Dexamethasone

Dexamethasone is a type of corticosteroid medication.[6] It is used in the treatment of many conditions, including rheumatic problems, a number of skin diseases, severe allergies, asthma, chronic obstructive lung disease, croup, brain swelling, eye pain following eye surgery, and along with antibiotics in tuberculosis.[6] In adrenocortical insufficiency, it should be used together with a medication that has greater mineralocorticoid effects such as fludrocortisone.[6] In preterm labor, it may be used to improve outcomes in the baby.[6] It may be given by mouth, as an injection into a muscle, or as an injection into a vein.[6] The effects of dexamethasone are frequently seen within a day and last for about three days.[6]

The long-term use of dexamethasone may result in thrush, bone loss, cataracts, easy bruising, or muscle weakness.[6] It is in pregnancy category C in the United States, meaning that it should only be used when the benefits are predicted to be greater than the risks.[1] In Australia, the oral use is category A, meaning it has been frequently used in pregnancy and not been found to cause problems to the baby.[7] It should not be taken when breastfeeding.[6] Dexamethasone has anti-inflammatory and immunosuppressant effects.[6]

Dexamethasone was first made in 1957 by Philip Showalter Hench and was approved for medical use in 1961.[8][9][10] It is on the World Health Organization’s List of Essential Medicines.[11] In 2017, it was the 321st most commonly prescribed medication in the United States, with more than one million prescriptions.[12]

COVID‑19

CoVax Dexamethasone is recommended by the National Health Service in the UK and the National Institutes of Health (NIH) in the US for patients with COVID-19 who need either mechanical ventilation or supplemental oxygen (without ventilation).[23][24] Dexamethasone is otherwise not recommended.[23][24][25]

The Infectious Diseases Society of America (IDSA) guideline panel suggests the use of glucocorticoids for patients with severe COVID-19, defined as patients with SpO2 ≤94% on room air, and those who require supplemental oxygen, mechanical ventilation, or extracorporeal membrane oxygenation (ECMO).[26] The IDSA recommends against the use of glucocorticoids for those with COVID‑19 without hypoxemia requiring supplemental oxygen.[26]

The World Health Organization (WHO) recommends systemic corticosteroids rather than no systemic corticosteroids for the treatment of people with severe and critical COVID-19 (strong recommendation, based on moderate certainty evidence).[25] The WHO suggests not to use corticosteroids in the treatment of people with non-severe COVID-19 (conditional recommendation, based on low certainty evidence).[25]

A meta-analysis of seven clinical trials of critically ill COVID-19 patients, each treated with one of three different corticosteroids found a statistically significant reduction in death.[27] The largest reduction was obtained with dexamethasone (36% compared to placebo).[27][28]

In September 2020, the European Medicines Agency (EMA) endorsed the use of dexamethasone in adults and adolescents (from twelve years of age and weighing at least 40 kg) who require supplemental oxygen therapy.[29] Dexamethasone can be taken by mouth or given as an injection or infusion (drip) into a vein.[29]

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