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    Old 08-05-2008, 08:05 AM   #1
    dalmatinka
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    feeling worse on Cortef

    Hi guys,

    I was so happy when finally I was diagnosed with adrenal fatigue and prescribed Cortef. For years I have been struggling with intolerance to thyroid meds, iron and other supplements, and everything I have ever tried to take. I am currently on a very small dose of Armour, 2x a day .31 grain.

    I was prescribed 5 mg Cortef to take in the morning and another one if I need in the afternoon. I started by taking 2.5 mg in the morning and 2.5 mg in the afternoon. At first I would have nice energy kick after each dose but it would not last for more then couple of hours and then I would crush. Then I tried to take 5 mg in the morning but that did not go well at all. I was fogy, crushed, my back was hurting, I was nervous, I just felt awful. Then my doctor switched me to 2.5 mg SR Cortisol. I took it for two days and felt awful, I had no energy and was so depressed all day, I just felt very bad.
    I continue by taking my regular Cortef but less then 5 mg, maybe 3.5 or 4 (I cut off one small corner of the pill) I was expecting that I will need some time to adjust, but now more then two weeks later I feel worse then before I started it. I am always sleepy, I feel lightheaded, I have no energy, I am more depressed and I am crushing more then before. Higher dose seems to make me feel worse, smaller dose makes me feel very sleepy.
    My appointment is coming up soon, but what can I do until then? Am I doing something wrong?
    My saliva test clearly showed low adrenal function.
    Thank you so much for any suggestions you might offer.

     
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    Old 08-05-2008, 10:04 AM   #2
    Hormoneman
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    Re: feeling worse on Cortef

    I've seen your problem countless times over the years. It's my opinion that you are taking enough cortisol to make you feel bad. In other words, the cortisol is suppressing more than it's replacing. Replacement is not 1 for 1. I haven't seen anyone manage well with less than 25 mg, especially when dosing Armour. Keep in mind that for 20% of people, Medrol is what they need because cortef isn't strong enough for them.

    Last edited by Hormoneman; 08-05-2008 at 10:04 AM.

     
    Old 08-05-2008, 05:29 PM   #3
    rumpled
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    Re: feeling worse on Cortef

    I will give you more food for thought, some of which agrees, some of which sort of disagrees (respectfully) the other poster, and why.

    A replacement dose is usually around 20mg of hydrocortisone. Hydrocortisone lasts around 6-8 hours. Medrol, on the other hand, only lasts 2.4 to 3.5 hours so I am not sure that is an advantage. When comparing steroids - you always have to know - if they are short, medium or long acting (how long it takes them to take effect) and then the half life - that is, how long approximately they will last. Short will go into effect quickly and are hydrocortisone and medrol, medium are like prednisone.

    The body has a diurnal cycle - so just taking doses willy nilly does not help but interferes. The body reaches a high in the morning, goes down to around half that in the late afternoon and down to almost nothing at around midnight. People mostly adjust their dosing (if they are on short acting ones) to mimic this cycle. Just taking more can lead to issues as too much leads to damage. I had this as I had Cushing's. You may not see is right away but it will be there.

    10mg - eh. But taking it like you are given - your doc is not... experienced - get to someone who knows so you will do the best with the minimal damage.

     
    Old 08-05-2008, 05:59 PM   #4
    dalmatinka
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    Re: feeling worse on Cortef

    Thanks both of you for replying to my post.
    My doctor knows how sensitive I am to everything so he wanted me to start slow and take time to adjust. I am sure he will have some suggestions for me when I see him, but I don't know what to do 20 days until then.
    Rumpled, do you suggest I need more Cortef in the morning, maybe 10 mg? See, what I experience on 5 mg I am not sure if that's because I am not getting enough or because my body is not used to cortisol and reacting like with everything else. I get tightness in the chest and throat, I feel speedy but crushed and sleepy at the same time, I am fogy and I feel like I am on the clouds (in a bad way). I also noticed that I get lightheaded easily and I get sick feeling if I do sudden move or try to do something crazy, like dance.
    I don't know what is worse, 2.5 or 5 mg so far. In the beginning when I started taking Cortef I felt better for period of time after taking a dose, even though I was more sleepy and I was crushing more then before Cortef, I still felt better then I do now two weeks later.

     
    Old 08-05-2008, 07:06 PM   #5
    Hormoneman
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    Re: feeling worse on Cortef

    I will give you more food for thought, all of which disagrees the other poster.

    A replacement dose or hydrocortisone (short acting) is at least 25 mg and Medrol (long acting) lasts a lot longer than hydrocortisone. Do the research and you'll see the other poster has it wrong about HC lasting longer than Medrol. Medrol is much stonger, lasts much longer. I haven't seen anyone get Cushing's from 25 to 30 mg HC, nor have I heard of this in the 5 years and thousands of people I've helped with hormone problems (I'm a patient, not a doc). Taking 20 mg and less is under treatment pure and simple, but there are some who say the sky will fall on you if you take more, hogwash. You do want to take the minimum amount it takes to make you feel better, but I've not seen that in others less than 25 mg do it.

    HC is anywhere from 1 to 8 hour half life. Those who only get a 1 to 3 hour half life or so out of HC usually end up on Medrol which has a half life of 8 to 16 hours depending on the individual. Medrol's half life is roughly the same as prednisone, but Medrol is much better on the liver so is recommended.

    HC can usually be dosed to approximate the diurnal cycle of natural cortisol, but Medrol can't approximate so is why you should give HC every chance to work which includes raising up to but not past 30 mg. You're welcome.

    Last edited by Hormoneman; 08-05-2008 at 07:09 PM.

     
    Old 08-05-2008, 10:33 PM   #6
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    Re: feeling worse on Cortef

    Not to interrrupt your post but I have another question regarding cortef.
    I am on 30mg and have been for a year and a half. Tried to go lower by decreasing 2mg at a time. All my symptoms returned in four or five days both times my doctor and i tried. (3 months ago)
    I have been dealing with severe mono for 6 weeks, my energy is less but tolerable in the afternoons and after my 5 oclock dose I wake up and can't fall asleep until after midnight. I take 10 at 8 another 10 at 1230 and the last 10 at 5 I am also on 100mcg of synthroid and 15mg of cytomel and thyroid is in good range. Just had it checked.

    What does this mean?

    Last edited by kmatthew; 08-05-2008 at 10:34 PM.

     
    Old 08-06-2008, 05:13 AM   #7
    dalmatinka
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    Re: feeling worse on Cortef

    Hi neighbor, as you see, I have not much experience with Cortef, but what I can suggest is that you don't even try lowering it now since you have mono. Wait until you are completely better and ready for it. Why do you want to lower it, are you having side effects?
    Another suggestion is to take 15 mg first thing in the morning, 10 at lunch time and 5 in the afternoon. Maybe lower dose in the afternoon will help you sleep better.

     
    Old 12-29-2010, 09:03 PM   #8
    cooks95
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    Re: feeling worse on Cortef

    Hormoneman- I am so glad you said this- I need help with a similar issue. I had very low adrenal steriod results from a 24hr urine test given by Dr Therese Hertoghue and very low saliva cortisol results. I've had hypotension all me life. Then my TSH was 4.1 and my Ft3 was 297 (240- 420 range)
    and low FT3/ rt3 ratio - 14.9. So my Doc started me on 5mgs medrol- I was so tired I could not stay awake. So he switched me to 20mg HC, and that helped. But when I tried adding Armour, even the smallest amount made me hyper felling terrible. I lost a lot of weight got sweaty etc.

    So I stopped everything for 6 months and felt pretty good - though not optimal - but my TSH rose - ft3 fell- and my cholestrol rose too. So I just began HC 4 weeks ago and Val from **** told me I can't take thyroid meds because my adrenals couldn't take it - and to go up to 30mgs HC- and gradually took Cytomel this time. I started 30mgs of HC first and I got these strong headahces behind my eyes and dark circles came back like crazy under my eyes- I used to have these when i was really at my sickest. I read that HC can lower potassium so I ate more bananas- and that seemed to help. Within about 3 to 4 weeks weeks I got up to 50mcgs cytomel- I just am not feeling anything positive- more fatigue i think and muscle weakness- weights i used to lift no problem in the gym are like lead.

    Am I not taking enough HC? Should I just ride out the cytomel reactions and increase it gradually? I am at a loss. I felt half way descent before starting any of this and would take those intial feelings as bad as they were any day over this.

    The only thing that is keeping me trying all this stuff is this. Six years ago a Dr Flechas gave me 90mcg tabs of Sustained release cytomel and compounded DHEA. Felt nothing for 15 days then all of a sudden I felt such well being that have never felt before or since in my life. All the fog /depression lifted. But I also felt intense tightening in my chest. He was worried abiout the chest thing and asked me to stop all meds- but I never really got back on them. Two years ago another doc gave me armour to take and the first day of taking it I felt the same thing! That's when i knew it was the thyroid meds. I was so happy- but this feeling faded in two days never to come back. A few people told me it left me because i wasn't taking any HC and my adrenals couldnt take the armour. Maybe true- but I can't help thirsting for that feeling again, and it showed me for the fir4sdt time in my life what feeling good is like.

    I don;t want to give up because of the hope i can feel it again- but I was better off before when on noithing than i am now. Just wanted to see what you thought of all this.

    Thanks for your consideration.
    Chris




    Quote:
    Originally Posted by Hormoneman View Post
    I've seen your problem countless times over the years. It's my opinion that you are taking enough cortisol to make you feel bad. In other words, the cortisol is suppressing more than it's replacing. Replacement is not 1 for 1. I haven't seen anyone manage well with less than 25 mg, especially when dosing Armour. Keep in mind that for 20% of people, Medrol is what they need because cortef isn't strong enough for them.

     
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