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In patients with Pneumocystis jirovecii pneumonia and hypoxia, prednisone therapy reduced the risk of death; 2 however, in outbreaks of other novel coronavirus infections (i. Corticosteroids have been studied in critically ill patients with acute respiratory distress syndrome (ARDS) with conflicting results. Recommendations on the use of corticosteroids for COVID-19 are largely based on data from the RECOVERY trial, a large, multicenter, randomized, open-label trial performed in the United Kingdom. This trial compared hospitalized patients who received up to 10 days of dexamethasone to those who received the standard of care. Mortality at 28 days was lower among patients who were randomized to receive dexamethasone than among those who received the standard of care. No benefit of dexamethasone was seen in patients who did not require supplemental oxygen at enrollment. Details of the RECOVERY trial are discussed in Table 4a. 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, halotestin steroid bodybuilding. 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.
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