From the Guidelines
Dexamethasone is a corticosteroid used to treat various conditions, including inflammatory and autoimmune disorders, cancer, and neurological conditions, with its uses supported by evidence from studies such as 1 and 1. The medication has been shown to improve ambulation in patients with lung cancer and spinal cord compression, with a randomized trial demonstrating that 81% of patients in the high-dose dexamethasone treatment arm remained ambulatory after treatment, compared to 63% in the control arm 1. In patients with brain metastases, dexamethasone is used to reduce cerebral edema and improve neurologic function, although its effects are typically short-lived, lasting up to 1 month 1. Some of the key uses of dexamethasone include:
- Reducing brain swelling in neurological conditions
- Managing side effects of chemotherapy in cancer treatment
- Treating adrenal insufficiency
- Managing severe eye inflammation
- Suppressing the immune system and reducing inflammation in inflammatory and autoimmune disorders The typical dosing of dexamethasone varies widely based on the condition being treated, ranging from 0.5mg to 20mg daily, and it can be administered orally, intravenously, or topically 1. However, the use of dexamethasone can be associated with significant toxicity, including side effects such as increased blood sugar, mood changes, increased infection risk, and long-term use may cause osteoporosis, muscle weakness, and adrenal suppression 1. Therefore, the use of dexamethasone should be carefully considered and monitored, with patients only being treated if they are symptomatic, and with close attention to potential side effects and toxicity 1.
From the FDA Drug Label
CLINICAL PHARMACOLOGY Dexamethasone sodium phosphate has a rapid onset but short duration of action when compared with less soluble preparations. Because of this, it is suitable for the treatment of acute disorders responsive to adrenocortical steroid therapy Naturally occurring glucocorticoids (hydrocortisone and cortisone), which also have salt-retaining properties, are used as replacement therapy in adrenocortical deficiency states. Their synthetic analogs, including dexamethasone, are primarily used for their potent anti-inflammatory effects in disorders of many organ systems. The uses of dexamethasone include:
- Treatment of acute disorders responsive to adrenocortical steroid therapy
- Anti-inflammatory effects in disorders of many organ systems
- Replacement therapy is not the primary use of dexamethasone, but rather its use is for its potent anti-inflammatory effects 2
From the Research
Uses of Dexamethasone
- Dexamethasone is used in the treatment of acute spinal cord injury, as it has been shown to improve outcomes in patients with complete and incomplete injuries 3.
- It is also used to treat inflammatory diseases, including those affecting the blood-brain barrier, where it can attenuate the inflammatory response induced by lipopolysaccharide 4.
- Dexamethasone has been used to treat a variety of diseases, including autoimmune diseases, allergies, ocular disorders, cancer, and COVID-19, although its usage is often restricted due to its poor water solubility and potential side effects 5.
- Low-dose dexamethasone treatment has been shown to promote the pro-survival signalling pathway in the adult rat prefrontal cortex, which may be relevant for its use in chemotherapy for brain tumors 6.
- Dexamethasone is also used to alleviate edema in patients with intracranial lesions and to combat immune-related adverse events that arise with immune checkpoint blockade treatment, although it can suppress the immune response and may need to be used cautiously in combination with immunotherapy 7.
Therapeutic Applications
- Treatment of acute spinal cord injury
- Treatment of inflammatory diseases, including those affecting the blood-brain barrier
- Treatment of autoimmune diseases, allergies, ocular disorders, cancer, and COVID-19
- Chemotherapy for brain tumors
- Alleviation of edema in patients with intracranial lesions
- Combating immune-related adverse events that arise with immune checkpoint blockade treatment
Delivery Systems
- Dexamethasone can be delivered through various systems, including liposomes, polymers, hydrogels, nanofibers, silica, calcium phosphate, and hydroxyapatite, which can help to improve its solubility and reduce its side effects 5.