What is Dexamethasone?

As the country continues to fight COVID-19 and develop a vaccine, many are working to identify the best treatment options for this potentially deadly disease. 

The powerful steroid dexamethasone has recently been in the news for showing promise as a treatment for COVID-19. Earlier this year clinical trial results published in The New England Journal of Medicine found that giving dexamethasone to patients hospitalized with COVID-19 reduced their risk of dying from the virus.  

Dexamethasone is commonly used to help those with arthritis, skin and blood disorders and cancer. For cancer patients who have leukemia, lymphoma and mycosis fungoides, the steroid in conjunction with other drugs is used to reduce the inflammation and suppress the body’s immune response. 

The study showed that the use of the dexamethasone in COVID-19 patients resulted in lower 28-day mortality among those who were receiving either invasive mechanical ventilation or oxygen alone but not among those receiving no respiratory support. In fact, it may cause harm to those with minor infections. 

Rod Quilitz, a registered pharmacist at Moffitt Cancer Center

“While dexamethasone’s anti-inflammatory effects can be used in the treatment of some infectious complications such as COVID-19-associated ‘cytokine storm,’ it is important to note that dexamethasone can impair the immune system and increase the risk for a variety of infections, especially with long term use,” said Rod Quilitz, a registered pharmacist at Moffitt Cancer Center.

Cytokine release syndrome occurs when a large number of cytokines, which are small proteins released by immune cells, are rapidly released into the blood. This can cause a patient to have a fever, increased heart rate, difficulty breathing and low blood pressure.

Dexamethasone can be used alone or with other drugs to prevent or treat other conditions associated with cancer, such as: 

• Drug hypersensitivity (allergic reactions)
• Nausea (induced by certain chemotherapy drugs)
• Anemia
• Cerebral edema (fluid build-up in the brain) associated with brain tumors.
• Hypercalcemia (high blood levels of calcium)
• Thrombocytopenia (low platelet levels)

“Dexamethasone is usually administered orally in the form of tablets, rarely as an oral suspension,” said Quilitz. “It can be administered intravenously (through the vein) as well, but this route is typically limited to patients who are critically ill or are unable to take oral medications.”

Quilitz says the steroid is strictly a prescription medication and for a good reason. It can cause acute side effects such as high blood sugar, which can be a real problem in patients with diabetes or borderline diabetes.

“In some cases, dexamethasone can acutely cause agitation, anxiety or even temporary psychosis, also known as steroid psychosis,” said Quilitz.