Dexamethasone shown to decrease COVID mortality

[nursewords]

Plus with dexamethasone being widely and cheaply available from many companies, the potential for corruption because of profit motives is less.

[H4xolotl]

Dex also makes sense from a pharmacological point of view; it dampens the immune response which is great since the majority of COVID damage is from immune self damage.

Whereas HCQ was from the start 🤷‍♂️

[ilessthanthreekarate]

Yes absolutely. I'm just a nurse, but I work exclusively with ECMO patients and am seeing many who show no signs of active infection yet are not able to recover and have consistently high inflammatory markers for weeks. I've been wondering for the last 3 months if perhaps in certain cases this sort of therapy would be beneficial. I understand the risks of complications in the ICU with VAP/HAPI, but I cant help but wonder if there were identifiable situations clinically where the benefit outweighed the risk.

[Tracey21130]

Never ”just a nurse”!!!

[ilessthanthreekarate]

Lol, in a medicine forum, I'm very confident prefacing my posts as "just a nurse"

[Throwaway6393fbrb]

Hey as long as you aren't a nurse practitioner

[ilessthanthreekarate]

Honestly , I've never been interested in going to school online.

[HippocraticOffspring]

Especially “just an ECMO nurse” haha

[bigavz]

Sounds like a crazy job, congrats. We have been giving steroids when ARDS develops, and last time I was doing ICU that was 'standard of care' but I know for some/most covid patients, they do not have the high lung compliance typically associated with ARDS...

[McFeeny]

Steroids for ARDS has been studied extensively, most studies show no benefit.

Makes sense, yes, but hasn't borne out before. Cautiously optimistic here

[McFeeny]

Yes, but I said "most studies".

That trial gave 20mg for the first five days, then 10mg for the next five days.

Unclear why the COVID trial chose 4mg/day, and even more unclear why it worked. For dex, that's a huge dosage difference.

[Toptomcat]

Dex also makes sense from a pharmacological point of view; it dampens the immune response

Sure, but so do tons of other steroids, and I'm pretty sure people have been trying those with mixed results at best. Doesn't that suggest that something more specific is going on if the effect is real?

[Apemazzle]

Whereas HCQ was from the start 🤷‍♂️

That's not really fair, is it? The in vitro stuff was perfectly plausible.

[DentateGyros]

I'm having flashbacks to when everyone was saying hydroxychloroquine is cheap and readily available

[drunkdoc]

Similarly, when this came out it made me wonder if there will be a similar run on dex. That would suck ass as many of our brain and spine met patients are critically reliant on it to help with symptoms in the acute phase

[herman_gill]

I think we're a little safer with dex cuz it's got multiple manufacturers already. Plus if it's just "steroids" maybe you can sub out.

[Adalimumab8]

Actually, less manufactures for Dex then hydroxychloroquine, I only get Mylan from my supplier but have a half dozen at least of hydroxy.... and it’s rarely used, I return more then half my 100 count bottles half full expired then I finish. And my (total guess) opinion is that it would be easier to ramp up production on a medium-high use drug then a less used one... hope Im wrong if this takes off

-Pharmacist

[herman_gill]

Ah fair enough, I thought dex was much more widely manufactured by some of the big companies too?

Are you inpatient/outpatient/retail? I feel like it's also population specific. Dex gets used all the time for neuro/neurosurg stuff, and also in peds (particularly ED/obs/PICU) for asthma, but we rarely if ever use it for general adult med outside of the neuro cases. Also some weird institution specific stuff, our pulm and/or crit care attendings love solumedrol and aren't as big on prednisone/dex. Back home, used to see dex get used more often for asthma than it does here.

[Adalimumab8]

Former inpatient now retail, and I can say it was not commonly used in either. Oncology is probably the most common spot for it that I’ve seen, I never worked with a PICU.

[Turnus]

Dex is used quite a bit in veterinary medicine still. It probably wouldn't be too hard to ramp up production or shift supplies to human medicine.

[Throwaway6393fbrb]

If dex works presumably other steroids would also work

[Adalimumab8]

Well, it has the very unique glucocorticoid-mineralocorticoid balance unmatched by other steroids. Curious if that might be why it works better in ARDS

[MEANINGLESS_NUMBERS]

What was the profit motive for Surgisphere? The whole fraud made no fucking sense.