Corticosteroids

Dexamethasone

Rapid Review

  • Mechanism of Action: Corticosteroid; decreases production of inflammatory mediators, reverses capillary permeability, and suppresses normal immune response.
  • Indications: Allergic reactions, asthma, and autoimmune conditions. May also be used to treat acute COVID-19 infections. 
  • Contraindications: allergy to drug or class
  • Dosage: Usually 4 – 20mg in single or divided doses; depending on disease.
  • Half-life: 4 hours for oral, 1-5 hours for IV
  • Adverse Reactions: nausea, dizziness, 
  • Special Considerations: Use may have small increase in risk for sepsis, fractures, and venous thromboembolism

Pearls

  • The PO formulation of dexamethasone contains alcohol and is not well tolerated by kids due to it’s poor taste. Recommend mixing with juices/soft food or considering alternative routes (IM/IV)
  • Interestingly, rapid administration of dexamethasone may significant burning/pruritus sensation in the perianal region. This can be avoided by pushing slowly or diluting with normal saline
Video Credit: Concept Clear

Hydrocortisone

Rapid Review

Pearls

Deep Dive

Methylprednisolone

Rapid Review

  • Mechanism of Action: Synthetic corticosteroid; anti-inflammatory properties with minimal mineralocorticoid activities.
  • Indications: Multiple sclerosis exacerbation, asthma, anaphylaxis, optic neuritis, temporal arteritis
  • Contraindications: Hypersensitivity, systemic fungal infection, premature infants
  • Dosage: Generally 125 mg IV or 1 mg/kg
  • Onset: 1 hour
  • Duration: Variable
  • Adverse Reactions: Hyperglycemia, adrenal suppression , immunosuppression

Pearls

  • Methylprednisolone is an intermediate-acting steroid, like prednisone. It is ideal for acute exacerbations such as asthma or anaphylaxis.
  • Although commonly stored in “single-dose” 125 mg vials, this is equivalent to approximately 156 mg of prednisone or 23 mg of dexamethasone. 

Prednisone

Rapid Review

  • Mechanism of Action: Corticosteroid; decreases inflammation via suppression of polymorphonuclear leukocytes and reversal of increased capillary permeability. 
  • Indications: Asthma, allergic reaction, multiple sclerosis exacerbation, adrenal insufficiency
  • Contraindications: Hypersensitivity, systemic fungal infection, recent varicella/measles infection or live-attenuated vaccines
  • Dosage: Generally 1 mg/kg/day PO
  • Onset: 3-4 hours
  • Duration: 18-36 hours
  • Adverse Reactions: Hyperglycemia, immunosuppression, infections, fractures, sodium/fluid retention

Pearls

  • Prednisone, like other steroids, often causes an increase in white blood cell count due to the demargination of the endothelium. The amount of increase is highly variable, ranging between 4,000/mm to 20,000/mm.
  • Prednisone is considered intermediate acting (duration 18-36 hours), similar to methylprednisolone and prednisolone. For a longer acting agent, consider dexamethasone (36-54 hours)