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Dexamethasone

See ((Glucocorticoids (corticosteroids, steroids) ))

A type of corticosteroid medication.

It is an agonist of the glucocorticoid receptor (GR).

A chemical modification of cortisol molecular structure with a prolonged duration of action from approximately 8 to 36 hours, and an increase of anti-inflammatory potency 20 fold over cortisol.

It is used in the treatment of many conditions.

Used to treat: rheumatic problems, skin diseases, severe allergies, asthma, chronic obstructive lung disease, and brain swelling.

Used together with a mineralocorticoid for adrenal insufficiency.

May be used to improve outcomes in premature labor.

Administered by mouth, intramuscular, SC, or intravenously.

The effects frequently seen within a day and last for about three days.

US: C -Risk not ruled out.

Bioavailability 80–90%

Protein binding 77%

Metabolism hepatic.

Biological half-life 190 minutes.

Excretion Urine at 65%.

The long-term use may result in thrush, bone loss, cataracts, easy bruising, or muscle weakness.

Should not be taken when breastfeeding.

Has anti-inflammatory and immunosuppressant effects.

Used to treat many inflammatory and autoimmune conditions, such as rheumatoid arthritis and bronchospasm.

Idiopathic thrombocytopenic purpura, responds to 40 mg daily for four days.

Commonly given as a treatment for croup in children, as a single dose can reduce the swelling of the airway to improve breathing and reduce discomfort.

Can be injected into the heel when treating plantar fasciitis.

Counteracts allergic anaphylactic shock.

It is present in eye drops, nasal spray (trade and ear drops.

Dexamethasone intravitreal steroid implants

are used to treat ocular conditions such as diabetic macular edema, central retinal vein occlusion, and uveitis.

Used with antibiotics to treat acute endophthalmitis.

Used in transvenous screw-in cardiac pacing leads to minimize the inflammatory response of the myocardium.

May be administered before antibiotics in cases of bacterial meningitis, to reduce the inflammatory response of the body to the bacteria killed by the antibiotics.

Counteract certain side effects of their antitumor chemotherapy treatments.

Can increase the antiemetic effect of 5-HT3 receptor antagonists.

In brain tumors it is used to counteract the development of CNS edema.

It is also given in cord compression, where a tumor is compressing the spinal cord.

Used as a direct chemotherapeutic agent in hematological malignancies, especially in the treatment of multiple myeloma.

It can be used in congenital adrenal hyperplasia in older adolescents and adults to suppress ACTH production.

May be given to women at risk of delivering prematurely to promote maturation of the fetus’ lungs.

Used during pregnancy as an off-label prenatal treatment for the symptoms of congenital adrenal hyperplasia in female babies, although it’s use is controversial.

It is used in the treatment of high-altitude cerebral edema, as well as high-altitude pulmonary edema.

Dexamethasone and ondansetron are more effective than ondansetron alone in preventing postoperative nausea and vomiting.

Adverse effects :

Acne

Insomnia

Vertigo

Increased appetite

Weight gain

Impaired skin healing

Depression

Euphoria

Hypertension

Increased risk of infection

Raised intraocular pressure

Vomiting

Dyspepsia

Confusion

Amnesia

Irritability

Nausea

Malaise

Headaches

Cataract

Papilledema

Adrenal suppression

Growth stunting in children

Cushing’s syndrome

Peptic ulcer

Osteoporosis

Myopathy

Diabetes mellitus type 2

Hyperglycaemia

Pancreatitis

Sodium and water retention

Mania

Psychosis

Glaucoma

Cardiomyopathy

Abdominal distension

Corneal or scleral thinning

Candidiasis

Skin atrophy

Bruising

Telangiectasia

Striae

Leukocytosis

Thromboembolism

Psychological dependence

Vertebral collapse

Esophageal ulcer

Seizures

Hypertriglyceridaemia

Intracranial hypertension with long-term use

Facial plethora

Hypokalaemia

Hypocalcaemia

Muscular atrophy

Nitrogen depletion due to protein catabolism

Allergic reactions including anaphylaxis

Contraindications include:

Uncontrolled infections

Known hypersensitivity to dexamethasone

Cerebral malaria

Systemic fungal infection

Concurrent treatment with live virus vaccines

Known drug interactions include:

Inducers of hepatic microsomal enzymes such as barbiturates, phenytoin, and rifampicin can reduce the half-life of dexamethasone.

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