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Adrenal Glands and Alternate Day Prednisone Therapy

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Adrenal Glands and Alternate Day Prednisone Therapy

Adrenal glands that have become damaged, fatigued and unable to respond to normal stress may require alternate day prednisone therapy. This approach helps minimize the risk of adrenal insufficiency – a condition in which insufficient amounts of cortisol are produced by these glands.

Glucocorticoids (hydrocortisone, dexamethasone and methylprednisolone) are used to mimic the natural body hormones cortisol and ACTH that the adrenal glands release when under stress. These hormones are administered on a schedule so as to replicate the changes in cortisol levels experienced over a 24-hour period by the body.

Cortisol levels follow a daily cycle, with high concentrations in the morning and low peaks in late evening. These variations are indicative of our internal clock, or circadian rhythm, which dictates how we feel.

This dosing strategy is an effective way to prevent adrenal insufficiency, as it mimics the body’s natural internal rhythms. This allows the adrenal glands to rest and repair themselves more rapidly than with a traditional daily dosing regimen that releases only one corticosteroid at a time.

Alternate day therapy is safe and effective when done under the guidance of an endocrine nurse or doctor. On each new day, the dose of medication is gradually decreased to allow your adrenals to recover from any stressors from the previous day and gradually increased at each new start date to ensure a steady supply.

An additional advantage of alternate day dosing is that it can be administered by the same individual each day, decreasing the likelihood of medication errors. This is especially helpful for children who often struggle to remember when to take their medications.

Studies have demonstrated that alternate dosing of prednisone can provide better long-term control and fewer side effects than when given as an immediate release dose. For instance, one such study involved patients with rheumatoid arthritis who received prednisone twice daily for 12 months.

Alternating day doses of drugs can also reduce the likelihood of rebound flares, which occur when they are abruptly or prematurely stopped. Rebound flares can be severe and adversely affect how a patient feels in their body.

These may include thinning skin, easy bruising, changes to body fat distribution or shape/location, acne or facial hair growth, menstrual problems and loss of interest in sex. If you experience any of these symptoms or any other unusual ones, call your doctor immediately for further evaluation.

Other side effects of alternate day dosing may include headache, mood swings, dizziness and insomnia. If these occur, contact your doctor immediately and discontinue taking the medication.

Prednisone taken in the morning can often result in weight gain, which is usually a positive indication that it is working to restore adrenal function. Conversely, taking it late at night may result in weight loss – an indication that the medication isn’t having an impact on your adrenals.

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