
GENERIC NAME: dexamethasone, oral
BRAND NAME: Decadron
DRUG CLASS AND MECHANISM: Dexamethasone is a synthetic
adrenal
corticosteroid. Corticosteroids are natural substances produced
by the
adrenal glands located adjacent to the kidneys. Corticosteroids
have
potent anti-inflammatory properties, and are used in a wide
variety of
inflammatory conditions such as arthritis, colitis, asthma,
bronchitis,
certain skin rashes, and allergic or inflammatory conditions of
the nose
and eyes. There are numerous preparations of corticosteroids,
including
oral tablets, capsules, liquids, topical creams and gels,
inhalers and eye
drops, and injectable and intravenous solutions. Dexamethasone that is
prescribed in oral tablet form is addressed in this article.
Dosage requirements of corticosteroids vary among individuals
and
diseases being treated. In general, the lowest possible
effective dose is
used. Corticosteroids given in multiple doses throughout the
day are more
effective, but also more toxic, than if the same total dose is
given once
daily, or every other day.
PRESCRIPTION: yes
GENERIC AVAILABLE: yes
PREPARATIONS: tablets: .25mg, .5mg, .75mg, 1.5mg, 4mg,
6mg
STORAGE: Store at room temperature, sealed container.
PRESCRIBED FOR: Dexamethasone is used to achieve prompt
suppression of inflammation in many conditions. Some examples
include
rheumatoid arthritis, systemic lupus, acute gouty arthritis,
psoriatic
arthritis, ulcerative colitis, and Crohn's disease. Severe
allergic
conditions that fail conventional treatment may also respond to
dexamethasone. Examples include bronchial asthma, allergic
rhinitis,
drug-induced dermatitis, and contact and atopic dermatitis.
Chronic skin
conditions treated with dexamethasone include dermatitis
herpetiformis,
pemphigus, severe psoriasis and severe seborrheic dermatitis.
Chronic
allergic and inflammatory conditions of the uvea, iris,
conjunctiva and
optic nerves of the eyes are also treated with dexamethasone.
Dexamethasone is also used in the treatment of blood cell
cancers
(leukemias), and lymph gland cancers (lymphomas). Blood
diseases involving
destruction of platelets by the body's own immune cells
(idiopathic
thrombocytopenia purpura), and destruction of red blood cells
by immune
cells (autoimmune hemolytic anemia) can also be treated with
dexamethasone. Other miscellaneous conditions treated with this
medication
include thyroiditis and sarcoidosis. Finally, dexamethasone is
used as a
hormone replacement in patients whose adrenal glands are unable
to produce
sufficient amounts of corticosteroids.
DOSING: Should be taken with food.
DRUG INTERACTIONS: Prolonged use of dexamethasone can
depress
the ability of body's adrenal glands to produce
corticosteroids. Abruptly
stopping dexamethasone in these individuals can cause symptoms
of
corticosteroid insufficiency, with accompanying nausea,
vomiting and even
shock. Therefore, withdrawal of dexamethasone is usually
accomplished by
gradual tapering. Gradually tapering dexamethasone not only
minimizes the
symptoms of corticosteroid insufficiency, it also reduces the
risk of an
abrupt flare of the disease under treatment.
Dexamethasone and other corticosteroids can mask signs of
infection and
impair the body's natural immune response to infection.
Patients on
corticosteroids are more susceptible to infections, and can
develop more
serious infections than healthy individuals. For instance,
chicken pox and
measles viruses can produce serious and even fatal illnesses in
patients
on high doses of dexamethasone. Live virus vaccines, such as
small pox
vaccine, should be avoided in patients taking high doses of
dexamethasone,
since even vaccine viruses may cause disease in these patients.
Some
infectious organisms, such as tuberculosis (TB) and malaria,
can remain
dormant in a patient for years. Dexamethasone and other
corticosteroids
can reactivate dormant infections in these patients and cause
serious
illnesses. Patients with dormant tuberculosis may require anti-
TB
medications while undergoing prolonged corticosteroid
treatment.
By interfering with the patient's immune response,
dexamethasone can
impede the effectiveness of vaccinations. Dexamethasone can
also interfere
with the tuberculin (TB) skin test and cause false negative
results in
patients with dormant tuberculosis infection.
Dexamethasone impairs calcium absorption and new bone
formation.
Patients on prolonged treatment with dexamethasone and other
corticosteroids can develop osteoporosis and an increased risk
of bone
fractures. Supplemental calcium and vitamin D are encouraged to
slow this
process of bone thinning. In rare individuals, destruction of
large joints
can occur while undergoing treatment with dexamethasone or other
corticosteroids. These patients experience severe pain in the
involved
joints, and can require joint replacements. The reason behind
such
destruction is not clear.
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
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