From the Guidelines
Dexamethasone (Decadron) should be prescribed at a dose of 6 mg once daily for up to 10 days for hospitalized COVID-19 patients requiring supplemental oxygen or mechanical ventilation. This recommendation is based on the most recent and highest quality study, the RECOVERY trial, which demonstrated a statistically significant reduction in mortality with corticosteroid treatment in patients receiving invasive mechanical ventilation and a lesser but still statistically significant mortality benefit in those requiring supplementary oxygen 1.
Key Considerations
- The medication works by reducing inflammation and suppressing the immune system's overreaction (cytokine storm) that can damage lungs and other organs in severe COVID-19.
- Dexamethasone is not recommended for patients with mild COVID-19 who don't require oxygen therapy, as it may be harmful in these cases.
- Common side effects include elevated blood sugar, increased risk of secondary infections, mood changes, and insomnia.
- Blood glucose should be monitored during treatment, especially in diabetic patients.
- Dexamethasone should be used cautiously in patients with diabetes, hypertension, or a history of psychiatric disorders, and the benefits should outweigh the risks in each individual case.
Administration and Monitoring
- Dexamethasone can be given orally or intravenously depending on the patient's condition.
- The dose of 6 mg once daily for up to 10 days should not be exceeded, as the benefits and risks of prolonged treatment are not well established.
- Patients receiving dexamethasone should be closely monitored for signs of adverse events, including elevated blood sugar, secondary infections, and mood changes 1.
Evidence Summary
The RECOVERY trial, a multicenter RCT conducted in 176 NHS hospitals, found that dexamethasone reduced 28-day mortality by 35% amongst the invasive mechanical ventilation patients and by 20% amongst patients on supplemental oxygen therapy with or without noninvasive ventilation 1. A systematic review and meta-analysis of critically ill patients with COVID-19 confirmed the benefit of corticosteroids on mortality in this population, with a pooled odds ratio of 0.70 (95% CI 0.48–1.01) 1.
From the Research
Dose of Decadron (Dexamethasone) in COVID-19
- The recommended dose of dexamethasone for patients with severe or critical COVID-19 is 6 mg daily for up to 10 days 2, 3.
- A study comparing low-dose (6 mg daily) and high-dose (20 mg daily) dexamethasone found that the high-dose group did not improve clinical outcomes and was possibly associated with higher 28-day mortality in patients on high-flow oxygen or noninvasive ventilation 3.
- Another study found that predicted body weight-based dexamethasone therapy may shorten the length of hospital stay and duration of oxygen therapy and reduce the use of additional respiratory support in patients with COVID-19 pneumonia 4.
- A three-arm randomized clinical trial comparing the efficacy and safety of different doses of dexamethasone found that higher doses of dexamethasone failed to improve efficacy and resulted in an increase in adverse events and worsened survival in hospitalized patients with moderate to severe COVID-19 5.
- A randomized clinical trial comparing the effects of 20 mg dexamethasone vs. 6 mg dexamethasone in patients with moderate-to-severe acute respiratory distress syndrome (ARDS) and COVID-19 found no significant difference in ventilator-free days, mortality, or adverse events between the two groups 6.
Key Findings
- The standard dose of 6 mg daily dexamethasone is recommended for patients with severe or critical COVID-19.
- Higher doses of dexamethasone may not improve clinical outcomes and may increase adverse events.
- Predicted body weight-based dexamethasone therapy may be beneficial in reducing the length of hospital stay and duration of oxygen therapy.
- The optimal dose of dexamethasone for patients with COVID-19 may depend on individual patient factors and should be tailored to the specific patient population.