I just went from cortef to 75ug dexamethasone. So far I feel really good, with no highs or lows and good energy all day. Is 75ug a reasonable replacement?
The 75ug dose of dexamethasone is higher than a normal physiological replacement of cortosol. Dexamethasone is long acting (24 hrs) versus (90 min)with cortisol, it is difficult to precisely compare doses as I don’t know what dose of cortisol you were on before the change. Between 25 and 50ug of dexamethasone is roughly equivalent to 20mg of cortisol, so 75ug of dexamethasone would be equivalent to about 50mg of cortisol. This is a large dose and because of its long duration of action, it tends to be more likely to result in side effects of too much glucocorticoid. You may be feeling so well because you are getting a higher dose of glucocorticoid than normal. This seems good in the short run, but may not be good in the long run. I prefer not to use dexamethasone for replacement in Addison’s disease.
