The long-term use may result inthrush, bone loss,cataracts, easy bruising, or muscle weakness.[3] It has been frequently used by mouth in pregnancy and not been found to cause problems for the baby.[4] It should not be taken whenbreastfeeding.[3] Dexamethasone hasanti-inflammatory andimmunosuppressant effects.[3]
Dexamethasone was first made in 1957 and was approved for medical use in 1961.[5][6] It is on theWorld Health Organization's List of Essential Medicines.[7] Dexamethasone is not expensive.[8] In the United States, a month of medication typically costs less than US$25.[3] In India, a course of treatment for preterm labor costs about US$0.5.[8] It is available in most areas of the world.[8] In 2017, it was the 321st most commonly prescribed medication in the United States, with more than one million prescriptions.[9]
Medical uses
Dexamethasone phosphate injection vialsA single vial of dexamethasone phosphate for injection
It is also given in small amounts[12] before and/or after some forms ofdental surgery, such as the extraction of thewisdom teeth, an operation which often leaves the patient with puffy, swollen cheeks.
Dexamethasone is commonly given as a treatment forcroup in children, as a single dose can reduce the swelling of the airway to improve breathing and reduce discomfort.[13]
Dexamethasone is used in transvenous screw-incardiac pacing leads to minimize the inflammatory response of themyocardium. 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 ofbacterial 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.[16]
Cancer
a) Extensive mucosal erythema b) gastric ulcer with bleeding spot at antrum c) 2 weeks of high-dose dexamethasone d) four cycles of high-dose dexamethasone, a healed ulcer scar
Inbrain tumors (primary or metastatic), dexamethasone is used to counteract the development ofedema, which could eventually compress other brain structures. It is also given incord compression, where a tumor is compressing the spinal cord.
Dexamethasone treatment is recommended by theNational Institutes of Health (NIH) in the US, and by theNational Health Service in the UK, for people with COVID-19 who who requiresupplemental oxygen or are mechanically ventilated.[20][21] Dexamethasone has not been recommended in people with COVID-19 who do not require supplemental oxygen or hospitalization,[20] and the NIH recommends against such use.[21]
TheInfectious Diseases Society of America (IDSA) guideline panel suggests the use of glucocorticoids for patients with severe COVID-19 where severe is defined as patients with SpO2 ≤94% on room air, and those who require supplemental oxygen, mechanical ventilation, or ECMO.[22] The IDSA recommends against the use of glucocorticoids for those with COVID-19 without hypoxemia requiring supplemental oxygen.[22]
Endocrine
Dexamethasone is the treatment for the very rare disorder of glucocorticoid resistance.[23][24]
It can be used incongenital adrenal hyperplasia in older adolescents and adults to suppress ACTH production. It is typically given at night.[25]
Pregnancy
Dexamethasone may be given to women at risk of delivering prematurely to promotematuration of the fetus' lungs. This administration, given from day to one week before delivery, has been associated withlow birth weight, although not with increased rates of neonatal death.[26]
Dexamethasone has also been used during pregnancy as anoff-label prenatal treatment for the symptoms ofcongenital adrenal hyperplasia (CAH) in female babies. CAH causes a variety of physical abnormalities, notablyambiguous genitalia. Early prenatal CAH treatment has been shown to reduce some CAH symptoms, but it does not treat the underlyingcongenital disorder. This use is controversial: it is inadequately studied, only around one in ten of the fetuses of women treated are at risk of the condition, and serious adverse events have been documented.[27] Experimental use of dexamethasone in pregnancy for fetal CAH treatment was discontinued in Sweden when one in five cases suffered adverse events.[28]
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.[29][30]
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.[33]
The combination of dexamethasone and a5-HT3 receptor antagonist such asondansetron is more effective than a 5-HT3 receptor antagonist alone in preventing postoperative nausea and vomiting.[34]
Dexamethasone, when used as an anti emetic during surgery, does not appear to increase rates of wound infection and it is unclear if it has an effect on wound healing.[35]
Sore throat
A single dose of dexamethasone or another steroid speeds improvement of asore throat.[36]
Dosage
Thedefined daily dose is 1.5 mg by mouth or by injection.[2] For anaphylaxis in adults typically a one time dose of 10 mg either by mouth or by injection is used.[37] In children the typical dose is typically 0.6 mg/kg.[37]
For inflammatory syndromes as a result of infection 0.5 to 24 mg a day may be used in adults and 0.2 to 0.4 mg/kg in children.[38] To speed the development of a babies lungs 6 mg by injection into a muscle twice per day for two days may be used during pregnancy.[38]
For altitude sickness a dose of 4 mg every 6 hours may be used.[39] Generally this is only needed for a day or two when used together with descending.[39]
The recommended dose for severe COVID19 is 6 mg by mouth or intravenously a day for 7 to 10 days.[40]
The exact rates of side effects of dexamethasone are not available, hence estimates have been made as to the incidence of the adverse effects below based on the adverse effects of related corticosteroids and on available documentation on dexamethasone.[42][43][44][45][46]
On 16 June 2020, theRECOVERY Trial announced preliminary results stating that dexamethasone improves survival rates of hospitalized patients withCOVID-19 receiving oxygen or on aventilator. Benefits were only observed in patients requiring respiratory support; those who did not require breathing support saw a worse survival rate than the control group, although the difference may have been due to chance.[57] A preprint containing the full dataset was published on 22 June 2020 and demand for dexamethasone surged after publication of the preprint.[58] The preliminary report was published inThe New England Journal of Medicine on 18 July 2020.[59]
TheWorld Health Organization (WHO) states that dexamethasone should be reserved for seriously ill and critical patients receiving COVID-19 treatment in a hospital setting,[60] and the WHO Director-General stated that "WHO emphasizes that dexamethasone should only be used for patients with severe or critical disease, under close clinical supervision. There is no evidence this drug works for patients with mild disease or as a preventative measure, and it could cause harm."[61] In July 2020, the WHO stated they are in the process of updating treatment guidelines to include dexamethasone or other steroids.[62]
In July 2020, theEuropean Medicines Agency (EMA) started reviewing results from the RECOVERY study arm that involved the use of dexamethasone in the treatment of patients with COVID-19 admitted to the hospital to provide an opinion on the results and in particular the potential use of dexamethasone for the treatment of adults with COVID-19.[63][64]
Society and culture
Cost
Dexamethasone is inexpensive.[8] In the United States a month of medication is typically priced less thanUS$25.[3] In India, a course of treatment for preterm labor is aboutUS$0.50.[8] The drug is available in most areas of the world.[8]
Combined withmarbofloxacin andclotrimazole, dexamethasone is available under the name Aurizon,CAS number 115550-35-1, and used to treat difficult ear infections, especially in dogs. It can also be combined withtrichlormethiazide to treat horses with swelling ofdistal limbs and generalbruising.[67]
↑"Prescribing medicines in pregnancy database".Australian Government. 3 March 2014.Archived from the original on 8 April 2014. Retrieved22 April 2014.Drugs which have been taken by a large number of pregnant women and women of childbearing age without any proven increase in the frequency of malformations or other direct or indirect harmful effects on the fetus having been observed.
↑World Health Organization (2019).World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization.hdl:10665/325771. WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
↑"Croup- Diagnosis & Treatment".Mayo Clinic.Archived from the original on 10 October 2017. Retrieved13 October 2017.Dexamethasone is usually recommended because of its long-lasting effects (up to 72 hours).
↑Holte K, Kehlet H (November 2002). "Perioperative single-dose glucocorticoid administration: pathophysiologic effects and clinical implications".Journal of the American College of Surgeons.195 (5):694–712.doi:10.1016/s1072-7515(02)01491-6.PMID12437261.
↑Harousseau JL, Attal M, Leleu X, Troncy J, Pegourie B, Stoppa AM, et al. (November 2006). "Bortezomib plus dexamethasone as induction treatment prior to autologous stem cell transplantation in patients with newly diagnosed multiple myeloma: results of an IFM phase II study".Haematologica.91 (11):1498–505.PMID17043025.
↑22.022.1"COVID-19 Guideline, Part 1: Treatment and Management".Infectious Diseases Society of America.Archived from the original on 6 October 2020. Retrieved22 July 2020.Recommendation 4. Among hospitalized patients with severe* COVID-19, the IDSA guideline panel suggests glucocorticoids rather than no glucocorticoids. (Conditional recommendation, Moderate certainty of evidence) Remark: Dexamethasone 6 mg IV or PO for 10 days (or until discharge if earlier) or equivalent glucocorticoid dose may be substituted if dexamethasone unavailable. Equivalent total daily doses of alternative glucocorticoids to dexamethasone 6 mg daily are methylprednisolone 32 mg and prednisone 40 mg. Recommendation 5. Among hospitalized patients with COVID-19 without hypoxemia requiring supplemental oxygen, the IDSA guideline panel suggests against the use of glucocorticoids. (Conditional recommendation, Low certainty of evidence)
↑42.042.142.242.3"Product Information Dexamethsone (dexamethasone)"(PDF).TGA eBusiness Services. Aspen Pharmacare Australia Pty Ltd. 10 August 2010.Archived from the original on 28 January 2017. Retrieved11 December 2013. (Accept terms and conditions to open PDF, which doesn't work in archived version)
↑"Product Information Dexmethsone Injection"(PDF).TGA eBusiness ServicesAspen Pharmacare Australia Pty Ltd. Aspen Pharmacare Australia Pty Ltd. 2 March 2011.Archived from the original on 29 January 2017. Retrieved11 December 2013. (Accept terms and conditions to open PDF, which doesn't work in archived version)
↑De Groot LJ, Chrousos G, Dungan K, Feingold KR, Grossman A, Hershman JM, Koch C, Korbonits M, McLachlan R, New M, Purnell J, Rebar R, Singer F, Vinik A, Nicolaides NC, Pavlaki AN, Maria Alexandra MA, Chrousos GP (2000)."Glucocorticoid Therapy and Adrenal Suppression".Endotext.PMID25905379.Archived from the original on 1 July 2020. Retrieved17 June 2020.
↑Raynor JW, Minor W, Chruszcz M (2007). "Dexamethasone at 119 K".Acta Crystallographica Section E.63 (6):o2791 –o2793.doi:10.1107/S1600536807020806.
↑Arth GE, Fried J, Johnston DBR, Hoff DR, Sarett HL, Silber RH, Stoerk HC, Winter CA (1958). "16-Methylated steroids. II. 16α-Methyl analogs of cortisone, a new group of anti-inflammatory steroids. 9α-Halo derivatives".Journal of the American Chemical Society.80 (12):3161–63.doi:10.1021/ja01545a063.
↑Taub D, Hoffsommer RD, Slates HL, lWendler NL (1958). "16β-Methyl cortical steroids".Journal of the American Chemical Society.80 (16): 4435.doi:10.1021/ja01549a095.
↑Valsler, Ben."Dexamethasone".Chemistry World.Archived from the original on 12 August 2020. Retrieved5 August 2020.
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