Have I got the right paper Carol? This one that you sent is all about the Bioavailability of cortisol when treating CAH. It does make interesting reading but it does not seem to touch on the dosing regime we are using at present. I did read through most of this one and it talks about the bioavailability of cortisol. I note that it doesn not really matter whether it is injected or oral, it all seems to be out of the system during the day in 6-7 hours and at night it takes up to 2 hours longer. I also noted that they commented on which dosing regime was best. Two times a day or three was the question we had. They seem to be stating that x3 times a day is better when it come to our kids being sick and having to have their meds doubled. I can identify with that since when Ash was on 10mg in the evening (on a twice daily dosing regime) I never really was happy with doubling that to 20mg or even tripling if he was sick. I remember distinctly now feeling the frist time he was sick that it was silly so I took the whole daily dose of 15mg , doubled that and got 30mg. So I divided that in two doses. It still seemed like an awful big dose to be giving a 4 yo but better than 20mg at night! So they actually state here that that is why three smaller doses are better than two big ones. yet another reason to dose three to four times as opposed to on. Also that stuff in the paper about the bioavailability after the morning dose would mean that Ash is flagging around 2.00pm. Normally I give him 6.75mg in the morning, but I used you calculations posted here the other day and thought that I would redistribute things a little. I give him 7.50mg at 7am now and then 3.75mg at 3.15pm and then I have cut the 3am dose back 1.25mg to 2.50mg since it seemed to large a dose in the early hours at 3.75mg. So his total daily dose now would be 13.75mg. STILL he is looking swollen in the face and it isn't as if it is getting anyless. Also his appetite is quite voracious and he is craving sweet stuff again. He has a little pot belly in fact at the moment. He got sunburnt quite a great deal the other day and that was with factor 30 sunblock. I give him the florinef 50mcg 7am, 25mcg 3.15pm and then 25mcg at 3am. We are doing ok on the regime and compliance is pretty good dosing that way. His moods are completely different, and most days he is quite happy. I thought to cut back as I saw signs that he was on too much and with dosing in a different way, and knowing that the 15mg was meant for conventional dosing, I saw no harm in cutting him back 1.25mg for now and distributing the doses in a more sensible way. I will see how it goes. Have not had the last blood tests results yet, but I suspect there was no prob as they would have been in touch otherwise I would think.