Monday 23 January 2017

Hydrocortisone VS Prednisone

My husband, diagnosed May 2015 with left frontal lobe GBM, had been using dexamethasone but the side-effect were becoming too severe even though he was down to 2mg per day. His arms easily bruised, bleeding from thinning skin. Does anyone here have any experience with Prednisone or hydrocortisone? Since Dec. 1, my husband started taking prednisone but he seems to get quite irritable even on 7.5mg. A friend, who happens to be a neuro-onc visiting from Scotland, recommended switching over to hydrocortisone.  Our UCLA neuro-onc recommends that we see an endocrinologist, but that's harder to find than you would think. Any conflicts with other off-labels meds or supplements? Thoughts?
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8 comments:

  1. Jo23 January 2017 at 18:09

    My husband was on hydrocortisone for several months. He seemed to tolerate it better than dexamethasone. One caution on the endocrinologist is that my husband had low T4 so they put him on synthroid to get it up. Little did I did know there is some evidence that T4 stimulates tumor growth. There is info on this site regarding hypothyroidism as treatment for solids tumors, including GBM. Not something all endocrinologists will be familiar with so you might take the article if there is an appointment.

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  2. AGM23 January 2017 at 19:51

    Jo, thanks for your response. What article are you referring to?

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    1. Stephen W23 January 2017 at 21:38

      I'd guess Jo was referring to this article:
      http://theoncologist.alphamedpress.org/content/20/1/72.full.pdf+html

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    2. AGM23 January 2017 at 21:39

      Thank you!

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    3. Stephen W23 January 2017 at 22:00

      You're welcome.
      These 3 steroids (dexamethasone, hydrocortisone, and prednisone) are very similar in structure. They are all basically analogs of each other, except dexamethasone contains a fluorine atom and the other two don't.

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  3. Anne Marie24 January 2017 at 04:33

    My husband was on Dex for a very long time and despite a long taper he still ended up being hospitalised due to adrenal insufficiency. The endocrinologist who treated him put him on hydrocortisone. The side effects we saw with the Dex disappeared, he is much more his old self.

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  4. SteveMDFP25 January 2017 at 04:36

    The various corticosteroids vary greatly in milligram potency, but when given for cerebral edema, the milligram dosing takes this into account, so there's relatively little difference in side effects among the agents.

    There's some significant difference in duration of action, with hydrocortisone leaving the body faster, dexamethasone being relatively long-acting, and prednisone and it's close relatives being in between.

    For this family, giving Avastin/bevacizumab was far more effective than 16 mg/d of dexamethasone. With that, we were able to rapidly taper, now just 0.5 mg of dexamethasone. We're taking that last 0.5mg away very slowly. I'm not terribly impressed with Avastin in terms of prolonging survival, but it can be wonderfully effective for edema and mass effects in the brain. Not everyone responds so well.

    I'm not sure exactly why, but the Avastin+rapid decadron taper has coincided with a near normalization of lymphocyte counts. Reduction of lymphocytes is a recognized effect of radiation therapy, and it doesn't usually reverse. Low lymphocyte counts are a negative prognostic indicator in glioblastoma, so this normalization is very welcome.

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  5. AGM4 February 2017 at 08:10

    Does anyone have a recommendation of an endocrinologist in Los Angeles who knows how to deal with GBM patients? We are still trying to figure out how to move my husband from dex to something with less side-effects. My husband will start on Avastin again on Monday, but he had suffered from side-effect from Avastin too.

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