Anti-inflammatory Dexamethasone is used to treat many
inflammatory and
autoimmune disorders, such as
rheumatoid arthritis and
bronchospasm.
Idiopathic thrombocytopenic purpura, a decrease in numbers of
platelets due to an immune problem, responds to 40 mg daily for four days; it may be administered in 14-day cycles. It is unclear whether dexamethasone in this condition is significantly better than other
glucocorticoids. It is also given in small amounts before and/or after some forms of
dental surgery, such as the extraction of the
wisdom teeth, an operation that often causes puffy, swollen cheeks. Dexamethasone is commonly given as a treatment for
croup in children. Dexamethasone is sometimes injected into the heel when treating
plantar fasciitis or heel pain, sometimes in conjunction with
triamcinolone acetonide. There is no evidence that this treatment helps in the long term, however, dexamethasone may provide short-term pain relief. It may be useful to counteract
allergic anaphylactic shock, however this is not usually recommended by clinical guidelines. It is present in certain
eye drops – particularly after
eye surgery – and as a
nasal spray, and certain ear drops (can be combined with an antibiotic and an antifungal). Dexamethasone intravitreal steroid implants have been approved by the US
Food and Drug Administration (FDA) to treat ocular conditions such as
diabetic macular edema,
central retinal vein occlusion, and
uveitis. However, the evidence is poor quality relating to the treatment of uveitis, with the potential side effects (
cataract progression and raised
intraocular pressure) being significant, and the benefits not certainly greater than standard treatment. Dexamethasone has also been used with antibiotics to treat acute
endophthalmitis. 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. Dexamethasone may be administered before antibiotics in cases of
bacterial meningitis.
Gram-negative bacteria — to which the causative agent of bacterial meningitis,
Neisseria meningitidis, belongs — have highly immunogenic
lipopolysaccharides as a component of their cell membrane and trigger a strong inflammatory response. Pre-administration of dexamethasone before the administration of antibiotics acts to reduce that response, thus reducing hearing loss and neurological damage.
Cancer People with
cancer undergoing
chemotherapy are often given dexamethasone to counteract certain
side effects of their antitumor treatments. Dexamethasone can increase the
antiemetic effect of
5-HT3 receptor antagonists, such as
ondansetron. The exact mechanism of this interaction is not well-defined, but it has been theorized that this effect may be due to, among many other causes, inhibition of
prostaglandin synthesis,
anti-inflammatory effects,
immunosuppressive effects, decreased release of
endogenous opioids, or a combination of the aforementioned. 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. Evidence on the safety and efficacy of using dexamethasone to treat malignant brain tumors is not clear. Dexamethasone is also used as a direct chemotherapeutic agent in certain
hematological malignancies, especially in the treatment of
multiple myeloma, in which dexamethasone is given alone or in combination with other chemotherapeutic drugs, including most commonly with
thalidomide (Thal-dex),
lenalidomide,
bortezomib (Velcade, Vel-dex), or a combination of
doxorubicin (Adriamycin) and
vincristine or bortezomib/lenalidomide/dexamethasone.
COVID-19 Dexamethasone is recommended by the
National Health Service in the UK and the
National Institutes of Health (NIH) in the US for people with
COVID-19 who need either
mechanical ventilation or
supplemental oxygen (without ventilation). The
Infectious Diseases Society of America (IDSA) guideline panel suggests the use of glucocorticoids for people with severe COVID-19, defined as people with
SpO2 ≤94% on room air, and those who require supplemental oxygen, mechanical ventilation, or
extracorporeal membrane oxygenation (ECMO). The IDSA recommends against the use of glucocorticoids for those with COVID-19 without hypoxemia requiring supplemental oxygen. A
meta-analysis of seven clinical trials of critically ill COVID-19 participants, each treated with one of three different
corticosteroids found a statistically significant reduction in death. 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 , who require supplemental oxygen therapy. Dexamethasone can be taken by mouth or given as an injection or infusion (drip) into a vein. Although dexamethasone, and other glucocorticoids, reduce mortality in COVID-19 they have also been associated with an increased risk of secondary infections, secondary infections being a significant issue in critically ill COVID-19 patients. The mechanism of action of dexamethasone involves suppression of late-stage
interferon type I programs in severe COVID-19 patients.
Surgery Dexamethasone is used fairly regularly, often as a single intravenous dose, during surgery to prevent postoperative nausea and vomiting, manage pain, potentially reduce the amount of pain medication required, and help reduce post-surgery hospitalisation time.
Endocrine Dexamethasone is the treatment for the very rare disorder of
glucocorticoid resistance. In
adrenal insufficiency and
Addison's disease, dexamethasone is prescribed when the patient does not respond well to
prednisone or
methylprednisolone. It can be used in
congenital adrenal hyperplasia in older adolescents and adults to suppress
adrenocorticotropic hormone (ACTH) production. It is typically given at night.
Pregnancy Dexamethasone may be given to women at risk of delivering prematurely to promote
maturation of the fetus's lungs. This administration, given from one day to one week before delivery, has been associated with
low birth weight, although not with increased rates of neonatal death. 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. Experimental use of dexamethasone in pregnancy for fetal CAH treatment was discontinued in Sweden when one in five cases had adverse events. 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.
High-altitude illnesses Dexamethasone is used in the treatment of
high-altitude cerebral edema (HACE), as well as
high-altitude pulmonary edema (HAPE). It is commonly carried on mountain-climbing expeditions to help climbers deal with complications of
altitude sickness.
Nausea and vomiting Intravenous dexamethasone is effective for the 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. 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.
Sore throat A single dose of dexamethasone or another steroid speeds the improvement of a
sore throat. ==Contraindications==