|Trade names||Dextenza, Ozurdex, others|
|By mouth, intravenous therapy (IV), intramuscular injection (IM), subcutaneous injection (IM), intraosseous (IO), eye drop|
|Elimination half-life||190 minutes (3.2 hours)|
|CompTox Dashboard (EPA)|
|Chemical and physical data|
|Molar mass||392.461 g·mol−1|
|3D model (JSmol)|
|Melting point||262 °C (504 °F)|
|(what is this?)|
Dexamethasone is a type of corticosteroid medication. 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, COVID-19, and along with antibiotics in tuberculosis. In adrenocortical insufficiency, it should be used together with a medication that has greater mineralocorticoid effects such as fludrocortisone. In preterm labor, it may be used to improve outcomes in the baby. It may be taken by mouth, as an injection into a muscle, or intravenously. The effects of dexamethasone are frequently seen within a day and last for about three days.
The long-term use of dexamethasone may result in thrush, bone loss, cataracts, easy bruising, or muscle weakness. It is pregnancy category C in the United States meaning use should be based on benefits being predicted to be greater than risks. In Australia, the oral use is category A, meaning it has been frequently used in pregnancy and not been found to cause problems to the baby. It should not be taken when breastfeeding. Dexamethasone has anti-inflammatory and immunosuppressant effects.
Dexamethasone was first made in 1957 by Philip Showalter Hench and was approved for medical use in 1961. It is on the World Health Organization's List of Essential Medicines. In 2017, it was the 321st most commonly prescribed medication in the United States, with more than one million prescriptions.
Dexamethasone is used to treat many inflammatory and autoimmune conditions, 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 which often leaves the patient with puffy, swollen cheeks.[medical citation needed]
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 FDA to treat ocular conditions such as diabetic macular edema, central retinal vein occlusion, and uveitis. 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.[medical citation needed]
Dexamethasone may be administered before antibiotics in cases of bacterial meningitis. It acts to reduce the inflammatory response of the body to the bacteria killed by the antibiotics (bacterial death releases proinflammatory mediators that can cause a response which is harmful), thus reducing hearing loss and neurological damage.
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.[medical citation needed]
Dexamethasone is also used as a direct chemotherapeutic agent in certain haematological 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.[medical citation needed]
Dexamethasone may be given to women at risk of delivering prematurely to promote maturation of the fetus' lungs. This administration, given from 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 foetuses of women treated are at risk of the condition, and serious adverse events have been documented. Experimental use of dexamethasone in pregnancy for foetal CAH treatment was discontinued in Sweden when one in five cases suffered 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.
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 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.
Dexamethasone, when used as an anti emetic during surgery, does not appear to increase rates of wound infection and it is unclear if it has an effect on wound healing.
- Uncontrolled infections
- Known hypersensitivity to dexamethasone
- Cerebral malaria
- Systemic fungal infection
- Concurrent treatment with live virus vaccines (including smallpox vaccine)
The exact incidence of the adverse effects of dexamethasone are not available, hence estimates have been made as to the incidence of the adverse effects below based on the adverse effects of related corticosteroids and on available documentation on dexamethasone.
- Increased appetite
- Weight gain
- Impaired skin healing
- Increased risk of infection
- Raised intraocular pressure
- Cataract (in cases of long-term treatment it occurs in about 10% of patients)
- Adrenal suppression
- Growth stunting (in children)
- Cushing's syndrome
- Peptic ulcer
- Diabetes mellitus type 2
- Pancreatitis (inflammation of the pancreas)
- Sodium and water retention
- Abdominal distension
- Corneal or scleral thinning
- Skin atrophy
- Psychological dependence
- Vertebral collapse
- Oesophageal ulcer
- Intracranial hypertension (long-term treatment)
- Facial plethora
- Muscular atrophy
- Nitrogen depletion due to protein catabolism
- Allergic reactions including anaphylaxis
Sudden withdrawal after long-term treatment with corticosteroids can lead to:
Known drug interactions include:
- Inducers of hepatic microsomal enzymes such as barbiturates, phenytoin, and rifampicin can reduce the half-life of dexamethasone.[medical citation needed]
- Cotreatment with oral contraceptives can increase its volume of distribution.[medical citation needed]
Dexamethasone is a synthetic pregnane corticosteroid and derivative of cortisol (hydrocortisone) and is also known as 1-dehydro-9α-fluoro-16α-methylhydrocortisone or as 9α-fluoro-11β,17α,21-trihydroxy-16α-methylpregna-1,4-diene-3,20-dione. The molecular and crystal structure of dexamethasone has been determined by X-ray crystallography.
To synthesize dexamethasone, 16β-methylprednisolone acetate is dehydrated to the 9,11-dehydro derivative. This is then reacted with a source of hypobromite, such as basic N-bromosuccinimide, to form the 9α-bromo-11β-hydrin derivative, which is then ring-closed to an epoxide. A ring-opening reaction with hydrogen fluoride in tetrahydrofuran gives dexamethasone.
Society and culture
Dexamethasone is inexpensive. In the United States a month of medication is typically priced less than US$25. In India, a course of treatment for preterm labor is about US$0.50. The drug is available in most areas of the world.
Dexamethasone is given in legal Bangladesh brothels to prostitutes not yet of legal age, causing weight gain aimed at making them appear older and healthier to customers and police.
On 16 June 2020, the RECOVERY Trial announced preliminary results stating that dexamethasone improves survival rates of hospitalized patients with COVID-19 receiving oxygen or on a ventilator. Benefits were only observed in patients requiring respiratory support; those who did not require breathing support saw a higher survival rate in the control group, although the difference was not statistically significant. Several experts have called for the full dataset to be published quickly to allow wider analysis of the results. A preprint was published on 22 June 2020 and demand for dexamethasone surged after publication of the preprint.
The World Health Organization (WHO) states that dexamethasone should be reserved for seriously ill and critical patients receiving COVID-19 treatment in a hospital setting, and the WHO Director-General stated that "WHO emphasizes that dexamethasone should only be used for patients with severe or critical disease, under close clinical supervision. There is no evidence this drug works for patients with mild disease or as a preventative measure, and it could cause harm."
Based on those preliminary results, dexamethasone treatment has been recommended by the National Institutes of Health for patients with COVID-19 who are mechanically ventilated or who require supplemental oxygen but are not mechanically ventilated. The NIH recommends against using dexamethasone in patients with COVID-19 who do not require supplemental oxygen. The WHO is in the process of updating treatment guidelines to include dexamethasone or other steroids.
Combined with marbofloxacin and clotrimazole, dexamethasone is available under the name Aurizon, CAS number 115550-35-1, and used to treat difficult ear infections, especially in dogs. It can also be combined with trichlormethiazide to treat horses with swelling of distal limbs and general bruising.
- "Dexamethasone Use During Pregnancy". Drugs.com. Archived from the original on 17 May 2016. Retrieved 9 June 2016.
Dexamethasone is only recommended for use during pregnancy when there are no alternatives and benefit outweighs risk.
- "Dexamethasone". The American Society of Health-System Pharmacists. Archived from the original on 31 August 2017. Retrieved 29 July 2015.
- "Prescribing medicines in pregnancy database". Australian Government. 3 March 2014. Archived from the original on 8 April 2014. Retrieved 22 April 2014.
Drugs which have been taken by a large number of pregnant women and women of childbearing age without any proven increase in the frequency of malformations or other direct or indirect harmful effects on the fetus having been observed.
- "Dexamethasone". 17 June 2020.
- Rankovic, Zoran; Hargreaves, Richard; Bingham, Matilda (2012). Drug discovery and medicinal chemistry for psychiatric disorders. Cambridge: Royal Society of Chemistry. p. 286. ISBN 9781849733656. Archived from the original on 5 March 2016.
- Fischer, Jnos; Ganellin, C. Robin (2006). Analogue-based Drug Discovery. John Wiley & Sons. p. 485. ISBN 9783527607495.
- World Health Organization (2019). World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. hdl:10665/325771. WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
- "Dexamethasone - Drug Usage Statistics". ClinCalc. Retrieved 11 April 2020.
- Till J. "Paramedic Clinical Training Aid". Archived from the original on 31 March 2012. Retrieved 30 August 2011.
- Provan D, Stasi R, Newland AC, Blanchette VS, Bolton-Maggs P, Bussel JB, Chong BH, Cines DB, Gernsheimer TB, Godeau B, Grainger J, Greer I, Hunt BJ, Imbach PA, Lyons G, McMillan R, Rodeghiero F, Sanz MA, Tarantino M, Watson S, Young J, Kuter DJ (January 2010). "International consensus report on the investigation and management of primary immune thrombocytopenia". Blood. 115 (2): 168–86. doi:10.1182/blood-2009-06-225565. PMID 19846889.
- Schmelzeisen R, Frölich JC (1993). "Prevention of postoperative swelling and pain by dexamethasone after operative removal of impacted third molar teeth". European Journal of Clinical Pharmacology. 44 (3): 275–77. doi:10.1007/BF00271371. PMID 8491244. S2CID 12528750.
- "Croup- Diagnosis & Treatment". Mayo Clinic. Retrieved 13 October 2017.
Dexamethasone is usually recommended because of its long-lasting effects (up to 72 hours).
- Brady CJ, Villanti AC, Law HA, Rahimy E, Reddy R, Sieving PC, Garg SJ, Tang J (2016). "Corticosteroid implants for chronic non-infectious uveitis". Cochrane Database Syst Rev. 2: CD010469. doi:10.1002/14651858.CD010469.pub2. PMC 5038923. PMID 26866343.
- Kim CH, Chen MF, Coleman AL (2017). "Adjunctive steroid therapy versus antibiotics alone for acute endophthalmitis". Cochrane Database Syst Rev. 2: CD012131. doi:10.1002/14651858.CD012131.pub2. PMC 5419424. PMID 28225198.
- Brouwer, Matthijs C.; McIntyre, Peter; Prasad, Kameshwar; van de Beek, Diederik (4 June 2013). "Corticosteroids for acute bacterial meningitis". The Cochrane Database of Systematic Reviews (6): CD004405. doi:10.1002/14651858.CD004405.pub4. ISSN 1469-493X. PMID 23733364.
- Roila F, Ballatori E, Ruggeri B, DeAngelis V (May 2000). "Dexamethasone Alone or in Combination with Ondansetron for the Prevention of Delayed Nausea and Vomiting Induced by Chemotherapy". N Engl J Med. 342 (21): 1554–59. doi:10.1056/NEJM200005253422102. PMID 10824073.
- Holte K, Kehlet H (November 2002). "Perioperative single-dose glucocorticoid administration: pathophysiologic effects and clinical implications". J Am Coll Surg. 195 (5): 694–712. doi:10.1016/s1072-7515(02)01491-6. PMID 12437261.
- Harousseau JL, Attal M, Leleu X, Troncy J, Pegourie B, Stoppa AM, Hulin C, Benboubker L, Fuzibet JG, Renaud M, Moreau P, Avet-Loiseau H (November 2006). "Bortezomib plus dexamethasone as induction treatment prior to autologous stem cell transplantation in patients with newly diagnosed multiple myeloma: results of an IFM phase II study". Haematologica. 91 (11): 1498–505. PMID 17043025.
- Chrousos GP, Detera-Wadleigh SD, Karl M (December 1993). "Syndromes of glucocorticoid resistance" (PDF). Ann. Intern. Med. 119 (11): 1113–24. doi:10.7326/0003-4819-119-11-199312010-00009. PMID 8239231. S2CID 26040431. Archived (PDF) from the original on 14 August 2017. Retrieved 4 July 2020.
- Charmandari E, Kino T, Ichijo T, Chrousos GP (May 2008). "Generalized glucocorticoid resistance: clinical aspects, molecular mechanisms, and implications of a rare genetic disorder". J. Clin. Endocrinol. Metab. 93 (5): 1563–72. doi:10.1210/jc.2008-0040. PMC 2386273. PMID 18319312.
- Dan L. Longo, Anthony Fauci, Dennis Kasper, Stephen Hauser, J. Jerry Jameson and Joseph Loscalzo, Harrison's Principles of Internal Medicine, 18th edition, p. 3055
- Bloom SL, Sheffield JS, McIntire DD, Leveno KJ (April 2001). "Antenatal dexamethasone and decreased birth weight". Obstet Gynecol. 97 (4): 485–90. doi:10.1016/S0029-7844(00)01206-0. PMID 11275014. S2CID 33601749.
- Elton, Catherine (18 June 2010). "A Prenatal Treatment Raises Questions of Medical Ethics". Archived from the original on 31 August 2016 – via content.time.com.
- Hirvikoski T, Nordenström A, Wedell A, Ritzén M, Lajic S (June 2012). "Prenatal dexamethasone treatment of children at risk for congenital adrenal hyperplasia: the Swedish experience and standpoint". The Journal of Clinical Endocrinology and Metabolism. 97 (6): 1881–83. doi:10.1210/jc.2012-1222. PMID 22466333.
- Hirvikoski T, Nordenström A, Lindholm T, Lindblad F, Ritzén EM, Wedell A, Lajic S (February 2007). "Cognitive functions in children at risk for congenital adrenal hyperplasia treated prenatally with dexamethasone". J. Clin. Endocrinol. Metab. 92 (2): 542–48. doi:10.1210/jc.2006-1340. PMID 17148562.
- Lajic S, Nordenström A, Hirvikoski T (2011). "Long-term outcome of prenatal dexamethasone treatment of 21-hydroxylase deficiency". Endocr Dev. Endocrine Development. 20: 96–105. doi:10.1159/000321228. ISBN 978-3-8055-9643-5. PMID 21164263.
- Cymerman A, Rock PB (1994). "Medical Problems in High Mountain Environments. A Handbook for Medical Officers" (PDF). USARIEM-TN94-2. US Army Research Inst. of Environmental Medicine Thermal and Mountain Medicine Division Technical Report. Retrieved 17 June 2020. Cite journal requires
- Eledrisi MS (April 2007). "First-line therapy for hypertension". Annals of Internal Medicine. 146 (8): 615. doi:10.7326/0003-4819-146-8-200704170-00021. PMID 17438328.
- Grape S, Usmanova I, Kirkham KR, Albrecht E (April 2018). "Intravenous dexamethasone for prophylaxis of postoperative nausea and vomiting after administration of long-acting neuraxial opioids: a systematic review and meta-analysis". Anaesthesia. 73 (4): 480–89. doi:10.1111/anae.14166. PMID 29226971.
- Kovac AL (May 2006). "Meta-analysis of the use of rescue antiemetics following PONV prophylactic failure with 5-HT3 antagonist/dexamethasone versus single-agent therapies". Ann Pharmacother. 40 (5): 873–87. doi:10.1345/aph.1G338. PMID 16670361. S2CID 32843029.
- Polderman JA, Farhang-Razi V, Van Dieren S, Kranke P, DeVries JH, Hollmann MW, Preckel B, Hermanides J, et al. (Cochrane Anaesthesia Group) (November 2018). "Adverse side effects of dexamethasone in surgical patients". The Cochrane Database of Systematic Reviews. 11: CD011940. doi:10.1002/14651858.CD011940.pub3. PMC 6426282. PMID 30480776.
- Sadeghirad B, Siemieniuk RA, Brignardello-Petersen R, Papola D, Lytvyn L, Vandvik PO, Merglen A, Guyatt GH, Agoritsas T (September 2017). "Corticosteroids for treatment of sore throat: systematic review and meta-analysis of randomised trials". BMJ. 358: j3887. doi:10.1136/bmj.j3887. PMC 5605780. PMID 28931508.
- "Decadron, Dexamethasone Intensol (dexamethasone) dosing, indications, interactions, adverse effects, and more". Medscape Reference. WebMD. Archived from the original on 12 December 2013. Retrieved 11 December 2013.
- "Product Information Dexamethsone (dexamethasone)" (PDF). TGA eBusiness Services. Aspen Pharmacare Australia Pty Ltd. 10 August 2010. Retrieved 11 December 2013. (Accept terms and conditions to open PDF, which doesn't work in archived version)
- "Product Information Dexmethsone Injection" (PDF). TGA eBusiness ServicesAspen Pharmacare Australia Pty Ltd. Aspen Pharmacare Australia Pty Ltd. 2 March 2011. Retrieved 11 December 2013. (Accept terms and conditions to open PDF, which doesn't work in archived version)
- "Dexamethasone tablet [ECR Pharmaceuticals]". DailyMed. ECR Pharmaceuticals. December 2010. Archived from the original on 13 December 2013. Retrieved 11 December 2013.
- "Dexamethasone Tablet BP 2.0 mg – Summary of Product Characteristics (SPC)". electronic Medicines Compendium. Merck Sharp & Dohme Limited. 26 January 2018. Retrieved 17 June 2020.
- "Dexamethasone 4.0 mg/ml injection – Summary of Product Characteristics (SPC)". electronic Medicines Compendium. Merck Sharp & Dohme Limited. 4 December 2013. Archived from the original on 8 May 2015. Retrieved 11 December 2013.
- De Groot LJ, Chrousos G, Dungan K, Feingold KR, Grossman A, Hershman JM, Koch C, Korbonits M, McLachlan R, New M, Purnell J, Rebar R, Singer F, Vinik A, Nicolaides NC, Pavlaki AN, Maria Alexandra MA, Chrousos GP (2000). "Glucocorticoid Therapy and Adrenal Suppression". PMID 25905379. Cite journal requires
- Khan MO, Park KK, Lee HJ (2005). "Antedrugs: an approach to safer drugs". Curr. Med. Chem. 12 (19): 2227–39. doi:10.2174/0929867054864840. PMID 16178782.
- Elks J (14 November 2014). The Dictionary of Drugs: Chemical Data: Chemical Data, Structures and Bibliographies. Springer. pp. 366–. ISBN 978-1-4757-2085-3. Archived from the original on 15 February 2017.
- Index Nominum 2000: International Drug Directory. Taylor & Francis. January 2000. pp. 310–. ISBN 978-3-88763-075-1. Archived from the original on 24 August 2017.
- J. W. Raynor, W. Minor, M. Chruszcz (2007). "Dexamethasone at 119 K". Acta Crystallographica Section E. 63: o2791–o2793. doi:10.1107/S1600536807020806.CS1 maint: multiple names: authors list (link)
- Arth GE, Fried J, Johnston DBR, Hoff DR, Sarett HL, Silber RH, Stoerk HC, Winter CA (1958). "16-Methylated steroids. II. 16α-Methyl analogs of cortisone, a new group of anti-inflammatory steroids. 9α-Halo derivatives". Journal of the American Chemical Society. 80 (12): 3161–63. doi:10.1021/ja01545a063.
- Taub D, Hoffsommer RD, Slates HL, lWendler NL (1958). "16β-Methyl cortical steroids". Journal of the American Chemical Society. 80 (16): 4435. doi:10.1021/ja01549a095.
- "Dexamethasone for Accelerating Lung Maturation in Preterm Babies" (PDF). Archived (PDF) from the original on 22 December 2015. Retrieved 29 July 2015.
- Dummett M (30 May 2010). "Bangladesh's dark brothel steroid secret". BBC News Online. Archived from the original on 22 February 2012.
- "Prohibited In-Competition: Glucocorticoids". World Anti-Doping Agency.
- "Dexamethasone in COVID-19" (PDF). www.gpni.co.uk. 16 June 2020. Retrieved 18 June 2020.
- "Steroid drug hailed as 'breakthrough' for seriously ill COVID-19 patients". Reuters. 17 June 2020. Retrieved 18 June 2020.
- Ducharme, Jamie. "A Low-Cost Steroid Shows Promise for Treating COVID-19. But Take the News With a Grain of Salt". Time. Retrieved 18 June 2020.
- Mahase E (June 2020). "Covid-19: Demand for dexamethasone surges as RECOVERY trial publishes preprint". BMJ. 369: m2512. doi:10.1136/bmj.m2512. PMID 32576548.
- "Important to use dexamethasone only for serious COVID cases - WHO". 17 June 2020. Retrieved 18 June 2020.
- "WHO Director-General's opening remarks at the media briefing on COVID-19 - 22 June 2020". World Health Organization. Retrieved 26 June 2020.
- "Dexamethasone | Coronavirus Disease COVID-19". COVID-19 Treatment Guidelines. National Institutes of Health. Retrieved 12 July 2020.
- "Q&A: Dexamethasone and COVID-19". www.who.int. Retrieved 12 July 2020.
- "Trichlormethiazide and Dexamethasone for veterinary use". Wedgewood Pharmacy. Archived from the original on 12 December 2007. Retrieved 23 January 2008.
|Wikimedia Commons has media related to Dexamethasone.|