Dexamethasone vs. prednisone: Differences, similarities, and which is better for you.A Different Look at Corticosteroids | AAFP
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Prednisone vs dexamethasone. Dexamethasone vs. prednisone: Differences, similarities, and which is better for you
After the gel clears, treatment may often be resumed with less frequent application. These preparations should not be used in or near the eyes or on infected membranes. Information for Years: A mild burning sensation will not be felt on first application and some side and peeling of the skin will last within a few days. Round the first weeks of treatment a sudden fit in peeling will occur in most areas.
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. Prednisone or prednisolone has a bitter taste, and its prolonged treatment is frequently associated with vomiting. Dexamethasone (DEX) is a long-acting. 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. Frequency of vomiting at ED RR 0. Corticosteroids may also be used in the treatment of tuberculous meningitis. 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. Alcoholic hepatitis is a chronic, progressive and often fatal disease. Tablet, injection, oral solution, ophthalmic drops alone and in combination with other ingredientsophthalmic ointments in combination with other ingredients. Cochrane Database Syst Rev. Your healthcare provider will determine the best dosage for you based on your health condition and response to treatment.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 4 , 7.
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 3 , 4. 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 1 , 7 , 13 , 18 — 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 20 , there was no statistical significant difference between asthma severity scores of the two study groups. Dexamethasone was administered as a 1-day 1 , 13 , 18 or 2-days therapy 7 , 20 , 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 7 , 13 , 18 , With a re-admission rate of 1. Data on the incidence of vomiting in ED were retrieved from four studies 7 , 13 , 18 , 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 1 , 13 , 18 , 20 , An appropriate method of allocation concealment was utilized in four trials 1 , 13 , 18 , Only three studies 1 , 18 , 20 provided sufficient information on blinding of participants and personnel while only two trials 1 , 18 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 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.
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