The long-term use of dexamethasone may result in thrush, bone loss, cataracts, easy bruising, or muscle weakness.[6] It is in pregnancy category C in the United States, meaning that it should only be used when the benefits are predicted to be greater than the risks.[1] In Australia, the oral use is category A, meaning it has been frequently used in pregnancy and not been found to cause problems to the baby.[7] It should not be taken when breastfeeding.[6] Dexamethasone has anti-inflammatory and immunosuppressant effects.[6]
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.[16]
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.[medical citation needed]
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.[19]
A single ampoule of dexamethasone phosphate for injection
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.[medical citation needed] Evidence on the safety and efficacy of using dexamethasone to treat malignant brain tumors is not clear.[22]
The Infectious Diseases Society of America (IDSA) guideline panel suggests the use of glucocorticoids for patients with severe COVID-19, defined as patients with SpO2 ≤94% on room air, and those who require supplemental oxygen, mechanical ventilation, or extracorporeal membrane oxygenation (ECMO).[27] The IDSA recommends against the use of glucocorticoids for those with COVID‑19 without hypoxemia requiring supplemental oxygen.[27]
The World Health Organization (WHO) recommends systemic corticosteroids rather than no systemic corticosteroids for the treatment of people with severe and critical COVID-19 (strong recommendation, based on moderate certainty evidence).[26] The WHO suggests not to use corticosteroids in the treatment of people with non-severe COVID-19 (conditional recommendation, based on low certainty evidence).[26]
A meta-analysis of seven clinical trials of critically ill COVID-19 patients, each treated with one of three different corticosteroids found a statistically significant reduction in death.[28] The largest reduction was obtained with dexamethasone (36% compared to placebo).[28][29]
In September 2020, the European Medicines Agency (EMA) endorsed the use of dexamethasone in adults and adolescents (from twelve years of age and weighing at least 40 kg) who require supplemental oxygen therapy.[30] Dexamethasone can be taken by mouth or given as an injection or infusion (drip) into a vein.[30]
Endocrine
Dexamethasone is the treatment for the very rare disorder of glucocorticoid resistance.[31][32]
It can be used in congenital adrenal hyperplasia in older adolescents and adults to suppress ACTH production. It is typically given at night.[33]
Pregnancy
Dexamethasone may be given to women at risk of delivering prematurely to promote maturation of the fetus' lungs. This administration, given from day to one week before delivery, has been associated with low birth weight, although not with increased rates of neonatal death.[34]
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 fetuses of women treated are at risk of the condition, and serious adverse events have been documented.[35] Experimental use of dexamethasone in pregnancy for fetal CAH treatment was discontinued in Sweden when one in five cases suffered adverse events.[36]
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.[37][38]
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.[42]
The combination of dexamethasone and a 5-HT3 receptor antagonist such as ondansetron is more effective than a 5-HT3 receptor antagonist alone in preventing postoperative nausea and vomiting.[43]
Sore throat
A single dose of dexamethasone or another steroid speeds improvement of a sore throat.[44]
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.[46][47][48][49][50]
On 16 June 2020, the RECOVERY Trial announced preliminary results stating that dexamethasone improves survival rates of hospitalized patients with COVID‑19 receiving oxygen or on a ventilator. 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.[60]
A preprint containing the full dataset was published on 22 June 2020 and demand for dexamethasone surged after publication of the preprint.[61] The preliminary report was published in The New England Journal of Medicine on 18 July 2020.[62]
The World Health Organization (WHO) states that dexamethasone should be reserved for seriously ill and critical patients receiving COVID‑19 treatment in a hospital setting,[63] 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."[64] In July 2020, the WHO stated they are in the process of updating treatment guidelines to include dexamethasone or other steroids.[65] In September 2020, the WHO released updated guidance on using corticosteroids for COVID‑19.[26]
In July 2020, the European 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.[66][67] In September 2020, the EMA received an application for marketing authorization of dexamethasone for COVID‑19.[68]
Society and culture
Price
Dexamethasone is inexpensive.[69] In the United States a month of medication is typically priced less than US$25.[6] In India, a course of treatment for preterm labor is about US$0.50.[69] The drug is available in most areas of the world.[69]
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.[72]
^ abc"Dexamethasone Use During Pregnancy". Drugs.com. Archived from the original on 17 May 2016. Retrieved 9 June 2016. Dexamethasone is only recommended for use during pregnancy when there are no alternatives and benefit outweighs risk.
^ abcdefghij"Dexamethasone". The American Society of Health-System Pharmacists. Archived from the original on 31 August 2017. Retrieved 29 July 2015.
^"Prescribing medicines in pregnancy database". Australian Government. 3 March 2014. Archived from the original on 8 April 2014. Retrieved 22 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.
^Schmelzeisen R, Frölich JC (1993). "Prevention of postoperative swelling and pain by dexamethasone after operative removal of impacted third molar teeth". European Journal of Clinical Pharmacology. 44 (3): 275–77. doi:10.1007/BF00271371. PMID8491244. S2CID12528750.
^"Croup – Diagnosis & Treatment". Mayo Clinic. Retrieved 13 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.
^ ab"COVID-19 Guideline, Part 1: Treatment and Management". Infectious Diseases Society of America. Retrieved 22 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)
^Kovac AL (May 2006). "Meta-analysis of the use of rescue antiemetics following PONV prophylactic failure with 5-HT3 antagonist/dexamethasone versus single-agent therapies". The Annals of Pharmacotherapy. 40 (5): 873–87. doi:10.1345/aph.1G338. PMID16670361. S2CID32843029.
^ abcd"Product Information Dexamethsone (dexamethasone)"(PDF). TGA eBusiness Services. Aspen Pharmacare Australia Pty Ltd. 10 August 2010. Retrieved 11 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. Retrieved 11 December 2013. (Accept terms and conditions to open PDF, which doesn't work in archived version)
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^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.