Dexamethasone – composition, indications, action, contraindications, side effects

Proven content

Dexamethasone is an organic chemical, a synthetic steroid hormone (glycocodicosteroid). It has a very strong anti-inflammatory, antiallergic and immunosuppressive effect. It is estimated that its anti-inflammatory effect is almost 6,5 times stronger than that of prednisone and 30 times stronger than that of hydrocortisone.

Dexamethasone – action

Dexamethasone reduces the level of accumulating leukocytes and their attachment to the endothelium. It also inhibits the process of phagocytosis, the breakdown of lysosomes, lowers the number of lymphocytes, eosinophils, monocytes, and blocks the secretion of histamine and leukotrienes. As a result, it works by reducing the swelling of the capillaries. It also regulates carbohydrate, protein and fat metabolism. It also participates in the absorption and excretion process.

In addition, it exhibits anti-edema action in the case of vasomotor cerebral edema, in brain tumors and after mechanical injuries and surgical procedures performed within the skull. The first symptoms of the action of dexamethasone appear a few minutes after administration, both in the case of intravenous and intramuscular injection.

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When is dexamethasone used?

Dexamethasone is used in the following cases:

1. anaphylactic shock,
2. strong allergic reactions,
3. serum sickness,
4. heart wheezing,
5. bronchial asthma,
6. aspiration pneumonia,
7. inflammation of the airways that reduces their patency,
8. swelling of the glottis
9. multiple myeloma,
10. Hodgkin’s disease,
11. metastatic compression of the spinal cord,
12. joint inflammation,
13. maintaining a painful neck syndrome,
14. bursitis and tendon sheath inflammation,
15. tendon disorders,
16. brain abscess,
17. bacterial meningitis,
18. XNUMXst degree burns,
19. non-Hodgkin’s lymphoma,
20. swelling of the brain
21. general infections of an intense course with accompanying complications in the work of the circulatory system or the brain,
22. acute hypothyroidism or congenital adrenal hyperplasia,
23. thyroiditis
24. acute rheumatoid arthritis,
25. stiffness and inflammation of the spine joints,
26. lipid nephrosis,
27. lymphocytic and myeloid leukemia,
28. agranulocytoza,
29. intense and chronic inflammation or allergic conditions in the eyeball,
30. pemphigus,
31. exudative erythema multiforme,
32. erytrodermia,
33. psoriasis,
34. skin allergies,
35. acute skin blemishes,
36. contact dermatoses,
37. urticarial lichen.

In addition, dexamethasone is used as a cover during neurosurgical procedures and in medical diagnostics. It is used as a test for hyperadrenocorticism, in the diagnosis of hypogonadism and virilization in women.

In addition, dexamethasone in combination with antiemetics is used to prevent and reduce the vomiting associated with chemotherapy. Dexamethasone is used to prevent traumatic shock lung syndrome.

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Dexamethasone dosage

Speaking of oral doses, in adults, dexamethasone is most often used in doses: 0,5-16 mg 2-3 times a day. In children up to one year of age, the dose is 0,25-1 mg once a day. For older children, the dose is up to 2 mg once a day. The dose volume and duration of dose may vary depending on why you are taking dexamethasone, patient age, weight, and co-morbidities.

Due to the numerous side effects of dexamethasone, the lowest dose of the drug that has the desired therapeutic effect should be used.

Dexamethasone is available as tablets, intravenous and intramuscular injections, an aerosol spray on the skin surface, an ophthalmic suspension, and an ointment.

In the form of eye drops, dexamethasone is dosed depending on the disease or injury. The usual dose is 1-2 drops in the affected eye (s) repeated several times a day.

For dexamethasone injection, 2 mg (intraocular administration) to 8 mg dexamethasone (intra-articular or periarticular injection) is used. The dose can be repeated at the earliest after 3 weeks.

Intravenous doses of dexamethasone vary depending on the disease entity.

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Dexamethasone – overdose

In the case of long-term use of dexamethasone in the form of eye drops and ointments, systemic side effects (suppression of the hypothalamic-pituitary-adrenal axis, immunosuppression of the immune system and greater susceptibility to infections, growth inhibition in children and adolescents) may occur. Similar effects may occur when dexamethasone is applied in high doses to the skin as a spray, under an occlusive (airtight) dressing, and over large areas of the skin. Additionally, the epidermis may disappear, stretch marks and develop skin infections.

In the event of intravenous dexamethasone administration, overdosage may result in metabolic disturbances and electrolyte imbalance. Dexamethasone taken by mouth in too high doses can cause steroid side effects.

See also: Diagnostics of growth disorders in children

Dexamethasone – side effects

As with all medications, taking dexamethasone can cause side effects. The most common are:

1. build up of fatty tissue in the face (known as the lunate face)
2. accumulation of fatty tissue around the neck and torso,
3. weight gain,
4. red skin stretch marks,
5. emotional disorders,
6. psychosis,
7. increase in blood pressure,
8. osteoporosis,
9. diabetes, glucose intolerance,
10. atrophy of muscle tissue and weakened muscle strength,
11. in children: bone growth delay, dwarfism.

Dexamethasone – contraindications

In addition, treatment with dexamethasone is not recommended if the patient suffers from the following ailments:

1. ulcers in the stomach or duodenum,
2. Cushing’s disease
3. osteoporosis,
4. herpes,
5. viral or fungal diseases of the conjunctiva or the cornea,
6. an implant in the vitreous body,
7. eye or immediate area infections
8. glaucoma,
9. exudative states with an intense course,
10. tuberculosis,
11. kidney failure
12. intense mental illness (psychosis),
13. diabetes,
14. hypertension,
15. kidney failure
16. post-vaccination symptoms,
17. precancerous and neoplastic skin conditions,
18. skin infections of viral and fungal nature,
19. ordinary and rosacea acne,
20. inflammation of the skin around the mouth
21. severe systemic infections,
22. infection of the joint or its surroundings,
23. arthritis of a bacterial nature,
24. torn tendon,
25. Charcot’s joint (joint disease resulting from damage to the innervation),
26. periarticular calcification,
27. extravascular bone necrosis,
28. bleeding tendency,
29. joint instability requiring treatment.

Dexamethasone – precautions

Dexamethasone spray on mucous membranes is not recommended. In this form, only application to the skin is permitted. It is also very important to compress the inner corner of the eye for several seconds after administering dexamethasone to the conjunctival sac. In this way, let’s limit the absorption of substances into the general circulation. The use of dexamethasone is also discouraged if the causes of the bloodshot eyes are not established. The use of lenses is not recommended during treatment with dexamethasone.

Tuberculosis or hepatitis B infection may recur while taking dexamethasone (Dexamethasone can make infections difficult to diagnose).

Blood cortisol levels should be monitored and the dose of dexamethasone increased as necessary in case of physical stress. It is related to the action of glucocorticosteroids and their influence on the adrenal cortex where they are produced. stress hormones.

Special care should be taken in diabetics during treatment with dexamethasone, as the doses of oral antidiabetic drugs and insulin are often required to be adjusted.

It is also not advisable to use dexamethasone while receiving vaccinations.

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Dexamethasone and pregnancy and breastfeeding

In the case of pregnant and breastfeeding women, the possibility of dexamethasone treatment should be consulted with a doctor.

Dexamethasone belongs to a group of drugs that have shown foetotoxic effects in clinical trials in animals (cleft palate, inhibition of intrauterine growth, brain defects). However, it should be added that such studies in humans have not been repeated, therefore drugs from this group are allowed only when the benefits for the mother outweigh the potential risk to the fetus. Dexamethasone is most often used in the first trimester of pregnancy.

Dexamethasone belongs to a group of medicines that are assumed to be safe while breastfeeding. However, it has been shown that children who are breastfed by women taking high doses of dexamethasone can develop an impairment of the adrenal cortex.

Dexamethasone – fertility effects

Dexamethasone reduces the production of testosterone and the adrenocorticotropic hormone ACTH, which inhibits spermatogenesis and the ovulatory cycle.

Also check: Fertile days calendar. How to calculate fertile and infertile days?

Dexamethasone – drug interactions

Dexamethasone therapy may reduce reactions in skin allergy tests, cause false-negative results in the nitrotetrazolium blue reduction test (detection of bacterial infections) and result in a positive doping test.

In addition, dexamethasone should not be combined with anticoagulants, hypoglycemic drugs, diuretics, non-steroidal anti-inflammatory drugs, barbiturates, glutemides, antiepileptic drugs, antihistamines, rifampicin and ephedrine.

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Dexamethasone and diet

It is recommended that dexamethasone be taken immediately or with a meal, which reduces the risk of gastrointestinal damage. In addition, while using dexamethasone, it is not recommended to drink caffeinated beverages. It is also recommended to reduce sodium intake in the diet and increase the supply of potassium-rich foods. While taking dexamethasone, the patient’s diet should be rich in calcium and vitamin D, which will reduce the risk of developing steroidal osteoporosis.

It is disgusted to consume alcohol-containing drinks while taking dexamethasone.

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Dexamethasone and driving

If dexamethasone is administered to the eye, it may cause temporary visual disturbances, which makes it necessary to exercise caution when driving a car or motor vehicle.

Dexamethasone – absorption

Dexamethasone is well absorbed when administered orally (bioavailability of 80-90% of the dose). Its maximum concentration in the blood after oral administration occurs 1-2 hours after taking the drug. According to the data, dexamethasone is absorbed through the placenta and is excreted in breast milk.

When dexamethasone is applied to large areas of the skin, it may be absorbed into the systemic circulation (especially if the patient has skin inflammation, the drug is applied to large areas of the skin or under an occlusive dressing).

Dexamethasone in the blood is bound to plasma proteins, mostly albumin. The bound fraction is determined by the dose administered (the higher the dose, the higher the concentration of free dexamethasone in the blood) and decreases in the presence of hypoalbuminaemia. Dexamethasone diffuses into the cerebrospinal fluid and tissue fluids.

Dexamethasone metabolism is mainly carried out in the liver via the cytochrome P450 CYP3A4 and partly in the kidney. Dexamethasone is metabolised by hydroxylation to 6-alpha-hydroxydexamethasone and 6-beta-hydroxydexamethasone. It is excreted from the body through the kidneys in the form of dexamethasone alcohol or metabolites in the form of sulphates and glucuronides.