DEXAMETHASONE; DOES IT REALLY WORK IN COVID-19

Dexamethasone is one of the corticosteroid medication. It was first made in 1957 by Philip Showalter Hench and was approved for medical use in 1961 A.D. Bio-availability of this drug is 80-90% and protein binding capacity is 77%. Usually this drug is metabolised through liver and approximately (65%) excreted through urine where as it’s elimination half life is about 190 minutes i.e. 3.2 hours.

It works is to decrease the information. Another way this drug works is by altering the body’s normal immune system responses. This drus is less expensive than lots of other drugs and thus available most of the countries of the world.

Route of administration – Intravenous (IV), Intramuscular (IM) , Subcutaneous (SC), Oral, Intraosseous (IO), eye drop as well as Topical.

Uses of Dexamethasone

1. As we know Dexamethasone is an anti inflammatory medicine thus, helps to reduce inflammation. Used in swelling (edema) reduction.
2. Used in allergic reactions treatment or prevention.Used in autoimmune disorders like Rheumatoid arthritis(RA) , other rheumatic diseases, consisting ankylosing spondylitis (AS), psoriatic arthritis, juvenile rheumatoid arthritis ( JRA), lupus, & acute gouty arthritis.
3. Used in skin disorders such as eczema , pemphigus, severe erythema multiforme (Stevens-Johnson syndrome), exfoliative dermatitis, bullous dermatitis herpetiformis, severe seborrheic dermatitis, severe psoriasis, or mycosis fungoides  beside these also used in asthma and certain lung diseases.
4. Used in treatment of different types of tumors such as leukemia , multiple myeloma and lymphoma.
5. Used in treatment for nausea and vomiting that is associated with chemotherapy.
6. Used to stimulate appetite in cancer patients.
7. Used in adrenal insufficiency.
8. Used in treatment of intestinal diseases such as ulcerative colitis (UC). 
9. Also used in management of multiple sclerosis, myesthena gravis .
10. Recently most of countries using in COVID19 management as well.

Conditions where Dexamethasone is not used such as

• Don’t receive a live vaccine while using dexamethasone since the vaccine may not be effective this time.
• In case of a recently heart attack, not use dexamethasone as it increased risk for further heart damage.Not use in case of fungal infections, or a history of parasite infections or tuberculosis.
• Long term use of dexamethasone can lead to eye problems eg. cataracts or glaucoma & may also cause damage to the optic nerves, or fungal or viral eye infections as well.
• Not use in case of Measles or Chickenpox.

Dexamethasone may interect with certain medications that are as follow

• Anti- fungal  such as ketoconazole, itraconazole, posaconazole,  etc .
• Antibiotics such as erythromycin .
• Amphotericin B , usually this drug is used to treat fungal infections and using it with dexamethasone may increase risk of having low potassium level and thus results muscle cramps, weakness, tiredness, and an irregular heartbeat.
• Blood thinners such as apixaban , rivaroxaban using these drugs with Dexamethasone may reduces their effectivity and thus increase chances of having clots or Stoke.
• Warfarin is also a blood thinner and using of it with dexamethasone may increases risk of bleeding.
• Colesterol lowering drugs such as cholestyramine, colesevelam, colestipol
• Aminoglutethimide using this drug with Dexamethasone may reduce it’s dose in the body and may not work well.
• As Dexamethasone  increases glucose level in blood that’s why it needs to change the doses of diabetic drugs while using with dexamethasone.
• Diuretics such as bumetanide, furosemide, hydrochlorothiazide while using with Dexamethasone thus results less potassium level and results muscle cramps, weakness, tiredness, and an irregular heartbeat. 
• Antiepileptic drugs such as phenytoin, phenobarbital, carbamazepine, etc. Using these drugs with Dexamethasone  that leads  to reduce the level of Dexamethasone in blood and thus it don’t work well.
• Digoxin using with dexamethasone could rises  risk of irregular heartbeats caused by low potassium levels.
• Certain hormones containing drugs such as estrogens, oral contraceptives using these with Dexamethasone  causes reduce level of hormones in the body and thus need to adjust doses of either dexamethasone or hormonal drugs.
• Using HIV medication with Dexamethasone  reduces the effectivnes of HIV medications and thus body may not response well with HIV medications.
• Using (NSAIDs eg . ibuprofen, indomethacin, etc ) with dexamethasone raises the  risk of stomach upset.
• Anti-Tuberculosis drugs such as rifampin, rifabutin, rifapentine and using with dexamethasone reduces the level of Dexamethasone and thus not work well. Isoniazid using with dexamethasone then level of Isoniazid is reduced and thus it’s effectiveness reduces.

Side effects of Dexamethasone 

Common side effects > 30%

• Increased appetite
• Irritability
• Insomnia
• Swelling in ankles & feet (fluid retention)
• Heartburn
• Muscle weakness
• Impaired wound healing
• Increased blood sugar levels.
• Brushing and discolaration of skin 
• Nausea, vomiting, upset stomach.

Less common side effects <10

• Headaches
• Dizziness
• Mood swings or spinning sensation
• Cataracts and bone thinning (after  long-term use).
• Vision changes 
• Rapid weight gain 
• Dry skin
• Acne, increased sweating, increased hair growth.

Recent Research on Dexamethasone

The first drug proven to cut deaths from Covid-19 is not some new, expensive medicine but an old, cheap-as-chips steroid i.e Dexamethasone and this drug is used by  IV in intensive care & in tablet form for less seriously ill patients.

WHO welcomes the first clinical trial results from (UK) that show dexamethasone,can be lifesaving for patients who are critically ill with COVID-19. Patients on ventilators, it’s use was shown to reduce mortality by approx 1/3, & for patients only oxygen, mortality was cut by 1/5 and Dexamethasone become the first effective and life saving medicine somehow but it’s not the conformed medicine to cure COVID 19.

In the trial, led by a team from Oxford University, about 2,000 hospital patients were given dexamethasone & compared with more than 4,000 who were not for patients on ventilators, it cut the risk of death from 40% to 28%. For patients needing oxygen, it cut the risk of death from 25% to 20%. Chief investigator Prof Peter Horby said,”This is the only drug so far that has been shown to reduce mortality and it reduces it significantly. It’s a major breakthrough.”

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