Dexamethasone side effects and how to avoid them

Dexamethasone side effects | Serious side effects| How long do side effects last? | Warnings | Interactions | How to avoid side effects

Dexamethasone is a common generic steroid medication that treats a variety of medical conditions including swelling, allergic reactions, shock, arthritic disorders, severe skin disorders, eye diseases, blood disorders, respiratory disorders, digestive system disorders, leukemia, lymphoma, autoimmune disorders, multiple sclerosis, and head injury. 

Dexamethasone is also a first-line treatment for severe coronavirus (COVID-19) infections. It is given orally or as an injection. For eye conditions, dexamethasone can be applied as ophthalmic drops, injected into the eye as an implant, or installed in the bottom eyelid as a slow-release insert. It is also administered as ear drops for ear conditions.

Dexamethasone belongs to a class of drugs called corticosteroids (or glucocorticoids). Corticosteroids are different from the class of anabolic steroids that some athletes abuse. Drugs like dexamethasone drugs are used primarily to reduce swelling or suppress the immune system. There are, however, some common side effects and drug interactions when taking this drug.

RELATED: Learn more about dexamethasone

Common side effects of dexamethasone

Dexamethasone has a large number of commonly experienced side effects. These include:

• Nervous system changes
  • Mood swings
  • Anxiety
  • Depression
  • Vertigo
  • Dizziness
  • Headache
• Digestive system problems
  • Nausea
  • Vomiting
  • Appetite changes
  • Abdominal discomfort
• Skin problems
  • Acne
  • Rash
  • Facial redness
  • Thinning skin
  • Changes in skin pigmentation
  • Increased sweating
  • Unwanted hair growth
  • Bleeding problems beneath the skin
• Fluid and electrolyte disturbances
  • Elevated blood pressure
  • Fluid retention (edema)
  • Sodium retention
  • Low potassium
• Hormone disturbances
  • Irregular menstrual periods
  • Decreased glucose tolerance
  • Cushing syndrome (with long-term use)
• Muscle and bone problems
  • Loss of muscle mass
  • Muscle weakness
• Eye problems
  • Increase in eye pressure
  • Eye pain (from dexamethasone eye drops)
  • Bloodshot eyes (from dexamethasone eye drops)
  • Blurred vision (from dexamethasone eye injections)
• Slow wound healing
• Injection site reactions

Serious side effects of dexamethasone

Dexamethasone’s most serious side effects include:

• Immune system disorders
  • Immune suppression
  • Infections
• Nervous system changes
  • Steroid-induced psychosis, mania, or depression
  • Seizures
  • Increased intracranial pressure (pseudotumor cerebri) with swelling of the optic disc  
• Digestive system problems
  • Peptic ulcer
  • Perforation
  • Pancreatitis
  • Ulcerative esophagitis
• Fluid and electrolyte disturbances
  • Alkaline blood
  • High blood pressure (hypertension)
  • Congestive heart failure
• Hormone disturbances
  • The emergence of latent diabetes or worsening of existing diabetes
  • Adrenal insufficiency
  • Growth suppression in children due to long-term use
• Muscle and bone problems
  • Tendon rupture
  • Bone death
  • Osteoporosis due to long-term use
  • Bone fractures
• Eye disorders
  • Glaucoma due to long-term use
  • Cataracts as a consequence of long-term use
  • Eye bulging
• Tumor lysis syndrome when used for cancer treatment

In rare cases, dexamethasone has caused severe side effects such as blindness, stroke, paralysis, and even death when injected into the spinal cord.

How long do dexamethasone side effects last?

With a half-life of four hours (the amount of time it takes the body to eliminate half a dose), a 20 mg dose is eliminated from the body in about 24 hours. Many of the temporary side effects of dexamethasone, such as mood changes or anxiety, will wear off by that time. 

Dexamethasone is not applied directly to skin, but long-term use can affect the skin. These side effects may take longer to clear up after the medication is discontinued. Some such responses, like skin thinning, can be treated. Pigment changes or stretch marks, though, may be permanent. 

More severe side effects may take longer to resolve. Peptic ulcers, perforation, bone fractures, tendon rupture, cataracts, and glaucoma are longer-lasting and will often require medical treatment. Adrenal insufficiency caused by prolonged use of dexamethasone could take months to resolve. Some of the most serious side effects, such as congestive heart failure, can be lifelong.

Dexamethasone contraindications & warnings

Dexamethasone is used for a wide range of medical conditions, some quite serious. However, a doctor or healthcare provider may need to avoid using dexamethasone in people with certain pre-existing conditions.

Dexamethasone is never used in people with:

• Systemic fungal infections
• Known hypersensitivity to dexamethasone or corticosteroids
• Cerebral malaria

Dexamethasone eye drops, implants, or injections are never used in people with:

• Viral, mycobacterial, or fungal infections of the eye
• Glaucoma
• Torn or ruptured posterior lens capsule

Dexamethasone ear drops are never given to people with:

• Perforation of the drum membrane
• Fungal infections of the ear

People with other conditions may encounter problems when taking dexamethasone. These include:

• Infections: Dexamethasone may worsen an existing infection, so patients with active or latent infections will need to be watched—particularly those with tuberculosis or herpes infections of the eye.
• Compromised immune system: Because dexamethasone suppresses the immune system, caution and monitoring are required when the drug is given to people with weakened immune systems.
• High blood pressure: Dexamethasone raises blood pressure, so people being treated for high blood pressure will need to have regular blood pressure monitoring and adjustments to their hypertension therapies as seen fit by their provider.
• Conditions that risk gastrointestinal perforation: Dexamethasone raises the risk of gastrointestinal perforation in any person with peptic ulcer disease, diverticulitis, nonspecific ulcerative colitis, or fresh intestinal anastomosis.
• Congestive heart failure: Dexamethasone can cause high blood pressure, fluid retention, and sodium retention, worsening heart failure or its symptoms.
• Heart attack: In people who have recently experienced a heart attack, corticosteroid use can result in a rupture in the heart wall.
• Psychiatric disorders: Dexamethasone could worsen existing emotional instability or psychotic tendencies.
• Osteoporosis: Corticosteroids can cause bone loss, worsening existing osteoporosis.
• Diabetes: Dexamethasone can worsen diabetes, so blood sugar monitoring is necessary.
• Myasthenia gravis: Although dexamethasone and other corticosteroids are a standard treatment for myasthenia gravis, the drug raises the risk of muscle damage.
• Overactive thyroid: An overactive thyroid can block the body’s ability to break down dexamethasone, raising the risk of side effects.
• Liver cirrhosis: Cirrhosis also blocks the body’s ability to break down dexamethasone.
• Kidney problems: Dexamethasone and other corticosteroids can worsen kidney problems.

Overdose

An overdose of dexamethasone is not considered life-threatening. If an overdose is suspected, seek emergency medical attention even if there are no symptoms. Do not try to induce vomiting. If an overdose of dexamethasone eye drops is suspected, call a hospital or poison helpline and begin flushing the eye with a normal saline solution. 

Abuse and dependency

Dexamethasone may produce physical dependence and steroid withdrawal due to adrenal insufficiency. Corticosteroids can throw off the body’s adrenal glands, the organs responsible for producing natural corticosteroids. When the drug is suddenly discontinued after high-dose or long-term use, the adrenal glands are unable to perform their normal hormone functions, a condition called adrenal insufficiency. Symptoms include headache, nausea, fever, lethargy, muscle pain, loss of appetite, weight loss, and general malaise. To avoid steroid withdrawal, people will often be given a steadily decreasing dose when the drug needs to be discontinued.

Corticosteroid misuse and abuse have been documented for both over-the-counter and prescription topical steroids applied to the skin. Dexamethasone, which is not applied to the skin, is not commonly misused.

Children

Dexamethasone is as safe and effective in children as adults. Like adults, children will be regularly monitored for blood and eye pressure as well as signs of infection, ulcers, hormone problems, and other possible side effects. Dexamethasone, however, does suppress growth in children. Doctors are advised to use the lowest possible dose and monitor height and weight. 

Pregnancy

The effects of dexamethasone on unborn babies have not been well-studied, but dexamethasone has caused cleft palates in newborns during animal studies. The decision to use dexamethasone during pregnancy will have to balance the risks of using versus the risks of not using the drug.

Breastfeeding

Women who are breastfeeding should not take dexamethasone. Dexamethasone is present in a nursing mother’s breast milk. It may interfere with the infant’s growth or natural corticosteroid production. Either dexamethasone or breastfeeding should be discontinued.

Senior citizens

There are not enough studies to determine how safe or effective dexamethasone is in people older than 65. In practice, dexamethasone is used cautiously in the elderly, usually by starting at the lowest possible dose.

Dexamethasone interactions

Dexamethasone is injected, taken orally, or applied to the eye’s surface. When taken orally, dexamethasone is best taken with food to avoid stomach irritation. However, it is important to avoid grapefruit or grapefruit juice. Grapefruit has substances that interfere with the body’s metabolism of dexamethasone. This may raise the concentration of the drug in the bloodstream and, as a result, increase the risk of side effects.

Dexamethasone has many potential drug interactions that can interfere with its effectiveness or increase the risk of side effects.

• Live vaccines—CONTRAINDICATED: People taking dexamethasone should never be given live vaccines, even if the vaccine is weakened. Dexamethasone suppresses the immune system, so live vaccines may cause a serious infection.
• OTHER CONTRAINDICATED DRUGS: Some drugs are never used with steroids for a variety of reasons. These drugs include:
  • Desmopressin
  • Mifepristone, if corticosteroids are being administered long-term
  • Edurant (rilpivirine), if more than one dose of dexamethasone is given
  • Imlygic (talimogene laherparepvec) is never given to people with compromised immune systems, which is a possible side effect of dexamethasone

Other vaccines, diabetes and heart drugs, diuretics, NSAIDs, anticholinesterase medications, CYP3A4 inhibitors and inducers, blood thinners, and some birth control pills are also contraindicated. Check with your healthcare provider before taking dexamethasone.

How to avoid dexamethasone side effects

1. Take dexamethasone as directed

Take the dose as prescribed. Do not increase or decrease the dose. Stopping dexamethasone or reducing the dose on your own may cause unpleasant or even serious side effects. If efficacy or side effects are a problem, consult a healthcare provider before adjusting the dose.  

2. Take dexamethasone as scheduled

Some people will receive dexamethasone injections from a healthcare provider. They may be given once or on a schedule. Make sure to keep all appointments for injections. 

For other forms of dexamethasone, a healthcare provider will furnish a dosing schedule. For tablets or oral solutions, doses are usually taken once or twice a day. Dexamethasone eye drops have an initial dosing schedule of once per hour that eventually might fall to three or four doses a day. Ear drops will have a schedule of three or four doses a day. These can be complex dosing schedules, so use an alarm, medication diary, or smartphone app to be sure not to miss a dose. 

Talk to a doctor, pharmacist, or other healthcare professional for medical advice about what to do for a missed dose.

3. Tell the doctor about all medical conditions and medications

Because of the risk of side effects, inform the healthcare professional prescribing or dispensing dexamethasone about all medical conditions and medications, including:

• Any current or past medical conditions, especially 
  • Any fungal infection
  • Tuberculosis, malaria, or herpes eye infection
  • Any current or recent infection
  • Exposure to measles or chickenpox
  • Mental illness
  • Diabetes
  • High blood pressure
  • Congestive heart failure
  • Liver disease
  • Kidney disease
  • Gastrointestinal problems, particularly stomach ulcers, ulcerative colitis, diverticulitis, or recent intestinal surgery (intestinal anastomosis)
  • Osteoporosis
  • Glaucoma
  • Cataracts
  • Myasthenia gravis
  • Thyroid problems
• All medications, over-the-counter medications, and supplements currently being taken, especially antibiotics, antifungals, NSAIDs, or birth control pills
• Any recent vaccinations

4. Keep all follow-up appointments

To minimize adverse effects when taking dexamethasone over the long-term, follow-up visits and tests may be required to monitor blood pressure, hormone function, blood sugar levels, signs of infection, and other possible problems caused by corticosteroid use. These follow-up visits can spot issues before they become serious problems, so make sure to show up to appointments.

5. Avoid over-the-counter NSAIDs

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, naproxen, or ibuprofen can increase the risk of gastrointestinal problems when taken with dexamethasone.

6. Carry a medication record card

Dexamethasone is a vital and even life-saving medication with a wide variety of potentially hazardous drug interactions. Always carry a medical record card on your person that includes all medications being taken along with their doses and dosing schedule.