How bad was taking oral hydrocortisone + Ativan?

[[wa...]]

Buddies,

 

Before joining BB, I didn't realize that taking low-dose Ativan + low-dose hydrocortisone (1-5 mg cortisone for a few months) was probably BAD.

 

I tapered off both, then started developing horrid anxiety & insomnia about 2 weeks later, then started reading these boards, then learned the 2 meds are cross-tolerant.

 

Am I correct in understanding that each may have intensified the addictive properties of the other? And that the cortisone may have masked/blunted W/D symptoms between Ativan doses (I took Ativan once daily--even less)? So when I quit both at around the same time, I was in for a shock?

 

Every one tells me, "Withdrawing from such a low dose of Artivan couldn't possibly have caused your insomnia and anxiety." Maybe they're not taking into account the cortisone?

 

ALSO: I apply topical (vaginal) betamethesone .05% 3x/week. I've read mixed reviews of topical steroids on these boards. I can't correlate my bad insomnia/anxiety days to my betamethonse days. Still, I wonder how much harm I'm doing myself.

 

Thanks!

 

 

[[Ti...]]

Hello Want,

 

I was on a low dose of Ativan 0.5mg at night before bed and the very next week started having horrible anxiety

and insomnia.  So yes it does happen more than it should, and happens to other's on the same dosage who took

it for very short times of just one month or less.  You may also be getting w/d from the steriods if you c/t'd them.

I'm not familiar with the w/d syndrome for steriods, but it could be that you are having w/d from both.

 

I don't know about masking or blunting w/d, I would think it would make it much worse from what I have read

here on the boards.

 

I would use the search forum to side effects of hyrocortisone and other steriods.  Everything I've read definately

keeps me from taking it.  I wouldn't want to risk it myself.

 

Perhaps you could keep some kind of log of how you feel when you use them and when you don't and how you

feel.

 

I hope this helps some.

 

*Hugs*

Tink

[[wa...]]

Sorry to be dense . . . what does c/t mean? I've seen it all over the boards. Thx for replying!

[[wa...]]

Oh, duh. C/T = cold turkey, right?

[[fi...]]

Yes, you are correct.

 

fg

[[Ti...]]

lol it's okay, cold turkey.

 

[[Pe...]]

wanttosleep,

 

Hydrocortisone and betamethesone are in a class of drugs know as Glucocorticosteroids (also called corticosteroids and glucocorticoids) which are cross tolerant to benzos.

 

Here is some reading for you explaining this- which I know is a lot, but this info is super important for anyone considering any type of steroid therapy...which includes topical creams.

 

The first link is to a thread I started explaining how both benzos and steroids effect the HPA Axis and glucocorticoid feedback system.  You will want to read the two research papers located on pages 1 and 3 of this thread:

 

http://www.benzobuddies.org/forum/index.php?topic=44373.0

 

Here is a link to an article from a Medical Endocrine Journal  which explains the tolerance and withdrawal which can occur from steroid therapies:

 

http://edrv.endojournals.org/content/24/4/523.full

 

Here is a paragraph from Wikipedia that explains a little about the cross-tolerance aspect between the two:

 

There is cross tolerance between alcohol, the benzodiazepines, the barbiturates, the nonbenzodiazepine drugs, and corticosteroids, which all act by enhancing the GABAA receptor's function via modulating the chloride ion channel function of the GABAA receptor.[23][24][25][26][27]

 

The cross-tolerance between GABAA receptor positive modulators occurs because of the similar mechanism of action and the subunit changes that occur from chronic use from one or more of these compounds in expressed receptor isoforms. Abrupt withdrawal from any of these compounds, e.g., barbiturates, benzodiazepines, alcohol, corticosteroids, neuroactive steroids, and nonbenzodiazepines, precipitate similar withdrawal effects characterized by central nervous system hyper-excitability, resulting in symptoms such as increased seizure susceptibility and anxiety.

 

http://en.wikipedia.org/wiki/Benzodiazepine_dependence

 

So as you can see...this class of medication is not a good idea while either taking or recovering from benzos.

[[wa...]]

Thanks so much, Perseverance. You're a legend on the forum, and I'd already read some of your posts and links.

 

Can you clarify a few things? Apologies if this stuff should be obvious. I don't have a head for the technical/scientific.

 

Oh, first you should know that I was on a physiologic dose of the oral hydrocortisone (Cortef). My doc wanted me to ramp up to 15 mg day: 10 upon arising and 5 several hours later. I took me a couple of months just to ramp up to 5 mg, and I was at 5 mg for just one week before tapering off. In essence, I was taking between 1 and 5 mg, which is far from a pharmacological dose. That said, I'm extremely drug-sensitive, which is likely why <.5 mg Ativan did me in. (Or perhaps it was the Ativan-cortisone combo that screwed me.)

 

1. According to your Wikipedia link (http://en.wikipedia.org/wiki/Benzodiazepine_dependence), Ativan's and Cortef's cross-tolerance means each will alleviate the W/D symptoms of the other. And your post on benzos and HPA axis dysregulation (http://www.benzobuddies.org/forum/index.php?topic=44373.0) says that glucorticosteriods and benzos have similar effects on the HPA axis. My takeaway is that each can amplify the addictive properties of the other. Is that correct??

 

2. On the other hand, your post on benzos and HPA axis dysregulation

(http://www.benzobuddies.org/forum/index.php?topic=44373.0) says that benzos decrease the adrenal output of cortisol. Somehow this seems to contradict the fact that glucorticosteroids and benzos have similar effects on the HPA axis. Can you straighten me out here?

 

Thanks so much!

 

PS I've been keeping track, and my topical betamethasone (.05%) days don't seem to correlate with my bad days.

[[Pe...]]

Hey wanttosleep- I will do my best to clarify this stuff for you.

 

Oh, first you should know that I was on a physiologic dose of the oral hydrocortisone (Cortef). My doc wanted me to ramp up to 15 mg day: 10 upon arising and 5 several hours later. I took me a couple of months just to ramp up to 5 mg, and I was at 5 mg for just one week before tapering off. In essence, I was taking between 1 and 5 mg, which is far from a pharmacological dose. That said, I'm extremely drug-sensitive, which is likely why <.5 mg Ativan did me in. (Or perhaps it was the Ativan-cortisone combo that screwed me.)

 

What was the doctors reasoning for the 15 mg?  Did you have any portion of an Adrenal Gland removed or Addison's disease?  According to my endocrinologist anything above 5 mg is extremely high...she never puts her Addison's patients at anything above 10 mg.  Just a little FYI...The reason a higher dose is prescribed in the morning is to try to mimic the bodys diurnal production.

 

1. According to your Wikipedia link (http://en.wikipedia.org/wiki/Benzodiazepine_dependence), Ativan's and Cortef's cross-tolerance means each will alleviate the W/D symptoms of the other. And your post on benzos and HPA axis dysregulation (http://www.benzobuddies.org/forum/index.php?topic=44373.0) says that glucorticosteriods and benzos have similar effects on the HPA axis. My takeaway is that each can amplify the addictive properties of the other. Is that correct??

 

The addition of one to the other can act like an increase in dosage of either because both are Positive Allosteric Modulators.  A Positive Allosteric Modulator is any drug (or supplement) which enhances the action of GABA causing the chloride channel on the neuron to stay open longer...thus increasing the amount of chloride entering the neuron.

 

Since both glucocorticosteroids and benzos allosterically modulate GABA this way...addition of one can act in a similar fashion as an increase in dosage of the other therefore alleviating the WD sx's (because the chloride channels are now staying open longer again).

 

The brain is always trying to maintain a level of equilibrium (called homeostasis) and when it sensed the rise in chloride caused by the benzo it tried to compensate for it by making some changes, called neuroadaptations.  During recovery from benzos the brain is in the process of reversing these neuroadaptations...so if you take a drug, such as a glucocorticosteroid, which also causes the chloride channel to stay open longer you discourage this reversal.

 

2. On the other hand, your post on benzos and HPA axis dysregulation

(http://www.benzobuddies.org/forum/index.php?topic=44373.0) says that benzos decrease the adrenal output of cortisol. Somehow this seems to contradict the fact that glucorticosteroids and benzos have similar effects on the HPA axis. Can you straighten me out here?

 

Because their mechanisms of action on the GABAA receptor are similar, both can have the same ripple effects- esp on a steroid peptide produced by the Parvocellular neurons in the PVN in the brain, called Corticotropin Releasing Hormone (CRH), which ultimately controls the HPA Axis.  If you compare the statements below- one describing benzos effect on CRH (aka CRF) and ACTH, and glucocorticosteroids (GCs) effect on the same...you will see they act in an identical fashion:

 

Since benzos increase the inhibitory effect of GABA it disrupts this GABA-Glutamate balance. The excess GABAergic inhibition brought on by the benzos causes a reduction in the levels of CRH and AVP, which in turn blunts ACTH secretion. Thus the end result is suppression of the HPA Axis.

 

http://www.benzobuddies.org/forum/index.php?topic=44373.0

 

An overview of the most common and most serious AEs [Adverse Events] associated with GC therapy is the following:

 

...Physiologically, the hypothalamus secretes CRH which stimulates the release of ACTH from the anterior pituitary. ACTH leads to the release of cortisol from the zona fasciculata of the adrenal gland, which in turn exerts negative feedback on CRH and ACTH release. Administration of exogenous GCs even in small doses for only few days leads to a measurable suppression of the HPA axis by decreasing CRH synthesis and secretion and by blocking the trophic and ACTH-releasing actions of CRH on the anterior pituitary.

 

http://www.endotext.org/adrenal/adrenal14/adrenalframe14.htm

 

 

Once the Benzos are discontinued there occurs a rebound activation of the HPA Axis, and therefore an increase in Cortisol levels.  Also, there can be a repetitive pattern of suppression followed by rebound while on benzos due to interdose withdrawal, causing Cortisol levels to swing in both directions.

 

Most Endocrinologists are very familiar with HPA Axis suppression/rebound caused by glucocorticosteroids...this is a well know occurrence which can happen.  What is not as well known is that benzos can effect the HPA Axis in similar fashion.

 

PS I've been keeping track, and my topical betamethasone (.05%) days don't seem to correlate with my bad days.

 

Again, any medication that is a Positive Allosteric Modulator of the GABAA receptor can interfere with the reversal of neuroadaptations necessary for a full recovery.  The glucocorticosteroid in this cream enters the body transdermally...you may not notice a difference as the amount absorbed through the skin is small...but even a small amount of steroid can cause effects so you may want to talk to your doctor about non-steroid treatments.

 

I hope these explanations helped to clarify this for you.  I know endocrine stuff is rather complicated and since each mechanism effects so many others it can be difficult to keep it all straight...so if you have any more questions feel free to ask.

[[wa...]]

Thanks again, Perseverance!!!

 

1. OK, let me explain a few things. An ACTH test revealed borderline low levels of cortisol after stimulation. My then-neuroendocrinologist hypothesized that I was deficient in the enzyme that converts DOC (cortisol precursor) to cortisol. He thought this picture might suggest adult-onset, nonclassic, congenital adrenal hyperplasia. This was a tentative diagnosis. He suggested a trial of a physiologic dose of oral hydrocortisone (Cortef): 10 mg upon awakening; 5 mg in the afternoon. (Yes, I'm aware of the circadian nature of cortisol output.) He wanted to see if the Cortef would help alleviate my fibromyalgia symptoms.

 

I started the Cortef trial under the supervisor of another doctor. I spent maybe 2.5 months ramping up from 1 to 5 mg. My appetite increased, I was eating more, I was gaining weight, and I didn't like the whole idea of being on the med. So I spent maybe 1.5 months tapering off.

 

When I expressed concerns about taking Cortef, both doctors said, "If you're deficient in cortisol and taking a physiologic dose, all you're doing is augmenting what you lack and bringing it up to normal endogenous levels. A person with healthy cortisol levels doesn't experience side effects!"

 

I'm confused. I can't reconcile what the doctors said with the link you sent me:

http://www.endotext.org/adrenal/adrenal14/adrenalframe14.htm

 

 

2. Can't believe I forgot to mention that in addition to the thrice-weekly topical vaginal betamethasone (.05%), I'm also applying daily topical vaginal estradiol (.005%). Before I began this regimen, menopause shrank me. A lot. This regimen has arrested the shrinkage. So you can see why I don't want to discontinue these topicals. I really feel like I'm in a bind.

 

(Oh, I was concerned that longterm steroid use would thin/atrophy the skin/tissue; but my GYN--a vulvovaginal specialist--said it's not a concern w/ vaginal tissue, which regenerates differently from other skin [or something to this effect]. She checks me every few months, and I'm looking and feeling better than I did pre-treatment.)

 

 

3. I understand that benzos and cortisone both open the chloride channel gate--and that both suppress the HPA axis. But I get stuck re: the fact that benzos decrease our body's production of cortisol. If benzos decrease cortisol levels, and if cortisone (and, by extension, cortisol) suppresses the HPA axis, wouldn't this mean benzos un-suppress the HPA axis? Do you see where I'm getting tripped up? (Clear as mud?)  ;-)

 

Thanks!

 

 

PS I'm seeing an endocrinologist Wed. Originally I wanted to discuss a trial of HRT. No more! Now I'll discuss Cortef and my topicals. Unfortunately, he likely won't be able to address the benzo component. I wish I could find a specialist who could address benzos and steroids.

 

[[wa...]]

Sorry. For some reason, I ended up posting in duplicate, and I can't delete this second post!

[[Pe...]]

Wanttosleep- a few questions and hopefully more clarification for you.

 

1. OK, let me explain a few things. An ACTH test revealed borderline low levels of cortisol after stimulation. My then-neuroendocrinologist hypothesized that I was deficient in the enzyme that converts DOC (cortisol precursor) to cortisol. He thought this picture might suggest adult-onset, nonclassic, congenital adrenal hyperplasia. This was a tentative diagnosis. He suggested a trial of a physiologic dose of oral hydrocortisone (Cortef): 10 mg upon awakening; 5 mg in the afternoon. (Yes, I'm aware of the circadian nature of cortisol output.) He wanted to see if the Cortef would help alleviate my fibromyalgia symptoms.

 

Are you still a patient of the Neuroendocrinologist?  If you are- could you schedule an extended appointment, where the scheduler blocks off a larger amount of time for your appointment in order to discuss the neuroendocrine involvement with him?  I think it would be worth while for you to present the two research papers on pages 1 and 3 from the link I gave you on the HPA Axis and discuss benzos involvement in all this.  I say this because benzo tolerance and/or WD sx's mimic Fibromyalgia...infact they both can involve HPA Axis dysregulation.  If your Fybromyalgia sx's started after taking benzos I would be highly suspect that the benzos might be the root cause.

 

How low was your Cortisol after the ACTH stim test?  Was it low-normal or below normal?  This is important because the ACTH stim test narrows down the Cortisol malfunction to the Adrenal Glands.  If it were still within the normal range but low...it may be a better idea to just keep an eye on it rather than take exogenous cortisol therapy while trying to recover from benzos.

 

I started the Cortef trial under the supervisor of another doctor. I spent maybe 2.5 months ramping up from 1 to 5 mg. My appetite increased, I was eating more, I was gaining weight, and I didn't like the whole idea of being on the med. So I spent maybe 1.5 months tapering off.

 

When I expressed concerns about taking Cortef, both doctors said, "If you're deficient in cortisol and taking a physiologic dose, all you're doing is augmenting what you lack and bringing it up to normal endogenous levels. A person with healthy cortisol levels doesn't experience side effects!"

 

I agree with your doctor...you should feel vastly better after taking exogenous Cortisol therapy if you genuinely have a problem producing it...not have worse sx's.  This is another reason why I suspect you may just be suffering repercussions from benzos effect on the HPA Axis.

 

I'm confused. I can't reconcile what the doctors said with the link you sent me:

http://www.endotext.org/adrenal/adrenal14/adrenalframe14.htm

 

Could you be a little more specific?  I am not quite sure what you are asking.

 

2. Can't believe I forgot to mention that in addition to the thrice-weekly topical vaginal betamethasone (.05%), I'm also applying daily topical vaginal estradiol (.005%). Before I began this regimen, menopause shrank me. A lot. This regimen has arrested the shrinkage. So you can see why I don't want to discontinue these topicals. I really feel like I'm in a bind.

 

(Oh, I was concerned that longterm steroid use would thin/atrophy the skin/tissue; but my GYN--a vulvovaginal specialist--said it's not a concern w/ vaginal tissue, which regenerates differently from other skin [or something to this effect]. She checks me every few months, and I'm looking and feeling better than I did pre-treatment.)

 

Have you tried the Estradiol cream alone (without the additional betamethasone cream) to determine if you need both creams to help this?

 

3. I understand that benzos and cortisone both open the chloride channel gate--and that both suppress the HPA axis. But I get stuck re: the fact that benzos decrease our body's production of cortisol. If benzos decrease cortisol levels, and if cortisone (and, by extension, cortisol) suppresses the HPA axis, wouldn't this mean benzos un-suppress the HPA axis? Do you see where I'm getting tripped up? (Clear as mud?)  ;-)

 

First off- both suppress the HPA Axis by inhibiting production of CRH.  Here is how it works-

 

The body regulates Cortisol production through the Cortisol feeback loop.  Mineralcorticoid receptors (MR) and Glucocorticoid receptors (GR), located in various regions throughout the brain, sense levels of cortisol in the blood stream.  When levels reach a certain peak, they signal the other parts of the brain which control cortisol release to halt this activity.  Conversely when levels drop too low, they signal these areas to increase activity.  This prevents cortisol levels from getting too high or too low.

 

MRs and GRs send signals to the CRH secreting neurons, telling them to either step up or down production- which in turn steps up or down production of ACTH from the Pituitary, which then steps up or down production of Cortisol from the Adrenals.

 

Since benzos and synthetic glucocorticoids inhibit the CRH response in the glucocorticoid feedback system, Cortisol production can become irratic.  While benzos and synthetic glucocorticoids are in the system the CRH response can be suppressed.  On the other hand, during inter-dose WD rebound activation of CRH can occur.  The combination causes a dysregulation of the Cortisol feedback loops operation.

 

PS I'm seeing an endocrinologist Wed. Originally I wanted to discuss a trial of HRT. No more! Now I'll discuss Cortef and my topicals. Unfortunately, he likely won't be able to address the benzo component. I wish I could find a specialist who could address benzos and steroids.

 

Again, the Neuroendocrinologist would best understand benzos effect on the neuropeptide CRH in the brain.  I think it was a wise decision to hold off on HRT and focus the discussion on your current meds.

 

[[wa...]]

Thanks for your questions and concern, Perseverance! It's very kind of you to take the time to help me figure this out. I appreciate your . . . perseverance! 

 

First, I had fibromyalgia way, way, way before this benzo/cortisol fiasco. In fact, my former rheumatologist (whom I used to see re: my fibro) referred me to the neuroendocrinologist b/c he thought perhaps my pain might have a neuroendo component. The neuroendo ordered the cort-stim test and then recommended a cortisone trial. It was this cortisone (just 1-5 mg!) that increased my appetite, causing me to pig out on chocolate ice cream before bed, causing me to be wired instead of tired, causing me to pop low-dose Ativan so I could sleep. (Note: I *was* an excellent sleeper before this fiasco, but caffeine before bed has always been too stimulating.)

 

All my cort-stim test results would take up too much room here b/c I was tested at frequent intervals after the stim (you know how it goes). Highlights: At 60 minutes after stim, my cortisol was 16.3 (my neuroendo preferred a higher level, though the *random* ref range was 0 - 23) and my DOC was a whopping 184 (ref range 10-79). My neuroendo explained that in a futile attempt to produce cortisol, my body kept churning out DOC--hence the high DOC level. He theorized that I have a partial enzyme deficiency of the 11-beta hydroxylase enzyme, needed to convert DOC to cortisol. I asked whether I have adrenal fatigue, and he said no, my problem is "farther down the chain." He even drew the chain!

 

I can go back to the neuroendo, but he wasn't too happy w/ my incessant questions. And a couple of other docs have allowed that he's brilliant--but a bit "out there" (as in, he s/times arrives at off-the-wall diagnoses). He's affiliated w/ Harvard Med School, and if I start challenging him . . . you can see where I'm going.

 

I tapered off the cortisone at the same time I tapered off the Ativan, meaning I was pretty much on the two drugs concurrently. I realize this rendered the cortisone trial useless! I can't say whether the cortisone made me feel better, alas. In addition, I was just dx'd with osteoporosis. The last thing I need is cortisone, I figure.

 

 

>>I'm confused. I can't reconcile what the doctors said with the link you sent me:

http://www.endotext.org/adrenal/adrenal14/adrenalframe14.htm<<

>Could you be a little more specific?  I am not quite sure what you are asking.<

 

It seemed you provided the link to warn me against the evils of cortisone. Yet the neuroendo--and the holistic doctor who oversaw my cortisone trial--said that if I were cortisol-deficient and using the cortisone to bring my levels up to normal, I needn't worry about side effects. (?)

 

 

>Have you tried the Estradiol cream alone (without the additional betamethasone cream) to determine if you need both creams to help this?<

 

No, and I'm afraid that if I do, I may start shrinking again. I've gotten totally paranoid.

 

 

>Since benzos and synthetic glucocorticoids inhibit the CRH response in the glucocorticoid feedback system, Corrtisol production can become erratic.<

 

But on the other hand, wouldn't the exogenous cortisone more than compensate for this inhibition? That's the whole point of taking cortisone: to augment low native cortisol levels. Plus, the holistic doctor said my dose (1-5 mg) was too low to have suppressed my body's cortisol production. (This is sooo confusing!)

 

 

I suppose the bottom line is this: I have no desire to start another trial of cortisone. But I do want to know how badly I messed myself up (by taking both cortisone + Ativan); how long recovery should take; and whether I'm doing myself harm by using topical vaginal estradiol and betamethasone. (And then there's still the matter of Ativan w/d.)

 

PS How did you come by all this knowledge? Are you, or were you, in the medical/science field?

 

[[Pe...]]

Ok wanttosleep…let’s see if we can sort all this out.

 

First, I had fibromyalgia way, way, way before this benzo/cortisol fiasco. In fact, my former rheumatologist (whom I used to see re: my fibro) referred me to the neuroendocrinologist b/c he thought perhaps my pain might have a neuroendo component. The neuroendo ordered the cort-stim test and then recommended a cortisone trial. It was this cortisone (just 1-5 mg!) that increased my appetite, causing me to pig out on chocolate ice cream before bed, causing me to be wired instead of tired, causing me to pop low-dose Ativan so I could sleep. (Note: I *was* an excellent sleeper before this fiasco, but caffeine before bed has always been too stimulating.)

 

Your reaction to the steroid was not typical of someone who is low.  People who have low cortisol production generally respond quite favorably to steroid therapy.  It appears you were having the opposite reaction…especially being ‘wired instead of tired’…which makes me think the small amount of steroid you were taking was causing too much cortisol elevation.

 

All my cort-stim test results would take up too much room here b/c I was tested at frequent intervals after the stim (you know how it goes). Highlights: At 60 minutes after stim, my cortisol was 16.3 (my neuroendo preferred a higher level, though the *random* ref range was 0 - 23) and my DOC was a whopping 184 (ref range 10-79). My neuroendo explained that in a futile attempt to produce cortisol, my body kept churning out DOC--hence the high DOC level. He theorized that I have a partial enzyme deficiency of the 11-beta hydroxylase enzyme, needed to convert DOC to cortisol. I asked whether I have adrenal fatigue, and he said no, my problem is "farther down the chain." He even drew the chain!

 

I would disagree with saying your cortisol was low after the stim test.  Mine was 13 and my Endocrinologist thought that was a good response.  The excess DOC may be going to the production of Aldosterone.  If you look at this biosynthesis pathway chart…you can see there is a another route which involves both DOC and the 11-beta hydroxylase enzyme.  Did they run blood tests for Aldosterone and Potassium, and/or do a urine 17-Ketosteroid test?  Also, have you ever been diagnosed with hypertension?  Have you had any symptoms of urinary frequency or incontinence?

 

http://www.glowm.com/resources/glowm/uploads/1213675378_steroid_pathway.bmp

 

I can go back to the neuroendo, but he wasn't too happy w/ my incessant questions. And a couple of other docs have allowed that he's brilliant--but a bit "out there" (as in, he s/times arrives at off-the-wall diagnoses). He's affiliated w/ Harvard Med School, and if I start challenging him . . . you can see where I'm going.

 

Sometimes doctors will get impatient because of the time pressure…which is why I said you should schedule an extended appointment.  No one likes to be ‘challenged’…and how you approach the matter will produce different results with different doctors.  However, in light of what you have told me perhaps you could ask the Endocrinologist and if he would order the tests I named above…provided you have not already had them.

 

I tapered off the cortisone at the same time I tapered off the Ativan, meaning I was pretty much on the two drugs concurrently. I realize this rendered the cortisone trial useless! I can't say whether the cortisone made me feel better, alas. In addition, I was just dx'd with osteoporosis. The last thing I need is cortisone, I figure.

 

Yes, steroids definitely affect the bones.  I do not think the whole cortisone trial was useless…correct me if I am wrong…but it looks like you were not on either one for a great length of time.

 

>>I'm confused. I can't reconcile what the doctors said with the link you sent me:

http://www.endotext.org/adrenal/adrenal14/adrenalframe14.htm<<

>Could you be a little more specific? I am not quite sure what you are asking.<

 

It seemed you provided the link to warn me against the evils of cortisone. Yet the neuroendo--and the holistic doctor who oversaw my cortisone trial--said that if I were cortisol-deficient and using the cortisone to bring my levels up to normal, I needn't worry about side effects. (?)

 

Doctors will have varying opinions on this…same as they do with benzodiazepines.

 

>Have you tried the Estradiol cream alone (without the additional betamethasone cream) to determine if you need both creams to help this?<

 

No, and I'm afraid that if I do, I may start shrinking again. I've gotten totally paranoid.

 

Since the betamethasone contains a steroid, I think it would be worthwhile in light of your situation with benzodiazepines, provided your doctor agrees (assuming they understand the cross-tolerance aspect between steroids and benzos).

 

>Since benzos and synthetic glucocorticoids inhibit the CRH response in the glucocorticoid feedback system, Cortisol production can become erratic.<

 

But on the other hand, wouldn't the exogenous cortisone more than compensate for this inhibition? That's the whole point of taking cortisone: to augment low native cortisol levels. Plus, the holistic doctor said my dose (1-5 mg) was too low to have suppressed my body's cortisol production. (This is sooo confusing!)

 

If it more than compensates it can shut the whole thing down and throw you into a state of Adrenal Crisis…which is what happened to me.  It is dangerous to combine the two.  The body will shut the whole thing down if the Cortisol level is elevated too long.

 

I suppose the bottom line is this: I have no desire to start another trial of cortisone. But I do want to know how badly I messed myself up (by taking both cortisone + Ativan); how long recovery should take; and whether I'm doing myself harm by using topical vaginal estradiol and betamethasone. (And then there's still the matter of Ativan w/d.)

 

A question which I would also like to have the answer to.  If you look at my signature you will see that I was in a similar situation.  Unfortunately there is no way to predict how long you will be symptomatic…but there is no structural damage induced by these drugs…it is just a matter of the body re-balancing everything.

 

Again the betamethasone contains a steroid…which could possibly interfere with the body’s reversal of events.  The Estradiol would still be fine IMHO.

 

PS How did you come by all this knowledge? Are you, or were you, in the medical/science field?

 

After suffering an Adrenal Crisis which almost killed me and getting no answers as to why it happened from my doctors, I began to study the endocrine effects of these drugs on my own. As a rule, I try to only read credible information from the medical libraries and journals.  It has been quite an education.

 

[[pi...]]

Hi WTS,

 

Just want to chime in and to say I am happy you have connected with our resident expert Perse, she is AMAZING and has helped me understand so much about what has happened to me.  For me knowledge is power.

 

I would second what perse said about your reaction to cortisone.  I had the same reaction you did. I have a friend who has polymyalgia rhumatica and takes steroids long term. She does not have the symptoms that you and I had and it is helping her as her sed rate was extremely high.

 

I have estradiol cream but never used it.  I was on bioidentical hormones while on benzos and quit them right after I finished my taper.  I was pretty miserable with witdrawal but I am pretty sure the excitatory effect of estrogen did add to my symptoms.  I do believe that the hormones, steroids and levaquin is impacting my recovery.  BUT I am so much better today than this time last year.

 

pianogirl

[[wa...]]

Thanks, Pers & Piano!!

 

Pers, another note of clarification: It wasn't the cortisone that amped me up and caused me to take Ativan so I could sleep; it was the pint of chocolate ice cream before bed! Major caffeine for my sensitive bod! I couldn't figure out why I wanted to pig out so much and so consistently. Finally I put 2 and 2 together and realized it was the cortisone. Last time my appetite was so high was when I was taking Pamelor (this goes back years), a tricyclic that was then prescribed for fibro.

 

(And yes, you're right: I was on both the Ativan and the Cortef for about 5 months, plus or minus--including taper. I took a break in the Cortef for about a month, and I did not take the Ativan daily, tho I did take it often.)

 

And no, no hypertension at all. And no incontinence. I do have a dx (based on cystoscopy) of (mild) interstitial cystitis, so I do pee more frequently than the average bear.

 

 

>Did they run blood tests for Aldosterone and Potassium, and/or do a urine 17-Ketosteroid test<

 

I just looked and can't find any tests for aldosterone. As part of my annual physical, my primary care dr recently ran blood tests for a bunch of stuff including potassium, which was 3.5 (ref range 3.6-5).

 

Also, it just occurred to me: my cort-stim test was run WHILE I WAS USING TOPICAL ESTRADIOL & BETAMETHASONE. My doctor told me to stay on (he had his reasons, but I can't remember them).

 

 

>After suffering an Adrenal Crisis which almost killed me and getting no answers as to why it happened from my doctors, I began to study the endocrine effects of these drugs on my own. <

 

I am so, so sorry to hear this. The hell Buddies endure just blows my mind. You must've been terrified. Do your doctors now respect your opinion re: what happened to you?

 

 

PS I can't figure out how to use the quotes function properly. I'd like to quote an excerpt, but all "Quote" does is quote the whole reply.

[[Ca...]]

Perse,

I am 10 months free of ativan.  I have had classic sx's of cortisol deficiency throughout 2 yrs of tolerance plus 10 mos of drug free.  7 yrs ago, I was on prednisone for over 2 yrs due to a chronic condition (crohn's disease).  As I do my research to find answers as to why I cant lift my arms and have severe difficulty lifting my legs to walk, I found your info.  It got me thinking back in hindsight.  I feel like i never recovered from the prednisone and may need to take addition cortisol for the rest of my life.  I have been getting progressively weaker for 7 years.  I stopped wearing heals 5 yrs ago.  I started benzos 3 yrs ago.  During tolerance, I began with the more severe weakness.  Now 10 mos free, I am SO much worse than ever.  I am bed bound and can barely shower.  Washing hair is next to impossible as is hang closes up and putting cream on my face.  Any activities that requires reaching over my head is nearly imposible.

 

My question is this:  If I need cortisol replacement do u think this will screw up my healing or because I was deficient before maybe it will help me?

 

I am currently awaiting my blood test results from the endocrinologist.  Medical peeps just dont have the info, as u know.  It's difficult to research this while in such a comprimised state mentally.

 

Thanks for any light u can shed on my situation.  Candy

[[fi...]]

PS I can't figure out how to use the quotes function properly. I'd like to quote an excerpt, but all "Quote" does is quote the whole reply.

 

You are correct.  The "Quote" function will quote the whole reply.  You just have to delete the text you don't want inside the quote tags.

 

Hope this helps.