The new normal for prescribing medication

prescribing during a pandemic
on Tue 9 Jun

 

Health specialists across all disciplines have had to work very hard over the recent months in order to review the way in which medication is prescribed to their patients during the COVID pandemic.

 

Many factors have had to be taken into account:

 

  • It may not have been possible to change the level of medication without a face to face review.
  • Normal monitoring may have been unavoidably disrupted
  • The type and amount of medication may have been impacted  with the onset of Coronavirus symptoms
  • The use of electronic prescribing has had to be increased
  • Some patients will have had to be advised about how to self-monitor. This may have included the use of personal blood pressure and oxygen monitors
  • The potential benefits and risks of starting or maintaining treatment and the consequences of it being postponed or withheld
  • Working out how to best mitigate, monitor and manage any adverse effects
  • Consideration as to the practical restraints of requesting, supplying and continuing prescriptions – for example when the patient is unable to collect their prescription
  • Working out efficient mechanisms of communication with other involved colleagues
  • Getting accord on new advice between experts from the many various medical disciplines
  • Working out how to enable pharmacies to supply controlled drugs to patients who are using these
  • Creating written guidance for patients to access retain and follow -  such as this NHS Emergency Steroid Card

 

Advising Patients

As a result of the above many patients will have letters sharing specific advice about managing their medications during the current pandemic.

Here is a sample of updated advice with regard to sick day rules for patients who are steroid dependent due to Addison’s disease, adrenal insufficiency, pituitary steroid insufficiency or other conditions requiring the long term use of steroids.

 

Patients taking Hydrocortisone (including Plenadren)

If you are mildly unwell and taking ordinary Hydrocortisone

Take ordinary Hydrocortisone tablets 20mg four times daily (every 6 hours).

If taking Plenadren switch to immediate release hydrocortisone and take 20mg orally every 6 hours

Switch to ordinary Hydrocortisone tablets 20 mg four times daily (every 6 hours).

If high fever persists or you are feeling ill and severely fatigued

Increase your Hydrocortisone to 50mg orally every 6 hours and seek medical advice.

 

Patients taking Prednisolone

If you are mildly unwell and your usual dose is between 3-10 mg per day

Increase to 10 mg twice a day

If you are mildly unwell and your usual dose is between 10-20 mg per day

 

Increase to 10 mg twice a day

If you are mildly unwell and your usual dose is more than 20 mg per day

 

Continue on the same dose but split to twice a day, e.g.

·     25 mg a day to 15 mg in the am, 10 mg in the pm

·     30 mg a day to 15 mg in the am, 15 mg in the pm

·     40 mg a day to 20 mg in the am, 20 mg in the pm

 

If high fever persists or you are feeling ill and severely fatigued

 

Increase to 20 mg twice a day and seek medical advice.

 

Fludrocortisone: if you are taking this, continue at usual dose

  • Drink plenty of fluid and make sure you are passing urine regularly.  You may need to wake in the night to keep drinking whilst fevers are high.
  • Take paracetamol 1000 mg every 6 hours. WARNING: Do not take other paracetamol containing products such as cough and flu remedies on top of this paracetamol.
  • Seek medical advice by calling 111 or accessing the coronavirus online information

 

If you feel extremely unwell and are admitted to hospital

Please do not hesitate to contact medical emergency services, if your symptoms of coronavirus infection significantly worsen by calling 111 or 999.

 

You should also mention that you are STEROID DEPENDENT, at risk of adrenal crisis.

Consider making your own way to hospital and take your 100mg intramuscular emergency hydrocortisone injection.

 

If you are admitted to hospital we recommend:

 

  • Hydrocortisone 100mg per intravenous injection followed by continuous IV infusion of 200mg hydrocortisone/24h.
  • Alternatively 50mg every 6h per intravenous or intramuscular bolus injection
  • Pause fludrocortisone.
  • Intravenous Fluids.
  • Show the medical team this letter.

 

If you receive communication like this it is important to put it somewhere where you can easily find it in the event of an emergency. Tell others in the house or a nearby friend or family member where this is too.

 

I hope this has been helpful. 

 

 

Although every effort is made to ensure that all health advice on this website is accurate and up to date it is for information purposes and should not replace a visit to your doctor or health care professional.

 

As the advice is general in nature rather than specific to individuals Dr Vanderpump cannot accept any liability for actions arising from its use nor can he be held responsible for the content of any pages referenced by an external link

 

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