1. Introduction
Dexamethasone is a potent corticosteroid with anti-inflammatory and immunosuppressant properties. It is widely used to treat a range of conditions, including inflammation, autoimmune disorders, and certain cancers. It works by inhibiting inflammatory mediators and suppressing the immune response, making it highly effective in managing swelling, redness, and hypersensitivity reactions.
2. Indications
- Approved Indications:
- Inflammatory and autoimmune diseases (e.g., rheumatoid arthritis, lupus, ulcerative colitis).
- Allergic reactions (e.g., asthma exacerbations, anaphylaxis).
- Certain cancers (e.g., leukaemia, lymphoma, and multiple myeloma).
- Cerebral oedema associated with brain tumours or head injury.
- Adrenal insufficiency (as replacement therapy).
- Prevention and treatment of nausea and vomiting induced by chemotherapy.
- COVID-19 (severe cases requiring oxygen or mechanical ventilation).
- Off-Label Uses:
- Acute mountain sickness.
- Croup in children.
3. Dosage
- Adults:
- Inflammatory conditions: 0.5–10 mg daily, adjusted based on the condition and response.
- Cerebral oedema: Initial dose of 10 mg IV, followed by 4 mg every 6 hours until symptoms improve.
- COVID-19: 6 mg orally or IV once daily for up to 10 days.
- Children:
- Inflammatory conditions: 0.08–0.3 mg/kg/day in divided doses (maximum: 16 mg/day).
- Croup: Single oral dose of 0.15–0.6 mg/kg (maximum: 10 mg).
- Elderly:
- Use the lowest effective dose due to increased risk of side effects.
4. Administration
- Oral tablets: Can be taken with or without food. Take with food if gastrointestinal discomfort occurs.
- Injectable forms: Administer intramuscularly, intravenously, or intra-articularly, depending on the condition.
- Topical forms: Apply thinly to affected areas; avoid prolonged use.
5. Forms Available
- Tablets: 0.5 mg, 2 mg, 4 mg.
- Injectable solution: 4 mg/mL, 10 mg/mL.
- Topical forms (creams, ointments): 0.05%.
- Oral solution: 0.5 mg/5 mL.
6. Side Effects
6.1. Common Side Effects
- Insomnia.
- Increased appetite and weight gain.
- Hyperglycaemia.
- Mood changes (e.g., anxiety, irritability).
6.2. Less Common Side Effects
- Hypertension.
- Acne or skin thinning.
- Muscle weakness.
6.3. Rare but Serious Side Effects
- Adrenal suppression (with long-term use).
- Osteoporosis and fractures.
- Increased risk of infections.
- Cataracts and glaucoma.
7. Warnings
- Adrenal Suppression: Prolonged use can suppress adrenal gland function; taper doses gradually to avoid adrenal crisis.
- Infections: May mask signs of infection or increase susceptibility to infections.
- Psychiatric Effects: Can cause mood swings, depression, or psychosis.
- Caution in Diabetes: May worsen hyperglycaemia; monitor blood glucose levels.
8. Precautions
- Use cautiously in patients with peptic ulcer disease, hypertension, osteoporosis, or infections.
- Monitor closely in children, as prolonged use can impair growth.
- Use with caution in elderly patients due to increased risk of side effects like osteoporosis and glaucoma.
9. Interactions
- Drug-Drug Interactions:
- NSAIDs: Increased risk of gastrointestinal bleeding.
- Antidiabetic drugs: Reduced efficacy, requiring dose adjustment.
- CYP3A4 inducers (e.g., rifampin, phenytoin): Reduce dexamethasone levels.
- CYP3A4 inhibitors (e.g., ketoconazole): Increase dexamethasone levels.
- Drug-Food Interactions:
- Avoid excessive sodium intake, as dexamethasone can cause fluid retention.
10. Monitoring Parameters
- Blood pressure and blood glucose levels, especially in diabetic patients.
- Weight and electrolyte levels (sodium, potassium).
- Bone density in long-term therapy.
- Signs of infection or adrenal insufficiency.
11. Use in Children
- Safe for short-term use at appropriate doses, but monitor for growth suppression in long-term use.
12. Use in Pregnancy
- Category C: May be used if benefits outweigh risks, particularly in life-threatening conditions.
- Prolonged use may lead to foetal growth restriction or adrenal suppression in the neonate.
13. Use in Elderly
- Use cautiously to minimise risks of osteoporosis, hypertension, and glucose intolerance. Start at the lowest effective dose.
14. Use in Kidney Disease
- No specific dose adjustment is required, but monitor fluid retention and electrolyte imbalance.
15. Use in Liver Disease
- May require dose adjustments due to altered metabolism in hepatic impairment.
16. Patient Counselling Points
- Take dexamethasone exactly as prescribed and avoid abruptly stopping the medication.
- Report signs of infection, unusual bruising, or severe mood changes to your doctor.
- Take oral doses in the morning to reduce the risk of insomnia.
- For long-term users, discuss calcium and vitamin D supplementation to prevent bone loss.
- Carry a steroid treatment card if on prolonged therapy, to inform healthcare providers in emergencies.
17. Table of Brand Names, Manufacturers, and Prices
Brand Name | Manufacturer | Price (USD) |
---|---|---|
Decadron | Merck & Co. | $20–30 (30 tablets, 4 mg) |
Dexasone | Various | $15–25 (30 tablets, 4 mg) |
Generic Options | Various | $10–20 (30 tablets, 4 mg) |
18. FAQs (15 Questions)
- What is dexamethasone used for?
It is used to treat inflammation, allergies, autoimmune diseases, certain cancers, and severe COVID-19. - How does dexamethasone work?
It suppresses inflammation and the immune response by inhibiting inflammatory mediators. - Can dexamethasone be used long-term?
Yes, but it requires close monitoring due to risks like adrenal suppression and osteoporosis. - What are the common side effects of dexamethasone?
Insomnia, weight gain, hyperglycaemia, and mood changes are common. - Can dexamethasone cause weight gain?
Yes, due to increased appetite and fluid retention. - Can dexamethasone be stopped suddenly?
No, it should be tapered gradually to avoid adrenal insufficiency. - Can dexamethasone be taken during pregnancy?
It may be used if the benefits outweigh the risks, particularly for severe conditions. - How should dexamethasone be taken?
Follow the prescribed dose and timing; take oral forms with food if gastrointestinal discomfort occurs. - Does dexamethasone interact with other medications?
Yes, it interacts with NSAIDs, CYP3A4 inhibitors/inducers, and antidiabetic drugs. - What should I do if I miss a dose of dexamethasone?
Take it as soon as you remember, unless it’s close to the next dose. Do not double up. - Can dexamethasone cause mood changes?
Yes, it can cause mood swings, anxiety, or even psychosis in some patients. - How long does it take for dexamethasone to work?
Effects vary, but symptom relief may occur within hours to a few days. - Can children take dexamethasone?
Yes, it is safe for short-term use, but monitor for growth suppression in long-term therapy. - What should I avoid while taking dexamethasone?
Avoid excessive sodium, alcohol, and close contact with people who have infections. - How should dexamethasone be stored?
Store at room temperature, away from light and moisture.