Fludrocortisone vs cortisone

[Sarah Tee]

I notice that fludrocortisone seems to be prescribed for some people with dysautonomia. What's the difference between it and hydrocortisone?

I was prescribed hydrocortisone, a fairly low dose, and it helped my symptoms but unfortunately I got a lot of side effects, including euphoria, and had to stop it after three days.

Is it possible someone could tolerate fludrocortisone better if they can't take HC?

[sue1234]

Fludrocortisone is a mineralocorticoid, which means it helps you hold onto salt, and thus it holds onto fluid.  It is used for low blood pressure.  Hydrocortisone is considered a glucocorticoid, which is replacing cortisol itself.  It has some mineralocorticoid properties as well.    It depends on what you need.  If your doctor has found you actually have low cortisol, he can replace it with hydro., but he needs to investigate why it is low.   If you only have low blood pressure, the fludro. would be the better choice.

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[Sarah Tee]

1 hour ago, sue1234 said:

Fludrocortisone is a mineralocorticoid, which means it helps you hold onto salt, and thus it holds onto fluid.  It is used for low blood pressure.  Hydrocortisone is considered a glucocorticoid, which is replacing cortisol itself.  It has some mineralocorticoid properties as well.    It depends on what you need.  If your doctor has found you actually have low cortisol, he can replace it with hydro., but he needs to investigate why it is low.   If you only have low blood pressure, the fludro. would be the better choice.

 

Thanks, sue1234, that's very helpful. I actually don't know why I was prescribed hydrocortisone, because I was told that my cortisol levels were normal.

I am not seeing that endocrinologist any more. He was very unhelpful when I got the side effects, and in other ways. Luckily for me, the pandemic meant I was able to reconnect with my former endocrinologist in another city by telehealth. She is excellent.

However, we are none the wiser as to why the hydrocortisone resolved my fatigue symptoms. But she says that because the side effects were so unpleasant, I should not take it again. (Euphoria was the most alarming, because I was not thinking clearly at all. Thank goodness I do not drive because I really was out of it.)

Hopefully I will be seeing a neurologist soon.

[sue1234]

Can I ask what dose of hydro. you were taking?

 

[Sarah Tee]

7 hours ago, sue1234 said:

Can I ask what dose of hydro. you were taking?

 

I think it was 10mg, 5mg, 5mg, distributed during the day. I took the medication back to the chemist for disposal so I don't have the bottle to refer to.

I then tried a single dose of 5mg, but still felt awful (from the side effects).

I think I will ask my GP to find out from the endocrinologist why it was prescribed. I cannot remember him giving me a rationale, but this happened in February, and I spent ages getting over the side effects, so my memory is a little vague.

[Sarah Tee]

@sue1234, am I right in thinking that hydrocortisone could raise blood volume because of its mineralocorticoid properties?

I am wondering if this might be why it made me feel better. (I have reason to suspect from the effects of another intervention that my problems are related to low blood volume ... not confirmed yet ... waiting for post-holiday appointments!)

[sue1234]

It very well could be.