Using the data from Effect of Dose Size on the Pharmacokinetics of Oral Hydrocortisone Suspension by Toothtaker, Craig and Welling. I've decided to change my hydrocortisone dosing a bit. I'm reporting on it here so you all know how it goes. Perhaps theory does not align with practice?
According to Effect of Dose Size, there is a "...nonporportional relationship between circulating hydrocortisone levels and the size of the oral dose." 5 mg of hydrocortisone yields 3.55 mg of cortisol. 10 mg of hydrocortisone yields 5.7 mg of cortisol. If you'd like to see Part 1 of this post, click here.
Here's how I'm figuring out my new dosing schedule. Please do not change your hydrocortisone dosing without first consulting your physician.
2) I wake up at 5 AM so "noon" is 10 AM for me
3) 1/3 of the daily dose should be after noon and before 4 or 5 PM
4) Based on a 5 AM wake up, "noon" of 10 AM, 1/3 of my daily dose should be between 10 AM and 2 or 3 PM
5) I take 45 mg of hydrocortisone per day split 10/10/10/10/5 according to the Effect of Dose Size the yield of my dosing is 26.35 mg [(5.7*4) + 3.55]
6) To maintain the approximate yield of 26.35 mg per day while lowering the actual oral dosing, I'm going to take 40 mg split in two 10 mg doses and four 5 mg doses for a yield of 25.6 mg cortisol [(5.77*2)+(3.55*4)]. I will be cutting my overall hydrocortisone dose by about 1 mg HC.
7) Schedule will be as follows:
5 AM 10 mg HC
7 AM 5 mg HC
9 AM 10 mg HC
11 AM 5 mg HC
1 PM 5 mg HC
3 PM 5 mg HC
8) Next steps for me. Set phone alarms and label accordingly. Refill pill containers.
Although the yield for 5 mg doses is higher than for 10 mg doses, I chose to add two 10 mg HC doses because I'm too lazy to take pills 10 or 11 times a day (this includes vitamins and thyroid meds at night) and I only have ten alarms on my phone.
I will try to post periodically about how this experiment works out.