|Main use||Active ingredient||Manufacturer
|Diseases involving inflammation ||Dexamethasone sodium phosphate||Non-proprietary
How does it work?
Dexamethasone is a type of medicine known as a corticosteroid. Corticosteroid medicines are derivatives of the corticosteroid hormones cortisol and aldosterone that are produced naturally by the adrenal glands. They are often simply called steroids, but it should be noted that they are very different from another group of steroids, called anabolic steroids, which have gained notoriety because of their abuse by some athletes and body builders.
Corticosteroids have many important functions on every organ system. They affect the strength of heart muscle and its response to natural chemicals affecting heart rate. They affect the water and salt balance in the body and also enable the body to cope with stress. Stress includes changes in temperature, pain, fear, anxiety and illness. Corticosteroids allow us to respond to stress by increasing the rate and force of the heartbeat, increasing blood supply to essential tissues (muscle, heart, brain), increasing the body's supply of energy by raising blood sugar and by several other effects on body systems.
Dexamethasone sodium phosphate is a synthetic corticosteroid that is given by injection into a vein (intravenously) or into a muscle (intramuscularly) in severe conditions when treatment by mouth is not possible. This includes the treatment of shock, a condition which is characterised by a loss of blood circulation to the vital organs. This may be a result of excessive bleeding (haemorrhage), surgery, trauma or infections. The dexamethasone helps the body to cope in these situations. Once treatment by mouth is possible, patients should be switched to dexamethasone tablets if corticosteroids are still required.
Corticosteroid hormones are also involved in controlling inflammatory responses in the body. Dexamethasone has an anti-inflammatory effect and is used to decrease inflammation in various different diseases and conditions.
Dexamethasone decreases inflammation by acting within cells to prevent the release of certain chemicals that are important in the immune system. These chemicals are normally involved in producing immune and allergic responses. By decreasing the release of these chemicals in a particular area, inflammation and allergic reactions are reduced.
Dexamethasone injection is used in serious or emergency situations when rapid control of symptoms is needed, for example in severe asthma attacks or severe allergic reactions such as anaphylaxis.
Dexamethasone can also be injected directly into inflamed soft tissue, for example in tennis elbow, or directly into a joint in arthritis, to decrease inflammation in that particular area.
What is it used for?
- Severe drop in blood pressure and decreased blood supply to the vital organs (shock) due to surgical or accidental trauma, bleeding (haemorrhage) or severe infection.
- Reducing swelling in the brain or raised pressure inside the skull associated with brain tumours.
- Severe allergic reactions, such as anaphylaxis, angioedema or severe asthma attack.
- Local injection into inflamed soft tissue, such as tennis elbow, tenosynovitis, or bursitis.
- Injection into the joints in inflammatory diseases of the joints (eg rheumatoid arthritis).
- Treatment of other inflammatory conditions that require rapid and intense corticosteroid therapy, or when treatment by mouth is not possible.
- This medicine must not be stopped suddenly if you have been given more than 1mg daily for more than three weeks; if you have been given high doses (more than 6mg) even if only for three weeks or less; if you have been treated with corticosteroid tablets or injections in the last year; if you had problems with your adrenal glands before treatment was started; or if you have been given repeated doses in the evening. In these situations this medicine can suppress the natural production of corticosteroids by the adrenal glands, which means that the body becomes temporarily reliant on the medicine. When it is time to stop treatment the dose should be tapered down gradually, to allow the adrenal glands to start producing adequate amounts of natural steroids again. However, in general dexamethasone injection is not intended for long-term use and is unlikely to be used for longer than a few days. If corticosteroid treatment is still needed after this you are likely to be switched to a corticosteroid taken by mouth where possible. Other steroids should also not be stopped abruptly.
- If you are having long-term or repeated treatment with steroids you will be given a steroid card that you should carry with you at all times. Show it to anyone who treats you (eg doctor, nurse, pharmacist, dentist, anaesthetist). The card contains details of your prescriber, type of steroid, dose taken and the duration of treatment. It's purpose is to act as a reminder that your medicine should not be stopped suddenly, and to provide information of your treatment to other people treating you. This is important because the effects that corticosteroids have on the body may affect other medical treatment you may be given. If you have an accident the card contains information that could save your life. You should also show your steroid card to anyone who treats you for three months after you stop treatment with steroids.
- During times of physical stress, for example illnesses, trauma or surgery, your adrenal glands would normally produce more steroid hormones to cope. However, during long-term treatment with this medicine the action of your adrenal glands will be suppressed, so this increase in hormones won't happen naturally. As a result your steroid dose will normally need to be increased temporarily during these kind of events. Discuss this with your doctor.
- Corticosteroids decrease the body's natural immune and inflammatory responses. They may increase your susceptibility to infections and can also mask the symptoms of infections, making you think they are less serious than they are. For this reason, it is important to consult your doctor if you get any signs of infection during treatment.
- If you have never had
chickenpox you could be at risk of severe chickenpox while having treatment with this medicine and
should avoid close personal contact with people who have chickenpox or
shingles (herpes zoster). You should also avoid contact
with people who have
measles. If you are exposed to people with these diseases either during treatment, or in the three months after stopping treatment, you should consult your
doctor urgently, as you will need an injection of immunoglobulin to help you stop getting the diseases. This is very important as these diseases can be life-threatening in people treated with long-term corticosteroids.
- Corticosteroid treatment, especially with high doses, can alter
mood and behaviour early in treatment. People may experience confusion, irritability, nightmares, difficulty sleeping, mood changes and depression, and suffer from delusions and suicidal thoughts. In a few cases these effects have also occured when corticosteroid treatment is being withdrawn. For this reason, it is important to let
your doctor know if you notice any change in your mood or behaviour during
treatment or when stopping treatment, particularly if you begin to feel depressed, or have any disturbing
thoughts or feelings. Most of these problems go away if the dose is lowered or the medicine is stopped. However if problems do happen they might need treatment.
- Children and adolescents having long-term treatment with this medicine should have their growth regularly monitored.
- Injections administered into joints are associated with a risk of introducing infection into the joint. Before the injection is given, the fluid found in the joint should be examined to make sure there is not an existing infection that could be made worse. Joint injections should only be given under sterile conditions.
- After having a joint injection it is important to let your doctor know if you experience a distinct increase in pain accompanied by swelling, further restriction of joint movement, fever and feeling generally unwell, as these symptoms could suggest that the joint is infected. If this is the case, antimicrobial treatment will be needed.
- It is important not to overuse joints that feel better after joint injection, as the inflammatory process may remain active.
Use with caution in
- Children and adolescents.
- Elderly people.
- Decreased kidney function.
- Liver failure or cirrhosis.
Inflammation of the bowel and back passage (ulcerative colitis).
- Painful inflammation of small sacs or pouches in the wall of
the gut (diverticulitis).
- People who have recently had a surgical procedure called intestinal
anastomosis, which involves the joining together of
ends of the intestine after a section has been removed.
- People with a history of blood clots in the blood vessels (thromboembolism).
- People who have recently had a heart attack.
High blood pressure (hypertension).
Diabetes, or a family history of diabetes.
Underactive thyroid gland (hypothyroidism).
Glaucoma, or a family history of glaucoma.
- Current severe psychiatric illness, or a personal or family
history of psychiatric illness, including depression, manic depression or schizophrenia.
- History of psychiatric illness caused by the use of a
- Women who have passed the
Abnormal muscle weakness (myasthenia gravis).
- People who have previously experienced muscle disorders (myopathy) caused by steroids.
- People with a history of tuberculosis (TB).
Herpes simplex virus infection of the eye.
- People with parasitic infections, eg amoebiasis.
Malaria affecting the brain (cerebral malaria).
- History of allergies.
Not to be used in
- People with widespread infection, unless this is being treated with specific anti-infectives.
- Corticosteroids should not be used for the management of head injury or stroke because they are unlikely to be of benefit and may even be harmful.
- Dexamethasone should not be injected into a joint when there is an infection in the joint or surrounding tissue.
- Dexamethasone should not be injected directly into tendons.
This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.
If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.
Pregnancy and breastfeeding
Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.
- This medicine should be used with caution during pregnancy, and only if the expected benefit to the mother is greater than any possible risk to the developing baby. When administered for long periods or repeatedly during pregnancy, corticosteroids may increase the risk of slowed growth in the developing baby. They may also cause the baby to make less of its
own steroid hormones after birth, although this usually resolves on its own and rarely causes any problems. Seek further medical advice from your doctor.
- This medicine passes into breast milk. It should be used with caution in mothers who are breastfeeding and only if the benefits to the mother outweigh any risks to the nursing infant. Lower doses taken by the mother are unlikely to significantly affect the baby, but if the mother is treated with high doses for long periods of time, the medicine could cause the baby's adrenal glands to make less of their own steroid hormones. Seek medical advice from your doctor.
Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here does not mean that all people using this medicine will experience that or any side effect.
- Raised blood sugar level.
- Increased appetite and weight gain.
- Increased susceptibility to infections and increased severity of infections (see warnings above).
- Effects on the gut, such as indigestion or abdominal bloating, nausea, ulceration in the stomach or intestine, inflammation of the pancreas (pancreatitis).
- Ulceration or thrush infection in the throat.
- Muscle weakness or wasting.
- Thinning of the bones (osteoporosis) and increased risk of breaking a bone.
- Effects on the skin, such as skin thinning, impaired healing, acne, bruising, stretch marks, increased sweating, change in pigmentation, increased hair growth (hirsutism).
- Psychiatric reactions, such as mood changes (including irritability, depression and suicidal thoughts), psychotic reactions (including mania, delusions and hallucinations), anxiety, confusion, memory loss, sleep disturbances (see warning above).
- Cushing's syndrome, characterised by a moon-shaped face.
- Menstrual disturbances.
- Decrease in the production of natural steroids by the adrenal glands (adrenal suppression - see warning above).
- Effects on the eyes, such as raised pressure inside the eye (glaucoma), cataracts.
- Slowed growth in children and adolescents.
- Blood clots in the blood vessels (thromboembolism).
- Increased inflammation or introduction of infection into the joint following joint injection (see warning above).
The side effects listed above may not include all of the side effects reported by the medicine's manufacturer.
For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.
How can this medicine affect other medicines?
It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while having treatment with this one, to ensure that the combination is safe.
Dexamethasone may increase blood sugar levels and so may oppose the blood sugar lowering effects of antidiabetic medicines. People with diabetes may need an increase in their dose of insulin or antidiabetic tablets.
Dexamethasone may enhance the anti-blood-clotting effect of anticoagulant medicines such as warfarin. People taking anticoagulant medicines in combination with dexamethasone should have their blood clotting time (INR) regularly monitored, particularly after starting or stopping treatment with dexamethasone and after any dose changes.
If dexamethasone is used in combination with non-steroidal anti-inflammatory drugs (NSAIDs) eg ibuprofen, there may be an increased risk of side effects on the gut, such as stomach ulceration and bleeding.
Dexamethasone may decrease the blood levels of the following medicines:
Dexamethasone may also decrease the blood levels of salicylates such as aspirin. When dexamethasone is stopped, this may result in excessive levels of the salicylate, unless the dose is readjusted.
The following medicines may increase the removal of dexamethasone from the body, thus reducing its effects. You may need a larger dose of dexamethasone if you are also taking any of these medicines:
- barbituates, eg amobarbital,
The effect of corticosteroids may be reduced in the three to four days following use of mifepristone.
The following medicines may reduce the removal of dexamethasone from the body and so may increase its effects or side effects:
- ciclosporin (dexamethasone may also increase the blood level and risk of side effects of ciclosporin)
- macrolide-type antibiotics, eg erythromycin
- protease inhibitors, eg ritonavir.
There may be an increased chance of side effects on the liver or blood cells if dexamethasone is used in combination with high-dose methotrexate.
Dexamethasone may decrease the body's immune response. This
means that vaccines may be less effective if given during treatment, because
the body does not produce sufficient antibodies. Live vaccines may cause
serious infections. Live vaccines include: measles, mumps, rubella, MMR, BCG, chickenpox, oral
polio, oral typhoid and yellow fever. These should not be given to people
whose immune system is underactive due to treatment with this medicine.
Corticosteroids can cause fluid and salt retention and so may oppose the effects of antihypertensive medicines used to treat high blood pressure
and diuretics, eg furosemide.
However, dexamethasone is much less likely than other corticosteroids to have this effect.
Corticosteroids can also lower the amount of potassium in the blood, though this is much less likely with dexamethasone than with other corticosteroids. However, there may be an increased chance of the level of potassium in the blood falling too low (hypokalaemia) if dexamethasone is used in combination with the following medicines:
- beta agonists, eg salbutamol, salmeterol, terbutaline
- potassium-losing diuretics, eg furosemide, bendroflumethiazide
Other medicines containing the same active ingredient
||Maxidex eye drops
Last updated 18.06.2008
Source Net Doctor
Date 29 - 04 - 2012