GENERIC NAME: dexamethasone, oral

BRAND NAME: Decadron

DRUG CLASS AND MECHANISM: Dexamethasone is a synthetic adrenal corticosteroid. Corticosteroids are natural substances produced by the adrenal glands located adjacent to the kidneys. Corticosteroids have potent anti-inflammatory properties, and are used in a wide variety of inflammatory conditions such as arthritis , colitis, asthma , bronchitis, certain skin rashes, and allergic or inflammatory conditions of the nose and eyes. There are numerous preparations of corticosteroids, including oral tablets, capsules, liquids, topical creams and gels, inhalers and eye drops, and injectable and intravenous solutions. Dexamethasone that is prescribed in oral tablet form is addressed in this article.

Dosage requirements of corticosteroids vary among individuals and diseases being treated. In general, the lowest possible effective dose is used. Corticosteroids given in multiple doses throughout the day are more effective, but also more toxic, than if the same total dose is given once daily, or every other day.

PRESCRIPTION: yes

GENERIC AVAILABLE: yes

PREPARATIONS: tablets: .25mg, .5mg, .75mg, 1.5mg, 4mg, 6mg

STORAGE: Store at room temperature, sealed container.

PRESCRIBED FOR: Dexamethasone is used to achieve prompt suppression of inflammation in many conditions. Some examples include rheumatoid arthritis , systemic lupus, acute gouty arthritis, psoriatic arthritis, ulcerative colitis , and Crohn's disease . Severe allergic conditions that fail conventional treatment may also respond to dexamethasone. Examples include bronchial asthma, allergic rhinitis, drug-induced dermatitis, and contact and atopic dermatitis . Chronic skin conditions treated with dexamethasone include dermatitis herpetiformis, pemphigus, severe psoriasis and severe seborrheic dermatitis. Chronic allergic and inflammatory conditions of the uvea, iris, conjunctiva and optic nerves of the eyes are also treated with dexamethasone.

Dexamethasone is also used in the treatment of blood cell cancers (leukemias), and lymph gland cancers (lymphomas). Blood diseases involving destruction of platelets by the body's own immune cells (idiopathic thrombocytopenia purpura), and destruction of red blood cells by immune cells (autoimmune hemolytic anemia ) can also be treated with dexamethasone. Other miscellaneous conditions treated with this medication include thyroiditis and sarcoidosis . Finally, dexamethasone is used as a hormone replacement in patients whose adrenal glands are unable to produce sufficient amounts of corticosteroids.

DOSING: Should be taken with food.

DRUG INTERACTIONS: Prolonged use of dexamethasone can depress the ability of body's adrenal glands to produce corticosteroids. Abruptly stopping dexamethasone in these individuals can cause symptoms of corticosteroid insufficiency, with accompanying nausea, vomiting and even shock. Therefore, withdrawal of dexamethasone is usually accomplished by gradual tapering. Gradually tapering dexamethasone not only minimizes the symptoms of corticosteroid insufficiency, it also reduces the risk of an abrupt flare of the disease under treatment.

Dexamethasone and other corticosteroids can mask signs of infection and impair the body's natural immune response to infection. Patients on corticosteroids are more susceptible to infections, and can develop more serious infections than healthy individuals. For instance, chicken pox and measles viruses can produce serious and even fatal illnesses in patients on high doses of dexamethasone. Live virus vaccines, such as small pox vaccine, should be avoided in patients taking high doses of dexamethasone, since even vaccine viruses may cause disease in these patients. Some infectious organisms, such as tuberculosis (TB) and malaria , can remain dormant in a patient for years. Dexamethasone and other corticosteroids can reactivate dormant infections in these patients and cause serious illnesses. Patients with dormant tuberculosis may require anti- TB medications while undergoing prolonged corticosteroid treatment.

By interfering with the patient's immune response, dexamethasone can impede the effectiveness of vaccinations. Dexamethasone can also interfere with the tuberculin (TB) skin test and cause false negative results in patients with dormant tuberculosis infection.

Dexamethasone impairs calcium absorption and new bone formation. Patients on prolonged treatment with dexamethasone and other corticosteroids can develop osteoporosis and an increased risk of bone fractures. Supplemental calcium and vitamin D are encouraged to slow this process of bone thinning. In rare individuals, destruction of large joints can occur while undergoing treatment with dexamethasone or other corticosteroids. These patients experience severe pain in the involved joints, and can require joint replacements. The reason behind such destruction is not clear.

PREGNANCY: Dexamethasone can be used in pregnancy, but is generally avoided.

SIDE EFFECTS: Dexamethasone side effects depend on the dose, the duration and the frequency of administration. Short courses of dexamethasone are usually well tolerated with few and mild side effects. Long term, high doses of dexamethasone will usually produce predictable, and potentially serious side effects. Whenever possible, the lowest effective doses of dexamethasone should be used for the shortest possible length of time to minimize side effects. Alternate day dosing can also help reduce side effects.

Side effects of dexamethasone and other corticosteroids range from mild annoyances to serious irreversible bodily damages. Side effects include fluid retention, weight gain, high blood pressure , potassium loss, headache, muscle weakness, puffiness of and hair growth on the face, thinning and easy bruising of skin, glaucoma , cataracts , peptic ulceration, worsening of diabetes, irregular menses, growth retardation in children, convulsions, and psychic disturbances. Psychic disturbances can include depression , euphoria, insomnia, mood swings, personality changes, and even psychotic behavior. The bone and joint complications of corticosteroids are discussed above in DRUG INTERACTIONS.

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