Michelle,

You are going from the equiv of ~20 mg hydro, to ~40 mg hydro. That is a big jump, so it is not altogether surprising that you are feeling so many side effects.

Be careful when using the equivalencies found in standrad drug tables. This is not the straightforward issue that it might seem. When used for treatment of adrenal insufficiency, dex is much more potent than what is written in those tables, closer to 70-80 times more potent than hydro, than the usually accepted 30-40 times.

This means that when changing from dex to hydro, you will tend to give too little hydro, if you go by the conversions listed in the standard tables. Conversely, you will end up giving too much dex, if switching from hydro to dex.

Sorry, I am prob not explaining very well right now, but I’m sorta in a rush. Suffice to say we have been through this and learned the hard way!

Here is a cite that will help to support what I am saying. There are others, but the info is contained in the full length articles, so it is a bit more difficult to direct you to those passages.

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http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?md=Retrieve&db=PubMed&list_uids=934750&dopt=Abstract

1: Pediatrics. 1976 Jun;57(6):942-7. Related Articles, Links

Variable efficacy of glucocorticoids in congenital adrenal hyperplasia.

Hansen JW, Loriaux DL.

We have examined the suppression of urinary pregnanetriol and 17-ketosteroids during treatment with cortisol, cortisone, prednisone, and dexamethasone in eight patients with congenital adrenal hyperplasia. A large individual variation in response to each agent was observed. In some individuals, cortisone is less effective than its generally accepted potency would indicate. At equivalent glucocorticoid dosage, dexamethasone was twice as effective as the other steroids in suppressing urinary 17-ketosteroids and pregnanetriol. The potency of dexamethasone in suppressing adrenal function was 80 times that of cortisol, about twice its generally accepted potency as a glucocorticoid or anti-inflammatory agent.