Per policy, orders for these non-formulary agents will be changed to formulary equivalents.
Non-Formulary Agent
Formulary Equivalent
methylPREDNISolone, hydrocortisone if unavailable (except in MS, Lupus, spinal cord injury, pediatrics)
dexAMETHasone (Decadron) 10 mg load, then if < 250 lb, 4 mg q6h; if > 250 lb, 8 mg q6h
2023 American Geriatrics Society Beers Criteria® for potentially inappropriate medication use in older adults.
Medication:
hydrocortisone (Solu-CORTEF, Cortef)
Criteria 2: Potentially inappropriate medication use in older adults due to drug–disease or drug–syndrome interactions that may exacerbate the disease or syndrome. (Table 3)
Comments
corticosteroids (oral and parenteral) Excludes inhaled and topical forms. Oral and parenteral corticosteroids may be required for conditions such as exacerbation of COPD but should be prescribed in the lowest effective dose and for the shortest possible duration.
Drug(s) ⇆ disease or syndrome
corticosteroids ⇄ Delirium
Rationale
Avoid in older adults with or at high risk of delirium because of the potential of inducing or worsening delirium. If needed, use the lowest possible dose for the shortest duration and monitor for delirium.
Recommendation
Avoid, except in situations listed under the rationale statement.
Quality of evidence: Moderate, Strength of Recommendation: Strong
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If needed, use the lowest possible dose for the shortest duration and monitor for delirium.