Dexamethasone: What Is It and What Is It For?

Dexamethasone is a drug that is used primarily to treat inflammation in allergic conditions, but it has also been used for cancers, multiple sclerosis, and brain edema.

Written and verified by el biólogo Samuel Antonio Sánchez Amador.

Last update: 26 June, 2023

Dexamethasone is a synthetic glucocorticoid drug with actions and effects similar to those of steroid hormones. Like the rest of glucocorticoids, it’s used to reduce the intensity of inflammatory responses and other immune processes. It’s prescribed to treat rheumatic problems, skin diseases, severe allergies, asthma, and chronic obstructive pulmonary disease (COPD).

It should be noted that dexamethasone is the active substance of the drug, but not all drugs that contain it receive this name. Beyond the generic forms, the drug is found under the trade name Fortecortin ®. In addition, there are multicomponent preparations that contain dexamethasone, such as Dexatavegil ®, Hongosan ®, Izitan ®, Neurodavur plus ®, and Resorborin ®.

This drug was synthesized for the first time in 1957 and its medical use was approved 4 years later, in 1961. It’s the 321st most prescribed medication in the United States, as in this region alone it’s prescribed in more than 1 million patients each year. If you want to know everything about this glucocorticoid that’s so useful in the medical field, then read on.

What is dexamethasone used for?

As we’ve said, dexamethasone is a synthetic glucocorticoid, with 20-30 times more potency than hydrocortisone and 4-5 times more than prednisone. In addition, it has very low or no mineralocorticoid activity, so it doesn’t directly intervene in the regulation of the body’s hydroelectrolyte metabolism.

This drug works by suppressing the migration of neutrophils to affected or damaged tissues and decreasing the proliferation of lymphocytes. If the action of these immune bodies is reduced, the amount of pro-inflammatory molecules and the recruitment of cells responsible for these processes is reduced, as indicated by the StatPearls portal.

In addition, this drug causes the capillary membrane to also become less permeable and the lysosomal membranes to have greater stability. After its application, the synthesis of prostaglandins and cytokines is inhibited. Its half-life is approximately 3 hours. Below we’ll explore some of the individual uses of the drug.

Anti-inflammatory action

Due to its immunosuppressive action, dexamethasone is used for various pathologies characterized by inflammation, such as rheumatoid arthritis and bronchospasms. Its prescription is also conceived in small doses before and after certain dental interventions.

Other conditions in which dexamethasone can be used are the following: plantar fasciitis, laryngotracheobronchitis, uveitis, diabetic macular edema, central retinal venous occlusion, and as an adjunct in the treatment of bacterial meningitis, together with the use of antibiotics.

Cancer

This drug is commonly used in people who are being treated with chemotherapy to counteract certain side effects. For example, it can increase the antiemetic effect of 5-HT3 receptor antagonists (such as ondansetron), as shown by studies.

In brain tumors, dexamethasone is used to prevent the development of edema in the brain, accumulations of fluid that could further complicate the medical condition. It’s prescribed for the same reason when a tumor is pinching the spinal cord.

Endocrine uses

In adrenal insufficiency, it’s prescribed when the patient doesn’t respond well to prednisone or methylprednisolone. It can also be used in congenital adrenal hyperplasia in older adolescents and adults to suppress the production of adrenocorticotropic hormone.

Pregnancy

In some cases, this drug is prescribed in pregnant women who are at risk of giving birth before term, to promote the maturation of the newborn’s respiratory tree before birth. It can also be used off-label to address congenital adrenal hyperplasia (CAH) in female infants. However, its use is controversial in this area.

How is dexamethasone given?

Dexamethasone comes in many different forms: direct-taken tablets, liquid to take by mouth, intramuscular/intravenous injection, and others. In the following lines, we present its dosage based on the method of administration.

Dexamethasone TAD ® 4 milligrams and 8 milligrams

Dexamethasone in oral pill form comes in several variants, as indicated on the package insert: 4 milligrams, 8 milligrams, 20 milligrams, and 40 milligrams. Each tablet can be divided into equal halves and the administration of 2 milligrams and 10 additional milligrams is intended to facilitate swallowing.

Depending on the condition to be treated, this drug is taken in a pharmacological range of 0.5 to 10 milligrams every 24 hours. In more seriously ill patients, this dose can be exceeded, but to minimize adverse effects, the minimum possible amount should always be used.

Dexamethasone KERN PHARMA 4 mg/ml SOLUTION INJECTABLE EFG ®

In this case, the solution is injected intramuscularly, intraarticularly, intralesionally, or intravenously directly in the hospital. According to the package insert, each milliliter of solution contains 4 milligrams of dexamethasone, which is equivalent to 3.33 milligrams of dexamethasone base. It’s only intended to be administered by a medical professional.

In the intravenous and intramuscular route, a single daily dose is usually chosen in the morning and on alternate days when possible. The intra-articular or intralesional route is only used when the affected joints or soft tissues are limited to 1 or 2 circumscribed sites. The dosage depends on the condition of the patient and their condition.

General indicative doses

Below, we’ll provide you with the general dosage of dexamethasone in all its variants, but you must bear in mind that only a doctor can prescribe your specific dose. Being a drug with so many uses and formats, the amount that must be ingested or administered varies between each patient:

• In the treatment of inflammation, it begins with a dose of 0.75 milligrams per day up to a maximum of 9 milligrams per day, divided into 2 to 4 doses per day. This dosage applies to the tablet variant, oral and intravenous alike.
• If it’s prescribed to avoid the exacerbation of multiple sclerosis, 30 milligrams a day is recommended for 7 days. Depending on the severity of the condition, during the following month 4 to 12 milligrams will be given every 24 hours.
• A brain edema is a life-threatening condition, requiring aggressive treatment. 10 milligrams of intravenous administration plus 4 milligrams of intramuscular administration every 6 hours are recommended, and then the dose is lowered.
• In allergic reactions and their inflammatory processes, patients have been shown to improve after an initial intramuscular injection of 4-8 milligrams, followed by subsequent oral doses of 1.5 to 0.75 milligrams.

Who shouldn’t take dexamethasone?

Dexamethasone is not recommended in a number of clinical pictures and special situations:

• The consumption of this medicine should be avoided if the patient has shown allergic reactions to dexamethasone or any of its excipients. Among the elements of the tablets for oral use, beyond the active principle, we can highlight lactose monohydrate, pregelatinized corn starch, anhydrous colloidal silica, and magnesium stearate.
• It isn’t intended for use in patients who have systemic infections or that affect very large sections of the body.
• It should be avoided in people who have an active stomach or duodenal ulcer.
• Its administration should be avoided in people who are going to be vaccinated with live vaccines (with weakened but active forms of the virus in question).

This drug has many antagonistic or notable effects with other drugs, such as warfarin, acetylsalicylic acid, diuretics, drugs for heart problems, ephedrine, acetazolamide, and many more. Inform your doctor of all compounds you are taking or have recently taken before being treated with dexamethasone.

Pregnancy and breastfeeding

As indicated by the Drugs.com portal, this drug crosses the placenta of pregnant women and reaches the fetus. The teratogenicity of dexamethasone has been demonstrated in animal studies, but hasn’t yet been proven in humans.

Like the rest of the corticosteroids, dexamethasone also occurs clearly in breast milk, although in very low concentrations. This could affect the development of the newborn baby, so it’s always recommended not to use it, unless the mother’s situation is serious.

What are the possible side effects of dexamethasone?

Like all synthetic glucocorticoids, dexamethasone has a series of adverse effects of fairly wide severity. We present to you some of the most probable when consuming the drug in its combined pill and intravenous form:

• Serious mental problems, affecting 5 out of 100 patients: Depression, suicidal feelings, unwarranted euphoria (mania), fluctuating moods, anxiety, sleep problems, confusion, memory loss, and hallucinations.
• Common problems, affecting 1 in 100 people: Decreased resistance to infection, hypoglycemia, increased appetite, predisposition to cataracts, hot flashes, gastric ulcers, delayed wound healing, osteoporosis, hirsutism, allergic skin reactions, and many more.
• Uncommon side effects, affecting 1 in 1000 people: Lymphopenia, eosinopenia, generalized allergic reaction, hypokalaemia, pancreatitis, edema, hypertension, gastrointestinal irritation, peptic ulcer, thromboembolism, excessive sweating, heart failure.
• Side effects of unknown frequency: A loss of vision, blurred vision and hiccups.

What happens if I miss a dose?

The dosage of this medicine in its oral form is quite variable, so it’s normal for the patient to ever forget one of his doses or consume a less-than-recommended amount. If you miss a dose, take it as soon as possible, but if the next one is coming up, skip the carelessness and continue with normal treatment as usual.

How should I act in case of an overdose?

As indicated by professional sources, dexamethasone overdose shouldn’t cause fatal side effects for the patient. However, prolonged use of high doses often causes skin fragility, easy bruising, changes in the presence of body fat, hirsutism, sexual problems, and decreased libido.

Although it shouldn’t be too dangerous if you take more pills than prescribed, don’t hesitate to call the emergency room if you make a mistake and take much more drugs than you should. Always notify an acquaintance or neighbor to accompany you until the ambulance arrives if you become very unwell.

How to store or dispose of this medicine?

Oral dexamethasone in tablet form doesn’t require special storage conditions. However, it is necessary to keep the box out of the reach of children, in a dry and dark environment. Be careful not to take the medicine beyond its expiration date indicated on the original container.

If you want to get rid of this medicine, don’t throw it away or put it down the toilet, as this can harm the natural environment. Find out where you can dispose of it by contacting local organizations that are in charge of collecting unused medicines.

Final notes on dexamethasone

Dexamethasone is used in many different conditions, from the resolution of allergic symptoms to the reduction of the effects of multiple sclerosis. However, never take this or any glucocorticoid on your own, as it has various harmful effects and interactions.

If you’re going to start treatment with dexamethasone, then discuss your medical history in detail with your doctor, as well as the medications you’re taking or have recently taken. Follow the dosage guidelines and never change the dosages yourself.