Certain drugs such as troleandomycin (TAO), erythromycin ( Ery-Tab , EryPed 200), and clarithromycin ( Biaxin ) and ketoconazole ( Nizoral ) can reduce the ability of the liver to metabolize (breakdown) corticosteroids and this may lead to an increase in the levels and side effects of corticosteroids in the body. On the other hand, phenobarbital, ephedrine , phenytoin ( Dilantin ), and rifampin ( Rifadin , Rimactane ) may reduce the blood levels of corticosteroids by increasing the breakdown of corticosteroids by the liver. This may necessitate an increase of corticosteroid dose when they are used in combination with these drugs.
What differentiates adrenal insufficiency from adrenal fatigue? More often than not, adrenal fatigue is modeled by an overabundance of cortisol, often at the “wrong” times, while adrenal insufficiency is a consistent inability to produce cortisol. They are related, though — many natural medicine practitioners, such as myself, see adrenal fatigue as a precursor to adrenal insufficiency. In fact, a description of adrenal insufficiency from the Cleveland Clinic states that “its early clinical presentation is most commonly vague and undefined, requiring a high index of suspicion.” ( 41 )