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6.3 Corticosteroids

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
     Hydrocortisone modified release hard capsules [Emfody]
     Second line treatment of congenital adrenal hyperplasia (CAH) in adolescents aged 12 years and over and adults.
     in the following circumstances:
  1. Patients showing signs of excess steroid replacement with alternative preparations such as prednisolone and hydrocortisone 
  2. Patients who have a specific difficulty with taking multiple daily doses of hydrocortisone 
  3. Patients developing Testicular Adrenal Rest Tumour (TART). 
  4. Patients desiring and not achieving fertility 
  5. Problems with pubertal growth and development (paediatrics) 
    The dose of hydrocortisone and the patient’s clinical condition should have been stabilised and reviewed prior to prescribing      
    responsibility passing to primary care clinicians.
    AMBER    Hydrocortisone modified release hard capsules [Emfody] 5mg, 10mg, 20mg
    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
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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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