I will skip a couple of the paragraphs as they were the same as stated on the pharmacist's letter. Alternative glucocorticoid preparations exist for your patients although they may not be marketed in formulations as convenient as CORTEF Oral Suspension. This is particularly true for the pediatric population. However, with appropriate re-education of the patient/caregiver, and careful dosage adjustment and retitration, these alternative preparations can be used for the same indications as CORTEF Oral Suspension. You may wish to consult a local pharmacist regarding the availability of other glucocoritcoids in tablet and liquid form that may be appropriate for your pediatric patients. Additional information regarding our decision to recall this product is presented below. Because our previous supplier was unable to provide a consistently high quality thickening agent called tragacanth gum that is used to suspend the active ingredient, we reformulated the product with an alternative thickening agent called xanthan gum. Reformulated product was introduced to the market on July 15, 1998. In November 1999, we noted that several spontaneous reports of lack of effect and/or resuspendability had been received with the new formulation. Our investigation into these reports initially concentrated on the resuspendability of the drug. In March 2000, we revised the product labeling to state that the product may require shaking for 5 to 7 minutes to fully resuspend the drug prior to the first use. To increase awareness of the revised product labeling, we alerted 73,000 pharmacies and 3,098 endocrinologists and pediatric endocrinologists nationwide by a letter sent in March of this year. *On June 30, 2000, we received data from a clinical study that reported 18 out of 19 patients with congenital adrenal hyperplasia were not adequately controlled with the current formulation of CORTEF Oral Suspension. After the patients were switched to hydrocortisone tablets, including a dose reduction of about 20% necessitated by overdose symptoms, 18 out of 19 patients had normal hormone levels. Based on our review of this data, Pharmacia & Upjohn has decided to discontinue distribution of the current formulation of CORTEF Oral Suspension and recall the product from the market. The letter goes on to say that "Patients may contact our Patient Product Information unit at 1-888-691-6813." *I hope this will answer any remaining questions and help relieve some of the anxiety about being able to achieve normal hormone levels on the Cortef Pill. As far as the anger goes, all I can say is that they have included their patient information number - use it even if it's only to blow off steam! Hang in there, Lynn P.S. Please excuse any type o's if there are any it's been a while since my last typing class.