Dexamethasone belongs to the group of synthetic glucocorticoids. Glucocorticoids are adrenal hormones that cause metabolic changes and influence the body’s electrolyte balance and tissue functions. They also have anti-inflammatory effects and suppress the body’s immune reactions, which helps to weaken excessive and painful inflammatory reactions. Due to their ability to suppress immune reactions, synthetic glucocorticoids are used, among other things, for the treatment of severe allergic reactions (e.g. allergic asthma), severe infectious diseases associated with toxic conditions, or autoimmune diseases. Keep reading to find answers to the 16 most common questions about dexamethasone.
- What is dexamethasone?
- Can dexamethasone be used in the treatment of COVID-19?
- How quickly does dexamethasone take effect?
- In which forms is dexamethasone available?
- How much does dexamethasone cost?
- What should I consider before taking dexamethasone?
- Does dexamethasone interfere with other drugs?
- How do I take dexamethasone?
- Should I make up for a missed dose of dexamethasone?
- For how long can I take dexamethasone?
- What is the best way to come off dexamethasone?
- What side effects can dexamethasone have?
- What should I do if I overdose on dexamethasone?
- Can I take dexamethasone whilst pregnant or breastfeeding?
- Can I drive whilst taking dexamethasone?
- Can I drink alcohol whilst taking dexamethasone?
1. What is dexamethasone?
The active ingredient dexamethasone is found in a variety of medications that prevent allergic and inflammatory reactions by suppressing the immune system. Dexamethasone can be used externally as a topical treatment and internally.
Dexamethasone is used in the following circumstances:
- For severe allergic reactions (e.g., severe acute asthma attack, brain swelling)
- For acute skin diseases (e.g., erythroderma, acute eczema, pemphigus vulgaris)
- For autoimmune diseases (e.g., systemic lupus erythematosus)
- For central nervous system vasculitis (e.g., polyarteritis nodosa, active rheumatoid arthritis, juvenile idiopathic arthritis, rheumatic fever with carditis)
- For serious infectious diseases with toxic conditions (e.g. tuberculosis, typhoid fever)
- For palliative therapy of malignant tumors
- For the prevention and treatment of dizziness and vomiting when taking cytostatic drugs
Dexamethasone is also used in the inhibition assay to rule out Cushing syndrome. For this laboratory test dexamethasone is administered late in the evening and cortisol values are measured in the morning. In a healthy person, cortisol levels are very low in the late evening and highest in the early morning.
2. Can dexamethasone be used in the treatment of COVID-19?
Dexamethasone was tested on hospitalized patients with COVID-19 in the UK and was found to benefit critically ill patients. According to findings shared with the World Health Organization, the treatment was shown to reduce mortality by about one third for patients on ventilators, and by one fifth for patients requiring only oxygen.
As such, the WHO strongly recommends that patients with severe and critical COVID-19 receive corticosteroids like dexamethasone orally or intravenously.
However, the WHO advises against the use of corticosteroids in the treatment of patients with non-severe COVID-19, unless the patient is already taking this medication for another condition.
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3. How quickly does dexamethasone take effect?
Dexamethasone usually takes effect after about an hour and a half. Dexamethasone has a long duration action of up to 48 hours and has a much stronger glucocorticoid effect than prednisolone and prednisone.
4. In which forms is dexamethasone available?
Dexamethasone is available in many different dosage forms, for example as a tablet (including 8 mg, 20 mg, and 40 mg), cream, injection solution, eye and ear drops, eye ointment or nasal spray. Medicinal products containing the active substance dexamethasone are only obtainable with a prescription.
Dexamethasone is the name for the active ingredient. The drug is marketed under the names Neofordex, Glensoludex, and Martapan in the UK, and under the names Baycadron Elixir, Decadron, Dekpak 13 day Taperpak, Dexamethasone Intensol, DexPak, Dexpak 10 day TaperPak, DexPak Jr, and Zema-Pak in the US.
5. How much does dexamethasone cost?
Dexamethasone is a relatively inexpensive drug. In the US it is usually priced at less than $25 for a month’s supply of medication.
6. What should I consider before taking dexamethasone?
Dexamethasone should not be taken in the following circumstances:
- In the case of hypersensitivity to the active ingredient or one of the other components of dexamethasone.
If any of the following scenarios apply to you, your physician will need to rigorously assess whether or not dexamethasone is a safe option for you:
- You have an acute viral infection (e.g., shingles, chickenpox, herpes simplex infections, inflammation of the cornea by herpes viruses)
- You've received a live vaccination in the past 2-8 weeks.
- You are immunosuppressed due to a variety of acute or chronic viral, bacterial, or fungal infections.
- You are pregnant or breastfeeding. See Can I take dexamethasone whilst pregnant or breastfeeding?
In the following circumstances patients must be monitored by their doctor whilst taking dexamethasone and treated accordingly:
- In case of bone loss (osteoporosis) or a high risk of bone loss (especially in older patients)
- In case of gastrointestinal ulcers
- In the case of severe heart failure
- In the case of low blood pressure
- In the case of diabetes which is difficult to control
- With mental illnesses
- With increased intraocular pressure (narrow and open-angle glaucoma)
- With injuries and ulcers of the cornea or the eye
In the following circumstances dexamethasone may only be taken for urgent medical reasons due to the risk of gastrointestinal perforation (ruptured bowel):
- In case of severe inflammation of the colon (ulcerative colitis) with impending breakthrough, with abscesses or purulent inflammation, possibly also without skin irritation
- In case of inflamed intestinal wall protrusions (diverticulitis)
- Immediately after certain intestinal operations.
7. Does dexamethasone interfere with other drugs?
Dexamethasone can interact with numerous other medications, so be sure to inform your physician of all other medications that you are taking. Below is a list of the main medicines that dexamethasone interacts with:
- ACE inhibitors for lowering blood pressure
There is a possible increased risk of changes in blood pressure.
- Heart medication (heart glycosides)
The effect of medicines that strengthen the heart can be enhanced by potassium deficiency
- Oral anti-diabetic drugs and insulin
The ability of these medicines to lower blood sugar could be inhibited by dexamethasone
- Anticoagulants (oral anticoagulants, coumarins)
Dexamethasone can change the effectiveness of anticoagulants, making them less effective or too effective at thinning the blood
- Medicines for inflammation and rheumatism (salicylates, indomethacin and other non-steroidal antiphlogistics)
Dexamethasone may increase the risk of stomach ulcers and gastrointestinal bleeding
- Diuretic medicines (saluretics, diuretics) or laxatives
Dexamethasone could amplify potassium excretion
- Non-depolarizing muscle relaxants
Dexamethasone could cause a prolongation of the muscle relaxant effect
- Atropine and other anticholinergics
Their effect can be increased
- Remedies against dracunculiasis (Guinea worm disease)
The effect can be reduced
- Medicines for malaria and rheumatic diseases (chloroquine, hydroxychloroquine, mefloquine)
Possible increased risk of muscle disease or heart muscle diseases (myopathies, cardiomyopathies)
- Growth hormones (somatropin)
Possible reduced effect, especially for long-term use of a high dosage
- Protirelin (a brain hormone)
Dexamethasone could inhibit the increase of the thyroid-stimulating hormone
Possible increased susceptibility to infections.
- Ciclosporin (immunosuppressant)
The risk of seizures can be increased.
- Fluoroquinolones (a group of antibiotics)
The risk of tendon ruptures can be increased
- Strong licorice (with a high glycyrrhizin concentration of at least 0.2g/100g)
Glycocryrrhizine prevents the inactivation of cortisol in the kidney cells and can increase blood pressure
- Allergy tests
Skin reactions in the allergy test can be suppressed by the immunosuppressive effect of dexamethasone.
The use of the following medicines may reduce the effect of dexamethasone:
- Certain sleeping remedies (barbiturates)
- Anti-seizure medications (phenytoin, carbamazepine, primidone)
- Certain medicines against tuberculosis (rifampicin)
- Ephedrine (for example, in medicines for hypotension, chronic bronchitis, asthma attacks and for the decongestion of the mucous membranes in case of rhinitis, as part of appetite suppressants)
- Medicine against excessive acid production of the stomach (antacids): the intakes should be done at a time interval of 2 hours to prevent reduced absorption
The effects of dexamethasone may be enhanced when the following medicines are taken:
- Some medicines against HIV (ritonavir, cobicistat; dexamethasone should not be used with either of these medications)
- Medicinal products against fungal diseases (ketoconazole, itraconazole)
- Female hormones contained with the contraceptive pill
8. How do I take dexamethasone?
Unless it's used topically, dexamethasone is taken and not applied as a local treatment, it should be taken as a single dose early in the morning (between 06:00 and 8:00). In the early morning hours, the body’s cortisone production is at its highest, therefore the body’s ability to tolerate an additional intake of cortisone is at its best. High-dose treatment often requires additional doses throughout the day.
In tablet form, dexamethasone should be taken with or after a meal with a glass of water to minimize gastrointestinal irritation.
9. Should I make up for a missed dose of dexamethasone?
If you have forgotten to take a dose of dexamethasone, you can make up for it by taking the dose you missed, so as long as the next dose is not imminent. You should not take twice the amount in one go.
If you forget to take dexamethasone several times, it could lead to a worsening of the disease that is being treated. In such cases, contact your doctor to have your treatment checked out.
10. For how long can I take dexamethasone?
How long dexamethasone should be taken for depends on the disease that is being treated and the course of the disease, so follow your doctor’s instructions.
In general, dexamethasone should be used primarily as a short-term therapy. If long-term therapy is required, prednisolone or prednisone are more suitable because the adrenal cortex suppression is lower. Dexamethasone is more potent than either prednisolone or prednisone.
11. What is the best way to come off dexamethasone?
Follow your doctor’s advice if you want to terminate your dexamethasone treatment and do not come off the medication of your own accord. If dexamethasone is used to control an illness, abrupt withdrawal can lead to a worsening of the disease, which is why close consultation with your doctor is important.
After several weeks of treatment with dexamethasone, the body may have become accustomed to synthetic hormones. As a result, it is possible to experience strong psychological effects that resemble the symptoms of a mental illness.
In addition, long-term treatment with dexamethasone can lead to a sub-function of the adrenal cortex (NNR insufficiency). This means that the body’s production of glucocorticoids is suppressed due to the intake of synthetic glucocorticoids (such as dexamethasone). In this case, a gradual reduction of the dose over several weeks can ensure that the body recognizes the sub-function of the adrenal cortex and that it can recover.
12. What side effects can dexamethasone have?
The side effects of dexamethasone are highly dependent on the dose and duration of treatment - so the risk of side effects is low in the case of short-term therapy. For optimal tolerability, please stick to the intake in the early morning, with or after a meal.
Dexamethasone has a so-called Cushing threshold dose of 1-1.5 mg/day in adults. This means that Cushing syndrome can be triggered at doses above this value (typical signs are the development of a rounded face, abdominal obesity, and facial redness). If you experience symptoms of Cushing syndrome, talk to your doctor. Your doctor may decide to lower the dose or prescribe medication to combat symptoms such as increased blood pressure.
If you experience troublesome side effects, talk to your doctor and do not immediately stop the treatment without consulting your doctor. See What is the best way to come off dexamethasone?.
Possible side effects include:
- Increased risk of infection (virus, fungal, bacterial infections); aggravation of infections
- Change in blood count
- Hypersensitivity reactions (for example, drug rash)
- Severe anaphylactic reactions (such as arrhythmia, cramps of smooth bronchial muscles, high or low blood pressure, circulatory collapse, cardiac arrest)
- Changed fat metabolism (weight gain, also in the face, neck)
- High blood pressure (dose-dependent)
- Increased risk of thrombosis
- Increase in blood sugar levels, diabetes (diabetes mellitus)
- Storage of fluid from the vascular system (edema)
- Potassium deficiency, reduced vitamin D production, reduced calcium absorption from the intestine and increased excretion in the kidney, sodium is retained in the body
- Psychological changes (e.g., euphoria, depressive episode)
- Sub-function of the adrenal cortex (see What is the best way to come off dexamethasone?)
- Increased intracranial pressure, onset of previously latent epilepsy, more frequent seizures in known epilepsy
- Eye diseases (e.g., cataract, glaucoma)
- Inflammation of gastric mucosa and ulcers
- Atrophy of the skin, stretch marks, acne, skin bleeding (hematoma), poor wound healing
- Muscle weakness and atrophy (eg weakness, thin arms and legs)
- Bone loss (osteoporosis), bone necrosis (e.g., hip necrosis), in children: inhibition of growth
- Disorders of sex hormones (in women menstrual disorders, hirsutism; in men impotence)
- For external use (as an ointment): Allergic skin reactions and slowing of wound healing
13. What should I do if I overdose on dexamethasone?
In general, no special measures are necessary in case of an overdose of dexamethasone, as no complications are known to result from taking larger amounts in once go. However, contact your doctor if you experience increased or unusual side effects.
14. Can I take dexamethasone whilst pregnant or breastfeeding?
Dexamethasone should only be taken during pregnancy if the benefits outweigh the risks for mother and child. Long-term use can lead to growth disorders of the fetus and at the end of the pregnancy there is a risk of adrenal damage to the fetus. However, pregnant women at certain gestational ages at risk of preterm delivery may receive dexamethasone or other corticosteroids during pregnancy to maintain pregnancy and prevent preterm delivery. This increases the amount of time for fetal lungs to mature and reduces the risk of neonatal mortality and respiratory distress syndrome.
If you become pregnant whilst taking dexamethasone, do not stop taking it, but inform your doctor immediately about your pregnancy.
Corticosteroids are transferred to breast milk, so some drug manufacturers recommend avoiding long-term use. According to the World Health Organization, single doses of dexamethasone are appropriate. Otherwise, your physician may recommend avoiding dexamethasone while breastfeeding or stopping breastfeeding if dexamethasone treatment is essential.
15. Can I drive whilst taking dexamethasone?
So far, no impairments to driving ability have become known when taking dexamethasone. However, if you experience side effects such as dizziness, fainting, hallucinations, confusion, fatigue, or blurred vision, you should not be in control of a vehicle while taking dexamethasone.
16. Can I drink alcohol whilst taking dexamethasone?
It is recommended to refrain from consuming alcohol while taking dexamethasone, as alcohol can interfere with the effect of the medication unpredictably and, in combination with dexamethasone, can irritate the gastrointestinal tract.
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