From the Guidelines
Dexamethasone (Decadron) is recommended for hospitalized COVID-19 patients requiring supplemental oxygen or mechanical ventilation, at a dose of 6 mg once daily for up to 10 days, as evidenced by the RE-COVERY trial 1. The standard protocol for Dexamethasone in COVID-19 patients is based on the results of a multicenter RCT conducted in 176 NHS hospitals, which found that Dexamethasone reduced 28-day mortality by 35% amongst patients on invasive mechanical ventilation and by 20% amongst patients on supplemental oxygen therapy with or without noninvasive ventilation 1.
Key Considerations
- The medication should be used with caution in patients with certain underlying conditions, such as uncontrolled diabetes, active infections, or immunosuppression.
- Blood glucose monitoring is advised during treatment, especially in diabetic patients, due to the potential for elevated blood sugar as a side effect.
- Dexamethasone can be administered orally or intravenously with equivalent effectiveness.
- The medication works by reducing inflammation and immune system overreaction (cytokine storm) that damages lungs and other organs in severe COVID-19.
Patient Selection
- Dexamethasone is not recommended for non-hospitalized patients with mild to moderate COVID-19 who don't require oxygen therapy, as it may be harmful in these cases.
- The medication should be used judiciously, taking into account the potential benefits and risks, and should be tapered gradually after prolonged use to avoid adverse effects.
Monitoring and Precautions
- Potential side effects include increased risk of secondary infections, psychiatric effects, and gastrointestinal issues, which should be monitored closely during treatment.
- Pregnant women should use Dexamethasone with caution, under the guidance of a healthcare provider.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
COVID-19 Protocol for Decadron (Dexamethasone)
- The use of dexamethasone in patients with COVID-19 has been studied in several trials, with varying results 2, 3, 4, 5, 6.
- The RECOVERY trial showed that dexamethasone reduced 28-day mortality compared to standard care in hospitalized patients with suspected or confirmed COVID-19 requiring supplemental oxygen or invasive mechanical ventilation 3.
- The EARLY-DEX COVID-19 trial is investigating the use of dexamethasone in hospitalized patients with COVID-19 pneumonia without additional oxygen requirements and at risk of progressing to severe disease 2.
- The results of the RECOVERY trial suggest that dexamethasone may be beneficial for patients with COVID-19 who are receiving supplemental oxygen or invasive mechanical ventilation, but not for those who are not receiving respiratory support 3.
- A study comparing standard and extended dexamethasone duration found that extended duration was associated with a significant increase in in-hospital mortality in patients with severe COVID-19 4.
- A randomized clinical trial comparing low-dose and high-dose dexamethasone found that high-dose dexamethasone did not result in better clinical improvement and was associated with higher 28-day mortality in patients on high-flow oxygen or noninvasive ventilation 5.
- A national cohort study found that early administration of dexamethasone was associated with reduced odds of mortality or discharge to hospice in patients requiring supplemental oxygen or mechanical ventilation, but not in those requiring no supplemental oxygen or noninvasive positive pressure ventilation 6.
Dexamethasone Dosage and Duration
- The recommended dose of dexamethasone for patients with COVID-19 is 6 mg daily for up to 10 days 3, 4.
- The duration of dexamethasone treatment may vary depending on the patient's condition and response to treatment 4, 5.
- Extended duration of dexamethasone treatment has been associated with increased in-hospital mortality in patients with severe COVID-19 4.