Treatment for bronchial asthma and other disorders such as rheumatic conditions and endocrine disorders includes the use of glucocorticoid. Dexamethasone is a medication of this category that is used for treating the above conditions, in addition to inflammatory conditions. The drug recently became popular as part of treatment regimen for Covid-19, and had been extensively used on patients with respiratory complications. The drug was acknowledged as one that helped save lives of patients who required ventilation and oxygen support.

Following subsections offer a detailed view, including the mechanism of action and side effects of dexamethasone to help users identify symptoms of undesirable outcomes and take suitable remedial or preventive actions. Details include drug interactions of the medication with other drugs.

Overview of dexamethasone

Belonging to the category of glucocorticoids, this is prescribed for treating various conditions that afflict the endocrine system, in addition to rheumatic, allergic and respiratory conditions. The drug is also used for conditions that involve the collagen, that are dermatologic, ophthalmic and hematologic in nature. The drug is similar to other corticosteroids such as prednisolone, and hydrocortisone and is also used in treating gastrointestinal, neoplastic, and edematous conditions. In use for more than six decades since FDA approval, the medication gained popularity, as outlined above, in the treatment of patients with respiratory complications from Covid-19.

Dexamethasone – mechanism of action

The outcomes of the medication are primarily attributed to the short-term actions of medications of this category. For instance, a reduction in vasodilation, and leukocyte migration is linked to the drug. Actions and properties of the drug results in effects that last for many days.  The drug is known to inhibit neutrophil apoptosis, and this in turn contributes to the reduction in arachidonic acid production. The mechanism of action of the drug is also known to promote anti-inflammatory action. The drug has a distinct property; at lower doses, the outcome is anti-inflammatory, while the outcomes are immunosuppressive at higher doses. When administered for a longer duration, higher doses bring about an increase of sodium levels and a reduction in potassium.

Available forms of dexamethasone

The medication is available as tablets, oral solution, and drops, apart from injectable form, in generic and branded formulations. Dexamethasone as injectable/intraocular solution is only administered in a healthcare facility. In addition to the conditions mentioned above, the drug is also used to treat aggravation of ulcerative colitis.

Categories of individuals at risk of complications from the drug

Certain categories of individuals are at risk of exposure to certain complications from the drug. This includes possibility of allergies, impact on patients with heart ailments, patients with existing infections, and individuals who have had chickenpox/measles.

Risks:  The glucocorticoid may expose patients to severe allergies in certain rare instances. Symptoms of allergic reactions include, difficulty in breathing, or outbreak of rashes, or itching sensations. Other discernible symptoms include swelling in the limbs, or the tongue. It is necessary to seek medical intervention in the event of any swelling, difficulty in breathing, or rashes that spread, as this could turn in to a serious condition if left untreated. Patients who have had a heart attack in the recent past may be exposed to a higher risk of heart complications. Cardiac patients are to intimate history of heart ailments to treating specialist. Similarly, individuals with existing infections may also be exposed to aggravation of infections. Apart from possibility of aggravation, individuals on dexamethasone may also end up with new infections during the course of treatment. Patients diagnosed with tuberculosis, and patients with any existing parasitic or fungal infections are not to be administered dexamethasone due to the possibility of the above risks.

Patients on the drugs are at risk of exposure to eye complications, and this includes glaucoma, and cataract complications. The glucocorticoid is known to cause damage to optic nerves, and may trigger infections of the eye, and any other fungal infection. As outlined previously, patients with chicken pox or measles are not to be treated with dexamethasone, due to the possibility of complications.

Conditions treated with dexamethasone

Specific conditions treated with the glucocorticoid include inflammatory conditions linked to the immune system, and hormones. Rheumatoid conditions treated with the drug include, rheumatic arthritis, psoriatic arthritis, lupus, and ankylosing spondylitis. Skin conditions that are treated with the medication include eczema, exfoliative dermatitis, psoriasis, and seborrheic dermatitis. Certain intestinal conditions are also managed with the medication; including aggravation of ulcerative colitis. Dexamethasone is also used prior to treatment of chemotherapy, in an effort to bring down the inflammation and other possible undesirable outcomes of cancer treatment.

The glucocorticoid is also used for treating lymphoma and leukemia, apart from controlling aggravation of multiple sclerosis. Other main conditions that are treated with the drug include a condition of lack of adequate production of hormones from the adrenal glands.

Commonly reported side effects of dexamethasone

All medications come with the possibility of undesirable effects, and the corticosteroid is no exception. Unwanted outcomes are typically classified into broad categories such as mild or moderate effects and serious or adverse effects. The mild effects may not require medical intervention, and may resolve naturally after a period. Only those effects that are a persistent in nature or intense, may require medical attention. The serious or adverse effects may require medical attention, and it is necessary to carefully look for symptoms of effects that may turn serious in nature. It is also necessary to bear in mind that all individuals on the drug may not necessarily experience effects; a significant number of patients on the medication may not experience any effects whatsoever.

The actual effects depend on various factors, such as the age of the patient, the condition being treated, the dosage administered, the schedule, the period of intake, overall health, existing conditions and medications in use. Here is a compilation of commonly recorded side effects of the glucocorticoid. This is not an exhaustive compilation and is not complete in nature, but is only intended to be a broad reference of the possible undesirable outcomes.

Frequently occurring effects

Frequently occurring effects are generally mild in nature, and this includes possible nausea when on dexamethasone. Patients may also experience vomiting sensations, while some are known to end up with an upset stomach. There could be possible swelling, while headache may also be experienced when on the glucocorticoid. Other effects include the possibility of dizziness, while a small section of users may experience behavioral changes. For instance, there could be possible change in mood, while some may feel depressed or exhibit changes in certain personality traits.

Other effects that may be experienced include difficulty in falling asleep, while some may feel anxious without any apparent reason. Fatigue is also attributed to the medication, as a result of a dip in potassium levels. The drug may also cause a spike in blood glucose levels, apart from an increase in blood pressure. The increase in blood glucose or blood pressure levels may trigger effects linked to the conditions.

Effects that are a cause for concern

Apart from the above effects, there are other effects that are a cause for concern. These effects need to be treated at the earliest to prevent the conditions from turning serious or uncontrollable.  For instance, certain symptoms that are intense in nature could be an indication of a serious outcome. This includes tiredness and fatigue that is extremely high, that is not linked to any other underlying condition. Similarly, dizziness that persists, that does not resolve naturally in a few days after the treatment is commenced is also a reason for concern. Blood pressure could also increase as a result of the drug, and this needs to be controlled. Certain digestion related complications also need to be treated appropriately. This includes pain in the stomach, and traces of blood in the feces or urine. Stool that is dark in color is also an indication of a serious intestinal condition, and needs to be treated accordingly.

Other effects that may be experienced

Individuals are at risk of experiencing frequent bruising and bleeding for no apparent reason. Similarly, swelling in the body, or the abdomen is also a possibility. Other effects include infections, fever, pain in the muscles, and joints. The patient may exhibit symptoms of depression, or may also appear euphoric without any reason. The color of the skin may also darken when on the medication due to insufficient hormone production in the adrenal glands.

Drug interactions of dexamethasone

Similar to undesirable effects, medications also come with the possibility of drug interactions when taken along with other drugs. This is not limited to prescription drugs, but may also occur when taken alongside OTC formulations, herbal remedies, supplements and alternative medications. The nature of drug interactions is also classified into three different categories. For instance, ether of the two medications or products may deliver increased outcome or potency. The second outcome could be a decrease in the potency or outcome of the medication and the third outcome could be aggravation of side effects of either or both the medications. Options to manage these interactions include discontinuation of either of the two medications, depending on the importance or criticality of the condition.

Specialists may also change either of the two drugs, with replacements that have a different mechanism of action. The last option is alteration of dosage or intake schedule so as to minimise the possibility of interactions. This option is chosen when both the medications are equally important and need to continued. Here is compilation of some of the common interactions; this is not an exhaustive list of drugs that interact, but is intended to only serve as a broad reference of the possible interactions.

Antibiotics may interact and cause side effects of dexamethasone, and this includes medications such as erythromycin, used for handling bacterial infections. The interaction may result in an increase of dexamethasone, and this may cause aggravation of undesirable outcomes. Similarly, drug interactions are possible when the glucocorticoid is taken alongside medications used for treating fungal infections. For instance, drugs such as ketoconazole may cause an increase in the levels of the drug and this may result in possible aggravation of undesirable outcomes. Other anti-fungal drugs that can cause an interaction include Amphotericin B. Other drugs include medications classified as blood thinners.


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