribed 20 mg/day of HC in 2 divided doses. In

general, I think people would do better on 4 divided doses per day

rather than 2. The half-life of cortisol is supposed to be about 4

hours so two doses per day (morning and evening) will likely be a

little bit too drawn out for most people.

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