What Is Dexamethasone?

Dexamethasone is a synthetic glucocorticoid used in the treatment of inflammatory and immune conditions in children and adults. It is available in forms that can be taken by mouth, through a patch placed on the skin, as a cream, in eye drops, and as an injectable. Take the tablet form of the medication with a full glass of water (8 oz). To prevent stomach upset, it can be taken with food.

Dexamethasone is typically used for treating chronic conditions, but it can be a short-term treatment for acne. Because it suppresses the immune system, dexamethasone isn’t usually prescribed when a person is at risk of developing an infection. However, it is sometimes used, with caution, to manage the effects of severe inflammatory reactions caused by infections.

Uses 

Dexamethasone is a steroid that imitates the effects of glucocorticoids—natural steroid hormones produced by the adrenal glands. While it can be used to treat a deficiency of naturally-occurring glucocorticoids, most commonly, dexamethasone is used to treat inflammatory and autoimmune conditions, like lupus and sarcoidosis.

Dexamethasone works by suppressing the immune system and reducing inflammation. Because it reduces edema, or swelling of the body’s tissues, dexamethasone is often used to decrease fluid accumulation related to trauma, post-operative swelling, or cancer. 

Indications 

Dexamethasone is approved for treating acute and chronic illnesses as well as certain medical emergencies. 

Common conditions treated with dexamethasone include: 

• Inflammatory conditions, including osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, bursitis, systemic lupus erythematosus (SLE), and rheumatic carditis 
• Skin conditions like severe psoriasis, pemphigus, Stevens­ Johnson syndrome, and atopic dermatitis 
• Respiratory inflammation in laryngeal edema (swelling of the throat), childhood croup, and bronchial asthma 
• Inflammation of the eye associated with uveitis, choroiditis, and optic neuritis
• Neurological diseases like multiple sclerosis and temporal arteritis
• Gastrointestinal disease like ulcerative colitis
• Systemic conditions including autoimmune hemolytic anemia and nephrotic syndrome
• Severe infections related to pulmonary tuber­culosis 
• Cerebral edema (swelling of the brain) due to cancer, trauma, a severe stroke, or brain surgery

It may also be used for:

• Replacement of glucocorticoids in acute and chronic adrenal insufficiency such as Addison's disease
• Adjunctive treatment with chemotherapy for cancer, including leukemia and multiple myeloma 
• Pre-operative treatment before certain procedures 

Off-Label Uses 

Sometimes, dexamethasone is used to manage symptoms characterized by swelling and hyperreactive inflammation even when a diagnosis is not clearly established.

Treatment for COVID-19 Patients

Low-dose dexamethasone is one of several existing medications being investigated as potential treatments for COVID-19 infection in the RECOVERY (Randomised Evaluation of COVID-19 Therapy) trial, which began in March 2020. It is being used to treat people suffering from severe complications, particularly patients on ventilators.

Dexamethasone seems to reduce severe inflammation that worsens COVID-19. However, because it suppresses the immune system, there is also a risk that it could interfere with the body’s ability to fight the virus.

Other treatments in the trial include:

• lopinavir-ritonavir
• hydroxychloroquine (discontinued in the study)
• azithromycin
• tocilizumab
• convalescent plasma from donors who have recovered from COVID-19

In the trial, 2,104 patients hospitalized for COVID-19 were randomly selected to receive 6 milligrams (mg) of dexamethasone once per day for 10 days, either by mouth or IV injection. These patient outcomes were compared to those of 4,321 COVID-19 patients who did not receive dexamethasone as an investigational treatment.

Preliminary results released on June 16 show dexamethasone reduced the 28-day COVID-19 mortality rate by 17% and was especially beneficial for people who needed supplemental oxygen or intubation. Researchers found no benefits of dexamethasone for COVID-19 for patients who did not require oxygen.

The trial is still underway. Results have not been published or peer-reviewed.

Before Taking

Your healthcare provider may require diagnostic testing, like blood tests or imaging tests, before prescribing dexamethasone for something like an inflammation condition. Blood tests can confirm a high white blood cell count consistent with inflammation, and imaging tests can confirm swelling or fluid accumulation indicative of edema.

Typically, when dexamethasone is used for the management of a chronic condition like bronchial asthma or sarcoidosis, the diagnosis has already been confirmed.

Precautions and Contraindications 

Limit alcoholic beverages as alcohol usage may increase your risk for stomach bleeding.

Dexamethasone is not recommended for people who have a fungal infection. 

Use dexamethasone with caution if you have certain conditions, including:

• A gastrointestinal ulcer
• Diverticulitis
• Osteoporosis
• Myasthenia gravis
• Cataracts
• Glaucoma
• Diabetes

All forms of dexamethasone can pose a risk to unborn babies or breastfeeding mothers and their babies. This medication may also interfere with fertility for men and women. 

Dosage

There are several forms and doses of dexamethasone. While not every formulation is used for each condition, some conditions can be treated with more than one formulation of dexamethasone. The recommended dose varies widely depending on the condition being treated.

When used as a patch, cream, or eye drops, the medication is generally applied directly to the affected area. It is used daily (or several times per day) until the acute inflammatory condition subsides.

Oral Dose

In an oral pill or liquid form, dexamethasone may be started at a dose between 0.5 to 9 mg per day. For children, the initial dose typically ranges from 0.02 to 0.3 mg/kg per day divided into three or four divided doses throughout the day.

Injected Dose

Dexamethasone sodium phosphate at a strength of 10 mg/mL is used for intramuscular injection. It can be given directly from the vial, or added to sodium chloride injection or dextrose injection and administered via an intravenous drip. As with the oral dose, the injected dose varies depending on the condition being treated.

For example, when it is used to treat allergic diseases, dexamethasone may be administered at a dose of 4 to 8 mg as an injection, followed by oral treatment of 1.5 mg twice daily, and gradually lowered over time.

Side Effects

Many of the common side effects of dexamethasone, such as infections and hypertension, are fairly mild, especially when the medication dose is low and when you don’t have serious medical conditions.

Common 

Even on a low dose of dexamethasone, you can experience a number of side effects. Typically, these side effects resolve within a few weeks after you stop taking it.

Common side effects include:

• Increased appetite
• Trouble sleeping
• High blood pressure
• Heartburn
• Headache
• High blood sugar
• Low potassium
• Sodium retention
• Edema of the hands, feet, or other areas of the body
• Infections
• Oral thrush (yeast infection in the mouth and throat)
• Acne
• Gastrointestinal ulcers
• Osteoporosis
• Cataracts

Severe 

Severe side effects of dexamethasone are rare and can be life-threatening. These side effects may require urgent medical intervention. If you experience serious side effects, do not abruptly stop taking dexamethasone, because that can cause withdrawal effects.

Severe side effects include:

• Inhibition of growth in children
• Very high blood sugar
• Malignant hypertension (extremely high blood pressure)
• Endocrine dysfunction
• Severe infections
• Heart failure
• Myopathy (muscle disease)
• Glaucoma
• Mood instability
• Bone necrosis (severe degeneration of the bone)
• Cushing's syndrome (with chronic use)

Warnings and Interactions

Because it is a steroid, dexamethasone can interact with a number of medications. Some of the commonly used medications that can interact with dexamethasone include:

• Aspirin: Using aspirin and dexamethasone together increases the chances of gastrointestinal irritation, ulcers, and bleeding.
• Hydrochlorothiazide: Taking this diuretic (water pill) when you are taking dexamethasone can exacerbate low potassium levels.
• Erythromycin: This antibiotic can raise the concentration of dexamethasone in the body.
• Metformin: This medication is used to treat high blood sugar in diabetes. Dexamethasone can raise blood sugar, necessitating a metformin dose adjustment.
• Hormones such as estrogen and testosterone: Dexamethasone can interact with these hormones, and taking them together may lower the concentration of either the therapeutic dexamethasone or testosterone or estrogen in the body.

Withdrawal 

Withdrawal can be a serious problem if you abruptly stop taking dexamethasone. It may lead to sudden dangerous changes in your blood pressure and blood sugar levels. Often, the medication needs to be gradually reduced with a slow, scheduled dose reduction before it is completely discontinued so your body can resume its normal glucocorticoid production.