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Dexamethasone

(deks-uh-meth-uh-zone)

Trade/other name(s): Decadron, Dexamethasone Intensol, dexamethasone acetate, dexamethasone sodium phosphate

Why would this drug be used?

Dexamethasone can be used in cancer treatment in a number of different ways:

  • to help treat some leukemias, lymphomas, and other types of cancer (usually along with chemotherapy)
  • to help prevent or treat allergic reactions to certain drugs
  • to prevent or treat nausea and vomiting caused by some chemotherapy drugs
  • to increase appetite
  • to reduce swelling (edema), especially for tumors in the brain, spinal cord, or bones
  • to help lower blood calcium levels in people with cancers in the bones

It is also used to help treat a wide variety of other conditions:

  • to reduce inflammation (to help treat some conditions of the eyes, skin, lungs, digestive tract, kidneys, or other parts of the body)
  • to help prevent or treat allergies or asthma
  • to treat arthritis or other autoimmune disorders
  • to treat some autoimmune blood disorders
  • to help prevent transplant rejection
  • to replace the body's normal steroids when the adrenal glands aren't working well

Doctors may prescribe dexamethasone for a number of other uses as well.

How does this drug work?

Dexamethasone is a type of steroid drug known as a glucocorticosteroid. It is a man-made version of a natural hormone produced by the adrenal glands. Glucocorticosteroids have a wide range of actions on many parts of the body. The ways in which they cause these many different effects aren't exactly clear.

The main effects of dexamethasone and steroids like it seem to be due to their anti-inflammatory properties and their ability to alter immune system responses. For example, dexamethasone helps prevent white blood cells from traveling to areas of the body where they might add to swelling problems (such as around tumors). It also seems to help with the treatment of certain blood cancers (such as leukemias) by causing some cancerous white blood cells to commit suicide.

The reasons for some of its other actions, such as increasing appetite and reducing nausea, aren't as clear.

Before taking this medicine

Tell your doctor…

  • If you are allergic to any medicines, dyes, additives, or foods.
  • If you have (or have recently been exposed to people with) any type of infection, including tuberculosis or viral (chickenpox, measles), fungal, or parasitic infections. Dexamethasone can suppress the immune system, which could lead to an increased risk of infection or make infections worse.
  • If you have recently had surgery or any serious injuries. This drug may slow wound healing.
  • If you have or have ever had diabetes. This drug may increase blood sugar levels.
  • If you have ever had an ulcer or other digestive problems. This drug may raise the risk of further complications.
  • If you have ever had congestive heart failure or edema (swelling). This drug can cause the body to retain fluid, which could make these conditions worse.
  • If you have a history of emotional problems or mental illness. Some people taking this drug have noted mood swings, confusion, or personality changes.
  • If you have ever had low thyroid function or cirrhosis of the liver. The effects of this drug may be enhanced in people with these conditions.
  • If you have ever had high blood pressure. Large doses of this drug may raise your blood pressure. Your doctor may want to monitor you closely during treatment.
  • If you take any blood-thinning medicines, such as warfarin (Coumadin) or aspirin, to help prevent blood clots. This drug may affect how well these medicines work.
  • If you have any other medical conditions such as kidney disease, liver disease (including hepatitis), heart disease (including a recent heart attack), bleeding or clotting problems, glaucoma, or gout. This drug may make some of these conditions worse. You may need closer monitoring of these conditions while being treated, or the drug dose, regimen, or timing may need to be changed.
  • If you are pregnant, trying to get pregnant, or if there is any chance of pregnancy. This drug might cause problems if either the male or female is taking it at the time of conception or during pregnancy. It is important to check with your doctor about whether birth control should be used with this medicine. This drug should be used during pregnancy only if the potential benefit is thought to justify the potential risk to the fetus.
  • If you are breast-feeding. This drug passes into breast milk and may affect the baby. Talk with your doctor about the possible risks of breast-feeding while taking this drug.
  • About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs. In fact, keeping a written list of each of these medicines (including the doses of each and when you take them) with you in case of emergency may help prevent complications if you get sick.

Interactions with other drugs

Dexamethasone may interact with several other drugs. Drugs that could possibly lower the effectiveness or increase the side effects of dexamethasone include:

  • antacids
  • macrolide antibiotics (erythromycin, clarithromycin, azithromycin)
  • tricyclic antidepressants (amitriptyline, desipramine, doxepin, imipramine, nortriptyline)
  • ephedrine
  • hormone therapies such as birth control pills and estrogen replacement
  • thyroid medicines
  • cholestyramine (Questran)

Because of the way this drug is processed by the liver, dexamethasone levels in the body may also be affected by a number of other drugs or supplements. These could include:

  • rifampin, a drug for tuberculosis (TB)
  • anti-seizure drugs such as phenytoin, phenobarbital, carbamazepine,
  • anti-fungal drugs such as itraconazole or ketoconazole
  • nefazodone (anti-depressant)
  • cimetidine (Tagamet), a stomach acid blocker
  • ritonavir, indinavir, and other drugs for HIV or AIDS
  • St. John's wort (herbal dietary supplement)

Other medicines may also have this effect.

Anti-diabetic drugs may not work as well while taking dexamethasone. Blood sugar may go up after starting this drug.

Dexamethasone could lower the effectiveness or raise the risk of side effects from some other drugs, including:

  • non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen
  • acetaminophen (Tylenol)
  • amphotericin B
  • warfarin (Coumadin)
  • asparaginase
  • digoxin (low potassium may cause risk of abnormal heart rhythm)
  • diuretics (water pills)
  • cyclosporine or other drugs that suppress the immune system (cyclosporine also increases risk of seizures if taken with dexamethasone)
  • anti-seizure drugs (carbamazepine, phenytoin, phenobarbital)
  • drugs for tuberculosis, such as isoniazid (INH)

There may be interactions with other drugs as well. Check with your doctor, nurse, or pharmacist about possible interactions with any medicines, herbs, or supplements you are taking.

Interactions with foods

The use of alcohol along with long-term dexamethasone may increase the risk of stomach ulcers.

Because sodium can also increase the amount of fluid you retain, your doctor may suggest you follow a low sodium diet while getting this drug.

No other serious interactions with food are known at this time. Check with your doctor, nurse, or pharmacist about whether some foods may be a problem.

Tell all the doctors, dentists, nurses, and pharmacists you visit that you are taking this drug.

How is this drug taken or given?

Dexamethasone can be given in many different ways, including being taken orally (as tablets, liquid, or as a liquid concentrate); injected into a vein (intravenous, or IV), muscle (intramuscular, or IM), or joint (intra-articular); applied as an ointment or cream to the skin or eyes; or applied as eye drops. Depending on why it is being used, dexamethasone may be given over a wide range of doses. In some cases the desired dose may depend on your body weight. Follow the instructions of your doctor or pharmacist to be sure you are taking it correctly.

Dexamethasone tablets or liquid should be taken with food or milk to help protect the stomach from irritation.

If you use the liquid concentrate, use only the dropper supplied with the medicine to measure your dose. The liquid can be mixed with soft drinks, juice, or a semi-solid food like applesauce or pudding. Eat or drink all of the mixture right away.

Store the tablets or liquid in a tightly closed container and out of the reach of children and pets.

Precautions

This drug can interact with a number of other medicines and should be used cautiously in people with a number of different medical conditions. See the "Before Taking This Medicine" section of this document for more information. Your doctor, nurse, or pharmacist can also tell you what to look out for.

This drug can suppress your immune system. This can raise your risk of getting an infection or of reactivating an old infection. Your doctor may advise you to avoid people who have infections (especially measles or chicken pox) while you are being treated. Be sure to let your doctor or nurse know right away if you are exposed, or if you have any signs of infection, such as fever, chills, pain when passing urine, new onset of cough, or bringing up sputum. This drug can also suppress symptoms of infection, so call the doctor even if symptoms seem minor.

This medicine may take time to start working for certain conditions. Do not stop taking this drug without first speaking to your doctor or nurse.

If you are going to stop taking dexamethasone, it should usually be tapered down over a few days or weeks, as directed by your doctor. Your body may stop making needed adrenal hormones while you are taking the drug, and it takes time to resume making as much as the body needs. Suddenly stopping the drug can cause nausea, loss of appetite, tiredness, dizziness, trouble breathing, joint pain, depression, low blood sugar, and low blood pressure.

Do not get any immunizations (vaccines), either during or after treatment with this drug, without your doctor's OK. This drug may affect your immune system, which could make vaccinations ineffective. Live virus vaccines could even lead to serious infections. Try to avoid contact with people who have recently received a live virus vaccine, such as the oral polio vaccine or smallpox vaccine. Check with your doctor about this.

This drug may cause your body to retain excess fluid. This can lead to swelling in the face, hands, or feet. Fluid may also collect in the abdomen, which could make you feel bloated. In more serious cases, fluid may collect in the chest, which can lead to trouble breathing. Let your doctor or nurse know right away if you suddenly gain weight, notice swelling in any part of your body, or develop shortness of breath.

This drug can irritate your stomach, and should be taken with food or milk if possible. When used for extended periods it may increase the risk of ulcers or bleeding in the digestive tract. People who already have digestive problems such as colitis or diverticulitis may be at higher risk. Tell your doctor if you notice a new onset of abdominal pain, trouble when eating, or bloody or dark colored stools.

People with diabetes should be aware that this drug may raise your blood glucose level. This may require more frequent monitoring of sugar levels and/or changes in insulin or other medicines. Even people without diabetes may have higher blood sugars on dexamethasone

This drug may delay wound healing. People who have recently had surgery or a major injury should discuss this with their doctor.

This drug may affect on blood levels of certain electrolytes (minerals) such as sodium and potassium. Too much sodium can lead to fluid retention, high blood pressure, and other problems. Low potassium levels can cause symptoms such as muscle cramping or weakness, nausea, confusion, increased urination, and changes in heart rhythm. Other drugs, such as certain diuretics (water pills), also may contribute to this. Your doctor may check your blood electrolyte levels and may advise you to follow a low sodium and/or high potassium diet during treatment.

Some possible long-term effects of taking dexamethasone include an increased risk of cataracts, glaucoma, bone thinning (osteoporosis), fractures, loss of muscle mass, abnormal hair growth, thinning skin, acne, and a change in the distribution of body fat.

Skin tests may not be accurate while you are on dexamethasone, because it can suppress your response.

Possible side effects

The side effects from dexamethasone and other steroids depend to a large part on the dose of the medicine and how long you are taking it.

You will probably not have most of the following side effects, but if you have any talk to your doctor or nurse. They can help you understand the side effects and cope with them.

Common

  • increased appetite
  • trouble sleeping
  • upset stomach
  • excess fluid or swelling in the face, hands, or feet*
  • weight gain
  • slowed wound healing*
  • increased blood glucose levels*

Less common

  • headache
  • feeling dizzy
  • mood swings (shifts between euphoria, anxiety, depression, and others)
  • low blood potassium level*
  • muscle weakness
  • high blood pressure
  • feeling restless
  • skin rash
  • nausea/vomiting
  • hot flashes
  • menstrual changes
  • sweating
  • bone or muscle pain
  • increased risk of infection due to suppressed immune system*
  • fewer and milder symptoms of infection*
  • skin thinning or bruising easily (with long-term use)
  • cataracts (with long-term use)
  • glaucoma (with long-term use)
  • thinning of bones (osteoporosis) (with long-term use)

Rare

  • bleeding or ulcers in the digestive tract*
  • vision changes
  • confusion or losing touch with reality
  • change in heart rhythm
  • congestive heart failure (can cause shortness of breath or swelling in hands or feet)
  • acne (with long-term use)
  • thinning hair (with long-term use)
  • bone fractures (with long-term use)
  • allergic reaction, with symptoms like trouble breathing or swelling of the face, lips, tongue, or throat after injections of the drug

*See "Precautions" section for more detailed information.

There are other side effects not listed above that can also occur in some patients. Tell your doctor or nurse if you develop these or any other problems.

FDA approval

Yes – first approved prior to 1984 (FDA cannot verify dates of drugs approved before 1984).

Disclaimer: This information does not cover all possible uses, actions, precautions, side effects, or interactions. It is not intended as medical advice, and should not be relied upon as a substitute for talking with your doctor, who is familiar with your medical needs.


Last Medical Review: 10/26/2009
Last Revised: 10/26/2009