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Use of dexamethasone and other corticosteroids in Covid-19

The HCSP reviewed recent publications on the use of dexamethasone and corticosteroids in the treatment of Covid-19, including the Recovery study and the WHO meta-analysis. Preliminary results demonstrate the usefulness and efficacy of dexamethasone in the treatment of some Covid-19 patients. The HCSP provides for alternative medicines in case of supply tension of dexamethasone.

The HCSP analyses the conditions of use of corticosteroids in different categories of patients hospitalized with Covid-19, in particular with regard to:

    • the corticosteroids actually used in clinical practice;
    • dosages and routes of administration (injectable or oral);
    • the time of initiation of treatment according to clinical and biological data;
    • the molecules to be used as substitutes.

The HCSP recommends the application of the Recovery protocol, i.e. 6 mg/day of dexamethasone for 10 days, or in case of tension in the supply of dexamethasone, 32 mg/day of methylprednisolone, or 40 mg/day of prednisone, or as a last resort, 160 mg/day of hydrocortisone for 10 days, with a gradual decrease in dose over a period of three or four days.

Although betamethasone has the closest pharmacological profile to dexamethasone, the HCSP has no opinion on its substitution due to lack of clinical data on its use for Covid-19.

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