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Corticosteroids used in various formulations and doses and for varying durations in patients with COVID-19 were also studied in several smaller randomized controlled trials. Given that the sample size of many these trials was insufficient to assess efficacy, evidence to support the use of methylprednisolone and hydrocortisone for the treatment of COVID-19 is not as robust as that demonstrated for dexamethasone in the RECOVERY trial. Data from some of these studies can be found in Table 4a. Corticosteroids Other Than Dexamethasone. If dexamethasone is not available, alternative glucocorticoids such as prednisone, methylprednisolone, or hydrocortisone can be used. For these drugs, the total daily dose equivalencies to dexamethasone 6 mg (oral or intravenous [IV]) 21 are: Prednisone 40 mg Methylprednisolone 32 mg Hydrocortisone 160 mg Half-life, duration of action, and frequency of administration vary among corticosteroids. Long-acting corticosteroid : dexamethasone; half-life: 36 to 72 hours, administer once daily. Intermediate-acting corticosteroids : prednisone and methylprednisolone; half-life: 12 to 36 hours, administer once daily or in two divided doses daily. Short-acting corticosteroid : hydrocortisone; half-life: 8 to 12 hours, administer in two to four divided doses daily. Hydrocortisone is commonly used to manage septic shock in patients with COVID-19; see Care of Critically Ill Patients With COVID-19 for more information. Unlike other corticosteroids previously studied in patients with ARDS, dexamethasone lacks mineralocorticoid activity and thus has minimal effect on sodium balance and fluid volume. Monitoring, Adverse Effects, and Drug-Drug Interactions. Clinicians should closely monitor patients with COVID-19 who are receiving dexamethasone for adverse effects (e. Prolonged use of systemic corticosteroids may increase the risk of reactivation of latent infections (e. The risk of reactivation of latent infections for a 10-day course of dexamethasone (6 mg once daily) is not well-defined. When initiating dexamethasone, appropriate screening and treatment to reduce the risk of Strongyloides hyperinfection in patients at high risk of strongyloidiasis (e. Dexamethasone is a moderate cytochrome P450 (CYP) 3A4 inducer. As such, it may reduce the concentration and potential efficacy of concomitant medications that are CYP3A4 substrates. Clinicians should review a patient’s medication regimen to assess potential interactions. Coadministration of remdesivir and dexamethasone has not been formally studied, but a clinically significant pharmacokinetic interaction is not predicted. Dexamethasone should be continued for up to 10 days or until hospital discharge, whichever comes first. A short course of betamethasone and dexamethasone, which are known to cross the placenta, is routinely used to decrease neonatal complications of prematurity in women with threatened preterm delivery, dianabolan 50 mg injectable steroids dianabol. Given the potential benefit of decreased maternal mortality and the low risk of fetal adverse effects for a short course of dexamethasone therapy, the Panel recommends using dexamethasone in hospitalized pregnant women with COVID-19 who are mechanically ventilated (AIII) or who require supplemental oxygen but who are not mechanically ventilated (BIII). The safety and effectiveness of dexamethasone or other corticosteroids for COVID-19 treatment have not been sufficiently evaluated in pediatric patients. Importantly, the RECOVERY trial did not include a significant number of pediatric patients, and mortality from COVID-19 is significantly lower among pediatric patients than among adult patients.
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