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- What is dexamethasone, and how does it work (mechanism of action)?
- What brand names are available for dexamethasone?
- Is dexamethasone available as a generic drug?
- Do I need a prescription for dexamethasone?
- What are the uses for dexamethasone?
- What are the side effects of dexamethasone?
- What is the dosage for dexamethasone?
- Which drugs or supplements interact with dexamethasone?
- Is dexamethasone safe to take if I'm pregnant or breastfeeding?
- What else should I know about dexamethasone?
What is dexamethasone, and how does it work (mechanism of action)?
Dexamethasone is a synthetic (man-made) corticosteroid. Corticosteroids are naturally-occurring chemicals produced by the adrenal glands located above the kidneys. Corticosteroids affect the function of many cells within the body and suppress the immune system. Corticosteroids also block inflammation and are used in a wide variety of inflammatory diseases affecting many organs. The FDA approved dexamethasone in October 1958.
What are the uses for dexamethasone?
Dexamethasone is used for reducing 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 to respond to other treatments also may respond to dexamethasone. Examples include:
Chronic skin conditions treated with dexamethasone include:
Dexamethasone is used in the treatment of cancers of the white blood cells (leukemias), and lymph gland cancers (lymphomas). Blood diseases involving destruction by the body's own immune system of platelets are also treated with dexamethasone, disease like idiopathic thrombocytopenia purpura, and red blood cells (autoimmune hemolytic anemia. Other miscellaneous conditions treated with dexamethasone include thyroiditis and sarcoidosis.
Finally, dexamethasone is used as replacement therapy in patients whose adrenal glands are unable to produce sufficient amounts of corticosteroids.
Many of the medical problems treated by this drug are “off label”; that is, its use is not sanctioned or approved by the FDA.
What are the side effects of dexamethasone?
Side effects of dexamethasone depend on the dose, the duration and the frequency of administration. Short courses of dexamethasone usually are well tolerated with few and mild side effects. Long term, high dose dexamethasone usually will produce predictable and potentially serious side effects. Whenever possible, the lowest effective dose of dexamethasone should be used for the shortest possible length of time to minimize side effects. Alternate day dosing also can help reduce side effects.
Side effects of dexamethasone and other corticosteroids range from mild annoyances to serious irreversible damage. Side effects include:
- fluid retention,
- weight gain,
- high blood pressure,
- loss of potassium,
- increase in serum glucose levels (especially in diabetics),
- muscle weakness,
- puffiness of and hair growth on the face,
- thinning and easy bruising of skin,
- peptic ulceration,
- worsening of diabetes,
Other side effects include:
- irregular menses,
- growth retardation in children,
- convulsions, and
- psychic disturbances.
Psychic disturbances include:
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 usually is accomplished by gradually reducing the dose. Gradually tapering dexamethasone not only minimizes the symptoms of corticosteroid insufficiency, but 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 that is important in fighting infection. Patients on corticosteroids are more susceptible to infections and can develop more serious infections than individuals not receiving corticosteroids. For example, chickenpox and measles viruses can produce serious and even fatal illnesses in patients on high doses of dexamethasone. Live virus vaccines, such as smallpox vaccine, should be avoided in patients taking high doses of dexamethasone, since even vaccine viruses may cause disease in these patients. Some infectious diseases, such as tuberculosis (TB) and malaria, can remain dormant in a patient for years. Dexamethasone and other corticosteroids can reactivate dormant infections. Patients with dormant tuberculosis may require treatment of the TB while undergoing 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 falsely 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. It has been demonstrated in some groups of patients treated with steroids that the loss of bone may be prevented by treatment with biphosphonate drugs, for example, alendronate (Fosamax).
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.
What is the dosage for dexamethasone?
Dosage requirements of corticosteroids vary greatly among individuals and the diseases being treated. In general, the lowest possible effective dose is used. The initial oral dose is 0.75 mg to 9 mg daily depending on the disease. The initial dose should be adjusted based on response. Corticosteroids given in multiple doses (2 to 4 times daily) throughout the day are more effective but also are more toxic as compared with the same total daily dose given once daily, or every other day.
Which drugs or supplements interact with dexamethasone?
Corticosteroids may increase or decrease the effect of blood thinners, for example, warfarin (Coumadin). Blood clotting should be monitored and the dose of blood thinner adjusted in order to achieve the desired level of blood thinning when patients receiving blood thinners are begun on corticosteroids, including dexamethasone.
Phenobarbital, ephedrine, phenytoin (Dilantin), and rifampin (Rifadin, Rimactane) may increase the breakdown of corticosteroids by the liver, resulting in lower blood levels and reduced effects. Therefore, the dose of corticosteroid may need to be increased if treatment with any of these agents is begun.
Mifepristone may reduce the action of corticosteroids via unknown mechanisms. Dexamethasone may decrease blood levels of mifepristone. Mifepristone should not be combined with steroids.
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Is dexamethasone safe to take if I'm pregnant or breastfeeding?
INFORMATION Use of dexamethasone in pregnant women has not been adequately studied. When corticosteroids are given systemically (orally, intramuscularly, or intravenously) to pregnant animals fetal abnormalities occurred.
What else should I know about dexamethasone?
What preparations of dexamethasone-decadron-dexpak are available?
Tablets: 0.5, 0.75, 1, 1.5, 2, 4, and 6 mg. Elixir/Solution: 0.5 mg /5 mL. Oral Concentrate: 1 mg/ml and for injection (IV, IM, intra-articular, intralesional or into tissue), 4mg/ml and 10mg/ml.
How should I keep dexamethasone-decadron-dexpak stored?
Dexamethasone should be stored at 20 C - 25 C (68 F - 77 F) and not frozen.
Dexamethasone oral (Decadron, DexPak) is a drug prescribed to reduce inflammation in many conditions, including:
- rheumatoid arthritis,
- systemic lupus,
- acute gouty arthritis,
- psoriatic arthritis,
- ulcerative colitis, and
- Crohn's disease.
It is also prescribed to treat severe allergic conditions bronchial asthma, allergic rhinitis, drug-induced dermatitis, contact and atopic dermatitis. Dexamethasone is also used to treat chronic skin conditions as well as for the treatment of cancers of the white blood cells, lymph gland cancers, and blood diseases. It is also prescribed to treat conditions such as thyroiditis and sarcoidosis. Side effects, drug interactions, warnings and precautions, and efficacy during pregnancy information should be reviewed prior to taking this medication.
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Related Disease Conditions
Colitis refers to inflammation of the inner lining of the colon. Symptoms of the inflammation of the colon lining include diarrhea, pain, and blood in the stool. There are several causes of colitis, including infection, ischemia of the colon, inflammatory bowel disease (Crohn's disease, ulcerative colitis, infectious colitis like C. difficile, or microscopic colitis). Treatment depends on the cause of the colitis.
Buildup of uric acid crystals in a joint causes gouty arthritis. Symptoms and signs include joint pain, swelling, heat, and redness, typically of a single joint. Gout may be treated with diet and lifestyle changes, as well as medication.
Anemia is the condition of having less than the normal number of red blood cells or less than the normal quantity of hemoglobin in the blood. The oxygen-carrying capacity of the blood is, therefore, decreased. There are several types of anemia such as iron deficiency anemia (the most common type), sickle cell anemia, vitamin B12 anemia, pernicious anemia, and aplastic anemia. Symptoms of anemia may include fatigue, malaise, hair loss, palpitations, menstruation, and medications. Treatment for anemia includes treating the underlying cause for the condition. Iron supplements, vitamin B12 injections, and certain medications may also be necessary.
Eczema is a general term for many types dermatitis (skin inflammation). Atopic dermatitis is the most common of the many types of eczema. Other types of eczema include: contact eczema, allergic contact eczema, seborrheic eczema, nummular eczema, stasis dermatitis, and dyshidrotic eczema.
Psoriasis is a long-term skin condition that may cause large plaques of red, raised skin, flakes of dry skin, and skin scales. There are several types of psoriasis, including psoriasis vulgaris, guttate psoriasis, inverse psoriasis, and pustular psoriasis. Symptoms vary depending on the type of psoriasis the patient has. Treatment of psoriasis may include creams, lotions, oral medications, injections and infusions of biologics, and light therapy. There is no cure for psoriasis.
Laryngitis is an inflammation of the voice box (vocal cords). The most common cause of acute laryngitis is infection, which inflames the vocal cords. Symptoms may vary from degree of laryngitis and age of the person (laryngitis in infants and children is more commonly caused by croup). Common symptoms include a "barky" cough, a hoarse cough, fever, cold, runny nose, dry cough, and loss of voice. Chronic laryngitis generally lasts more than three weeks. Causes other than infection include smoking, excess coughing, GERD, and more. Treatment depends on the cause of laryngitis.
Rheumatoid Arthritis (RA)
Rheumatoid arthritis (RA) is an autoimmune disease that causes chronic inflammation of the joints, the tissue around the joints, as well as other organs in the body. Because it can affect multiple other organs of the body, rheumatoid arthritis is referred to as a systemic illness and is sometimes called rheumatoid disease. The 16 characteristic early RA signs and symptoms include the following. Anemia Both sides of the body affected (symmetric) Depression Fatigue Fever Joint deformity Joint pain Joint redness Joint stiffness Joint swelling Joint tenderness Joint warmth Limping Loss of joint function Loss of joint range of motion Many joints affected (polyarthritis)
Leukemia is a type of cancer of the blood cells in which the growth and development of the blood cells are abnormal. Strictly speaking, leukemia should refer only to cancer of the white blood cells (the leukocytes) but in practice it can apply to malignancy of any cellular element in the blood or bone marrow, as in red cell leukemia (erythroleukemia).
Eczema refers to skin inflammation. There are many different types of eczema that produce symptoms and signs that range from oozing blisters to crusty plaques of skin. Treatment varies depending upon the type of eczema the person has.
Lupus (Systemic Lupus Erythematosus or SLE)
Systemic lupus erythematosus is a condition characterized by chronic inflammation of body tissues caused by autoimmune disease. Lupus can cause disease of the skin, heart, lungs, kidneys, joints, and nervous system. When only the skin is involved, the condition is called discoid lupus. When internal organs are involved, the condition is called systemic lupus erythematosus (SLE).
Crohn's disease is a chronic inflammatory disease, primarily involving the small and large intestine, but which can affect other parts of the digestive system as well. Abdominal pain, diarrhea, vomiting, fever, and weight loss are common symptoms.
Asthma is a condition in which hyperreactive airways constrict and result in symptoms like wheezing, coughing, and shortness of breath. Causes of asthma include genetics, environmental factors, personal history of allergies, and other factors. Asthma is diagnosed by a physician based on a patient's family history and results from lung function tests and other exams. Inhaled corticosteroids (ICS) and long-acting bronchodilators (LABAs) are used in the treatment of asthma. Generally, the prognosis for a patient with asthma is good. Exposure to allergens found on farms may protect against asthma symptoms.
Non-Hodgkin's lymphoma is cancer of the lymphatic system, a vital part of the body's immune system. Symptoms and signs include swollen lymph nodes, fever, night sweats, coughing, weakness, chest pain, unexplained weight loss, and abdominal pain. Treatment depends on which type of non-Hodgkin's lymphoma one has, the stage of the cancer, one's age, how fast the cancer is growing, and whether one has other health problems.
Eye allergy (or allergic eye disease) are typically associated with hay fever and atopic dermatitis. Medications and cosmetics may cause eye allergies. Allergic eye conditions include allergic conjunctivitis, conjunctivitis with atopic dermatitis, vernal keratoconjunctivitis, and giant papillary conjunctivitis. Dry eye, tear-duct obstruction, and conjunctivitis due to infection are frequently confused with eye allergies. Eye allergies may be treated with topical antihistamines, decongestants, topical mast-cell stabilizers, topical anti-inflammatory drugs, systemic medications, and allergy shots.
Ulcerative colitis is a chronic inflammation of the colon. Symptoms include abdominal pain, diarrhea, and rectal bleeding. Ulcerative colitis is closely related to Crohn's disease, and together they are referred to as inflammatory bowel disease. Treatment depends upon the type of ulcerative colitis diagnosed.
Sarcoidosis, a disease resulting from chronic inflammation, causes small lumps (granulomas) to develop in a great range of body tissues and can appear in almost any body organ. However, sarcoidosis most often starts in the lungs or lymph nodes.
Amyloidosis is a group of diseases resulting from abnormal deposition of certain proteins (amyloids) in various bodily areas. The amyloid proteins may either be deposited in one particular area of the body (localized amyloidosis) or they may be deposited throughout the body (systemic amyloidosis). There are three types of systemic amyloidosis: primary (AL), secondary (AA), and familial (ATTR). Primary amyloidosis is not associated with any other diseases and is considered a disease entity of its own. Secondary amyloidosis occurs as a result of another illness. Familial Mediterranean Fever is a form of familial (inherited) amyloidosis. Amyloidosis treatment involves treating the underlying illness and correcting organ failure.
Hay Fever (Allergic Rhinitis)
Hay fever (allergic rhinitis) is an irritation of the nose caused by pollen and is associated with the following allergic symptoms: nasal congestion, runny nose, sneezing, eye and nose itching, and tearing eyes. Avoidance of known allergens is the recommended treatment, but if this is not possible, antihistamines, decongestants, and nasal sprays may help alleviate symptoms.
There are two types of asthma medications: long-term control with anti-inflammatory drugs and quick relief from bronchodilators. Asthma medicines may be inhaled using a metered-dose inhaler or nebulizer or they may be taken orally. People with high blood pressure, diabetes, thyroid disease, or heart disease shouldn't take OTC asthma drugs like Primatene Mist and Bronkaid.
Psoriatic arthritis is a disease that causes skin and joint inflammation. Symptoms and signs include painful, stiff, and swollen joints, tendinitis, and organ inflammation. Treatment involves anti-inflammatory medications and exercise.
There are many unusual symptoms of asthma, including sighing, difficulty sleeping, anxiety, chronic cough, recurrent walking pneumonia, and rapid breathing. These symptoms may vary from individual to individual. These asthma complexities make it difficult to accurately diagnose and treat asthma.
Cushing's syndrome, sometimes referred to as hypercortisolism, is a hormonal disorder caused by prolonged exposure to high levels of the hormone cortisol. Symptoms may include obesity, thinning arms and legs, a rounded face, and increased fat around the neck. Some causes of Cushing's syndrome is from taking glucocorticoid hormones such as prednisone for inflammatory diseases. Treatment for Cushing's syndrome depends on the cause.
Thyroiditis is the inflammation of the thyroid gland. The inflamed thyroid gland can release an excess of thyroid hormones into the blood stream, resulting in a temporary hyperthyroid state. Some forms of thyroiditis can be diagnosed based on tenderness and enlargement of the thyroid gland. A thyroid scan sometimes is used in making the diagnosis. Thyroiditis can also be diagnosed with a biopsy of the thyroid gland.
Asthma in Children
Asthma in children manifests with symptoms such as coughing and wheezing. Rates of asthma in children are increasing. Asthma in children is usually diagnosed based on the description of symptoms. Lung function tests may also be used. A variety of medications are used for the treatment of childhood asthma.
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