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6.3 Corticosteroids

Equivalent anti-inflammatory doses of corticosteroids:

Prednisolone 5mg
Betamethasone 750 microgram
Cortisone Acetate 25mg
Deflazacort 6mg
Dexamethasone 750 microgram
Hydrocortisone 20mg
Methylprednisolone 4mg
Triamcinolone 4mg

6.3.1 Replacement therapy

A combination of hydrocortisone and the mineralocorticoid fludrocortisone are needed in primary adrenal deficiency states.
GREEN        Fludrocortisone tablets 100 microgram

6.3.2 Glucocorticoid therapy

The proportions of glucocorticoid to mineralocorticoid activity determine the uses of these corticosteroids:
Glucocorticoid and mineralocorticoid activity 
These are suitable for adrenal replacement therapy and as injection for emergency management of some conditions.
GREEN        Hydrocortisone, tablets 10mg, 20mg
AMBER        Hydrocortisone tablets 2.5mg, 5mg, 15mg [only as an extra option when stabilising therapy in adrenal replacement]
AMBER       Hydrocortisone sodium succinate injection 100mg
RED             Hydrocortisone Emergency  Injection Kit
Glucocorticoid activity mainly 
Most common corticosteroid for long term disease suppression.
GREEN      Prednisolone, tablets 1mg, 5mg, 25mg
       (NB - the 5mg tablets will disperse in water.)
                   tablets e/c 2.5mg
High glucocorticoid activity with insignificant mineralocorticoid activity 
Suitable for high dose therapy when water retention would be a disadvantage.
GREEN      Betamethasone tablets 500 microgram 
RED           Betamethasone injection 4mg/mL 
GREEN      Dexamethasone
                   tablets 500 microgram, 2mg
                   oral solution 2mg/5mL
RED           Dexamethasone injection 8mg/2mL
Other corticosteroid preparations 
RED           Methylprednisolone injection 500mg, 1g (Solu-Medrone®) 
GREEN      Methylprednisolone acetate injection 40mg/mL (Depo-Medrone®) 
GREEN       Triamcinolone injection 40mg/mL  [NOT receommended for use in hayfever]
Deflazacort may only be initiated by a paediatrician for the management of Duchenne Muscular Dystrophy.  Deflazacort
should only be used for patients in whom oral prednisolone is not tolerated due to cushingoid side effects. Treatment
is likely to be long term and prescribers should continue to monitor patients for side effects routinely (especially asymptomatic
cataracts and weight gain).  Therapy may be transferred to the primary care prescriber (following prior agreement) once therapy
has been initiated by the specialist.  Duration of treatment and dose adjustments should be clearly communicated at regular
AMBER     Deflazacort tablets 1mg, 6mg, 30mg

6.3.3 Dexamethasone and Covid-19

Offer dexamethasone  or hydrocortisone to people with severe or critical Covid-19 (in line with updated WHO guidance): that is, people with any of the following:
       > acute respiratory distress syndrome (ARDS)
       > sepsis or septic shock
       > other conditions that would normally need life-sustain therapies such as ventilation or vasopressor therapy
       > signs of severe respiratory distress
       > oxygen saturation <90% (or deteriorating) on room air
       > increased respiratory rate (>30 breaths per minute in adults and children over 5 years).

 Corticosteroids should not normally be used in people with COVID-19 that is not severe or critical, because there is
 a possibility of harm to such people.  See NICE Guidance - Covid-19 prescribing briefing: corticosteroids
RED        Dexamethasone [in Covid-19]
                tablets 500 microgram, 2mg
                injection 8mg/2mL

RED        Hydrocortisone sodium succinate injection 100mg  [in Covid-19]

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