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Dexamethasone: Uses, Side Effects, Interactions, Dosages

Highlights for dexamethasone

1. Dexamethasone oral tablet is available as both a generic and brand-name drug. Brand name: DexPak.
2. Dexamethasone comes as an oral tablet, oral solution, eye drops, and ear drops. It’s also available as an injectable solution or an intraocular solution given after surgery. These two forms are given only by a healthcare professional.
3. Dexamethasone oral tablet is used to treat many conditions. These include inflammation, allergic reactions, and flare-ups of ulcerative colitis. They also include adrenal insufficiency.

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Important warnings

• Allergic reaction: Dexamethasone may cause an allergic reaction in rare cases. If you have trouble breathing, a rash, or itchy skin, or notice swelling of your arms, feet, or tongue, call your doctor immediately. Call 911 if your symptoms feel life threatening or if you think you’re having a medical emergency.
• Heart damage: If you’ve recently had a heart attack, you may be at increased risk of further heart damage from this drug. Before starting this drug, be sure your doctor knows you’ve had a heart attack.
• Infection: Dexamethasone can cover up or worsen certain infections. In addition, infections can develop during treatment. Do not use this drug if you have fungal infections, or a history of parasite infections or tuberculosis. Tell your doctor about any past illnesses or infections.
• Eye problems: Using dexamethasone for long periods can lead to eye problems such as cataracts or glaucoma. The drug may also cause damage to the optic nerves, or fungal or viral eye infections.
• Measles or chickenpox: Tell your doctor if you have not had chickenpox or measles, or if you have not had the vaccines to prevent them. You could have more serious versions of these illnesses if you have them while taking dexamethasone.

What is dexamethasone?

Dexamethasone is a prescription medication. It’s available as an oral tablet, oral solution, eye drops, and ear drops. It’s also available as an injectable solution or an intraocular solution given after surgery. These last two forms are given only by a healthcare professional.

The dexamethasone tablet is available as the brand-name drugs DexPak and Decadron. It’s also available as a generic drug. Generic drugs usually cost less than the brand-name version. In some cases, they may not be available in all strengths or forms as the brand-name drug.

Why it’s used

The dexamethasone oral tablet is used to treat conditions that cause inflammation, conditions related to immune system activity, and hormone deficiency. These conditions include:

• inflammation
• allergic reactions
• rheumatoid arthritis and other rheumatic diseases, including ankylosing spondylitis, psoriatic arthritis, juvenile rheumatoid arthritis, lupus, and acute gouty arthritis
• skin diseases, such as atopic dermatitis (eczema), pemphigus, severe erythema multiforme (Stevens-Johnson syndrome), exfoliative dermatitis, bullous dermatitis herpetiformis, severe seborrheic dermatitis, severe psoriasis, or mycosis fungoides
• flare-ups of intestinal diseases, such as ulcerative colitis
• flare-ups of multiple sclerosis or myasthenia gravis
• pretreatment for chemotherapy to reduce inflammation and side effects from cancer medications
• certain leukemias and lymphomas
• adrenal insufficiency (a condition where the adrenal glands don’t produce enough hormones)

How it works

Dexamethasone belongs to a class of drugs called steroids. A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.

• For conditions with inflammation: With certain conditions, inflammation can cause the immune system to be overactive. This can damage the body’s tissues. Steroids such as dexamethasone help block the immune system’s response to inflammation, which helps prevent this damage.
• For adrenal insufficiency: The adrenal gland helps control certain body functions. These functions include managing blood glucose, defending against infection, and managing stress. In people with adrenal insufficiency, the adrenal gland releases lower amounts of certain hormones. Dexamethasone helps replace these hormones.

Dexamethasone side effects

Dexamethasone oral tablet doesn’t cause drowsiness, but it can cause other side effects.

More common side effects

The more common side effects that can occur with dexamethasone oral tablets include:

• nausea
• vomiting
• stomach upset
• swelling (edema)
• headache
• dizziness
• mood changes, such as depression, shifts in mood, or personality changes
• trouble falling asleep
• anxiety
• low potassium levels (causing symptoms such as tiredness)
• high blood glucose
• high blood pressure

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk with your doctor or pharmacist.

Serious side effects

Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

• Unusual tiredness
• Unusual dizziness
• Unusual digestive upset. Symptoms can include:
  • abdominal pain
  • nausea or vomiting
• Blood in your stool, or black stools
• Blood in your urine
• Unusual bleeding or bruising
• Unusual swelling throughout your body, or bloating in your abdomen (stomach area)
• Infection. Symptoms can include:
  • fever
  • muscle aches
  • joint pain
• Changes in mood or thoughts, or mood disorders such as depression. Symptoms can include:
  • severe mood shifts
  • euphoria (a feeling of intense happiness)
  • trouble sleeping
  • personality changes
• Severe allergic reaction. Symptoms can include:
  • fever
  • trouble breathing
• Adrenal insufficiency. Symptoms can include:
  • tiredness
  • nausea
  • darkened skin color
  • dizziness when standing
• More frequent infections (can occur with long-term use)
• Stomach ulcers. Symptoms can include:
  • pain in the abdomen (stomach area)
• Congestive heart failure. Symptoms can include:
  • shortness of breath
  • tiredness
  • swollen legs
  • rapid heartbeat
• Osteoporosis (thinning of the bones)

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare professional who knows your medical history.

Dexamethasone may interact with other medications

Dexamethasone oral tablet can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk with your doctor or pharmacist.

Examples of drugs that can cause interactions with dexamethasone are listed below. This is not an exhaustive list. Speak with your doctor before taking any new medications or supplements.

Antibiotics

Erythromycin is used to treat infections caused by bacteria. When used with dexamethasone, this drug can increase the amount of dexamethasone in your body. This raises your risk of side effects.

Antifungal drugs

When used with dexamethasone, certain drugs used to treat fungal infections can increase the level of dexamethasone in your blood. This can raise your risk of side effects. Examples of these drugs include:

• ketoconazole
• itraconazole
• posaconazole
• voriconazole

Amphotericin B is another drug used to treat fungal infections. Using this drug with dexamethasone raises your risk of low potassium levels. (Potassium is a mineral that helps your nerves, muscles, and organs work normally.) This can cause muscle cramps, weakness, tiredness, and an irregular heartbeat.

Blood thinners

Using dexamethasone with certain blood thinners can decrease the levels of these drugs in your body. This can make them less effective, and raise your risk of clots or stroke. Examples of these drugs include:

• apixaban
• rivaroxaban

Warfarin is also used to thin the blood. Using dexamethasone with this drug may result in changes to your risk of bleeding. Your doctor may need to monitor you closely.

Cholesterol drugs

If you take dexamethasone with certain drugs used to lower cholesterol, it can keep your body from absorbing dexamethasone well. This could keep dexamethasone from working well. Examples of these drugs include:

• cholestyramine
• colesevelam
• colestipol

Cushing’s syndrome drugs

Aminoglutethimide is used to treat symptoms of Cushing’s syndrome (a disease of the adrenal gland). Using this drug with dexamethasone may decrease the amount of dexamethasone in your body. This means it may not work as well.

Diabetes drugs

Dexamethasone may increase your blood glucose, although it is rare. If you take diabetes drugs, your doctor may need to change your dose. Examples of these drugs include:

• amylin analogs, such as:
  • pramlintide
• biguanides, such as:
  • metformin
• GLP-1 agonists, such as:
  • exenatide
  • liraglutide
  • lixisenatide
• DPP4 inhibitors, such as:
  • saxagliptin
  • sitagliptin
  • insulin
• meglitinides, such as:
  • nateglinide
  • repaglinide
• sulfonylureas, such as:
  • glimepiride
  • glipizide
  • glyburide
• SGLT-2 inhibitors, such as:
  • canagliflozin
  • dapagliflozin
  • empagliflozin
• thiazolidinediones, such as:
  • pioglitazone
  • rosiglitazone

Diuretics (water pills)

When used with dexamethasone, these drugs reduce your body’s potassium levels. (Potassium is a mineral that helps your nerves, muscles, and organs work normally.) This can cause muscle cramps, weakness, tiredness, and an irregular heartbeat. Examples of these drugs include:

• bumetanide
• furosemide
• hydrochlorothiazide

Epilepsy drugs

When used with dexamethasone, certain drugs used to treat epilepsy can lower the level of dexamethasone in your blood. This can keep dexamethasone from working well. Examples of these drugs include:

• phenytoin
• fosphenytoin
• phenobarbital
• carbamazepine

Heart drugs

Digoxin is used to treat heart rhythm problems or heart failure. Taking this drug with dexamethasone could increase your risk of irregular heartbeats caused by low potassium levels. (Potassium is a mineral that helps your nerves, muscles, and organs work normally.)

Hormones

Taking certain hormones with dexamethasone can cause decreased levels of these hormones in your body. Your doctor may have to adjust your dose of either the dexamethasone or hormone medications. Examples of these drugs include:

• estrogens
• oral contraceptives

HIV drugs

Taking certain drugs used to treat HIV with dexamethasone can potentially reduce the levels of these drugs in your body, although it’s rare. This means they may not work as well, and your body may stop responding to your HIV medications. Your doctor may avoid the use of these drugs with dexamethasone. Examples of these drugs include:

• protease inhibitors, such as:
  • atazanavir
  • darunavir
  • fosamprenavir
  • indinavir
  • nelfinavir
  • ritonavir
  • saquinavir
  • simeprevir
  • tipranavir
• non-nucleoside reverse transcriptase inhibitors, such as:
  • etravirine
• entry inhibitors, such as:
  • maraviroc
• integrase inhibitors, such as:
  • elvitegravir

NSAIDs

Using nonsteroidal anti-inflammatory drugs (NSAIDs) with dexamethasone raises your risk of stomach ulcers or bleeding events. Talk with your doctor about whether you can take these drugs together. Examples of NSAIDs include:

• aspirin
• ibuprofen
• indomethacin
• naproxen

Tuberculosis drugs

When used with dexamethasone, certain drugs used to treat tuberculosis (TB) can lower the level of dexamethasone in your blood. This can keep dexamethasone from working well. Examples of these drugs include:

• rifampin
• rifabutin
• rifapentine

Isoniazid is another TB drug. When it’s used with dexamethasone, levels of isoniazid can be lowered. This can keep isoniazid from working well.

Vaccines

Avoid getting live vaccines when taking dexamethasone. With live vaccines, you’re injected with a small amount of a virus so your body can learn to build an immune response against it.

You should not get these vaccines while using dexamethasone because the drug weakens your immune system. If this happens, your body will not be able to properly defend against the vaccine, and it may make you sick.

Live vaccines you should avoid while taking dexamethasone include:

• measles, mumps, rubella (MMR)
• intranasal flu (FluMist)
• smallpox
• chickenpox
• rotavirus
• yellow fever
• typhoid

Other drugs

Aspirin is an NSAID. It’s often used to treat pain, as well as thin the blood to reduce your risk of a heart attack. Dexamethasone can decrease your aspirin levels. This can make aspirin less effective and increase your risk of a heart attack.

Also, aspirin can increase your risk of bleeding from stomach ulceration (sores) when used with dexamethasone. If you take aspirin, talk with your doctor about whether dexamethasone is safe for you.

Thalidomide is used to treat skin lesions and multiple myeloma. Combining it with dexamethasone can cause toxic epidermal necrolysis. This skin condition can be life threatening. If your doctor prescribes both of these drugs for you, they will be cautious about the effects the combination can cause.

Cyclosporine is used to prevent organ rejection in people who receive a transplant, as well as to treat rheumatoid arthritis or psoriasis. Taking this drug with dexamethasone could increase the risk that your immune system will be suppressed (will not work well). This would raise your risk of infection.

Seizures have also been reported when these drugs are used together.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare professional about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.

Dexamethasone warnings

This drug comes with several warnings.

Allergies

Dexamethasone can cause a severe allergic reaction. Symptoms can include:

• trouble breathing
• swelling of your throat or tongue

If you have an allergic reaction, call your doctor or local poison control center right away. If your symptoms are severe, call 911 or go to the nearest emergency room.

Do not take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal (cause death).

For people with certain health conditions

For people with infections: Dexamethasone may make a systemic fungal infection worse. (Systemic means it affects the whole body, not just one part.) This drug should not be used if you’re taking medication to treat a systemic fungal infection. Also, dexamethasone may hide the signs of a nonfungal infection.

For people with congestive heart failure: Dexamethasone can increase sodium levels, edema (swelling), and potassium loss. This can make your heart failure worse. Before taking this drug, talk with your doctor about whether it’s safe for you.

For people with high blood pressure: Dexamethasone can increase sodium levels and edema (swelling). This can increase your blood pressure. Before taking this drug, talk with your doctor about whether it’s safe for you.

For people with peptic ulcers: Dexamethasone can increase the risk of stomach or intestinal bleeding and ulcers. If you have peptic ulcers or other conditions in the intestines, talk with your doctor about whether this drug is safe for you. Conditions of the intestines include:

• diverticulitis
• ulcerative colitis

For people with osteoporosis: Dexamethasone decreases bone formation. It also increases bone resorption (breakdown of bone). As a result, it raises the risk of osteoporosis (bone thinning) with long-term use. The risk is higher for people already at an increased risk of osteoporosis, including postmenopausal people.

For people with hyperthyroidism: This drug is removed from the body more quickly than usual. Your doctor may adjust your dose of this drug based on your condition.

For people with eye problems: Long-term use of dexamethasone may cause eye problems such as cataracts, glaucoma, or increased pressure in the eye. Your risk is higher if you already have eye problems.

For people with tuberculosis: If you have latent tuberculosis or tuberculin reactivity, dexamethasone can reactivate the disease. If you test positive for tuberculosis, talk with your doctor about whether taking this drug is safe for you.

For people with a recent history of heart attack: If you’ve recently had a heart attack, the use of dexamethasone may lead to a tear in your heart muscle. Before you start this drug, be sure your doctor knows you’ve had a recent heart attack.

For people with diabetes: Dexamethasone can increase blood sugar levels. As a result, your doctor may change the dose of drugs for your diabetes.

For people with myasthenia gravis (MG): If you have MG, using dexamethasone with certain drugs used to treat Alzheimer’s disease can cause severe weakness. Examples of these drugs include:

• memantine
• rivastigmine
• donepezil

If possible, wait at least 24 hours after taking these drugs to start dexamethasone therapy.

For pregnant people

Talk with your doctor if you’re pregnant or plan to become pregnant. Animal research has shown adverse effects on the fetus when the gestational parent takes the drug. There haven’t been enough studies done in humans to determine how the drug might affect the fetus. This drug should only be used if the potential benefit outweighs the potential risk.

For people who are nursing

Dexamethasone is not recommended for people who are nursing. The drug can pass to a child through breast milk and may cause side effects.

For seniors

The kidneys and liver of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, more of a drug stays in your body for a longer time. This raises your risk of side effects.

When to call your doctor

Call your doctor right away if you develop a new or worsened illness or symptoms while taking dexamethasone, including fever. Also, call your doctor right away if you become pregnant while taking this drug.

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How to take dexamethasone

All possible dosages and forms may not be included here. Your dose, form, and how often you take it will depend on:

• your age
• the condition being treated
• how severe your condition is
• other medical conditions you have
• how you react to the first dose

Dosage for inflammation and other conditions

Generic: Dexamethasone

• Form: oral tablet
• Strengths: 0.5 mg, 0.75 mg, 1 mg, 1.5 mg, 4 mg, and 6 mg

Brand: DexPak

• Form: oral tablet
• Strengths: 0.25 mg, 0.5 mg, 0.75 mg, 1 mg, 1.5 mg, 4 mg, and 6 mg

Adult dosage (ages 18 years and older)

Typical dosage: 0.75–9 mg every day, depending on the condition being treated.

Child dosage (ages 0–17 years)

Initial dosage: 0.02–0.3 mg per kilogram (kg) of body weight per day, taken in three or four divided doses. The dosage depends on the condition being treated.

Senior dosage (ages 65 years and older)

The kidneys and liver of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, more of a drug stays in your body for a longer time. This raises your risk of side effects.

Your doctor may start you on a lowered dose or a different dosing schedule. This can help keep levels of this drug from building up too much in your body.

Special dosage considerations

When stopping treatment, your dosage should be decreased slowly over time. This helps to prevent withdrawal side effects.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always speak with your doctor or pharmacist about dosages that are right for you.

Take as directed

Dexamethasone oral tablets are most often used for long-term treatment but can also be used for short-term treatment. They come with serious risks if you don’t take them as prescribed.

If you stop taking the drug suddenly or don’t take it at all

If you do not take the drug at all, your condition will not be managed. If you stop taking dexamethasone suddenly, you may have withdrawal side effects. These can include:

• tiredness
• fever
• muscle aches
• joint pain

Your dosage should be decreased over time to avoid withdrawal effects. Do not stop taking dexamethasone unless your doctor tells you to do so.

If you miss doses or don’t take the drug on schedule

Your medication may not work as well or may stop working completely. For this drug to work well, a certain amount needs to be in your body at all times.

If you take too much

You could have dangerous levels of the drug in your body. Symptoms of an overdose of this drug can include:

• irregular heartbeats
• seizures
• severe allergic reaction, with trouble breathing, hives, or swelling of your throat or tongue

If you think you’ve taken too much of this drug, call your doctor or local poison control center. If your symptoms are severe, call 911 or go to the nearest emergency room right away.

What to do if you miss a dose

If you miss a dose, wait and take the next dose as planned. Do not double your dose. This could result in dangerous side effects.

How to tell if the drug is working

The symptoms of your condition should be reduced.

Important considerations for taking dexamethasone

Keep these considerations in mind if your doctor prescribes dexamethasone for you.

General

• Take this drug at the time(s) recommended by your doctor.
• You can cut or crush the tablet.

Storage

• Keep dexamethasone tablets at room temperature between 68°F and 77°F (20°C and 25°C).
• Do not store this medication in moist or damp areas, such as bathrooms.

Refills

A prescription for this medication is refillable. You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.

Travel

When traveling with your medication:

• Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
• Don’t worry about airport X-ray machines. They can’t hurt your medication.
• You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled box with you.
• Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Clinical monitoring

Your doctor will monitor you during treatment with this drug. They may do tests to check for side effects from long-term use of dexamethasone. These tests may include:

• weight test
• blood pressure test
• blood sugar test

Dexamethasone: Uses, Side Effects, Interactions, Dosages

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