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May 26, 1999, Vol 281, No. 20 >

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Letters | May 26, 1999

Low-Dose Hydrocortisone for Chronic Fatigue Syndrome

Jacob E. Teitelbaum, MD; Barbara Bird, MT, CLS; Alan Weiss, MD; Laurie Gould
JAMA. 1999;281(20):1887-1889. doi:10-1001/pubs.JAMA-ISSN-0098-7484-281-20-jbk0526.
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To the Editor: We congratulate Dr McKenzie and colleagues1 on their excellent study but would like to correct an important error and add data that may increase the clinical utility of their study.

Our previously published pilot study2 and the work of Jefferies3- 4 suggests that using low-dose hydrocortisone (4 mg of hydrocortisone ≈ 1 mg of prednisone) in CFS at dosages of 7.5 to 20 mg/d is safe and effective. These low dosages have not caused the adrenal suppression3- 4 seen with the higher dosages (25-35 mg/d) used by McKenzie et al. They are also less likely to aggravate the already severe disruption of deep sleep present in CFS patients, as was seen in the study by McKenzie et al (P=.02 vs placebo).

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