In physiology, corticosteroids are
a class of steroid hormones that are produced in the
adrenal cortex. Corticosteroids are involved in a wide
range of physiologic systems such as stress response,
immune response and regulation of inflammation, carbohydrate
metabolism, protein catabolism, blood electrolyte levels,
Synthetic drugs with corticosteroid-like effect are
used in a variety of conditions, ranging from brain
tumours to skin diseases. Dexamethasone and its derivatives
are almost pure glucocorticoids, while prednisolone
and its derivatives have some mineralocorticoid action
in addition to the glucocorticoid effect. Fludrocortisone
(Florinef®) is a synthetic mineralocorticoid. Hydrocortisone
(cortisol) is available for replacement therapy, e.g.
in adrenal insufficiency and congenital adrenal hyperplasia.
Synthetic glucocorticoids are used in the treatment
of joint pain or inflammation (arthritis), dermatitis,
allergic reactions, asthma, hepatitis, lupus erythematosus,
inflammatory bowel disease (ulcerative colitis and Crohn's
disease), sarcoidosis and for glucocorticoid replacement
in Addison's disease or other forms of adrenal insufficiency.
Topical formulations for treatment of skin or inflammatory
bowel disease are available.
Typical undesired effects of glucocorticoids present
quite uniformly as drug-induced Cushing's syndrome.
Typical mineralocorticoid side effects are hypertension
(abnormally high blood pressure), hypokalemia (low potassium
levels in the blood), hypernatremia (high sodium levels
in the blood) without causing peripheral edema, and
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. Should be taken with food.
Prolonged use of dexamethasone can depress the ability
of the 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
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
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.
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.
Back to Top