Dexamethasone - Uses, Dosage, Side Effects, Drug Warnings, and Precautions

Overview:

Dexamethasone is a prescription drug that is available as a tablet or solution to be taken orally, eye drops, eardrops, an injectable solution, and an intraocular solution. The injectable forms can only be administered by a healthcare professional. This drug is used to treat various inflammatory conditions, including allergic reactions. It is also used for adrenal insufficiency. This drug relieves redness, itching, swelling, and allergic reaction by working on the immune system of the body.

Prolonged use of Dexamethasone can result in candidiasis (thrush), cataracts, loss of bone, or muscle weakness. It is usually not prescribed for pregnant and breastfeeding women, but it has not been found to affect the baby’s health significantly. It also suppresses the immune response.

Drug Group:

Dexamethasone belongs to the class of drugs called glucocorticosteroids (glucocorticoid). They are a synthetic form of corticosteroids, which are natural steroids secreted by the adrenal gland. The adrenal gland is a small gland located on top of the kidney. It suppresses inflammation, helps the body respond to stress, and regulates the metabolism of fat and sugar. Examples of other glucocorticoids are Beclomethasone, Budesonide, Cortisone, Hydrocortisone, Prednisolone, and Triamcinolone.

What Is Dexamethasone Used For?

Dexamethasone is used in the treatment of the following conditions that cause inflammation, and are related to immune response, and hormone insufficiency:

• Allergic reactions.

• Rheumatic diseases-

  • Rheumatoid arthritis.

  • Ankylosing spondylitis.

  • Psoriatic arthritis.

  • Juvenile rheumatoid arthritis.

  • Lupus.

  • Gout.

• Skin conditions-

  • Pemphigus.

  • Bullous dermatitis herpetiformis.

  • Stevens-Johnson syndrome.

  • Psoriasis.

  • Exfoliative dermatitis.

  • Severe seborrheic dermatitis.

• Ulcerative colitis flare-ups.

• Multiple sclerosis - An autoimmune condition that affects the brain and spinal cord.

• Myasthenia gravis - A neuromuscular condition that leads to skeletal muscle weakness.

• Before chemotherapy - To reduce inflammation and other side effects (nausea and vomiting) of chemotherapy.

• Adrenal insufficiency - Here, the adrenal glands do not produce enough hormones.

• Inflammation of the eye and ear.

• Bacterial meningitis - Bacterial infection resulting in inflammation of the protective membranes surrounding the brain.

• Cerebral edema - Excess water gets accumulated around the brain.

• Shock.

• Certain types of cancer, such as brain tumors.

• To prevent eye infection (conjunctivitis) in patients with leukemia or lymphoma during chemotherapy.

Never take Dexamethasone or any other medicine without consulting the doctor first.

Dexamethasone and COVID-19:

This is the first drug to show positive results in critically ill COVID-19 patients on ventilators or oxygen therapy. The RECOVERY clinical trial conducted by Oxford University found that Dexamethasone, in low doses, increases the survival rates in COVID-19 (coronavirus disease) patients requiring respiratory support.

The study showed the drug to reduce fatality in patients on ventilatory by one-third and in patients on oxygen by one-fifth. The drug did not show any effect on infected patients who did not need respiratory support.

DO NOT use this drug to treat the new coronavirus infection unless prescribed by the treating doctor.

How Does Dexamethasone Work?

• This is how Dexamethasone works on conditions that result in inflammation:

  • Certain inflammatory conditions make the immune system overactive, which can damage the cells in the body. Dexamethasone and other similar steroids block this immune response to inflammation and prevent further damage.

• And for adrenal insufficiency:

  • The hormones released by the adrenal gland help in controlling blood glucose levels, fighting infections, and managing stress. In adrenal insufficiency, these hormones are released in lower amounts. Dexamethasone replaces these hormones in the body.

Apart from this, corticosteroids also result in apoptosis (cell death) of certain cells. This action helps with certain types of cancer.

Onset Of Action:

It takes around 8 to 24 hours for the effects of Dexamethasone to be apparent if taken orally.

Habit-Forming:

There have been no reports of the habit-forming tendency in people taking Dexamethasone. But, a person might experience withdrawal symptoms if they stop taking the drug suddenly.

Expiry Date:

Avoid taking this medicine after it expires. The expiry date will be printed on the back of the pack.

What Is the Dosage of Dexamethasone?

The dosage of Dexamethasone will be decided by the doctor based on the age, weight, and other medical conditions. An individual will be first started on a low dosage, and depending on how the body reacts, the dosage will be modified. The oral tablet form of Dexamethasone is available in 0.25, 0.5, 0.75, 1. 1.5, 4, and 6 mg strengths.

For older adults (above 65 years of age), the dosage will be adjusted by your doctor depending on the creatinine clearance and liver function test.

Dexamethasone Overdose:

Taking too much of this drug can have severe side effects. The symptoms of overdose are irregular heartbeats, trouble breathing, hives, swelling of the throat or tongue, and seizures.

How to Use Dexamethasone?

Oral tablet and solution forms of Dexamethasone are usually prescribed. Based on the patients condition, the doctor will prescribe the appropriate dosage. Make sure the patient stick to the dosage. Read the prescription label properly, and in case the patient do not understand the prescription, ask the doctor or pharmacist to explain. Avoid taking Dexamethasone more or less than what is prescribed by the doctor, and take them after food.

This medication can also be given into the vein (intravenous), which only a healthcare provider can administer. The eye drops are used for various eye conditions and during chemotherapy, usually every 6 hours for 2 days. For skin disorders, the doctor will prescribe a topical lotion.

Never stop taking this medicine suddenly without consulting the doctor first. Sudden stoppage can result in loss of appetite, indigestion, drowsiness, headaches, confusion, fever, muscle pain, joint pain, weight loss, and dry skin. If a person have been taking this drug for a long time, they would have to reduce the dose and then stop gradually. This give body the time to adjust to the low levels of steroids. A person might experience these side effects even when they gradually decrease their dose or change to an inhalation corticosteroid drug. Report to the doctor immediately if the affected person develop these side effects. The doctor might ask the patient to start taking this medicine again or increase the dosage.

Missed Dose:

If a person miss a dose or do not take the drug on time, the drug's effectiveness might reduce, or it might stop working altogether. At all times, a certain level of this drug has to be present in the body for it to work well. In case the patient missed taking a dose of Dexamethasone, do not double the next dose. Instead, just skip the missed dose and take the next dosage.

What Are the Drug Warnings and Precautions?

There are a few things that need to be considered before taking this tablet, and inform the doctor in case they have any of the following conditions:

• Pregnancy - Dexamethasone falls under category C pregnancy drug, which means animal research has shown side effects to the fetus. Still, not enough studies have been conducted on humans to conclude anything.

• Breastfeeding - Unless necessary, the use of Dexamethasone is not recommended for breastfeeding women. The doctor will weigh the potential benefits and the risk involved before prescribing this drug.

• Allergic Reaction - This drug can potentially cause an allergic reaction. The symptoms include breathing troubles and throat swelling. Inform the doctor about any symptoms of allergy in the first instance. Never take this medicine again if the patient have had an allergic reaction. Doing so could be fatal.

• People With Other Diseases -

  • Fungal Infections - This medicine could worsen a fungal infection that affects the entire body. It might also hide the signs of other infections.

  • Recent Heart Attack - If prescribed for patients who recently had a heart attack, this drug could result in a tear in the heart muscle.

  • Congestive Heart Failure - Dexamethasone can worsen heart failure, as it increases swelling, sodium levels, and decreases potassium levels.

  • Intestinal Conditions - Dexamethasone could increase the risk of intestinal or stomach bleeding and peptic ulcers. Avoid taking this medicine if a person have peptic ulcers, diverticulitis, or ulcerative colitis.

  • Hypertension (High Blood Pressure) - As this drug increases the sodium levels in the blood, the blood pressure also increases. Talk to the physician if a person is hypertensive before taking this drug.

  • Osteoporosis - This drug can accelerate the breakdown of bone and decrease bone formation. This action increases the risk of osteoporosis (the bones become porous and thin). Postmenopausal women are more prone.

  • Hyperthyroidism - This drug is removed more quickly in people with an overactive thyroid gland than normal from the body. The dosage might need to be adjusted accordingly.

  • Eye Conditions - The risk of glaucoma and cataracts increases in patients who use Dexamethasone for a long time. People who already have an eye condition are more prone.

  • Myasthenia Gravis (MG) - If a person is taking drugs such as Memantine or Donepezil for Alzheimer’s and they have MG, taking Dexamethasone might result in severe weakness. They can prevent this by taking this medicine at least 24 hours after taking drugs for Alzheimer’s.

  • Tuberculosis - In patients with latent tuberculosis, this drug can re-activate the infection. If you ever had tuberculosis, inform your doctor before taking this drug.

  • Diabetes - The dosage of anti-diabetic drugs might need to be changed, as Dexamethasone can increase blood glucose levels.

• Abruptly Stopping the Drug - A person might experience severe withdrawal symptoms if you stop taking Dexamethasone abruptly. To prevent this, the doctor will gradually reduce the dosage before completely stopping it.

• Prolonged Wound Healing - This medicine might delay wound healing.

• Vaccinations - Live and attenuated vaccines should be avoided while on this therapy.

• Growth and Developmental Inhibition - Dexamethasone increases the risk of growth abnormalities, makes the bone brittle, and can result in other developmental problems. Its use should be restricted to children.

• Mental Health - This medicine increases the risk of anxiety, mood swings, depression, and other mental health symptoms, especially in patients with a pre-existing psychiatric disorder.

• Lowest Dosage - In order to keep the side effects and interactions under check, the doctor will start first on the lowest possible dose. The dosage will then be adjusted depending on the condition and how the patient respond.

• Kidney Conditions - Kidneys do not function efficiently in older adults, which slows the speed with which this drug is processed and excreted. This means the drug will stay in the body for a longer time, increasing the risk of side effects.

What Are the Side Effects of Dexamethasone?

The common side effects of Dexamethasone (oral tablets) are:

• Vomiting.

• Upset stomach.

• Nausea.

• Swelling or edema.

• Tiredness due to low potassium levels.

• High blood sugar levels.

• Hypertension.

• Headaches.

• Dizziness.

• Mood swings.

• Depression.

• Anxiety.

• Difficulty falling asleep.

These symptoms are usually mild and most usually go away in a few days. If it does not, consult a doctor immediately.

The serious side effects seen with Dexamethasone oral tablet include:

• Easy bruising and bleeding.

• Unusual stomach bloating.

• Black or tarry stools (blood in stools).

• Hematuria (blood in the urine).

• Swelling throughout the body.

• Frequent infections-

  • Fever.

  • Muscle and joint pain.

• Congestive heart failure-

  • Shortness of breath.

  • Swollen ankles and feet.

  • Racing heartbeat.

• Severe allergy.

• Adrenal insufficiency-

  • Severe tiredness.

  • The skin becomes darker.

  • Dizziness.

• Peptic ulcers.

• Osteoporosis.

• Mood disorders-

  • Personality changes.

  • Severe mood swings.

  • Feeling of intense happiness (euphoria).

In case a person exhibit any of these symptoms, call the doctor immediately. Dexamethasone can also result in other side effects that are not listed here, so always consult a doctor if they notice any unusual symptoms.

What Are the Interactions of Dexamethasone?

It is natural for all drugs to interact with other drugs, food, and supplements. This interaction can result in certain unwanted side effects. The common interactions of Dexamethasone are:

1) With medicine-

• Antifungals - Increases the levels of Dexamethasone.

  • Ketoconazole.

  • Itraconazole.

  • Voriconazole.

  • Amphotericin B.

• Erythromycin (antibiotic) - Increases the amount of Dexamethasone in the body and increases the risk of side effects when used together.

• Blood thinners - Decreases the levels of these drugs:

  • Apixaban.

  • Warfarin.

• Aminoglutethimide - A drug used to treat Cushing’s syndrome. It may decrease the levels of Dexamethasone in the body.

• Anti-diabetic drugs - Dexamethasone might increase blood glucose levels.

  • Amylin analogs.

  • SGLT-2 inhibitors.

  • Biguanides (Metformin).

  • GLP-1 agonists.

  • DPP4 inhibitors.

  • Insulin.

  • Sulfonylureas.

• Cholesterol medications - Reduce the effectiveness of Dexamethasone.

  • Cholestyramine and Colestipol.

• Diuretics-

  • Bumetanide.

  • Hydrochlorothiazide.

• Anti-epileptic drugs - Lowers the levels of Dexamethasone.

  • Phenytoin.

  • Phenobarbital.

  • Carbamazepine.

• Oral contraceptive pills.

• HIV drugs - Dexamethasone might reduce the levels of HIV drugs, such as:

  • Atazanavir.

  • Fosamprenavir.

  • Ritonavir.

  • Etravirine.

  • Elvitegravir.

• Digoxin - A drug used for heart failure and other conditions.

• NSAIDs (nonsteroidal anti-inflammatory drugs) - Increases the risk of stomach upset.

  • Aspirin.

  • Naproxen.

  • Ibuprofen.

• Thalidomide - A drug used to treat skin lesions and multiple myeloma. Taking it along Dexamethasone can result in toxic epidermal necrolysis, which is a life-threatening skin condition.

• Tuberculosis medications - Lowers the level of Dexamethasone or makes these drugs less effective.

  • Rifampin.

  • Rifapentine.

  • Isoniazid.

• Vaccines - Some vaccines do not work as well if given to people taking Dexamethasone. Avoid live vaccines, as this drug can make them stronger and can result in infection.

2) With disease-

• Electrolyte imbalance - As this medicine can change the levels of calcium, sodium, and potassium in the body, it can result in electrolyte imbalance.

• Heart attack - It can result in heart muscle damage if prescribed to patients who recently had a heart attack.

• Ruptured bowel - Otherwise called gastrointestinal perforations. The peptic ulcer side effect of this medicine can result in perforations and bleeding in the gut.

• Other conditions where this drug should be used with caution are eye herpes, scleroderma, and threadworm infection.

Dexamethasone in Treating COVID-19 Infection:

Dexamethasone, a steroid, is used to subside inflammation and swelling in infectious conditions. At the University of Oxford, researchers have found that Dexamethasone is used in reducing the mortality rates associated with COVID-19 patients who are critically ill. It has been estimated that about 1/3rd of patients survived when on Dexamethasone. Also, when taken in moderate doses, Dexamethasone reduced the fatality rates in people hospitalized with a ventilator. In addition, it has good effects on people who are on supplemental oxygen therapy but not on a ventilator.