Side Effects of Intravenous Dexamethasone
Intravenous dexamethasone can cause significant side effects including hyperglycemia, increased infection risk, psychiatric disturbances, and gastrointestinal complications, with severity often correlating with dose and duration of treatment. 1, 2
Common Side Effects
Metabolic effects: Hyperglycemia is one of the most common adverse events, occurring in up to 76% of patients receiving IV dexamethasone in intensive care settings 3
Increased infection risk: Dexamethasone may mask signs of infection and decrease resistance to new infections by suppressing immune function 1
Psychiatric disturbances: Can cause delirium, especially in critically ill patients, with studies showing a 48% increased risk compared to non-dexamethasone users 4
Gastrointestinal complications: Risk of gastrointestinal bleeding, ulceration, and perforation, particularly with high-dose regimens 2
Dose-Related Side Effects
High-dose regimens (e.g., 96 mg IV daily) have shown significantly higher rates of serious adverse effects (14.3%) compared to standard doses (16 mg daily) 2
Serious complications with high-dose regimens include:
- Fatal gastrointestinal ulcers with hemorrhage
- Gastrointestinal perforation
- Rectal bleeding 2
Standard doses (10-16 mg daily) generally have more manageable side effect profiles while maintaining therapeutic efficacy 5, 2
Cardiovascular and Fluid Balance Effects
Blood pressure elevation: Can cause hypertension, especially with prolonged use 1
Fluid retention: Sodium and water retention may occur, potentially worsening edema 1
Electrolyte disturbances: Increased potassium excretion and calcium excretion 1
Special Considerations in Specific Clinical Contexts
Immunotherapy-related toxicities: When used for cytokine release syndrome, dexamethasone doses of 10 mg IV are typically administered every 6-24 hours depending on severity 5
Perioperative antiemesis: A single intraoperative dose (typically 0.15-1.0 mg/kg) is effective for reducing postoperative nausea and vomiting with minimal side effects 5
COVID-19 treatment: At 6 mg daily for up to 10 days, dexamethasone reduces mortality in patients requiring oxygen or mechanical ventilation, with manageable side effect profile 6
Precautions and Contraindications
Anaphylactoid reactions: Rare but can occur, especially in patients with history of drug allergies 1
Sulfite sensitivity: IV dexamethasone contains sodium bisulfite, which may cause allergic reactions, particularly in asthmatics 1
Fungal infections: Should not be used in the presence of systemic fungal infections unless needed to control drug reactions to amphotericin B 1
Adrenal suppression: Rapid withdrawal can lead to secondary adrenocortical insufficiency; gradual dose reduction is recommended 1
Vaccination considerations: Administration of live virus vaccines is contraindicated in patients receiving immunosuppressive doses 1
Monitoring Recommendations
Blood glucose monitoring: Regular monitoring is essential, especially in patients with or at risk for diabetes 3
Infection surveillance: Increased vigilance for new infections is necessary, as signs may be masked 1
Psychiatric assessment: Regular monitoring for delirium and other psychiatric disturbances, particularly in ICU settings 4
Gastrointestinal symptoms: Monitor for abdominal pain, melena, or other signs of GI complications, especially with high doses 2
The risk-benefit profile of IV dexamethasone should be carefully considered, with the lowest effective dose used for the shortest duration necessary to achieve clinical goals 2.