Dexamethasone Uses, Indication and Side Effect

Dexamethasone is a corticosteroid that prevents the release of substances in the body that cause inflammation. Dexamethasone is used to treat many different inflammatory conditions such as allergic disorders and skin conditions. It is used in the treatment of many conditions, including rheumatic problems, a number of skin diseases, severe allergies, asthma, chronic obstructive lung disease, croup, brain swelling, eye pain following eye surgery, and along with antibiotics in tuberculosis. Recently, Dexamethasone on emergency uses for COVID19 patient.

Brand Names: Baycadron, Decadron, Dexamethasone Intensol, DexPak, TaperDex, Zema-Pak, ZoDex, Zonacort.

Drug Fact

Class : Corticosteroid Hormones

Category: Prescription Only

Uses: corticosteroid that prevents the release of substances in the body that cause inflammation

Consumed by: adults and children 

Pregnancy category: C

Category C

Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.

Dosage form: tablet, syrup, eye drop, eye ointment and injection.

Side Effect :

• Aggression
• agitation
• anxiety
• blurred vision
• decrease in the amount of urine
• dizziness
• fast, slow, pounding, or irregular heartbeat or pulse
• headache
• irritability
• mental depression

Administration

Should be taken with food.

Contraindications

Systemic fungal infections; systemic infection unless being treated with specific anti-infectives. Perforation of drum membrane (otic). Administration of live virus vaccine.

Special Precautions

Patient with hypertension, acute MI,  heart failure, diabetes mellitus, gastrointestinal diseases (e.g. diverticulitis intestinal anastomoses, active or latent peptic ulcer ulcerative colitis); ocular diseases (e.g. cataracts, glaucoma, history of ocular herpes simplex); osteoporosis, history of seizure disorder, thyroid disease. Renal and hepatic impairment. Elderly. Children. Pregnancy and lactation. Avoid abrupt withdrawal or rapid dose reduction.

Adverse Reactions

Significant: Adrenal suppression (e.g. hypercortisolism, suppression of hypothalamic-pituitary-adrenal [HPA] axis); Kaposi sarcoma; myopathy; perineal irritation, psychiatric disturbance, immunosuppression (e.g. secondary infections, activation of latent infections, mask acute infection); increased intra-ocular pressure, open-angle glaucoma and cataracts. Rarely, anaphylactoid reactions

Endocrine disorders: Growth retardation in children.

Eye disorders: Bacterial keratitis, eye irritation and pruritus, burning sensation, ocular discomfort.

General disorders and admin site conditions: Impaired wound healing.

Investigations: Weight gain.

Metabolism and nutrition disorders: Cushing’s syndrome, obesity.

Musculoskeletal and connective tissue disorders: Osteoporosis.

Nervous system disorders: Headache, muscle atrophy.

Psychiatric disorders: Euphoria, depression, suicidal tendencies.

Skin and subcutaneous tissue disorders: Skin fragility.

Pregnancy Category (US FDA)

IM/Intra-articular/Intralesional/Intravitreal/IV/Ophth/Otic/Parenteral/PO: C

Patient Counseling Information

Ophth: This drug may cause blurring of vision, if affected, do not  drive or reinsert operate machinery. Remove contact lenses prior to ophthalmic administration and after 15 minutes.

MonitoringParameters

Monitor growth for children and intraocular pressure.

Overdosage

Symptoms: Anaphylactic and hypersensitivity reactions. Management: Supportive treatment. May administer adrenaline, aminophylline; provide  positive pressure ventilation.

Drug Interactions

Decreased plasma concentration with CYP3A4 inducers (e.g. barbiturates, carbamazepine, ephedrine, phenytoin, rifabutin, rifampicin). Increased plasma concentration with CYP3A4 inhibitors (e.g. erythromycin, ketoconazole, ritonavir). May increase renal clearance of salicylates. May enhances hypokalaemic effects of diuretics (acetazolamide, loop, thiazide), amphotericin B injection, corticosteroids, carbenoxolone, and K-depleting agents. May enhance anticoagulant effect of warfarin.

Potentially Fatal: May diminish therapeutic effect of live virus vaccines.

Lab Interference

False negative results with nitroblue tetrazolium test for bacterial infection.

Action

Description: Dexamethasone is a highly potent and long-acting glucocorticoid which acts as an anti-inflammatory agent by suppressing neutrophil migration, decreasing production of inflammatory mediators, reversing increased capillary permeability, and suppressing immune response. It lacks mineralocorticoid properties and has minimal Na-retaining properties which makes it suitable for treating conditions where water retention is a disadvantage.

Pharmacokinetics:

Absorption: Readily absorbed from the gastrointestinal tract. Time to peak plasma concentration: 1-2 hours (oral); approx 30-120 minutes (IM); 5-10 minutes (IV).

Distribution: Crosses placenta and enters breast milk. Plasma protein binding: Approx 77%, mainly to albumins.

Metabolism: Metabolised in the liver by CYP3A4 enzyme.

Excretion: Via urine (up to 65%). Elimination half-life: 4±0.9 hours (oral); approx 1-5 hours (IV).

Chemical Structure

Storage

Store below 25°C.

ATC Classification

H02AB02 - dexamethasone ; Belongs to the class of glucocorticoids. Used in systemic corticosteroid preparations.

S01BA01 - dexamethasone ; Belongs to the class of corticosteroids. Used in the treatment of inflammation of the eye.

S03BA01 - dexamethasone ; Belongs to the class of corticosteroids used in ophthalmologic and otologic preparations.

A01AC02 - dexamethasone ; Belongs to the class of local corticosteroid preparations. Used in the treatment of diseases of the mouth.