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:

Patients showing signs of excess steroid replacement with alternative preparations such as prednisolone and hydrocortisone
Patients who have a specific difficulty with taking multiple daily doses of hydrocortisone
Patients developing Testicular Adrenal Rest Tumour (TART).
Patients desiring and not achieving fertility
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

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

intervals.

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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