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Dosage and Adrenal Insufficiency Question

Galixie

Senior Member
Messages
219
I am hoping someone here can tell me what dosage level of fludrocortisone would put a patient at risk of adrenal insufficiency if they were to go suddenly off the drug?

I take .2mg a day and, due to a refill snafu, I run out tomorrow and may suddenly not have any (so tapering down is not an option). My naturopath didn't think I would be at risk of drug induced adrenal insufficiency (we talked about it a few months ago, when I asked her if I needed to wear a medical bracelet), but it is a corticosteroid, so I gather there is some risk. I assume the risk increases in proportion to the dosage, so I am trying to figure out if it is something I really do need to watch out for, or if I have no reason to worry about it.

Can anyone shed some light on it for me?
 

Gingergrrl

Senior Member
Messages
16,171
I don't know the answer but am unfortunately in the same boat with Cortef and secondary adrenal insufficiency. My two prior attempts at tapering led to becoming allergic to food within one week. I hope to attempt another taper next year and really want off of this med without triggering an adrenal crisis or anaphylaxis.

Can't the pharmacy give you a few Florinef pills until the full prescription can be refilled?!!
 

Galixie

Senior Member
Messages
219
I ended up cutting my last pill in half so I could stretch it out. As you can imagine, that halfway worked. :lol:

I didn't feel that great, but that might have been due to another reason.

It took four trips to pharmacy, two emails, and a phone call to finally get it straightened out. Then I had to explain to the pharmacist that I also wanted to buy one single pill in addition to the regular refill because splitting the last pill in half meant the refill would only equal 29 & 1/2 days (and the missing half would've driven me nuts every time I got to the end of a bottle otherwise).

At least it's a happy ending. :)
 

invisiblejungle

Senior Member
Messages
228
Location
Chicago suburbs
I am hoping someone here can tell me what dosage level of fludrocortisone would put a patient at risk of adrenal insufficiency if they were to go suddenly off the drug?

I take .2mg a day and, due to a refill snafu, I run out tomorrow and may suddenly not have any (so tapering down is not an option). My naturopath didn't think I would be at risk of drug induced adrenal insufficiency (we talked about it a few months ago, when I asked her if I needed to wear a medical bracelet), but it is a corticosteroid, so I gather there is some risk. I assume the risk increases in proportion to the dosage, so I am trying to figure out if it is something I really do need to watch out for, or if I have no reason to worry about it.

Can anyone shed some light on it for me?

Hi Galixie,

Fludrocortisone, from what I know, would not cause an adrenal crisis if you suddenly stopped it. An adrenal crisis is caused by a critically low level of cortisol which can be caused by glucocorticoids. Fludrocortisone is a mineralocorticoid, and it operates on a different feedback loop than cortisol.
 

HelloHere

P.o.t.s, brugada,and now high Tsh or ME/CFS?
Messages
12
Location
south east coast US
Hi Galixie,

Fludrocortisone, from what I know, would not cause an adrenal crisis if you suddenly stopped it. An adrenal crisis is caused by a critically low level of cortisol which can be caused by glucocorticoids. Fludrocortisone is a mineralocorticoid, and it operates on a different feedback loop than cortisol.
Any references?
 

Galixie

Senior Member
Messages
219
Hi Galixie,

Fludrocortisone, from what I know, would not cause an adrenal crisis if you suddenly stopped it. An adrenal crisis is caused by a critically low level of cortisol which can be caused by glucocorticoids. Fludrocortisone is a mineralocorticoid, and it operates on a different feedback loop than cortisol.

Can you give more info?
My understanding was that the body gets accustomed to the artificial dose and stops producing its own. So stopping suddenly can cause a problem. I do realize that fludrocortisone is a little different, but isn't the end result the same if your system has come to rely on it?

As a wider and slightly off topic question, has anyone noticed their sleep patterns being affected by florinef? I find that I get really sleepy in the two hours leading up to the next dose, but then I seem to perk up and be very much awake after I take the next pill. This happens every day. It's a distinct pattern.
 

invisiblejungle

Senior Member
Messages
228
Location
Chicago suburbs
Can you give more info?
My understanding was that the body gets accustomed to the artificial dose and stops producing its own. So stopping suddenly can cause a problem. I do realize that fludrocortisone is a little different, but isn't the end result the same if your system has come to rely on it?

As a wider and slightly off topic question, has anyone noticed their sleep patterns being affected by florinef? I find that I get really sleepy in the two hours leading up to the next dose, but then I seem to perk up and be very much awake after I take the next pill. This happens every day. It's a distinct pattern.

https://en.wikipedia.org/wiki/Aldosterone#Control_of_aldosterone_release_from_the_adrenal_cortex

Taking any hormone can cause the body to decrease endogenous production, so yes, stopping suddenly can cause issues. But the risks are different depending on the hormone.

"Adrenal insufficiency" refers to a dangerously low level of cortisol, which can be life-threatening. Cortisol is the only hormone that is absolutely necessary for survival; without it our blood sugar would plummet and we would go into a coma. That's why it's recommended that people taking glucocorticoids wear a medical bracelet, because if they're in an accident, they need exogenous corticosteroids to keep their body going.

If you suddenly stopped taking fludrocortisone, you might feel really crappy, but it won't be a life-threatening "adrenal crisis" in the way that suddenly stopping glucocorticoids can be. (That's why your doctor said a medical bracelet isn't necessary in your situation.)
 

Galixie

Senior Member
Messages
219
https://en.wikipedia.org/wiki/Aldosterone#Control_of_aldosterone_release_from_the_adrenal_cortex

Taking any hormone can cause the body to decrease endogenous production, so yes, stopping suddenly can cause issues. But the risks are different depending on the hormone.

"Adrenal insufficiency" refers to a dangerously low level of cortisol, which can be life-threatening. Cortisol is the only hormone that is absolutely necessary for survival; without it our blood sugar would plummet and we would go into a coma. That's why it's recommended that people taking glucocorticoids wear a medical bracelet, because if they're in an accident, they need exogenous corticosteroids to keep their body going.

If you suddenly stopped taking fludrocortisone, you might feel really crappy, but it won't be a life-threatening "adrenal crisis" in the way that suddenly stopping glucocorticoids can be. (That's why your doctor said a medical bracelet isn't necessary in your situation.)

I tried reading that article but I couldn't follow it. Brain fog. :(

I can confirm that suddenly halving my dose for 24 hours did, in fact, make me feel crappy. It does seem like my body has come to depend on the artificial dose to stay functional. I think I would prefer never to find out what stopping suddenly does to me.

I tried looking up how fludrocortisone affects sleep patterns and all I could find were references to people having trouble sleeping. That probably explains why I perk up after I take it, but I didn't see anything about why I consistently get ridiculously tired a couple of hours before my next dose. It's not supposed to wear off after 10 hours, is it?
 

invisiblejungle

Senior Member
Messages
228
Location
Chicago suburbs
I tried reading that article but I couldn't follow it. Brain fog. :(

I can confirm that suddenly halving my dose for 24 hours did, in fact, make me feel crappy. It does seem like my body has come to depend on the artificial dose to stay functional. I think I would prefer never to find out what stopping suddenly does to me.

I tried looking up how fludrocortisone affects sleep patterns and all I could find were references to people having trouble sleeping. That probably explains why I perk up after I take it, but I didn't see anything about why I consistently get ridiculously tired a couple of hours before my next dose. It's not supposed to wear off after 10 hours, is it?

I don't take fludrocortisone right now, but when I was experimenting with it, it definitely gave me insomnia.

The half-life is supposed to be 18-36 hours, so theoretically it shouldn't wear off after 10 hours. But of course, everyone's different. Do you take it multiple times per day? Most people seem to take it once in the morning.
 

bertiedog

Senior Member
Messages
1,738
Location
South East England, UK
don't take fludrocortisone right now, but when I was experimenting with it, it definitely gave me insomnia.

When I have to take just half a tab of Fludro it definitely has an effect on my sleep and I find that I will go to bed later than normal. I respond very quickly to just half a tab and only need it in the Summer for a few days if I have been sweating excessively. For the rest of the year I do fine on 6mg Prednisolone alone for adrenal insufficiency.

Pam
 

Galixie

Senior Member
Messages
219
I don't take fludrocortisone right now, but when I was experimenting with it, it definitely gave me insomnia.

The half-life is supposed to be 18-36 hours, so theoretically it shouldn't wear off after 10 hours. But of course, everyone's different. Do you take it multiple times per day? Most people seem to take it once in the morning.

Yes, I take one pill twice a day. I gathered that the dosage was split in order to keep my levels relatively consistent.

I hope that the sleepiness is not some sort of sign that my adrenals are going into a sort of hyper drive and then tanking every ten hours. It seems like that wouldn't be healthy. But I do feel like I've been doing pretty well on it, so I don't really think it's a problem.
 

WoolPippi

Senior Member
Messages
556
Location
Netherlands
I take Fludro on top of my Hydrocortison (=HC). The HC is for my primary adrenal insufficiency. I've varied day dosage from 15 mg per day; 30 mg per day; 45 mg per day. I've now settled on 25 mg HC per day, in a dosage every 2 hours, tapering off as the day progresses. (4 - 4 - 4 - 3 - 2,5 - 2,5 - 2,5 and 2,5 for when I go walking or stub my toe)

But it wasn't enough. I kept having spells of weakness and buckling knees and ridiculous low blood pressure which caused lack of mental alertness. Fludrocortison fixed that (1 pill in the morning, 0,1mg). On warm days or when I feel my knees getting weak I take a second pill. (Taking HC puts one at risk for dehydration which requires more Fludro)

Since starting Fludro my adrenals seem to be fully dormant. Don't think it caused it though. With the Fludro there's less bodily stress and I can supplement the HC more evenly and even lower the dosage on a day without stresses.

PS I have insomnia every night. It is what caused my adrenals to burn out. I have not noticed an influence on it from Fludro. But I take it in the morning and at noon at the last.
If anything: when I take my morning dose HC upon waking I may grow drowsy after an hour (because bodily stress lessens?) and get in another two hours of refreshing sleep.
 

Galixie

Senior Member
Messages
219
I talked to a doctor yesterday and mentioned the afternoon sleepiness I get since starting florinef. She said that cortisol naturally spikes twice a day, once in the morning and once in the afternoon, with the morning spike being bigger than the afternoon one. She thinks taking florinef may have flattened out my afternoon spike to the point where I'm sleepy. The artificial supply would have dampened the signal to make more and create the spike.

At least that explains that issue.