T Nation

Inhaled Corticosteroids and Suppressed Cortisol

Dr Told Me to “Lay Off the Steroids”

The good news: he (my PCP) wasn’t talking about TRT, he’s talking about my inhaled/nasal corticosteroids for asthma and allergies

The bad news: he thinks that’s the cause of me feeling spaced, out of it, fatigued, etc the last couple weeks. My endo agrees (by email) as well. They might have a point.

I’m not sure if I should post this here or in pharma (or somewhere else), but anyone ever deal with this? Is this normal for inhaled steroids to suppress cortisol production?

I’m not sure about inhaled corticosteroids, but I will say every time I’ve taken prednisolone I feel very, very strange. It interferes with everything from kidney function to breathing, sleeping, cognition, etc. In my personal experience.

I have never been able to tolerate it long enough to finish an entire run. I wouldn’t use it again unless I had a very serious reason to.


Yes, depending on the dose. Its mostly happening in children which leads to poor growth, but it has also been described in adults.

Talk to your physician to switch to a drug called Alvesco (the active drug is Ciclesonide).

‘Ciclesonide (CIC) is a novel, airways-targeted ICS that is delivered as an inactive compound and converted by esterases to the active metabolite (desisobutyryl-ciclesonide) in the airways, where it elicits its anti-asthmatic effect’

‘For a similar decrease in hyperresponsiveness, cortisol secretion was suppressed significantly with moderate-to-high doses of fluticasone propionate (a ‘normal’ corticosteroid), but not with ciclesonide.’


Did you get your cortisol checked?

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Are you solely on a rescue inhaler? If so, how often are you using it? My doc said I’d need to switch to a maintenance inhaler if I needed my rescue more than 3-5 times a week. I get straight up anxious when I use it and have nightmares when I use it near bedtime, so I could see it hormonally fucking you sideways.

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Funny you say this…both my inhalers are ciclesonide (Alvesco and Omnaris).

I’ve definitely desponded better to it than to other ICS, but I feel like it’s still messing me up. Especially the nasal one (Omnaris).

Also after reading the study, how can they say that there’s no statistically significant suppressive effect from ciclesonide? Yea it’s less than fluticasone, but I’m still seeing a 10% drop there at the first dosing tier of CIC.

Yup, but thinking about asking to have it checked again

No, but I have one.

Try getting levalbuterol. I used to have similar problems and this isomer does much much better for me.

Thanks! I’ll look into it. I just filled my script for my normal albuterol, maybe I’ll see how expensive the levalbuterol is.

Whats your daily dose of Alvesco?

Yes, there is already a decrease in serum cortisol at a dose of 160 mcg, but it doesnt reach statistical significance. But yes, there seems to be a drop also when using ciclesonide. Best is to use the lowest effective dose, so if you are taking currently the typical maintenance dose of 160 mcg per day you could try to use Alvesco 80mcg once daily.

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I was on 160 a day…I was considering trying 80 and seeing how that goes too, but for now I’m abstaining for a bit to see how I feel. Wondering if that’s what caused me to gain a bunch of weight too.

It’s funny, in the stock trading world, 1-2% is huge, but in these studies, I always see ~10% as “insignificant.” I don’t know who these scientists are, but 10% has always been substantial to me!

Significance is a statistical term, its doesnt say if there is or that there is no impact on any clinical readout. It only says that the observed difference has a probability of <5% to be a chance finding.
Its purely based on the averages of the two populations and the standard deviation.

I am taking Alvesco whenever I come down with a bronchitis in winter time. My airways are hyperresponsive to the cold and it helps me with that. With 160 mcg per day I get bad headaches and very stranges dreams, 80 mcg is fine for me.

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