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March 21, 2001

Orthostatic Hypotension and Chronic Fatigue Syndrome—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorJody W.ZylkeMD, Contributing EditorIndividualAuthor

JAMA. 2001;285(11):1441-1443. doi:10.1001/jama.285.11.1441

In Reply: We do not think the study method of packaging ground fludrocortisone in a hard gelatin capsule with a methylcellulose filler would have interfered with absorption of the active drug, as Dr Baschetti suspects. In examining the dissolution rates of medications packed with various fillers into hard gelatin capsules, Shah and Moore1 identified a delay in dissolution of the medication only when starch was added as the filler to the capsule. Capsules containing ground tablets and various other fillers had varying (and sometimes faster) rates of dissolution than the unground, unencapsulated tablets themselves.1 Their concerns about bias therefore would not apply to the sort of capsule formulation used in our trial, since the capsules were not packaged with starch. We believe that Baschetti has misinterpreted the results of the study by Shah and Moore.