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- Prednisone vs dexamethasone
- Prednisone vs dexamethasone
Background: This systematic review and meta-analysis was conducted to compare relapse rates and adverse effects with oral dexamethasone vs. Dosage of dexamethasone and prednisone varied across studies. Studies were grouped based on the follow-up period and duration of dexamethasone administration. Results: There was no significant difference in the relapse rate between dexamethasone and prednisone at 1—5 days RR 1.
Pooled analysis found no significant difference in relapse rates with 1-day RR 1. Hospital readmission rates after initial discharge were not significantly different between the two drugs RR 1. Frequency of vomiting at ED RR 0. Conclusion: While our results indicate that both dexamethasone and prednisone have similar relapse rates when used for acute asthmatic exacerbations, strong conclusions cannot be drawn due to paucity of large scale RCTs and limited quality of evidence. Dexamethasone is however associated with lower incidence of vomiting as compared to prednisone.
Further homogenous RCTs are needed to provide robust evidence on this topic. Asthma is a common pediatric disease that results in significant limitation of activity and an estimated loss of The disease is characterized by chronic airway inflammation, airway edema, bronchoconstriction, and airway hyperresponsiveness which results in respiratory symptoms like wheezing, shortness of breath, chest tightness, and cough 2.
The intensity of the disease varies with time and episodes of exacerbation frequently require management in the pediatric Emergency Department ED 3. The primary line of treatment in acute exacerbations of asthma is directed at a quick reversal of bronchospasm and reduction of airway inflammation 4. For this purpose, oral steroids are extremely effective for alleviating symptoms in children 5.
Early use of oral steroid therapy is also recommended with prednisone being the drug of choice 6. Relapse after prednisone therapy has been attributed to several factors like the unpleasant bitter taste of the drug, side-effects like vomiting, and its multi-dose regimen of 3—5 days which may reduce patient compliance 8 — To improve patient compliance and reduce relapse rates, the role of dexamethasone has been evaluated in many trials 47.
Initial studies evaluating a single dose of intramuscular IM dexamethasone have found it to be as effective as a 3—5 day regimen of prednisone 11 Subsequently, studies have also compared oral 1 or 2-day therapy of dexamethasone against a 3—5 days regimen of oral prednisone 4 Oral formulations are desirable in children as they are associated with less pain.
To date, two meta-analyses have compared oral dexamethasone and prednisone for acute exacerbations of asthma in children, with the last literature search performed in April 34.
Due to the limited number of studies analyzed in these previous reviews, this study aimed to provide an updated Level 1 evidence on relapse rates and adverse effects of oral dexamethasone vs. Studies including adult asthma patients and utilizing the parenteral route of administration of dexamethasone or prednisone were excluded. We also excluded non-randomized studies, retrospective studies, case-series, and non-English language studies. The last literature search was conducted on 1st August After assessing the studies by their titles and abstracts, full-texts of selected articles were retrieved.
Both the reviewers assessed individual studies based on inclusion criteria. Disagreements, if any, were resolved by mutual agreement. Using an abstraction form, two reviewers retrieved data from selected studies. The primary outcome was the relapse rate defined by an unscheduled visit to the ED or clinic.
Secondary outcomes were hospital readmission after discharge and incidence of vomiting at ED or home. Every study was evaluated for the following variables: random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessment, incomplete outcome data, selective reporting, and other biases.
We rated studies on each variable as low risk, high risk, or unclear risk of bias. Anticipating heterogeneity amongst studies, a random-effects model was used to calculate the pooled effect size. Heterogeneity was calculated using the I 2 statistic. A sensitivity analysis was carried out to assess the influence of each study on the pooled effect size.
Sub-group analysis was conducted for relapse rates based on follow-up period 1—5 days or 10—15 days and dosage of dexamethasone. Using the method described by Muncer et al. Gpower software was used to calculate the power of studies.
Out of the potentially relevant articles, 10 were selected for full-text analysis Figure 1. Three studies evaluated intramuscular dexamethasone vs. A total of seven unique articles were included in this systematic review and meta-analysis 171318 — Details of individual studies are presented in Table 1.
All trials included pediatric patients, however, the age group varied across studies. All studies were performed in the ED with varying sample sizes 23— patients. One study excluded patients with severe asthma exacerbation One included patients with moderate severity of exacerbation only 1 while another study included patients with moderate to severe exacerbations Asthma severity was measured on different scales across trials.
With an exception of one study 20there was no statistical significant difference between asthma severity scores of the two study groups. Dexamethasone was administered as a 1-day 11318 or 2-days therapy 720 In one trial, patients were randomized into three groups of 1-day dexamethasone, 2-days dexamethasone, and prednisone Data of both dexamethasone groups were compared separately with prednisone in our meta-analysis.
The dosage of dexamethasone in the included studies was 0. Majority studies had an institutional asthma management protocol wherein additional drugs were given to all patients of the trial.
Inhaled or nebulized salbutamol, albuterol, and ipratropium bromide were commonly administered in the included studies. The follow-up period ranged from 1 to 15 days. For the meta-analysis, two sub-groups were created based on the follow-up period of relapse rates 1—5 days and 10—15 days. There was no significant difference in the relapse rate between dexamethasone and prednisone at 1—5 days RR 1.
With an overall relapse rate of 8. Sub-group analysis was carried out for 1-day and 2-days dosage of dexamethasone vs. Figure 2. Forrest plot for dexamethasone vs. Figure 3. Hospital readmission after initial discharge was evaluated by four trials 71318 With a re-admission rate of 1. Data on the incidence of vomiting in ED were retrieved from four studies 71318 Patients receiving dexamethasone vomited less frequently as compared to prednisone RR 0.
The frequency of vomiting at home was significantly higher with prednisone 5. Figure 4. Figure 5. There was no change in direction of effect size on sensitivity analysis for the variables: relapse rate, hospital readmission, and vomiting at home.
However, when the results of Qureshi et al. Figure 7. For the outcome variables, relapse rate and hospital readmission rate, all studies were underpowered.
The weighted mean effect size for relapse rate was 0. The power of our meta-analysis for detecting significant difference in relapse rate was For the variables, vomiting at ED and vomiting at home, the weighted mean effect sizes were 0. The authors' judgment of the risk of bias is presented in Figure 8.
Randomization was adequately described in five studies 1131820 An appropriate method of allocation concealment was utilized in four trials 11318 Only three studies 11820 provided sufficient information on blinding of participants and personnel while only two trials 118 reported blinding of outcome assessment. Attrition bias was found to be high in two studies 19 Figure 8. Risk of Bias assessment.
Green, low risk of bias; Yellow, unclear risk of bias; Red, high risk of bias. Management of acute asthma exacerbations in children not only depends on the therapy provided in the ED but also on strict adherence to medications prescribed on discharge.
On the other hand, Butler et al. Non-compliance to medications on discharge has been attributed to several factors like inadequate funds or lack of insurance, insufficient knowledge on the necessity of treatment, fear of side-effects and prolonged course of treatment 38 Dexamethasone, a long-acting corticosteroid, has been studied as an alternative to prednisone to allow a shorter course of treatment in asthmatic patients 4. While inhaled and single-dose IM dexamethasone may be used as a substitute to prednisone, oral formulation is preferable in managing children 9 Studies conducted on adult asthmatic patients have found no difference in relapse rates with 2-days oral dexamethasone and 5-days prednisone 24 Rehrer et al.
In our study, while comparing the use of oral dexamethasone and prednisone in pediatric asthma exacerbations, we found no difference in relapse rates between a short-course of dexamethasone as compared to the standard 3—5 days therapy of prednisone.
The hospital readmission rates after initial discharge were slightly higher with dexamethasone as compared to prednisone 1. The results of our study are similar to the previous meta-analyses on this subject. Keeney et al. However, results from both IM and oral dexamethasone trials were pooled in their analysis. Normansell et al.
❾-50%}Non-compliance to medications on discharge has been attributed to several factors like inadequate funds or lack of insurance, insufficient knowledge on the necessity of treatment, fear of side-effects and prolonged course of treatment 3 , 8 , Dexamethasone, a long-acting corticosteroid, has been studied as an alternative to prednisone to allow a shorter course of treatment in asthmatic patients 4.
While inhaled and single-dose IM dexamethasone may be used as a substitute to prednisone, oral formulation is preferable in managing children 9 , Studies conducted on adult asthmatic patients have found no difference in relapse rates with 2-days oral dexamethasone and 5-days prednisone 24 , Rehrer et al.
In our study, while comparing the use of oral dexamethasone and prednisone in pediatric asthma exacerbations, we found no difference in relapse rates between a short-course of dexamethasone as compared to the standard 3—5 days therapy of prednisone.
The hospital readmission rates after initial discharge were slightly higher with dexamethasone as compared to prednisone 1.
The results of our study are similar to the previous meta-analyses on this subject. Keeney et al. However, results from both IM and oral dexamethasone trials were pooled in their analysis.
Normansell et al. In comparison, while our updated review was able to include three more RCTs, we also conducted a power analysis to identify if the included studies and our meta-analysis was adequately powered to detect significant difference in outcome variables.
It is important to note that despite pooling of data from seven RCTs, our meta-analysis was underpowered to detect significant difference in relapse rates and hospital readmission rates between dexamethasone and prednisone. In a sub-group analysis, we also compared 1-day and a 2-days course of dexamethasone with 3—5 day therapy of prednisone. However, with just one trial reporting a three-way comparison of 1-day and 2-days dexamethasone with prednisone 19 , combined with limited power of our meta-analysis, conclusion cannot be drawn till further studies are carried out to explore the differences between 1 and 2-days dexamethasone protocol.
It is also important to note that relapse rates and hospital readmission rates may be influenced by factors like clinical decisions, hospital criteria for admission and accessibility to healthcare facilities The criteria for relapse rate are also broad varying from the visit of the child to a family doctor for continued wheezing and cough to a severe relapse requiring in-patient management Therefore, objective measures of reduction in asthma severity and assessment of persistent symptoms may better evaluate the differences in the two steroid treatment protocols.
Elkharwili et al. Paniagua et al. PRAM scores were measured at day 4 of treatment by Cronin et al. Altamimi et al. With a mean of 5. While individually all included studies reported dexamethasone to be as efficacious as prednisone, methodological heterogeneity of outcome measures precluded a meta-analysis of such variables in our study. Despite intra-venous dexamethasone and prednisone demonstrating similar efficacy for preventing nausea and vomiting after chemotherapy 28 , the unpleasant taste of oral prednisone frequently results in vomiting especially in children While the difference of taste between dexamethasone and prednisone has reportedly not been a hindrance in treatment adherence 21 , vomiting may affect treatment compliance in pediatric patients Hames et al.
In our meta-analysis, vomiting at ED and home was found to be significantly higher with prednisone as compared to dexamethasone. Similar results have been reported in the meta-analysis of Keeney et al. The strengths and limitations of our study need to be elaborated. Firstly, in our review three more RCTs were added since the last published meta-analysis, thereby providing an updated evidence.
Secondly, a sensitivity analysis was carried out to assess influence of individual studies on the overall results. Lastly, power analysis was also carried out to provide a guide to readers on the validity of the calculated results. The results of our review, however, should be interpreted with caution due to the following limitations.
Additionally, lack of adequate randomization and allocation concealment, as well as attrition bias in some studies, could have influenced the overall results. Secondly, there was considerable methodological heterogeneity amongst the seven trials especially concerning drug dose, duration of therapy, utilization of additional drugs, follow-up protocol, etc.
Thirdly, inclusion criteria varied amongst studies, with the trial of Paniagua et al. Asthma is usually not diagnosed at such a young age due to the prevalence of bronchiolitis in this age-group Lastly, our meta-analysis was not adequately powered to detect differences in relapse rates and hospital readmission rates, as out of the seven included trials, three studies 1 , 19 , 20 were of small sample size recruiting only 23—51 patients per group.
In our power analysis, all included studies were found to be underpowered for detection of significant difference in the primary outcome variable. To conclude, despite our results indicating similar relapse rates and hospital re-admission rates with dexamethasone and prednisone when used for acute asthmatic exacerbations in children, strong conclusions cannot be drawn due to paucity of large scale RCTs and limited quality of evidence.
It is also not known if both drugs are equally efficacious in reducing asthma severity. Our results however indicate that, vomiting is significantly less with dexamethasone as compared to prednisone. Further large-scale homogenous RCTs comparing the two drugs are warranted to establish guidelines for the use of oral steroid therapy in acute asthma exacerbations in children.
JW and QC conceived and designed the study. JW was involved in the writing of the manuscript. All authors have read and approved the final manuscript.
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Single-dose oral dexamethasone compared with three day course of oral prednisolone in children with moderate exacerbation of asthma-a pilot double-blinded randomised controlled trial. J Clin Diag Res. Scarfone RJ, Friedlaender E. Corticosteroids in acute asthma: past, present, and future. Pediatr Emerg Care. Different oral corticosteroid regimens for acute asthma. Cochrane Database Syst Rev. Dexamethasone for acute asthma exacerbations in children: a meta-analysis.
Is dexamethasone as effective as prednisone or prednisolone in the management of pediatric asthma exacerbations?
Ann Emerg Med. British Guideline on the Management of Asthma. PubMed Abstract Google Scholar. Comparative efficacy of oral dexamethasone versus oral prednisone in acute pediatric asthma. J Pediatr. Butler K, Cooper WO. Adherence of pediatric asthma patients with oral corticosteroid prescriptions following pediatric emergency department visit or hospitalization.
Randomized trial of single-dose intramuscular dexamethasone compared with prednisolone for children with acute asthma. Short report: crushed prednisolone tablets or oral solution for acute asthma? Arch Dis Child. The combination can lead to higher levels of dexamethasone in the body, which can cause serious side effects from the steroid. Avoid grapefruit and grapefruit juice while taking dexamethasone. Check labels of any products that may contain grapefruit products, such as fruit punch.
Warnings of corticosteroid treatment with dexamethasone or prednisone include:. Generic medications are more often covered by insurance, including Medicare and Medicaid. However, the cost of dexamethasone and prednisone with any insurance provider will vary. Cost factors include:.
Prescription drug prices often change. These are the most accurate medication prices at the time of publishing. Click the coupon buttons to see updated drug prices. Corticosteroids, also known as steroids, are used for various conditions that cause inflammation.
Steroids work by reducing inflammation and decreasing immune system activity. Like any type of drug, corticosteroids can have many side effects. Some side effects are common, such as stomach pain and headache. Others can be very serious, and not as common, especially when the steroid is taken for a long period of time. Your healthcare provider will tell you how to take the steroid, and how to taper off of the medication, without abruptly stopping it.
When you hear about people misusing steroids, the steroids in question are not corticosteroids. They are anabolic steroids. While corticosteroids are used for inflammatory conditions, anabolic steroids are related to testosterone. While they can be prescribed for legitimate uses, some athletes and bodybuilders misuse anabolic steroids to try to improve their performance or appearance.
Although they are similar, they are not exactly the same. The information above is a helpful comparison between the two drugs. Other steroid drugs you may have heard of include methylprednisolone , prednisolone , and hydrocortisone. Decadron is the brand name for dexamethasone and is the same drug as dexamethasone.
However, prednisone and Decadron are not the same. For example, Decadron is more potent and longer-acting than prednisone. There is not much data comparing the two drugs directly. One review of studies concluded that either drug is acceptable for the treatment of children with acute exacerbation of asthma who were treated in the emergency department.
Because there are so many different indications for the use of a steroid medication, your healthcare provider will take into account the condition being treated along with your medical history and other medications you take, when deciding which medication is better for you. When treatment with a steroid is needed for severe cases of COVID requiring oxygen or ventilation, dexamethasone is the preferred steroid.
NIH guidelines state that when dexamethasone is not available, an alternative steroid such as prednisone can be used instead. Studies that looked at steroids for asthma concluded that either steroid is effective. All steroids come with the risk of side effects see Warnings section , and some can be very serious.
Your healthcare provider will decide which medication is safer for you and prescribe the shortest course of treatment possible.
Often, you will taper off the steroid so that you do not stop suddenly. This helps your adrenal glands return to normal function. Corticosteroids such as dexamethasone or prednisone have been shown to harm the fetus in many species when given in doses equivalent to the dose a human would take, causing an increased incidence of cleft palate in the animal offspring.
Steroids may also cause growth restriction and decreased birth weight. There have been no adequate, well-controlled studies of dexamethasone or prednisone in pregnant women. Therefore, dexamethasone or prednisone should be used in pregnancy only if the benefit outweighs the risk to the fetus, and under close supervision of the healthcare provider. Infants born to mothers who have received high doses of steroids during pregnancy should be observed for signs of hypoadrenalism.
Dexamethasone is not recommended for use in breastfeeding women due to lack of data. Prednisone may be used during breastfeeding if approved by the healthcare provider. Women who take more than 20 mg of prednisone per day may be advised to wait at least 4 hours after taking the medication, to breastfeed.
Women who are pregnant, planning to become pregnant, or breastfeeding, should always consult their healthcare provider before taking any medication. Generally, alcohol should not be mixed with steroids.
Consult your healthcare provider for medical advice. Dexamethasone is long-acting medication and is considered to be a potent, or strong, steroid. It is 6 times more potent strong than prednisone. Corticosteroids like prednisone and dexamethasone are not controlled substances , and are generally not associated with abuse and dependence.
Some people may experience euphoria feeling intensely happy or excited from corticosteroids, so they may misuse the medication to try to get this effect. However, in most cases, this is not an issue. It depends on how the medication is administered. Given by injection, dexamethasone will begin working quickly. Oral dexamethasone may start working in one hour or up to several hours. Prednisone taken by mouth also takes about one or two hours to work. It depends on the reason. If you are allergic to one corticosteroid, you will likely be allergic to another steroid.
In long-term therapy, alternate-day administration should be considered. Some disease states, however, such as temporal arteritis and systemic lupus erythematosus, may not be adequately controlled with alternate-day therapy. Doubling the dosage and administering the drug every other day in the morning more closely mimics the endogenous corticosteroid circadian rhythm. This form of administration enables the patient to experience the therapeutic effects while side effects are minimized.
Viral croup is a common childhood disease. In fact, it is the most common form of upper airway obstruction in children six months to six years of age. Corticosteroids have been studied in the management of croup for the past 30 years, but their use in this condition is controversial.
The use of steroids in children with croup is associated with significant clinical improvement at about 12 hours post-treatment and results in less endotracheal intubation. Most current research focuses on outpatient use of corticosteroids in the treatment of moderate and severe croup.
Some authors have found that routine use of steroids reduces the need for hospitalization. Although budenoside is well tolerated with minimal side effects because of limited systemic availability, it is not yet available for use in the United States except in a nasal form.
A single intramuscular injection of 0. Therefore, intramuscular corticosteroid treatment should be considered in patients with moderate croup before discharge from the emergency department when outpatient therapy is entertained.
Pneumocystis carinii pneumonia PCP is a leading cause of morbidity and mortality in patients infected with human immunodeficiency virus HIV. This clinically significant complication of HIV infection occurs in 60 to 80 percent of patients with acquired immunodeficiency syndrome not receiving prophylaxis 14 and causes death in approximately 25 percent of its victims. Since the late s, adjunctive treatment with corticosteroids has been documented in case reports and research studies with favorable clinical results, and it is currently endorsed by the National Institutes of Health as a standard therapy.
Documented benefits of corticosteroid therapy in patients with PCP include reduced morbidity and mortality, decreased need for mechanical ventilation assistance and a reduced long-term decline in pulmonary function or exercise tolerance. Progression of other opportunistic infections associated with HIV infection as a result of the immunosuppressive effects of corticosteroids is a risk that must be considered.
While some studies report only minor complications associated with steroid therapy, such as reactivation of localized herpetic lesions, 18 others have reported an increased incidence of infection and cancer. Based on the benefits and risks of adjunctive corticosteroid therapy, the current recommendations are not intended for all patients but only for those with confirmed or suspected HIV and PCP infection who are at high risk of respiratory failure and death.
Patients at risk include those with an arterial oxygen pressure of less than 70 mm Hg or an arterial-alveolar gradient of more than 35 mm Hg. The recommended dosing regimen is oral prednisone, 40 mg twice daily for five days, then 40 mg once daily for five days, then 20 mg daily for the duration of the anti-pneumocystis therapy. Methylprednisolone, given at 75 percent of the oral prednisone dosage, can be substituted if parenteral therapy is necessary.
A confirmatory diagnosis of PCP and HIV infection should be obtained, and other diseases, such as tuberculosis and cryptococcosis, should be ruled out before steroid therapy is begun.
Further investigation is required to determine the appropriate use and benefits of steroid therapy when the patient has concomitant life-threatening infections and when the patient has already received more than three days of anti-pneumocystis therapy and has developed significant hypoxia.
Hyperthyroidism is a common disease affecting around 2 percent of women and 0. The amount of benefit and the effect on patient outcome in this circumstance is not yet known.
Graves' eye disease is treated by first normalizing the thyroid function and then administering diuretics and systemic glucocorticoids. Other causes of hyperthyroidism that may be treated with corticosteroids are subacute thyroiditis and thyroid storm. Hyperthyroid disease related to thyroiditis is usually mild and self-limited. Beta blockers may be used to treat symptoms. In subacute thyroiditis, non-steroidal anti-inflammatory drugs or corticosteroids can be used to relieve thyroid pain and tenderness.
Thyroid storm is a life-threatening condition of the hyperthyroid state. Corticosteroids are used as adjuvant analgesics for pain in cancer patients and patients with neuropathic pain such as herpes zoster—related neuropathy, spinal cord compression and pain following oral surgery.
Prednisone, at a dosage of 7. Patients with nerve compression pain or pain resulting from increased intracranial pressure showed a better response when compared with patients with other pain syndromes. Perioperative use of corticosteroids has been advocated to reduce pain and decrease edema and trismus following oral surgical procedures.
The most significant improvement occurs in the treatment of postoperative edema. Dosages of prednisone between 40 and 80 mg per day can be used. Maximal benefit has been achieved after third-molar extraction, although some benefit has been reported after other surgeries. Some evidence indicates that combining corticosteroids with acyclovir Zovirax will decrease the duration of zoster-associated pain.
Corticosteroids were first used in clinical practice in for the treatment of rheumatoid arthritis. Indications since then have spanned multiple specialties and organ systems, including dermatology, rheumatology, immunology and oncology. This review covers practical uses of steroids as well as current and frequently overlooked clinical applications that may be helpful to family physicians. If physicians understand the composition and physiologic effects of corticosteroid agents, appropriate drug selection can be made and inappropriate or problematic uses can be avoided.
Corticosteroid agents mimic the endogenous steroid hormones produced in the adrenal cortex—mineralocorticoid aldosterone and glucocorticoid cortisol.
Mineralocorticoids are primarily regulated by the renin-angiotensin system and possess salt-retaining properties. Glucocorticoids are primarily regulated by corticotropin ACTH and can have anti-inflammatory effects, as well as several metabolic and immunogenic effects, on the body. While several corticosteroid agents possess properties of both hormones, fludrocortisone is most commonly used for its mineralocorticoid activity and hydrocortisone, cortisone, prednisone and prednisolone are used for their glucocorticoid effects.
Table 1 summarizes the relative potencies of the hormonal effects in addition to providing equivalent doses. Therapeutic effects of steroids can often parallel undesirable side effects, especially when high doses and long-term therapy are required.
By anticipating the potential side effects and implementing preventive measures where possible Table 21 — 4 patients can obtain maximum benefits with minimum adverse effects. The dosage range for steroids is wide, and patient response is variable. A low or maintenance dosage is approximately 0. Short-term, low-dose steroid therapy rarely results in any of the adverse effects listed in Table 2. In long-term therapy, alternate-day administration should be considered. Some disease states, however, such as temporal arteritis and systemic lupus erythematosus, may not be adequately controlled with alternate-day therapy.
Doubling the dosage and administering the drug every other day in the morning more closely mimics the endogenous corticosteroid circadian rhythm. This form of administration enables the patient to experience the therapeutic effects while side effects are minimized. Viral croup is a common childhood disease.
In fact, it is the most common form of upper airway obstruction in children six months to six years of age. Corticosteroids have been studied in the management of croup for the past 30 years, but their use in this condition is controversial.
The use of steroids in children with croup is associated with significant clinical improvement at about 12 hours post-treatment and results in less endotracheal intubation. Most current research focuses on outpatient use of corticosteroids in the treatment of moderate and severe croup. Some authors have found that routine use of steroids reduces the need for hospitalization. Although budenoside is well tolerated with minimal side effects because of limited systemic availability, it is not yet available for use in the United States except in a nasal form.
A single intramuscular injection of 0. Therefore, intramuscular corticosteroid treatment should be considered in patients with moderate croup before discharge from the emergency department when outpatient therapy is entertained. Pneumocystis carinii pneumonia PCP is a leading cause of morbidity and mortality in patients infected with human immunodeficiency virus HIV. This clinically significant complication of HIV infection occurs in 60 to 80 percent of patients with acquired immunodeficiency syndrome not receiving prophylaxis 14 and causes death in approximately 25 percent of its victims.
Since the late s, adjunctive treatment with corticosteroids has been documented in case reports and research studies with favorable clinical results, and it is currently endorsed by the National Institutes of Health as a standard therapy.
Documented benefits of corticosteroid therapy in patients with PCP include reduced morbidity and mortality, decreased need for mechanical ventilation assistance and a reduced long-term decline in pulmonary function or exercise tolerance.
Progression of other opportunistic infections associated with HIV infection as a result of the immunosuppressive effects of corticosteroids is a risk that must be considered. While some studies report only minor complications associated with steroid therapy, such as reactivation of localized herpetic lesions, 18 others have reported an increased incidence of infection and cancer.
Based on the benefits and risks of adjunctive corticosteroid therapy, the current recommendations are not intended for all patients but only for those with confirmed or suspected HIV and PCP infection who are at high risk of respiratory failure and death. Patients at risk include those with an arterial oxygen pressure of less than 70 mm Hg or an arterial-alveolar gradient of more than 35 mm Hg. The recommended dosing regimen is oral prednisone, 40 mg twice daily for five days, then 40 mg once daily for five days, then 20 mg daily for the duration of the anti-pneumocystis therapy.
Methylprednisolone, given at 75 percent of the oral prednisone dosage, can be substituted if parenteral therapy is necessary. A confirmatory diagnosis of PCP and HIV infection should be obtained, and other diseases, such as tuberculosis and cryptococcosis, should be ruled out before steroid therapy is begun. Further investigation is required to determine the appropriate use and benefits of steroid therapy when the patient has concomitant life-threatening infections and when the patient has already received more than three days of anti-pneumocystis therapy and has developed significant hypoxia.
Hyperthyroidism is a common disease affecting around 2 percent of women and 0. The amount of benefit and the effect on patient outcome in this circumstance is not yet known.
Graves' eye disease is treated by first normalizing the thyroid function and then administering diuretics and systemic glucocorticoids.
Other causes of hyperthyroidism that may be treated with corticosteroids are subacute thyroiditis and thyroid storm. Hyperthyroid disease related to thyroiditis is usually mild and self-limited. Beta blockers may be used to treat symptoms. In subacute thyroiditis, non-steroidal anti-inflammatory drugs or corticosteroids can be used to relieve thyroid pain and tenderness. Thyroid storm is a life-threatening condition of the hyperthyroid state.
Corticosteroids are used as adjuvant analgesics for pain in cancer patients and patients with neuropathic pain such as herpes zoster—related neuropathy, spinal cord compression and pain following oral surgery. Prednisone, at a dosage of 7. Patients with nerve compression pain or pain resulting from increased intracranial pressure showed a better response when compared with patients with other pain syndromes.
Perioperative use of corticosteroids has been advocated to reduce pain and decrease edema and trismus following oral surgical procedures. The most significant improvement occurs in the treatment of postoperative edema. Dosages of prednisone between 40 and 80 mg per day can be used.
Maximal benefit has been achieved after third-molar extraction, although some benefit has been reported after other surgeries. Some evidence indicates that combining corticosteroids with acyclovir Zovirax will decrease the duration of zoster-associated pain. Systemic treatment with corticosteroids such as prednisone, at 40 mg per day for three weeks, decreases the proportion of patients affected by postherpetic neuralgia, especially pain occurring six to 12 weeks after onset.
Alcoholic hepatitis is a chronic, progressive and often fatal disease. Treatment has generally been supportive. Meta-analysis of studies from to supports the finding that patients with acute severe alcoholic hepatitis and hepatic encephalopathy, without gastrointestinal bleeding, benefit from a trial of corticosteroid therapy.
Further clinical trials were recommended to clarify the role of steroids in the treatment of alcoholic hepatitis. Bacterial meningitis is a serious disease that may result in death or permanent neurologic complications such as seizures, paralysis or sensorineural hearing loss. These produce inflammatory components such as cytokines, which lead to meningeal inflammation and increased intracranial pressure.
Studies show that potent corticosteroids, such as dexamethasone, combined with appropriate antibiotics reduce the risk of acquired sensorineural deafness and the incidence of other neurologic sequelae in meningitis caused by Haemophilus influenzae.
The drug was administered in a dosage of 0. Corticosteroids may also be used in the treatment of tuberculous meningitis. In one randomized, controlled study 55 involving 47 patients in India, dexamethasone was found to be useful as an adjunct treatment in cases of tuberculous meningitis, especially in patients with severe disease. A more recent randomized trial 56 using prednisone in children with tuberculous meningitis showed that prednisone in a dosage of 2 to 4 mg per kg per day for one month improved survival rate and intellectual outcome.
Table 4 57 lists other unlabeled uses of corticosteroids. This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Actions and Side Effects.
Edema Decreased salt intake Increased potassium excretion Potassium supplements may be necessary. Increased calcium excretion Use with caution in patients at increased risk of developing osteoporosis; calcium supplements may be necessary, especially in postmenopausal women. Gastrointestinal Gastric irritation Take with meals to prevent gastric upset.
Endocrine Hypercortisolism Cushingoid statesecondary adrenal insufficiency Associated with long-term use even at lower dosages Menstrual difficulties, including amenorrhea and postmenopausal bleeding Precipitation of diabetes mellitus Glucose intolerance, hyperglycemia In patients with diabetes, increased dosages of insulin or oral hypoglycemic agent and changes in diet should be expected.
Cardiovascular Hypertension Use with extreme caution in patients with recent myocardial infarction because of an apparent association with left ventricular free-wall rupture. Thromboembolism Use with caution in patients with thromboembolic disorders because of reports of rare increased blood coagulability. Thrombophlebitis CHF exacerbation Ocular Posterior subcapsular cataracts Prolonged use may result in increased intraocular pressure or damaged ocular nerve.
Use in patients with ocular herpes simplex may cause corneal perforation. Glaucoma May enhance secondary fungal or viral infections of the eye Musculoskeletal Muscle pain or weakness, muscle wasting, pathologic long bone or vertebral compression fractures, atrophy of protein matrix of bone, aseptic necrosis of femoral or humeral heads Use with caution in patients prone to development of osteoporosis; risk versus benefit should be reassessed if osteoporosis develops; elderly, debilitated or poorly nourished patients may be more prone to these effects.
Supplementation with calcium, 1, mg per day, and vitamin D, IU per day, is recommended. Neuropsychiatric Headache, vertigo, seizures, increased motor activity, insomnia, mood changes, psychosis Use with caution in patients with convulsive or psychiatric disorders.
Use may aggravate preexisting psychiatric conditions. Steroid-induced psychosis is dose-related, occurs within 15 to 30 days of therapy and is treatable if steroid therapy must be continued. Pseudotumor cerebri reported during withdrawal. Other Increased susceptibility to infections, masked symptoms of infections Contraindicated in patients with systemic fungal infections except to control drug reactions associated with amphotericin B [Fungizone] therapy.
Do not use live virus vaccinations during therapy. Reactions to skin tests may be suppressed. In most patients, endogenous corticosteroid secretions are equivalent to 5 to 7.
Recommended tapering schedules Tapering the dosage over 2 months or more may be necessary for patients on prolonged treatment more than 1 year. Depending on dosage, duration of therapy and risk of systemic disease, decrease dosage by the equivalent of 2. Then perform a challenge to determine the extent of HPA axis recovery.
Depending on the results and patient's symptoms, therapy may be discontinued or a slower taper considered. If symptoms do not subside when steroid dosage is adjusted, other causes must be considered.
In certain severe illnesses or during acute flare ups, daily dosing may be re-initiated. Pneumocystis carinii Pneumonia. Pain Management. Alcoholic Hepatitis.
Dexamethasone is long-acting medication and is considered to be a potent, or strong, steroid. It is 6 times more potent (strong) than prednisone. Can prednisone. Still, dexamethasone is more potent (stronger) than prednisone. If you're in a situation where you need a more potent steroid, dexamethasone. Decadron (dexamethasone) and prednisone are corticosteroids used to treat arthritis, skin, blood, kidney, eye, thyroid, intestinal disorders. Dexamethasone, a long-acting corticosteroid, has been studied as an alternative to prednisone to allow a shorter course of treatment in. Prednisone is shorter acting, with a half-life of 18 to 36 hours. If your total time taking the steroid is a week or so, you will only taper for the last few days of the week.Steroid medications are used in a wide variety of emergency medical situations as well as for many other acute and chronic inflammatory conditions and disease states. Both drugs are corticosteroids , also known as glucocorticoids or steroids. They are used for a wide variety of inflammatory conditions in many organ systems.
Although dexamethasone and prednisone are both steroids, they have some differences, which we will describe below. Dexamethasone is a corticosteroid, or steroid, medication. Although dexamethasone is usually filled as a generic drug, some brand names that contain dexamethasone include Decadron, Hemady, and TaperDex.
Oral dexamethasone is available as a tablet and oral solution. It is also available as an injection and in certain ophthalmic eye products. Dexamethasone is known as a long-acting drug. Its half-life is 36 to 72 hours.
Prednisone is also a steroid medication. Prednisone may be referred to as Deltasone, but the brand name is no longer available. Prednisone is available as a generic product in the forms of a tablet and oral solution. Prednisone is known as an intermediate-acting drug. Its half-life is about three to four hours. Oral prednisone is most commonly prescribed as an immediate-release tablet, but there is also a delayed-release prednisone tablet called Rayos. Rayos delayed-release tablets What form s does the drug come in?
Tablet, injection, oral solution, ophthalmic drops alone and in combination with other ingredients , ophthalmic ointments in combination with other ingredients Tablet, oral solution What is the standard dosage?
Varies by indication and response to treatment Varies by indication and response to treatment How long is the typical treatment?
Short-term; varies Short-term; varies Who typically uses the medication? Adults, sometimes in children Adults, sometimes in children Want the best price on dexamethasone? Sign up for dexamethasone price alerts and find out when the price changes! Get price alerts. Dexamethasone and prednisone have similar indications. Both medications are indicated for use in a wide variety of inflammatory conditions for various systems.
For example, both medications may be used for allergic conditions, when conventional treatment is not effective. The allergic and dermatologic conditions that dexamethasone and prednisone may treat include acute exacerbations of asthma, atopic or contact dermatitis, drug hypersensitivity reactions, perennial or seasonal allergic rhinitis, Stevens-Johnson syndrome, and serum sickness.
Because each category has many indications, there are too many to list. In the chart below, we will list several examples for each category. Consult your doctor for more information. Also, some doctors prescribe these medications off-label for certain uses. Off-label prescribing is when a medicine is prescribed for an indication that is not FDA-approved. For example, steroids may be prescribed for certain cancers in combination with other drugs , nausea and vomiting caused by chemotherapy, carpal tunnel syndrome in combination with other drugs , and exacerbations of chronic obstructive pulmonary disease COPD.
Studies comparing the two drugs head to head mostly looked at dexamethasone vs. A study treated children who had mild to moderate croup with one single dose of oral dexamethasone or one dose of prednisolone the active form of prednisone. The study found that prednisolone was less effective than dexamethasone in lowering the number of patients who returned to the hospital. Both a review of studies in Pediatrics and a study in The Journal of Pediatrics , concluded that two doses of dexamethasone are an effective alternative to a 5-day prednisone treatment, in children with acute asthma.
Because each drug can be used to treat a wide variety of medical conditions, it is difficult to say which drug is more effective. Your healthcare provider may choose dexamethasone if you need something that is longer-acting and more potent, or prednisone if you need something that is shorter-acting. The best drug for you can only be determined by your healthcare provider, who can take into account your medical history and conditions, and other medications you take that could potentially interact with dexamethasone or prednisone.
When taking steroid medication, it is important to take it exactly as directed. Often, the directions will specify that you start with a higher dose and then taper down to a lower dose. Steroids like dexamethasone or prednisone should be taken with food to reduce stomach side effects. The tables below outline standard dosages for some of the conditions that these steroids treat. More detailed information on dosing can be found for dexamethasone and prednisone on our dosing pages.
Sources: Dexamethasone , Prednisone. Steroid dosing for children varies by weight and the condition being treated. Note: Doses listed in the tables above are standard doses per condition. Starting and maximum doses vary by drug and indication. The tables above are not a complete list of all possible indications or doses for dexamethasone or prednisone. Your healthcare provider will determine the best dosage for you based on your health condition and response to treatment.
Unless the patient requires oxygen, using a steroid does not benefit the patient and can cause serious side effects such as high blood sugar, stomach bleeding, psychosis, infections, and other long-term effects.
Patients who are already taking a corticosteroid for another indication should continue treatment under supervision of their healthcare provider. In patients who are hospitalized and have suspected or confirmed severe COVID , and are on oxygen or a ventilator, a steroid may be used if the healthcare provider determines it will be useful.
If dexamethasone is used, the dose is usually 6 mg by mouth or IV daily. If dexamethasone is not available and prednisone is used, the dosage is usually 40 mg daily. When taking a steroid such as dexamethasone or prednisone, your healthcare provider will provide instructions for gradually tapering the medication over some time depending on how long you took the medicine.
Steroids must always be tapered if taken for more than a few days. If your total time taking the steroid is a week or so, you will only taper for the last few days of the week. However, if you took steroids for many months, your healthcare provider will instruct you to taper much more gradually, over several weeks or even months.
This is because prednisone affects the adrenal glands , so stopping the medicine slowly allows the adrenal glands to return to their normal function. Stopping a steroid too quickly can cause withdrawal symptoms such as extreme tiredness, weakness, lightheadedness, body aches, joint pain, nausea, and appetite loss. Sign up for prednisone price alerts and find out when the price changes! When you are prescribed a steroid medication, it is important to take the medication as directed, and taper the dose as directed by your healthcare provider when instructed to do so.
Below is a list of potential side effects that may occur with either dexamethasone or prednisone. This is not a full list of side effects. Consult your healthcare provider for a full list of adverse events. Source: DailyMed dexamethasone , DailyMed prednisone. Patients taking an anticoagulant , such as warfarin, should be monitored while taking steroid medication. Medications used for diabetes may need to be adjusted because steroids may affect blood glucose levels.
Certain medications that are metabolized by an enzyme called CYP3A4 may affect the metabolism of the steroid, requiring dosage adjustment. This is not a full list of drug interactions.
Consult your healthcare provider for a full list of drug interactions. Pioglitazone Antidiabetic agents Yes Yes Carbamazepine. These steroids should not be mixed with alcohol. Combining steroid medication with alcohol can lead to a higher risk of stomach ulcers, perforation, and bleeding.
Dexamethasone but not prednisone interacts with grapefruit and grapefruit juices. The combination can lead to higher levels of dexamethasone in the body, which can cause serious side effects from the steroid. Avoid grapefruit and grapefruit juice while taking dexamethasone. Check labels of any products that may contain grapefruit products, such as fruit punch. Warnings of corticosteroid treatment with dexamethasone or prednisone include:. Generic medications are more often covered by insurance, including Medicare and Medicaid.
However, the cost of dexamethasone and prednisone with any insurance provider will vary. Cost factors include:. Prescription drug prices often change. These are the most accurate medication prices at the time of publishing. Click the coupon buttons to see updated drug prices. Corticosteroids, also known as steroids, are used for various conditions that cause inflammation. Steroids work by reducing inflammation and decreasing immune system activity.
Like any type of drug, corticosteroids can have many side effects. Some side effects are common, such as stomach pain and headache. Others can be very serious, and not as common, especially when the steroid is taken for a long period of time. Your healthcare provider will tell you how to take the steroid, and how to taper off of the medication, without abruptly stopping it.
When you hear about people misusing steroids, the steroids in question are not corticosteroids. They are anabolic steroids. While corticosteroids are used for inflammatory conditions, anabolic steroids are related to testosterone. While they can be prescribed for legitimate uses, some athletes and bodybuilders misuse anabolic steroids to try to improve their performance or appearance.
Although they are similar, they are not exactly the same. The information above is a helpful comparison between the two drugs.
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