Dexamethasone
Dexamethasone is a glucocorticoid medication[10] used to treat rheumatic problems, a number of skin diseases, severe allergies, asthma, chronic obstructive lung disease, croup, brain swelling, eye pain following eye surgery, superior vena cava syndrome (a complication of some forms of cancer),[11] and along with antibiotics in tuberculosis.[10] In adrenocortical insufficiency, it may be used in combination with a mineralocorticoid medication such as fludrocortisone.[10] In preterm labor, it may be used to improve outcomes in the baby.[10] It may be given by mouth, as an injection into a muscle, as an injection into a vein, as a topical cream or ointment for the skin or as a topical ophthalmic solution to the eye.[10] The effects of dexamethasone are frequently seen within a day and last for about three days.[10]
The long-term use of dexamethasone may result in thrush, bone loss, cataracts, easy bruising, or muscle weakness.[10] It is in pregnancy category C in the United States, meaning that it should only be used when the benefits are predicted to be greater than the risks.[1] In Australia, the oral use is category A, meaning it has been frequently used in pregnancy and not been found to cause problems to the baby.[12] It should not be taken when breastfeeding.[10] Dexamethasone has anti-inflammatory and immunosuppressant effects.[10]
Dexamethasone was first synthesized in 1957 by Philip Showalter Hench and was approved for medical use in 1958.[13][14][15] It is on the World Health Organization's List of Essential Medicines.[16] In 2021, it was the 260th most commonly prescribed medication in the United States, with more than 1 million prescriptions.[17][18] It is available as a generic medication.[19]
Contraindications of dexamethasone include,[60][61] but are not limited to:
Known drug interactions include:[61]
History[edit]
Dexamethasone was first synthesized by Philip Showalter Hench in 1957.[78][14] It was introduced for medical use in 1958.[69]
On 16 June 2020, the RECOVERY Trial announced preliminary results stating that dexamethasone improves survival rates of hospitalized patients with COVID-19 receiving oxygen or on a ventilator. Benefits were only observed in patients requiring respiratory support; those who did not require breathing support saw a worse survival rate than the control group, although the difference may have been due to chance.[79]
A preprint containing the full dataset was published on 22 June 2020, and demand for dexamethasone surged after publication of the preprint.[80] The preliminary report was published in The New England Journal of Medicine on 18 July 2020.[81] The final report was published in February 2021.[82]
The World Health Organization (WHO) states that dexamethasone should be reserved for seriously ill and critical patients receiving COVID-19 treatment in a hospital setting,[83] and the WHO Director-General stated that "WHO emphasizes that dexamethasone should only be used for patients with severe or critical disease, under close clinical supervision. There is no evidence this drug works for patients with mild disease or as a preventative measure, and it could cause harm."[84] In July 2020, the WHO stated they are in the process of updating treatment guidelines to include dexamethasone or other steroids.[85] In September 2020, the WHO released updated guidance on using corticosteroids for COVID-19.[34][86]
In July 2020, the European Medicines Agency (EMA) started reviewing results from the RECOVERY study arm that involved the use of dexamethasone in the treatment of patients with COVID-19 admitted to the hospital to provide an opinion on the results and in particular the potential use of dexamethasone for the treatment of adults with COVID-19.[87][88] In September 2020, the EMA received an application for marketing authorization of dexamethasone for COVID-19.[89]
Society and culture[edit]
Nonmedical use[edit]
Dexamethasone is given in legal Bangladesh brothels to prostitutes not yet of legal age, causing weight gain aimed at making them appear older and healthier to customers and police.[91]
Dexamethasone and most glucocorticoids are banned by sporting bodies including the World Anti-Doping Agency.[92]
Veterinary use[edit]
Combined with marbofloxacin CAS number 115550-35-1and clotrimazole, dexamethasone is available under the name Aurizon, CAS number 50-02-2, and used to treat difficult ear infections, especially in dogs. It can also be combined with trichlormethiazide to treat horses with swelling of distal limbs and general bruising.[93]