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Dexamethasone is a type of corticosteroid medication.
The long-term use of dexamethasone may result in thrush, bone loss, cataracts, easy bruising, or muscle weakness.
Dexamethasone was first made in 1957.
Contents
1 Medical use
1.1 Anti-inflammatory
1.2 Cancer
1.3 Endocrine
1.4 Pregnancy
1.5 High-altitude illnesses
1.6 Nausea and vomiting
1.7 Sore throat
2 Adverse effects
2.1 Withdrawal
2.2 Contraindications
2.3 Interactions
3 Pharmacology
4 Chemistry
4.1 Synthesis
5 Society and culture
5.1 Cost
5.2 Nonmedical use
6 Veterinary use
7 See also
8 References
9 External links
Medical use
Dexamethasone
Anti-inflammatory
Dexamethasone is used to treat many inflammatory and autoimmune conditions, such as rheumatoid arthritis and bronchospasm.
It is also given in small amounts before and/or after some forms of dental surgery, such as the extraction of the wisdom teeth, an operation which often leaves the patient with puffy, swollen cheeks.
Dexamethasone is commonly given as a treatment for croup in children, as a single dose can reduce the swelling of the airway to improve breathing and reduce discomfort.
It is injected into the heel when treating plantar fasciitis, sometimes in conjunction with triamcinolone acetonide.
It is useful to counteract allergic anaphylactic shock, if given in high doses.
It is present in certain eye drops – particularly after eye surgery – and as a nasal spray (trade name Dexacort), and certain ear drops ( Sofradex, when combined with an antibiotic and an antifungal). Dexamethasone intravitreal steroid implants (trade name Ozurdex) have been approved by the FDA to treat ocular conditions such as diabetic macular edema, central retinal vein occlusion, and uveitis.
Dexamethasone is used in transvenous screw-in cardiac pacing leads to minimize the inflammatory response of the myocardium. 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 of bacterial 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.
Dexamethasone phosphate for injection
Cancer
People with cancer undergoing chemotherapy are often given dexamethasone to counteract certain side effects of their antitumor treatments. Dexamethasone can increase the antiemetic effect of 5-HT 3 receptor antagonists, such as ondansetron.
In brain tumors (primary or metastatic), dexamethasone is used to counteract the development of edema, which could eventually compress other brain structures. It is also given in cord compression, where a tumor is compressing the spinal cord.
Dexamethasone is also used as a direct chemotherapeutic agent in certain haematological malignancies, especially in the treatment of multiple myeloma, in which dexamethasone is given alone or in combination with other chemotherapeutic drugs, including most commonly with thalidomide (Thal-dex), lenalidomide, bortezomib (Velcade, Vel-dex), or a combination of doxorubicin (Adriamycin) and vincristine or bortezomib / lenalidomide /dexamethasone.
Endocrine
Dexamethasone is the treatment for the very rare disorder of glucocorticoid resistance.
In adrenal insufficiency and Addison’s disease, dexamethasone is prescribed when the patient does not respond well to prednisone or methylprednisolone.
It can be used in congenital adrenal hyperplasia in older adolescents and adults to suppress ACTH production. It is typically given at night.
Pregnancy
Dexamethasone may be given to women at risk of delivering prematurely to promote maturation of the fetus’ lungs. This has been associated with low birth weight, although not with increased rates of neonatal death.
Dexamethasone has also been used during pregnancy as an off-label prenatal treatment for the symptoms of congenital adrenal hyperplasia (CAH) in female babies. CAH causes a variety of physical abnormalities, notably ambiguous genitalia. Early prenatal CAH treatment has been shown to reduce some CAH symptoms, but it does not treat the underlying congenital disorder. This use is controversial: it is inadequately studied, only around one in ten of the foetuses of women treated are at risk of the condition, and serious adverse events have been documented.
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.
High-altitude illnesses
Dexamethasone is used in the treatment of high-altitude cerebral edema (HACE), as well as high-altitude pulmonary edema (HAPE). It is commonly carried on mountain-climbing expeditions to help climbers deal with complications of altitude sickness.
Nausea and vomiting
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.
The combination of dexamethasone and a 5-HT 3 receptor antagonist (5-HT 3 RA, e.g., ondansetron) is more effective than a 5-HT 3 RA alone in preventing postoperative nausea and vomiting.
Sore throat
A single dose of dexamethasone or another steroid speeds improvement of a sore throat.
Adverse effects
The exact incidence of the adverse 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.
Common:
Acne
Insomnia
Vertigo
Increased appetite
Weight gain
Impaired skin healing
Depression
Euphoria
Hypertension
Increased risk of infection
Raised intraocular pressure
Vomiting
Dyspepsia
Confusion
Amnesia
Irritability
Nausea
Malaise
Headaches
Cataract (in cases of long-term treatment it occurs in about 10% of patients)
Unknown incidence:
Papilloedema
Adrenal suppression
Growth stunting (in children)
Cushing’s syndrome
Peptic ulcer
Osteoporosis
Myopathy
Diabetes mellitus type 2
Hyperglycaemia
Pancreatitis (inflammation of the pancreas)
Sodium and water retention
Mania
Psychosis
Glaucoma
Cardiomyopathy
Abdominal distension
Corneal or scleral thinning
Candidiasis
Skin atrophy
Bruising
Telangiectasia
Striae
Leukocytosis
Thromboembolism
Psychological dependence
Vertebral collapse
Oesophageal ulcer
Seizures
Hypertriglyceridaemia
Intracranial hypertension (long-term treatment)
Facial plethora
Hypokalaemia
Hypocalcaemia
Muscular atrophy
Nitrogen depletion due to protein catabolism
Allergic reactions including anaphylaxis
Withdrawal
Sudden withdrawal after long-term treatment with corticosteroids can lead to:
Adrenal insufficiency
Hypotension
Fever
Myalgia
Arthralgia
Rhinitis
Conjunctivitis
Painful itchy skin nodules
Weight loss
Death
Contraindications
Contraindications include, but not limited to:
Uncontrolled infections
Known hypersensitivity to dexamethasone
Cerebral malaria
Systemic fungal infection
Concurrent treatment with live virus vaccines (including smallpox )
Interactions
Known drug interactions include:
Inducers of hepatic microsomal enzymes such as barbiturates, phenytoin, and rifampicin can reduce the half-life of dexamethasone.
Cotreatment with oral contraceptives can increase its volume of distribution.
Pharmacology
As a glucocorticoid, dexamethasone is an agonist of the glucocorticoid receptor (GR).
Chemistry
Dexamethasone is a synthetic pregnane corticosteroid and derivative of cortisol (hydrocortisone) and is also known as 1-dehydro-9α-fluoro-16α-methylhydrocortisone or as 9α-fluoro-11β,17α,21-trihydroxy-16α-methylpregna-1,4-diene-3,20-dione.
Synthesis
To synthesize dexamethasone, 16β-methylprednisolone acetate is dehydrated to the 9,11-dehydro derivative. This is then reacted with a source of hypobromite, such as basic N -bromosuccinimide, to form the 9α-bromo-11β-hydrin derivative, which is then ring-closed to an epoxide. A ring-opening reaction with hydrogen fluoride in tetrahydrofuran gives dexamethasone.
Dexamethasone synthesis
Society and culture
Cost
Dexamethasone is not expensive.
Nonmedical use
Dexamethasone is given in legal Bangladesh brothels to prostitutes not yet of legal age, causing weight gain aimed at making them appear older and healthier to customers and police.
Dexamethasone and most glucocorticoids are banned by sporting bodies including the World Anti-Doping Agency.
Veterinary use
Combined with marbofloxacin and clotrimazole, 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 with trichlormethiazide to treat horses with swelling of distal limbs and general bruising.
See also
Dexamethasone suppression test

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