From the Research
Dexamethasone (Decadron) can be used to treat hyperemesis gravidarum, a severe form of nausea and vomiting during pregnancy, when first-line treatments have failed, as supported by the most recent and highest quality study available 1.
Key Considerations
- Typical dosing is 10 mg IV initially, followed by 4 mg IV every 6 hours, or 8-12 mg oral/IV daily, with gradual tapering as symptoms improve.
- Dexamethasone should be used for the shortest duration possible, usually for severe cases that haven't responded to antiemetics like ondansetron, promethazine, or metoclopramide.
- The medication works by reducing inflammation and suppressing the immune response that may contribute to severe nausea and vomiting.
Important Safety Information
- Dexamethasone should be used cautiously during pregnancy, especially in the first trimester, as corticosteroids carry potential risks including gestational diabetes, hypertension, and possible effects on fetal development.
- Treatment should always be supervised by a healthcare provider who can weigh the benefits against potential risks and monitor for side effects.
- Hydration, nutritional support, and treatment of any underlying conditions should accompany medication therapy.
Evidence Summary
- A systematic review and economic assessment of treatments for hyperemesis gravidarum and nausea and vomiting in pregnancy found evidence that ginger, antihistamines, metoclopramide, and vitamin B6 are effective in reducing symptoms 1.
- Another study compared the efficacy of dexamethasone and ondansetron in preventing emesis induced by moderately emetogenic chemotherapy, and found that both drugs were effective, but dexamethasone had an advantage in controlling delayed nausea 2.
- The cellular mechanisms of the antiemetic action of dexamethasone and related glucocorticoids against vomiting involve anti-inflammatory effects, direct central action, and interaction with neurotransmitters and receptor proteins 3.