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Originator: CMO Messaging

 
From: Professor Chris Whitty

Issue date: Originally issued on 16-Jun-2020 17:39:46. This version was issued on 16-Jun-2020 17:39:46

Action by recipients:
  • NHS Foundation Trusts (England) - Medical Director
  • NHS Foundation Trusts (England) - Chief Executive
  • NHS Trusts (England) - Medical Director
  • NHS Trusts (England) - Chief Executive

Information to recipients:
  • MHRA (Medicines) Drug Alerts (Various Recipients)
  • Other contacts
  • Independent Healthcare Providers (registered with CAS)
  • Clinical Commissioning Groups
  • NHS Regional Offices
  • Special Health Authorities
  • CMO Urgent Messages - Non-NHS Recipients on Public Health Link
  • MHRA (Medicines) Drug Alerts - Non-NHS Recipients
  • Territorial CMOs in Northern Ireland, Scotland & Wales
  • Regional Directors of Public Health
  • Consultants in Communicable Diseases
  • CMO Urgent Messages - Recipients on Public Health Link
  • Director of Public Health
  • DHSC Supply Disruption - Medicines
  • Out of hours contacts

Action category: Important information for immediate action

Title: Dexamethasone in the treatment of COVID-19: Implementation and management of supply for treatment in hospitals

Broadcast content:
24 June: we have updated the Clinical Guidance section of this alert to include updated information on the interaction between remdesivir and dexamethasone. The updated alert is attached, the reworded section is in blue below.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely (University of Liverpool COVID-19 Drug Interactions). Dexamethasone is a substrate of CYP3A4 and although remdesivir inhibits CYP3A4, due to remdesivir's rapid clearance after i.v administration, remdesivir is unlikely to have a significant effect on dexamethasone exposure. Dexamethasone is unlikely to have a clinically significant effect on remdesivir as remdesivir has a moderate-high hepatic extraction ratio, and is used for a short duration in the treatment of COVID-19. Remdesivir is currently available as an EAMS.


Dexamethasone has been demonstrated to have a clear place in the management of hospitalised patients with COVID-19. There were no excess harms identified in using this dose of dexamethasone in this patient population. Dexamethasone was not used in pregnant women.

Clinicians should therefore consider dexamethasone for the management of hospitalised patients with COVID-19 who require oxygen or ventilation.

Out of hospital treatment is not appropriate.

There is no current or anticipated constraint on supply of the medicine in the UK.

Please see the attached alert for further information.


Additional information: This alert does not need to be cascaded to primary care.

Alert reference: CEM/CMO/2020/026

Attachments:

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Email: safetyalerts@mhra.gov.uk

Medicines and Healthcare products Regulatory Agency