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Dexamethasone interactions to avoid

If you use dexamethasone, you should be aware of potential interactions that might reduce its effectiveness or result in other problems, such as more severe side effects
Karen Berger medical writer and reviewer headshot
By | Mar. 1, 2024
Three Rx pill bottles: Dexamethasone interactions

Key takeaways

  • Dexamethasone is a generic prescription drug used for various conditions due to inflammation, such as asthma and severe allergies.

  • Dexamethasone interacts with certain medications, such as others. It can also interact with certain medical conditions, as well as alcohol and marijuana.

  • Always tell your healthcare provider about your complete medical history, medication allergies, and all the medicines you take, including prescription, over-the-counter, vitamins, and dietary supplements.

In this article:

Dexamethasone is a member of a drug class called corticosteroids or steroids. Dexamethasone is approved by the U.S. Food and Drug Administration (FDA) to treat various inflammatory conditions, such as asthma, severe allergies, rheumatoid arthritis, ulcerative colitis, and blood disorders. 

Dexamethasone is a generic medication and is commonly known by the brand name Decadron. Dexamethasone is available in several formulations, including oral tablets, oral solution (liquid), injections, and others.

Some of the most common side effects of dexamethasone include:

  • Stomach problems like vomiting, upset stomach, and stomach irritation
  • Headache
  • Dizziness
  • Trouble sleeping
  • Restlessness
  • Depression
  • Anxiety
  • Acne
  • Increase in hair growth
  • Increased appetite
  • Weight gain
  • Easy bruising
  • Menstrual period irregularities, including absent periods

Serious side effects may occur, especially with high doses or long-term use of dexamethasone, osteoporosis, cataracts, glaucoma, adrenal gland problems, allergic reactions, immune system suppression, and stomach problems, including perforation (holes) or ulcers (sores) in the gastrointestinal tract. 

Dexamethasone interacts with various drugs, including warfarin, macrolide antibiotics, diabetes medications, and others. For those who take dexamethasone, it’s important to be aware of possible interactions that can affect the effectiveness of this medication or cause other potential complications like more serious side effects.

Dexamethasone drug interactions

Dexamethasone interacts with various drugs and classes of drugs, which can result in different complications.

Warfarin

Warfarin is a blood thinner or anticoagulant used to prevent blood clots. Although evidence is mixed, steroids may affect the body’s response to warfarin. If you take warfarin and need to take a steroid like dexamethasone, your healthcare provider will monitor you more frequently while you take this combination of medications.

This potential interaction does not apply to newer blood thinners like Eliquis (apixaban) or Xarelto (rivaroxaban). 

Macrolide antibiotics

Macrolide antibiotics are a class of antibiotics used to treat certain bacterial infections. When combined with dexamethasone, these antibiotics affect how the body processes dexamethasone. As a result, higher levels of dexamethasone can occur in the body, which can cause worsened or serious side effects. If you take dexamethasone and need an antibiotic, your healthcare provider may decide to prescribe an antibiotic from a different class of drugs. Examples of macrolide antibiotics that may interact with dexamethasone include clarithromycin and erythromycin.

Diabetes medications

Steroids like dexamethasone can increase blood sugar levels. If you take insulin or other diabetes medications to control your blood sugar, you may need a higher dosage while you take dexamethasone. Consult your healthcare provider for medical advice on dosage recommendations if you have to take dexamethasone. Your provider may advise you to take a slightly higher dose while you are taking dexamethasone. They may also have you monitor your blood glucose levels more frequently than usual. 

Examples of diabetes medications include:

  • Amaryl (glimepiride)
  • Insulin 
  • Januvia (sitagliptin)
  • Metformin 
  • Mounjaro (tirzepatide)
  • Ozempic (semaglutide)

Estrogens and oral contraceptives

Estrogens, including those in oral contraceptives (birth control pills), can increase dexamethasone levels in the body, which can lead to more serious side effects of dexamethasone. Before taking dexamethasone, consult your healthcare professional for medical advice if you take any type of estrogen, including birth control pills.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Nonsteroidal anti-inflammatory drugs (NSAIDs) and steroids like dexamethasone are both associated with gastrointestinal side effects. Combining an NSAID with dexamethasone can increase the potential risk of these side effects—including stomach bleeding, perforation, and ulcers of the GI tract. If you take an NSAID and your healthcare provider recommends taking dexamethasone, you may need to switch to a medication that is not an NSAID, such as Tylenol (acetaminophen). Doctors will closely monitor you if you cannot avoid the combination.

Some examples of NSAIDs include:

  • Aleve (naproxen) 
  • Aspirin
  • Celebrex (celecoxib)
  • Mobic (meloxicam)
  • Motrin, Advil (ibuprofen)
  • Voltaren (diclofenac)

Drugs that affect an enzyme called CYP3A4

Cytochrome P450 3A4 is an enzyme that processes many medications in the body. Certain drugs can affect this enzyme. 

For example, CYP3A inducers can speed up the processing of dexamethasone in the body. This means your body eliminates the medication faster, so the usual dose may be less effective. If you take dexamethasone in combination with a CYP3A inducer, you may need a higher dose of dexamethasone. Some examples of CYP3A inducers include phenobarbital, Dilantin (phenytoin), Tegretol (carbamazepine), and rifampin. 

On the other hand, CYP3A inhibitors slow down the processing of dexamethasone in the body. This could result in higher dexamethasone levels in the body and worsening of adverse effects. Because there are many potential serious side effects of steroids, your healthcare provider may recommend an alternative treatment that does not combine interacting drugs. If there is no other alternative, and you have to take dexamethasone with a CYP3A inhibitor, your healthcare provider may prescribe a lower dose of dexamethasone. Examples of CYP3A inhibitors include antifungals such as itraconazole and ketoconazole and the antiretroviral medication ritonavir. 

Live vaccines

People who take a steroid, like dexamethasone, should not receive a live or live attenuated vaccine. In some cases, though, getting this vaccine may be okay—for example, if you take a low dose or a short course of steroids. If you take dexamethasone, check with your healthcare provider before receiving a live vaccine. You can also ask your pharmacist or other healthcare professional who administers your vaccine if the vaccine is live. 

Some examples of live vaccines that are routinely administered in the U.S. include:

Other dexamethasone interactions

Additionally, dexamethasone interacts with alcohol, marijuana, grapefruit, and certain medical conditions. 

Dexamethasone and alcohol 

Check with your healthcare provider before combining dexamethasone and alcohol. The combination could increase the risk of GI bleeding. 

Dexamethasone and marijuana

Consult your healthcare provider before combining marijuana with dexamethasone. Marijuana affects the CYP3A enzymes, resulting in higher levels and effects of dexamethasone. This combination could lead to an increased risk of serious side effects.

Dexamethasone and grapefruit 

Grapefruit and grapefruit juice affect the CYP3A enzymes, which leads to higher levels and effects of dexamethasone, which could cause an increased risk of serious side effects. Ask your healthcare provider before mixing the two.

Dexamethasone and certain medical conditions

There are some contraindications (situations where it is not safe to take a medication) associated with dexamethasone. You should not take dexamethasone if:

  • You are allergic to dexamethasone or any ingredient in the medication
  • You have a systemic fungal infection
  • You have cerebral malaria (a neurological complication of malaria)

There are also instances when a healthcare provider will prescribe dexamethasone with caution, weighing the risks and benefits, such as for individuals with certain medical conditions and people who are pregnant or breastfeeding.

As described above, you should not receive a live or live-attenuated vaccine while taking dexamethasone.

How to minimize dexamethasone interactions

Although dexamethasone has some potential interactions, in many cases, you can still take it safely with some precautions. 

Always consult your healthcare provider for medical advice before beginning a new medicine. Before you start taking dexamethasone, make sure your healthcare provider is aware of all of your medical conditions, especially if you are pregnant or trying to become pregnant, are breastfeeding, or have any of the following conditions:

Before you take dexamethasone, tell your physician about all your medicines. Your list should include prescription and OTC medicines, vitamins, dietary supplements, or herbal products. While taking dexamethasone, do not start any new medication unless approved by your health care provider.

Your healthcare professional may need to change your medication or adjust the dose of dexamethasone or another medication in the event of a potential drug interaction.

Always take your medication as directed by your healthcare provider. Do not take more medication than prescribed. Consult your healthcare provider if you have any questions or concerns about dexamethasone and interactions.

When to talk to a healthcare provider about dexamethasone interactions

This article outlines some common dexamethasone interactions. However, it is only a partial list of every possible interaction. Tell your healthcare provider about all the health conditions you have and all the medications you take, including prescription medicines, OTC drugs, vitamins, and supplements. Doing so helps ensure proper management and monitoring of your medical condition.

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