Dexamethasone: Side Effects, Dosage, Uses, and More

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Overview of  Dexamethasone

Dexamethasone oral tablet is available as both a generic and brand-name drug. Brand name: DexPak. Dexamethasone comes as an oral tablet, oral solution, eye drops, and eardrops. It’s also available as an injectable solution or an intraocular solution given after surgery. These two forms are only given by a healthcare provider. 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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Common Brand(s): Decadron
Generic Name(s): Dexamethasone

 

Important warnings on Dexamethasone

  • Heart Damage Warning: If you’ve recently had a heart attack, you may be at increased risk for further heart damage from this drug. Before starting this drug, be sure your doctor knows you’ve had a heart attack.
  • Infection Warning: Dexamethasone can cover up or worsen certain infections. In addition, infections can develop during treatment. Don’t 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 Warning: 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 Warning: Tell your doctor if you haven’t had chickenpox or measles, or if you haven’t 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 eardrops. It’s also available as an injectable solution or an intraocular solution given after surgery. These last two forms are only given by a healthcare provider.

The dexamethasone tablet is available as the brand-name drug DexPak. 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.

Uses of Dexamethasone

Dexamethasone is used to treat conditions such as arthritis, blood/hormone/immune system disorders, allergic reactions, certain skin and eye conditions, breathing problems, certain bowel disorders, and certain cancers. It is also used as a test for an adrenal gland disorder (Cushing’s syndrome).

This medication is a corticosteroid hormone (glucocorticoid). It decreases your body’s natural defensive response and reduces symptoms such as swelling and allergic-type reactions.

How to use Dexamethasone

Take this medication by mouth as directed by your doctor. Take with food or milk to prevent stomach upset. Take this medication by mouth with a full glass of water (8 ounces/240 milliliters) unless your doctor directs you otherwise. If you are using the liquid form of the medication, use a medication-measuring device to carefully measure the prescribed dose. Do not use a household spoon.

If you take this medication once daily, take it in the morning before 9A.M. If you are taking this medication every other day or on another schedule besides a daily one, it may help to mark your calendar with a reminder.

The dosage and length of treatment are based on your medical condition and response to therapy. Your doctor may attempt to reduce your dose slowly from time to time to minimize side effects.

Use this medication regularly in order to get the most benefit from it. To help you remember, take it at the same time(s) each day. It is important to continue taking this medication even if you feel well. Follow the dosing schedule carefully, and take this medication exactly as prescribed.

Do not stop taking this medication without consulting your doctor. Some conditions may become worse when this drug is suddenly stopped. Your dose may need to be gradually decreased.

Nb: Inform your doctor if your condition does not improve or worsens.

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, mood swings, 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 to 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

A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US –

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at medwatch.

In Canada – Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

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 to your doctor or pharmacist.

Examples of drugs that can cause interactions with dexamethasone are listed below.

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:

  1. ketoconazole
  2. itraconazole
  3. posaconazole
  4. 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. 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 reduce the levels of these drugs in your body. This means they may not work as well, and your body may stop responding to your HIV medications. Your doctor may avoid 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 upset. 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 vaccines when taking dexamethasone. Certain vaccines may not work as well for people taking this drug. Also, the drug may make some live vaccines stronger. This raises the risk of side effects from the vaccine.

Other drugs

Aspirin is a nonsteroidal anti-inflammatory drug (NSAID). It’s often used to treat pain, as well as thin the blood to reduce your risk of heart attack. Dexamethasone can decrease your aspirin levels. This can make aspirin less effective and increase your risk of 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 effects the combination can cause.

Cyclosporine is used to prevent organ rejection in transplant patients, 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 (won’t work well). This would raise your risk of infection. Seizures have also been reported when these drugs are used together.

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

Don’t 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 shouldn’t be used if you’re taking medication to treat a systemic fungal infection. Also, dexamethasone may hide the signs of a non-fungal 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 to 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 to 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 of the intestines, talk to 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). The risk is higher for people already at an increased risk of osteoporosis. These include postmenopausal women.

For people with hyperthyroidism. This drug is removed from the body more quickly than normal. 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 or glaucoma. Your risk is higher if you already have eye problems such as cataracts, glaucoma, or increased pressure in the eye.

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

For people with recent history of heart attack. If you’ve recently had a heart attack, 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 your antidiabetic drugs.

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

Precautions

Before taking dexamethasone, tell your doctor or pharmacist if you are allergic to it; or to other corticosteroids (e.g., prednisone); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: infections (e.g., tuberculosis, herpes, fungal infections), kidney disease, liver disease, mental/mood conditions (e.g., psychosis, anxiety, depression), low blood minerals (e.g., low potassium/calcium), thyroid disease, stomach/intestinal problems (e.g., ulcer, ulcerative colitis, diverticulitis, unexplained diarrhea), high blood pressure, heart problems (e.g., congestive heart failure, recent heart attack), diabetes, eye diseases (e.g., cataracts, glaucoma, herpes infection of the eye), brittle bones (osteoporosis), history of blood clots.

This medication may mask signs of infection or put you at greater risk of developing very serious infections. Report any injuries or signs of infection (e.g., persistent sore throat/fever/cough, pain during urination, muscle aches) that occur during treatment.

Using corticosteroid medications for a long time can make it more difficult for your body to respond to physical stress. Therefore, before having surgery or emergency treatment, or if you get a serious illness/injury, tell your doctor or dentist that you are using this medication or have used this medication within the past 12 months. Tell your doctor right away if you develop unusual/extreme tiredness or weight loss. If you will be using this medication for a long time, carry a warning card or medical ID bracelet that identifies your use of this medication.

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