From the Research
Proton pump inhibitors (PPIs) should be used with dexamethasone in patients at high risk of gastrointestinal complications, such as those with a history of peptic ulcer disease, concurrent NSAID use, anticoagulation therapy, or dexamethasone courses lasting longer than 1-2 weeks. The use of PPIs with dexamethasone is supported by the most recent study 1, which found that while there was no significant difference in objective findings between patients taking dexamethasone with and without a PPI, the study highlights the importance of considering individual patient risk factors for gastrointestinal complications. Key risk factors for gastrointestinal complications include:
- History of peptic ulcer disease
- Concurrent NSAID use
- Anticoagulation therapy
- Dexamethasone courses lasting longer than 1-2 weeks Common PPI options include:
- Omeprazole (20-40mg daily)
- Pantoprazole (40mg daily)
- Esomeprazole (20-40mg daily) These should be continued for the duration of steroid therapy, as corticosteroids like dexamethasone can increase gastric acid secretion and reduce protective mucus production, creating favorable conditions for peptic ulcer development 2, 3, 4. For short courses of dexamethasone (less than a week) in patients without additional risk factors, PPI prophylaxis may not be necessary, but clinical judgment should be used to assess individual patient risk 1.