Wednesday, June 22, 2011

Pulse and Stretch Protocol for Weaning off Hydrocortisone or Prednisone

Summary of Post
Here I give part of the Protocol specifically for Hydrocortisone to get you started. Much effort and time has gone into writing this Protocol, which is original content put to the test by myself and also used by hundreds of other readers with whom I have shared it.  

Is this Protocol for you?
This Protocol should be useful to you if you have been on steroids long-term (more than 6 months). If you have been taking steroids for only a few months, you should be able to taper much faster (following your doctor's advice) and won't need this Protocol. 

The Protocol can be adapted to Prednisone, although in my experience it is easier to wean off Hydrocortisone due to its shorter biologic half-life. (To wean off Prednisone, divide the dosages by 4 or use a handy corticosteroid conversion calculator). To facilitate weaning if you are on dexamethasone or corticosteroids with longer biologic half-lives, first switch to prednisone, then if possible, to hydrocortisone.

I have successfully tapered quicker than given in the Protocol, by drastically decreasing stress and increasing rest (read about my lifestyle changes HERE). It really depends on your body and how well you listen to it. I welcome you to email me or leave a comment on my blog if you have any questions and I will get back to you, usually within a day or two. I get half a dozen emails weekly and take time to consider and respond to each one. In return for my time, please do consider leaving me a tip ('Tip Jar' button on right side bar).

Testimonial from a reader
"I, for one, have never gotten any useful advice in the doctor's office about weaning off prednisone.  I think the effort a writer puts into a useful piece of information is certainly worth the price of a copay to the doctor's office or the copay on a prescription." (Sandy M., New Mexico)

IMPORTANT: Consult a licensed health care provider before embarking on this regimen or using any supplement in combination with, or in lieu of any Rx drug.

About Hydrocortisone and Cortisol
Hydrocortisone (HCT) is an important, potent and potentially dangerous Rx drug. Once you take 20-40 mg per day, your adrenal cortex stops producing its own cortisol altogether. Cortisol is the adrenal hormone that HCT and other corticosteroids (prednisone, dexamethasone, etc) simulate. The adrenal cortex may stop producing cortisol when a person is taking 20 mg a day of HCT, while for another person, natural cortisol production may stop when that person is taking 40 mg a day of HCT. Every person is different but the point remains - put in enough of the (synthetic) corticosteroids and the body will halt its own production of the real thing. Dexamethasone and prednisolone have a much longer biologic half-life than HCT and suppress the adrenal glands for a longer period of time.

If you have been on HCT a long time (more than 5 years), at doses of more than 20 mg/day your adrenal cortex may be badly damaged. Cortisol, the natural corticosteroid produced by the adrenal cortex, is necessary for survival. If the adrenal cortex is permanently damaged you will have to take HCT or a similar drug indefinitely. Ask your doctor about the synacthen test to see how well (or if) your adrenal glands are working.

Before Starting the Protocol
1.      I assume you will start your weaning at a dose of 40 mg per day (STEP 1, see ‘The Protocol’ below). For most of you, this is your ‘maintenance dose’, i.e., the minimum dose you take to stay symptom-free. Most people are able to take fairly large reductions in dose above STEP 1. If you are taking 60 mg per day, you will need to cut down your dose gradually, until you are at 40 mg, before starting this Protocol. If you are currently on 25 mg, start at STEP 4.  Start your weaning at the corresponding STEP for your current dose.
2.      You should be on a relatively ‘clean’ diet (i.e., no caffeine, other stimulants, recreational drugs, etc.) Relatively ‘clean’ lifestyle (i.e., nonsmoking, no alcohol at this time, etc.). You should also identify all sources of stress in your life (e.g., relationship, emotional, physical, lack of sleep) and implement changes to minimize this stress. The aim here is to reduce the ‘overhead’ on the body system and enhance both the speed and extent of your success. For more details on lifestyle changes, please read Adrenal Fatigue: The 21st Century Stress Syndrome  by Dr James Wilson (I review the book HERE). I don’t get commissions from Dr Wilson if you buy his book! I actually reviewed it after I had successfully weaned off HCT myself through trial and error, and it would have helped me hugely if I had his book earlier. It’s all there, so please read it!
3.      HCT is available in 10 mg tablets. Use a pill cutter to split a tablet down to 1/8 size (0.125 mg).....
4.
5.
6.

 (the remaining three Notes can be found in the full Protocol, see below)                                                                                                                                                                      
THE PROTOCOL

STEP 1. Take your routine dose of HCT daily for two weeks. Take it at the same time every day. Make sure you are stable.

STEP 2. After two weeks, reduce your dose by 5 mg You are now at 35 mg. Stay there 7-10 days AFTER you stabilize, assuming that within 3 days after the drop you feel some discomfort and that remaining at the new dose the discomfort settles down.

STEP 3. After 7-10 days of STABILITY, drop 5 mg. You are now at 30 mg. Stay there 7-10 days AFTER you stabilize, assuming that within 3 days after the drop you feel some discomfort and that remaining at the new dose the discomfort settles down.

STEP 4. After 7-10 days of STABILITY, drop 5 mg. You are now at 25 mg. Stay there 7-10 days AFTER you stabilize, assuming that within 3 days after the drop you feel some discomfort and that remaining at the new dose the discomfort settles down.

STEP 5. After 7-10 days of STABILITY, drop 5 mg. You are now at 20 mg. Stay there 7-10 days AFTER you stabilize, assuming that within 3 days after the drop you feel some discomfort and that remaining at the new dose the discomfort settles down.

STEP 6. After 7-10 days of STABILITY, drop 2.5 mg. You are now at 17.5 mg. Stay there 7-10 days AFTER you stabilize, assuming that within 3 days after the drop you feel some discomfort and that remaining at the new dose the discomfort settles down.
NOTE: CHANGE IN DROP QUANTITY.

STEP 7. After 7-10 days of STABILITY, drop 2.5 mg. You are now at 15 mg. Stay there 7-10 days AFTER you stabilize, assuming that within 3 days after the drop you feel some discomfort and that remaining at the new dose the discomfort settles down.

STEP 8. After 7-10 days of STABILITY, drop 2.5 mg. You are now at 12.5 mg. Stay there 7-10 days AFTER you stabilize, assuming that within 3 days after the drop you feel some discomfort and that remaining at the new dose the discomfort settles down.

STEP 9. Things often start to get dicey from here on out. At about 12 ± mg, your body has to start producing its own corticosteroids. This is where you start "stretching" or "pulsing".........


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Note: The Protocol continues up to STEP 14. 

You can receive via email the full six page PDF of the Pulse and Stretch Protocol with a secure Paypal payment of $10 below. Your donation will help offset my costs, i.e., hours spent responding to questions on how to wean off steroids. I have been giving my time for free for the past eight years, but I could really use some money now. Thank you for your understanding and your support!



xo Gracie

14 comments:

  1. I am currently taking 25 mg of hydrocortisone and 100mg synthroid for thyroid. I have been told that my pituitary glands not working and was told that I will have to take it from now on. I have gained 25 pounds. I had run out one day and. Couldn't take it until that evening and felt pretty good. It is hard to find a doctor that is willing to help me. Any suggestions would help.
    Thanks Karen

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    1. Hi Karen, thanks for your question. The common denominator underlying endocrine gland dysfunction I believe is stress (emotional, physical eg pollution and injury, and other forms of stressors). Many of the folk who write in who suffer from thyroid problems tend to be prescribed hydrocortisone too, maybe because thyroid and adrenal functioning are closely tied together. For starters,I would recommend a drastic reduction in stress, and reading the book adrenal fatigue by dr James Wilson. Let me know how it goes and hope this helps!

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  2. This was a great source of valuable information. I was diagnosed a year ago with Addison's. I have been on HCT for a year. I recently had a cortisol AM test come back 12.5 at 9:30(got to the lab a bit late) this was drawn without my previous PM dose or that AM's dose. So as I and my Endo are both very excited, I am warning and am comfortably at 15mg. 10am and 5pm. Sometimes I am so busy I have forgotten my pm dose. I am desperate to get rid of this stuff and lose my extra 18 lbs. Thank you so much for this article. My applause to you!

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    1. Hi thanks so much for the kind words! I am glad to hear all your positive feedback and thanks also for sharing your encouraging situation. I wish you all the very best in your weaning off the hydrocortisone. Would love to know how it goes. Take care.

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  3. Hi Gracie,
    I've been on HC for nearly a year now for andrenal fatigue caused by improper thyroid replacement therapy following thyroid cancer treatment, and I am desparate to get off. I dontated so that I could see the rest of your protocol, but I didn't get anything. Do I need to do something special to see it?

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    Replies
    1. Hi Kathryn so sorry to hear about all you've been through and I hope this pulse and stretch protocol will help you wean off the hydrocortisone as it as helped me and others. Thank you for your donation too - I have emailed the PDF directly to you. Take care and talk soon..

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  4. Hi Gracie

    Have been on hydrocortisone for 6 years and am now on 27.5mg. I really dont like the steroid as it is not working that well for me anymore, my body is use to it and I feel it has become toxic to my body. I use to be on a lot less but over the years have had to increase due to various stresses. I just need some hope here that it is possible to come off this drug. I am very sensitive to supplements that could help and support me which makes it all so frustrating as I realise you need to build up adrenal reserve so you dont crash. I dont think my liver clearance is that great but probably the hydrocortisone wouldnt be helping that either? Were supplements really important for you to wean off? I would love to get started but my doctor keeps saying you cant wean without adrenal reserve or you will crash but that may be never?. Should I just get started and do the 3 things you suggested regarding sleep, stress diet etc.? Your advice would be so appreciated.

    Kind Regards
    Mary

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    Replies
    1. Hi mary thanks for your question and sorry to hear about your predicament with the steroids. Six years is a long time to be on the steroids, but 27.5mg is a very low dose. I'd ask the doctor for a synacthen test to see how well the adrenals are currently working before deciding how to wean. And yes you can certainly start to work on diet, stress and sleep as these will help in your overall recovery of adrenal function and also weaning off the steroids. Feel free to ask as many questions as you have. Take care.

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    2. Hi,

      I take HCT in 4 divided doses. 6 years total at a daily dose of anywhere between 15 mg-20 mg. for the past year I've been at 25 mg. Does your full protocol show how to do the reductions spread over the day? Which dose would I choose to reduce first? Morning, late morning, early afternoon's, or late afternoon's?
      Also, my blood work shows that a year ago, my DHEA and pregnenolone have fallen below range? Is that an indication that my adrenals are suppressed and can I still be a candidate for this wean?
      Thank you,
      Lizzy

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    3. Hi Lizzy, thanks for your question. My protocol does not show reductions spread over the day for those taking HCT in 4 divided doses - it does describe by how much to reduce each day, but not detail the dose breakdown. Based on my experience and what seems to have worked for others, I reduced the last dose first. The morning dose is always the biggest dose, and usually the last one to work on weaning off of. Shoot me an email with your daily dose regimen and I'll be able to reply more in detail. As far as I know, a person is a candidate for weaning off steroids if the adrenal glands are still working. Since you have been taking a very low dose of hydrocortisone (albeit for a long time), I suspect your adrenal glands still function. One way to find out is to do a synacthen activation test - it challenges the adrenal glands to work and measures how well they are working.

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  5. Hi Lizzy, I have been on Dexamethasone 0.25mg (one daily dose in the morning) for over 7 years, because my endocrinologist said after 7 years of pituitary gland tumor removal (caused acromegaly) I had adrenal insufficiency. Two weeks ago I saw a new endocrinologist (old one has left Vanderbilt hospital) for my annual checkup. She told me I should never have been put on steroids, since my cortisol test 7 years ago was in the normal range. Now she wants to see if I can still produce my own cortisol by tapering down from 0.25mg Dexamethasone by switching to 10mg Hydrocortisone for about two month, then 5mg Hydrocortisone and eventually to no Hydrocortisone, depending how I feel and if I can tolerate it. This doctor then wants to see me again in one year to do a test to see if my body has started to produce it's own cortisol and if so, how much. In case of severe stress, surgical procedures, illness and/or fever she wants me to increase the 10mg/a day Hydrocortisone to 20mg Hydrocortisone both in the morning and evening for several days. Before I order your protocol I would like to know if it can be applied to my weaning off of Dexamethasone as well. Best regards, Liz

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    1. Hi Liz thanks for your question. You likely will do fine transitioning from dexamethasone to hydrocortisone as your doctor has suggested. Although dex has a much longer biological half life (36 hrs), the dose you have been on for the past seven years is very low. All the best with your weaning off the steroids and don't hesitate to ask if you have any other questions.

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  6. Hi Grace,
    I'm on 15mg of Hydrocortisone right now (was on 20mg). I want to get off of this desperately as it has made me gain a ton of weight and is contributing to my depression. Money is very tight for me (as I am on SS Disability), so I wanted to know if your protocol has detailed steps for going from 15mg down to nothing? Could you please email me? My email address is fureverywhere (at) gmail (dot) com.

    Thank you!
    Sierra

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    1. Hi Sierra, sorry to hear that the hydrocortisone is contributing to your weight gain and depression. Yes the protocol has detailed steps on weaning off the last 12mg. However you might be able to wean easier if you haven't been on it for long. Your dose is really low to start with. If you can get the 1mg pills, you split them In quarters and just take your dose down a little every week or two. Depending on how your body handles the step down. Hope this helps!

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