Dexamethasone

Medically Reviewed by Dr. Harshi Dhingra, M.D.

Last Reviewed: Nov 27, 2023

Warnings

Dexamethasone Risks, Warnings, and Complications

Dexamethasone can cause serious health complications in some people. Talk to your doctor about other treatment options if you are at an increased risk of adverse reactions from this medicine. Some of the risks of dexamethasone use include:

ALLERGIC REACTIONS: Severe allergic reactions to dexamethasone are rare but can occur in a small number of people. Seek emergency medical care if you develop swelling of the face, lips, tongue or throat, difficulty breathing, severe skin rash, hives, itching, blistering, or peeling skin.
EFFECTS ON THE HEART AND KIDNEYS: Systemic corticosteroids can cause increased blood pressure, sodium and fluid retention, and increased excretion of potassium and calcium. These effects are more likely to occur at high doses. Your doctor may recommend dietary salt restriction and potassium supplementation if this happens. Corticosteroids should be used with caution in patients who have recently had a heart attack.
ADRENAL INSUFFICIENCY: Stopping dexamethasone suddenly after taking it for a long time can be dangerous due to adrenal insufficiency (low serum cortisol levels). This happens because your body stops making cortisol hormones while you are on dexamethasone long-term. Symptoms of low serum cortisol levels may include low energy, joint pain, muscle pain, and depression. Do not stop taking dexamethasone without talking to your provider. Your doctor will tell you how to lower the dose gradually.
INCREASED RISK OF INFECTIONS: Dexamethasone suppresses the immune system. As a result, people who take dexamethasone are at an increased risk of infections caused by various pathogens (bacteria, viruses, fungi, protozoans, helminths) in any part of the body. During dexamethasone therapy, avoid contact with people who are sick, especially those with contagious infections like chickenpox or measles. Tell your doctor if you have had tuberculosis (TB) in the past. Your provider will monitor you carefully while you’re on dexamethasone. You may need to take antitubercular medications if your TB comes back.
VACCINATIONS: Talk to your healthcare provider about vaccinations. You may not be able to receive live vaccines while on high-dose dexamethasone, as it can increase your chances of getting sick. You may also need to delay receiving inactivated vaccines.
EYE PROBLEMS: Prolonged use of corticosteroids can cause eye problems such as glaucoma, cataracts, damage to the optic nerves, and an increased risk of secondary eye infections. Keep all your appointments with your eye doctor while on dexamethasone. Tell your doctor right away if you develop eye pain or vision changes.
STOMACH AND INTESTINAL PROBLEMS: Dexamethasone makes your gastrointestinal tract more susceptible to damage from aspirin, certain arthritis medications, and alcohol, increasing the risk of stomach irritation and ulcers. Tell your doctor right away if you develop stomach pain or bloody, black, or tarry stools.
EFFECTS ON BONES: High doses and long-term treatment with dexamethasone can make your bones weak, causing osteoporosis in adults and slowed bone growth in children. Your doctor may recommend eating foods rich in calcium and vitamin D, doing bone-strengthening exercises, and/or taking dietary supplements to improve bone health.

Precautions Before Starting Dexamethasone

Tell your doctor if you have had an allergic reaction to dexamethasone, any of the active or inactive ingredients in dexamethasone formulations, other corticosteroids, aspirin, tartrazine (a yellow-colored dye that’s an ingredient in some drugs and foods), or other drugs. Your pharmacy can give you a list of ingredients.

Give your doctor or pharmacist a complete list of your medications, including prescription drugs, over-the-counter medicines, vitamins, dietary supplements, and herbal products. This will help prevent interactions between dexamethasone and your other drugs.

Give your doctor a complete medical history. Dexamethasone may not be right for people with certain medical conditions, such as ongoing fungal infections (other than a fungal infection of the skin), liver disease, kidney disease, diabetes, heart disease, high blood pressure, stomach ulcers, intestinal diseases, hypothyroidism (underactive thyroid), osteoporosis, mental illness, tuberculosis, seizures, herpes eye infection, or myasthenia gravis.

Tell your doctor if you are pregnant, could be pregnant, are planning a pregnancy, or are breast-feeding.

Precautions During Use of Dexamethasone

Keep all your medical and lab appointments while on dexamethasone. Your doctor will adjust your dose based on your response.

Follow your doctor’s dietary instructions, such as a low-sodium (low-salt), high-potassium, or high-protein diet.

Tell your healthcare professional if you become pregnant while on dexamethasone.

Some medications can interfere with the results of certain lab tests. Tell all your healthcare providers and laboratory personnel you are on dexamethasone, especially before any procedures, including dental treatments.

Dexamethasone Drug Interactions

Taking dexamethasone with certain drugs can affect how it works. Possible interactions between dexamethasone and other medications can increase the risk of serious adverse events. Your doctor may change the dose of your medications, switch you to another medication, or monitor you carefully for side effects if there are known interactions between dexamethasone and your other medicines. Dexamethasone can have drug interactions with the following medications:

Anticoagulants or blood thinners such as warfarin (Jantoven, Coumadin)
Diuretics or water pills
Aspirin
Arthritis medications
Immunosuppressants such as cyclosporine (Neoral, Sandimmune)
Heart medications such as digoxin (Lanoxin)
Ephedrine
Antifungal agents such as ketoconazole (Nizoral)
Diabetes medication to lower blood glucose levels
Estrogen (Premarin) and oral contraceptives
Anti-seizure drugs such as phenobarbital and phenytoin (Dilantin)
Tuberculosis medications such as rifampin (Rifadin)
Medications prescribed for lung conditions, such as theophylline (Theo-Dur)
Vitamins

Give your healthcare professional a complete list of all the medications you are taking, including prescription drugs, non-prescription medicines, dietary supplements, and herbal remedies. Also, tell your healthcare provider if you smoke, drink alcohol, or use recreational drugs because some of these substances can cause serious health complications when used with prescription and over-the-counter medicines.

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