Dexamethasone: Brands, Price & Uses in Bangladesh

Dexamethasone is a potent, long-acting synthetic corticosteroid (glucocorticoid) with minimal mineralocorticoid activity. It is used systemically (oral or injectable) and locally (ophthalmic, otic, topical, intra-articular) for a wide range of conditions. Indications are classified below by strength of evidence.

Established/FDA-approved uses

• Endocrine disorders — adjunctive therapy in primary or secondary adrenocortical insufficiency (usually with a mineralocorticoid), congenital adrenal hyperplasia, non-suppurative thyroiditis, hypercalcemia associated with cancer
• Rheumatic disorders — adjunctive therapy in rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, acute gouty arthritis, acute rheumatic carditis, systemic lupus erythematosus, dermatomyositis
• Allergic states — control of severe allergic conditions such as seasonal or perennial allergic rhinitis, drug hypersensitivity reactions, serum sickness, contact dermatitis, and severe anaphylactic reactions (as an adjunct after epinephrine)
• Dermatologic diseases — pemphigus, severe erythema multiforme (Stevens-Johnson syndrome), exfoliative dermatitis, severe psoriasis, severe seborrheic dermatitis
• Respiratory diseases — symptomatic sarcoidosis, berylliosis, fulminating or disseminated pulmonary tuberculosis (with appropriate anti-tuberculous therapy), aspiration pneumonitis
• Hematologic disorders — acquired autoimmune hemolytic anemia, immune thrombocytopenia (ITP), erythroblastopenia
• Neoplastic diseases — palliative management of leukemias and lymphomas; supportive care in solid tumor chemotherapy
• Nervous system — cerebral edema associated with brain tumor, neurosurgery, or head injury
• Edematous states — nephrotic syndrome without uremia (idiopathic or due to lupus erythematosus)
• Gastrointestinal diseases — to help patients through a critical period of ulcerative colitis and Crohn’s disease
• Ophthalmic diseases — severe acute and chronic allergic and inflammatory processes involving the eye (as ophthalmic preparations)
• Antiemetic — prevention of chemotherapy-induced nausea and vomiting, often used in combination with other antiemetics
• Diagnostic use — the dexamethasone suppression test for evaluating hypothalamic-pituitary-adrenal axis function/Cushing’s syndrome

Guideline-supported / specific clinical uses

• COVID-19 — in hospitalized patients requiring supplemental oxygen or mechanical ventilation, per WHO and national treatment guidelines
• Croup (laryngotracheobronchitis) in children — single dose to reduce airway inflammation and severity of symptoms
• Bacterial meningitis — adjunctive therapy (given before or with the first antibiotic dose) in infants and children with Haemophilus influenzae type b meningitis, to reduce the risk of hearing loss and neurological sequelae
• Antenatal corticosteroid therapy — administered to the mother to accelerate fetal lung maturation when preterm delivery is anticipated (used under specialist obstetric supervision)
• High-altitude cerebral edema — treatment and prevention as an adjunct to descent

Use of Dexamethasone should always be guided and monitored by a qualified physician, with the lowest effective dose used for the shortest duration consistent with the condition being treated.

Dosage of Dexamethasone is highly individualized based on the condition being treated, severity, and patient response. The lowest effective dose for the shortest necessary duration should be used. The following are representative regimens; a physician's prescription should always be followed.

Pediatric dosing (representative)

See Dosage and Administration for hepatic/renal adjustment; no fixed dose reduction is well established for renal impairment, but caution and monitoring are advised in hepatic impairment as metabolism may be reduced.

Side effects of Dexamethasone are generally related to dose and duration of therapy.

Common

• Increased appetite, weight gain, fluid retention
• Insomnia, mood changes, nervousness or restlessness
• Indigestion, nausea
• Elevated blood glucose
• Acne, skin thinning, easy bruising

Less common but significant

• Adrenal suppression (see Precautions and Warnings)
• Increased susceptibility to infection, masking of signs of infection
• Peptic ulceration, especially with concurrent NSAID use
• Osteoporosis and increased fracture risk with long-term use
• Cataracts, glaucoma (with prolonged use, especially ophthalmic)
• Growth suppression in children with prolonged use
• Psychiatric effects including mood swings, insomnia, and rarely psychosis (can occur even with short courses in susceptible individuals)
• Hypertension, hypokalemia
• Cushingoid features (moon face, central obesity) with prolonged use