Dexamethasone is a steroid hormonal drug of the glucocorticoid class. Its main effects are anti-inflammatory and immunosuppressive. Dexamethasone can be used in different formulations: solution for injections, tablets, emulsions, eye- and eardrops and nasal spray.
Dexamethasone can be used for treatment of such diseases as rheumatic conditions (rheumatoid arthritis, systemic lupus erythematosus, scleroderma, polyarteritis nodosa, dermatomyositis etc), arthritis (podagric, psoriatic) and other acute and chronic joint diseases (osteoarthrosis, polyarthritis, ankylosing spondylitis etc), comas (hepatic, cerbral), bronchial asthma, asthmatic status, bronchospasm, acute pulmonary alveolitis, pulmonary fibrosis, sarcoidosis, berylliosis, Löffler’s syndrome, anemias, agranulocytosis, panmyelopathia, idiopathic thrombocytopenic purpura, leukaemias, myeloma, anaphylactic shock and other anaphylactoid and allergic reactions, other shocks (burn, posttraumatic, postoperative, toxic, cardiogenic, posthemotransfusional), spinal cord injury, cerebral edema of all causes, bacterial meningitis, disseminated sclerosis, Crohn’s disease, ulcerative colitis, hepatitis, acute glomerulonephritis, idiopathic nephrotic syndrome, inherent adrenal insufficiency and Addison’s disease, congenital adrenal hyperplasia in female fetus (experimentally), subacute thyroiditis, thyrotoxic crisis, dermatitis (psoriatic, contact, atopic, exfoliative, etc), exema, toxic epidermal necrolysis (Lyell’s disease), Stevens-Johnson syndrome, eyes diseases (inflammatory, allergeic, uveitis, optic neuritis, conjunctivitis of different causes, iritis etc). Besides Dexamethasone is used for altitude sickness treatment, nausea prophylaxis in a case of cytostatic therapy (antiemetic effect), to help prevent transplant rejection and lower blood calcium levels in people with bone cancers, in women at risk of preterm delivery and to prevent RDS in premature infants, and in some dental surgaries (extraction of the wisdom teeth)
Also it can be used for diagnostic purposes in a case of Cushing’s syndrome.
Side effects
Although Dexamethasone is a very widespread medicine for treatment in very different clinical situations it has quiet high level of the side effects development (more then 30%). The most common side effects of Dexamethasone are:
- Headache
- Dizziness
- Weakness
- Confusion
- Cushing’s Syndrome (manifests in upper-body obesity, “moon” face, increased fat around the neck)
- Mood swings
- Exaggerated sense of well-being (euphoria)
- General body discomfort
- Insomnia
- Irritability
- Anxiety
- Personality changes
- Nervousness
- Depression
- Neuritis
- Neuropathy
- Paresthesia
- Decreased resistance to infection
- Fever (up to 38◦C)
- Malaise
- Prolonged sore throat
- Hiccups
- Shortness of breath
- Chest pain
- High blood pressure
- Thrombophlebitis
- Vasculitis
- Increased appetite
- Appetite loss
- Heartburn
- Nausea
- Vomiting
- Dyspepsia
- Abdominal bloating
- Abdominal distention
- Abnormal fat deposits
- Diarrhea
- Puffing of the face (moon face)
- Swelling of feet or legs (due to sodium and fluid retention)
- Weight gain
- Weight loss
- Joint pain
- Muscle pain
- Muscle weakness
- Loss of muscle mass
- Eye infections
- Hot flashes
- Striae (skin stretching)
- Acne
- Change in skin pigmentation
- Skin atrophy (thinning skin)
- Dry scaly skin
- Thinning scalp hair
- Hirsutism (hypertrichosis)
- Unusual bruising
- Rash
- Ecchymoses
- Petechiae
- Erythema
- Increased sweating
- Osteoporosis
- Menstrual irregularities (up to amenorrhea)
Also people who use Dexamethasone rarer, but can experience:
- Impaired wound healing
- Steroid myopathy (after longtime intake)
- Secondary adrenocortical and pituitary unresponsiveness
- Depression of the adrenal glands function
- Thromboembolism
- Loss of peripheral vision
- Blurred or clouded vision
- Double vision
- Hallucinations
- Fungal infections of the skin, nails, or mucous membranes including thrush infection in the throat with ulceration
As far as Dexamethasone can be used in different forms they can have some different side effects. For eyes drops more typical to cause such adverse reactions as blurring of vision, persistent eye pain or redness, enlarged pupils, increased pressure in the eye, posterior subcapsular cataracts, continued or worsening itching or swelling, continuing blurred vision, discharge from eyes, glaucoma, vision problems. Eardrops can cause ear irritation (burning, stinging and redness). If it was used Dexamethasone solution besides other the most common side effects (although they can occur more frequent) it is more likely to develop: clumsiness, dizziness, facial hot flushing, feeling of whirling motion, general body discomfort, pain, swelling, redness or hypoderm atrophy at the injection site, seizures, tendon or bone pain, vision changes or other eye problems. Also solution more often can cause serious adverse reactions.
As any other medicine Dexamethasone can cause development of allergic reactions that manifests in: rash, hives, itching, difficulty breathing or swallowing, hoarseness, tightness in the chest, swelling of the face, eyes, mouth, lips, tongue, throat. Also Dexamethasone can cause severe anaphylactoid reaction, anaphylaxis, and angioedema. These reactions are serious and require immediate medical attention.
Laboratory test’s changes
Dexamethasone intake can cause some changes in your blood tests. So if your doctor reveals in your laboratory tests such changes as eosinopenia, lymphopenia, neutropenia, liver enzymes elevations (alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, γ-glutamyl transpeptidase, and bilirubin), hypocoagulation, decreased glucose tolerance, hyperglycemia, hypocalcemia, hypernatremia (due to sodium retention), hypokalemia with hypokalemic alkalosis (due to potassium loss), glycosuria, blood in urine, increased or decreased motility and number of spermatozoa, you should keep on mind that it can be result of the Dexamethasone use and usually these adverse reactions are reversible after its discontinuation.
Serious side effects
Dexamethasone can cause some serious side effects that require urgent medical help. Among them:
- Extreme fatigue
- Severe nausea or vomiting
- Ulcerative esophagitis
- Peptic ulcer with possible perforation and hemorrhage (steroid ulcer)
- Coughing up blood
- Vomiting material that looks like coffee grounds
- Black, tarry stools
- Perforation of the small and large bowel
- Fatty liver degeneration
- Hepatomegaly
- Pancreatitis
- Arrhythmias (irregular heartbeat)
- Bradycardia
- Tachycardia
- Hypertension
- Circulatory collapse
- Congestive heart failure
- Cardiac enlargement
- Cardiac arrest
- Pulmonary edema
- Myocardial rupture (after myocardial infarction)
- Fat embolism
- Thromboembolism
- Swelling, redness and/or pain in one extremity and not in the other
- Difficult or painful urination
- Increased intracranial pressure with papilledema
- Syncope
- Convulsions
- Mania
- Delusions
- Severe depression
- Steroid psychosis
- Increased pressure in the eye (glaucoma)
- Exophthalmos
- Aseptic necrosis of femoral and humeral heads
- Pathologic fracture of long bones
- Tendon rupture
- Vertebral compression fractures
- Increased susceptibility to severe infection diseases and its latent course (including urinary tract infections)
- Possible reactivation of the TB infection
- Adrenal insufficiency
- Manifestations of latent diabetes and worsening of existing diabetes
Side effects in pregnant women
Dexamethasone when it is used during pregnancy can lead to slowed development of the fetus, and adrenocortical insufficiency after baby’s birth. Also Dexamethasone passes into breast milk so it must be used under doctor’s supervision.
Side effects in children
In addition to the common and serious side effects that can equally develop in adult patients and in children in little patients Dexamethasone can slow growth and cause development of pseudotumor cerebri.
Conclusions
You may never experience any of listed above side effects. And your doctor cannot predict reaction of your body to Dexamethasone until you will try it. That’s why don’t forget to let your physician know if something in your health condition alert you. So when it seems that anything going wrong, ask your doctor for advice and he or she will diagnose if your problem is connected with medicine intake. And be careful because some of Dexamethasone side effects require urgent medical help. Also do not stop intake of Dexamethasone suddenly because it can cause side effects and worsening of your symptoms. Dexamethasone discontinuation should be gradual and pass under your health provider’s supervision.