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Dexamethasone - a corticosteroid

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Dexamethasone is a type of corticosteroid medication. It is used in the treatment of many conditions, including rheumatic problems, a number of skin diseases, severe allergies, asthma, chronic obstructive lung disease, croup, brain swelling, and along with antibiotics in tuberculosis. 


In adrenocortical insufficiency, it should be used together with a medication that has greater mineralocorticoid effects such as fludrocortisones. In preterm labor, it may be used to  improve outcomes in the baby. It may be taken by mouth, as an injection into a muscle, or intravenously. The effects of dexamethasone are frequently seen within a day and last for about three days.

The long-term use of dexamethasone may result in thrush, bone loss, cataracts, easy bruising, or muscle weakness. It is pregnancy category C in the United States meaning use should be based on benefits being predicted to be greater than risks. 

In Australia, it is category A, meaning it 
has been frequently used in pregnancy and not been found to cause problems to the baby. It should not be taken when breastfeeding. Dexamethasone has anti-inflammatory and immunosuppressant effects.

Dexamethasone was first made in 1957. It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system.

Dexamethasone is not expensive. In the United States a month of medication typically costs less than 25 USD. In India a course of treatment for preterm labor is about 0.5 USD. It is available in most areas of the world.

Uses


Dexamethasone is used to treat conditions such as arthritis, blood/hormone/immune system 
disorders, allergic reactions, certain skin and eye conditions, breathing problems, certain bowel disorders, and certain cancers. It is also used as a test for an adrenal gland disorder (Cushing's syndrome).

This medication is a corticosteroid hormone (glucocorticoid). It decreases your body's natural defensive response and reduces symptoms such as swelling and allergic-type reactions


Anti-inflammatory


Dexamethasone is used to treat many inflammatory and autoimmune conditions, such as rheumatoid arthritis and bronchospasm. 

Idiopathic thrombocytopenic purpura, a decrease in numbers of platelets due to an immune problem, responds to 40 mg daily for four days; it may be administered in 14-day cycles. It is unclear whether dexamethasone in this condition is significantly better than other glucocorticoids.

It is also given in small amounts[9] before and/or after some forms of dental surgery, such as the 
extraction of the wisdom teeth, an operation which often leaves the patient with puffy, swollen 
cheeks.

Dexamethasone is commonly given as a treatment for croup in children, as a single dose can reduce the swelling of the airway to improve breathing and reduce discomfort.

It is injected into the heel when treating plantar fasciitis, sometimes in conjunction with triamcinolone acetonide. It is useful to counteract allergic anaphylactic shock, if given in high doses.
It is present in certain eye drops – particularly after eye surgery – and as a nasal spray (trade name Dexacort), and certain ear drops (Sofradex, when combined with an antibiotic and an antifungal).

Dexamethasone intravitreal steroid implants (trade name Ozurdex) have been approved by the FDA to treat ocular conditions such as diabetic macular edema, central retinal vein occlusion, and uveitis.

Dexamethasone has also been used with antibiotics to treat acute endophthalmitis.

Dexamethasone is used in transvenous screw-in cardiac pacing leads to minimize the inflammatory response of the myocardium.

The steroid is released into the myocardium as soon as the screw is extended and can play a significant role in minimizing the acute pacing threshold due to the reduction of inflammatory response. The typical quantity present in a lead tip is less 
than 1.0 mg.
Dexamethasone may be administered before antibiotics in cases of bacterial meningitis. It acts to reduce the inflammatory response of the body to the bacteria killed by the antibiotics (bacterial death releases proinflammatory mediators that can cause a response which is harmful), thus reducing hearing loss and neurological damage. Dexamethasone phosphate for injection

Cancer


People with cancer undergoing chemotherapy are often given dexamethasone to counteract 
certain side effects of their antitumor treatments. Dexamethasone can increase the antiemetic
effect of 5-HT3 receptor antagonists, such as ondansetron.

The exact mechanism of this interaction is not well-defined, but it has been theorized that this effect may be due to, among many other causes, inhibition of prostaglandin synthesis, anti-inflammatory effects, immunosuppressive effects, decreased release of endogenous opioids, or a combination of the aforementioned.




In brain tumors (primary or metastatic), dexamethasone is used to counteract the development of edema, which could eventually compress other brain structures. It is also given in cord compression, where a tumor is compressing the spinal cord. 

Dexamethasone is also used as a direct chemotherapeutic agent in certain haematological malignancies, especially in the treatment of multiple myeloma, in which dexamethasone is given alone or in combination with other chemotherapeutic drugs, including most commonly with thalidomide (Thal-dex), lenalidomide, bortezomib (Velcade, Vel-dex), or a combination of doxorubicin (Adriamycin) and vincristine or bortezomib/lenalidomide/dexamethas ne. 

Endocrine


Dexamethasone is the treatment for the very rare disorder of glucocorticoid resistance. In adrenal insufficiency and Addison's disease, dexamethasone is prescribed when the patient does not respond well to prednisone or methylprednisolone. 

It can be used in congenital adrenal hyperplasia in older adolescents and adults to suppress ACTH production. It is typically given at night.

Pregnancy


Dexamethasone may be given to women at risk of delivering prematurely to promote maturation
of the fetus' lungs. This has been associated with low birth weight, although not with increased rates of neonatal death.

Dexamethasone has also been used during pregnancy as an off-label prenatal treatment for the symptoms of congenital adrenal hyperplasia (CAH) in female babies. CAH causes a variety of physical abnormalities, notably ambiguous genitalia.

Early prenatal CAH treatment has been shown to reduce some CAH symptoms, but it does not treat the underlying congenital disorder. 

This use is controversial: it is inadequately studied, only around one in ten of the foetuses of 
women treated are at risk of the condition, and serious adverse events have been documented.

Experimental use of dexamethasone in pregnancy for foetal CAH treatment was discontinued in Sweden when one in five cases suffered adverse events. A small clinical trial found long-term effects on verbal working memory among the small group of children treated prenatally, but the small number of test subjects means the study cannot be considered definitive.


High-altitude illnesses


Dexamethasone is used in the treatment of high-altitude cerebral edema (HACE), as well as high-altitude pulmonary edema (HAPE). It is commonly carried on mountain-climbing expeditions to help climbers deal with complications of altitude sickness.

Nausea and vomiting


Intravenous dexamethasone is effective for prevention of nausea and vomiting in people who had surgery and whose post-operative pain was treated with long-acting spinal or epidural spinal 
opioids.

The combination of dexamethasone and a 5-HT3 receptor antagonist such as ondansetron is more effective than a 5-HT3 receptor antagonist alone in preventing postoperative nausea and vomiting.

Sore throat


A single dose of dexamethasone or another steroid speeds improvement of a sore throat. 

Side Effects


Stomach upset, headache, dizziness, menstrual changes, trouble sleeping, increased appetite, or weight gain may occur. If any of these effects persist or worsen, notify your doctor or pharmacist promptly.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell your doctor right away if any of these unlikely but serious side effects occur: signs of infection (e.g., fever, persistent sore throat), bone/joint pain, increased thirst/urination, fast/slow/irregular heartbeat, eye pain/pressure, vision problems, heartburn, black stools, vomit 
that looks like coffee grounds, puffy face, swelling of the ankles/feet, stomach/abdominal pain, pain/redness/swelling of arms/legs, tiredness, mental/mood changes (e.g., depression, mood swings, agitation), unusual hair/skin growth, muscle pain/cramps, weakness, easy bruising/bleeding, slow wound healing, thinning skin, seizures.

A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling 
(especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

Contraindications


Contraindications of dexamethasone include
  • Uncontrolled infections
  • Known hypersensitivity to dexamethasone
  • Cerebral malaria
  • Systemic fungal infection
  • Concurrent treatment with live virus vaccines (including smallpox)
Dexamethasone - a corticosteroid Dexamethasone - a corticosteroid Reviewed by gafacom on July 16, 2019 Rating: 5

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