Side Effects of dexamethasone: A Synthesis of Findings from 24 Studies

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Original Abstract of the Article

Major Research Findings

Dexamethasone, a potent glucocorticoid, is widely used for treating rheumatoid arthritis and other inflammatory diseases. However, its side effects are a significant limitation in clinical use. Recent research has focused on developing new methods of administration and formulations to reduce these side effects while maintaining therapeutic efficacy. 24 explored liposomal delivery of dexamethasone phosphate in rodent arthritis, showing long-term suppression of arthritis, allowing for interval treatment. 6 developed a modular, pH-sensitive nanomedicine based on dexamethasone prodrugs, demonstrating improved therapeutic efficacy with less severe side effects in a collagen-induced arthritis rat model. Furthermore, 18 investigated the potential of a colon-targeting formulation of dexamethasone sodium phosphate in resin microcapsules, showing promise in treating experimental colitis in mice with fewer side effects. These studies suggest that innovative approaches to dexamethasone delivery can enhance its therapeutic potential while mitigating unwanted side effects.

Reasons for Side Effects

Dexamethasone's side effects stem from its similar structure to cortisol, a natural steroid hormone. It binds to the same receptors as cortisol, resulting in similar effects. However, dexamethasone is more potent and has a longer duration of action than cortisol, leading to a higher likelihood of side effects.

Common Side Effects

Weight Gain

Dexamethasone can cause weight gain due to its appetite-stimulating properties. 12 reported weight gain in rats treated with dexamethasone.

Increased Blood Sugar

Dexamethasone can raise blood sugar levels. 12 observed increased blood sugar levels in dexamethasone-treated rats.

Osteoporosis

Dexamethasone can inhibit bone formation, leading to osteoporosis. 20 demonstrated that dexamethasone can cause bone loss. However, certain formulations of dexamethasone have shown potential in reducing the risk of osteoporosis.

Muscle Weakness

Dexamethasone can promote muscle protein breakdown, leading to muscle weakness.

High Blood Pressure

Dexamethasone can elevate blood pressure.

Stomach Ulcers

Dexamethasone can damage the stomach lining, increasing the risk of stomach ulcers.

Immune Suppression

Dexamethasone can suppress the immune system, making individuals more susceptible to infections.

Mental Effects

Dexamethasone can affect mental well-being. These effects can include mood swings, insomnia, and depression. 3 noted the potential for dexamethasone to cause neurobehavioral side effects in pediatric leukemia patients. However, 1 did not find conclusive evidence on whether dexamethasone or prednisone causes more neuropsychological side effects. 14 suggested that the neurobehavioral side effects of dexamethasone may be influenced by individual glucocorticoid sensitivity.

Strategies to Manage Side Effects

Weight Gain Management

To minimize weight gain associated with dexamethasone, a balanced diet and regular exercise are crucial. A low-calorie, balanced diet and routine physical activity can help control weight.

Blood Sugar Management

Managing dexamethasone-induced blood sugar increases requires regular monitoring and, when necessary, the use of insulin or other medications. Regular blood glucose monitoring and appropriate medication can help stabilize blood sugar levels.

Osteoporosis Prevention

Preventing dexamethasone-induced osteoporosis requires adequate intake of calcium and vitamin D. Regular bone density screenings and the use of osteoporosis medications, if needed, can help protect bone health.

Muscle Weakness Management

Regular exercise is crucial for mitigating muscle weakness caused by dexamethasone. Starting with light exercise and gradually increasing intensity can help maintain muscle strength.

High Blood Pressure Management

Managing dexamethasone-induced high blood pressure involves regular blood pressure monitoring and the use of antihypertensive medications when necessary.

Stomach Ulcer Prevention

Preventing dexamethasone-induced stomach ulcers includes the use of medications to reduce stomach acid. Dietary modifications and lifestyle changes can also play a role.

Immune Suppression Management

To minimize the risk of infections associated with dexamethasone-induced immune suppression, maintaining good hygiene practices, such as handwashing and gargling, is essential. Avoiding crowded areas can also help.

Mental Effect Management

If you experience mental side effects from dexamethasone, it is crucial to consult with your doctor. If necessary, consider seeking evaluation by a psychiatrist.

Comparison Across Studies

Commonalities Across Studies

Numerous studies have consistently demonstrated that dexamethasone can lead to a range of side effects.

Differences Across Studies

The severity and type of side effects associated with dexamethasone can vary across studies. This variability is likely influenced by factors such as the method and formulation of dexamethasone administration, the specific disease being treated, and individual patient characteristics.

Considerations for Real-Life Applications

Dexamethasone is a potent medication, and self-administration is highly risky. If you require dexamethasone, always follow your doctor's instructions carefully. If you experience any unusual symptoms while taking dexamethasone, consult your doctor promptly.

Current Research Limitations

Research on the side effects of dexamethasone remains incomplete. Long-term side effects, in particular, require further investigation. Understanding the impact of individual patient characteristics and genetic factors on side effects also warrants more research.

Future Research Directions

Further research is essential to reduce the side effects of dexamethasone and enhance its therapeutic benefits. This research should focus on thoroughly understanding the mechanisms of action of dexamethasone, identifying the specific causes of its side effects, and developing new methods for predicting and preventing side effects. Additionally, research exploring the role of individual patient characteristics and genetic factors in side effect development is crucial.

Conclusion

Dexamethasone is a potent anti-inflammatory drug, but it carries the potential for various side effects. If you need dexamethasone, adhere to your doctor's instructions and be aware of the possible side effects before using this medication. Further research is necessary to optimize the use of dexamethasone for improved safety and efficacy.

Keywords
Benefit Keywords
ALL treatment
1
Reduced side effects
Targeted treatment
2
Overcome neurobehavioral problems
3
RA treatment
Reduce dexamethasone side effects
4
Improved survival
Lupus nephritis treatment
Reduced nephritis incidence
5
Improved drug delivery
Improved therapeutic efficacy
Reduced side effects
Targeted drug delivery
6
Postoperative nausea and vomiting prophylaxis
8
Early discharge
PONV prevention
Pain management
9
Early discharge
PONV prophylaxis
Pain management
10
Improved safety
Lupus nephritis treatment
Nephritis resolution
Reduced immune complex deposition
Survival improvement
11
Anti-inflammatory
Immunosuppressant
12
Anti-inflammatory activity
13
Macular edema treatment
Well-tolerated
15
Reduced bone loss
17
Oral delivery system
Ulcerative colitis treatment
18
ALL treatment
19
Prevents osteolysis
Reduced systemic toxicity
20
Pain relief
Reduced opioid use
Shorter recovery time
21
Lupus nephritis treatment
22
Accelerated tendon repair
23
Anti-inflammatory effect
Improved therapeutic window
24
Risk Keywords
Neuropsychological side effects
1
Neurobehavioral side effects
3
Dexamethasone side effects
7
Delayed wound healing
Increased glucose levels
Wound infection
8
Postoperative complications
9
Adrenal insufficiency
Diabetes mellitus
High blood pressure
Hyperglycemia
Increased infection risk
Osteoporosis
10
Bone metabolism abnormalities
Hyperglycemia
Lipid changes
Weight loss
12
Neurobehavioral side effects
14
Cataract
Implant migration
Infection
Ocular hypertension
Vitreomacular traction
15
Metabolic deregulation
16
Toxic side-effects
18
Neuropsychological side effects
19
Increased blood glucose
21
Gluconeogenesis
HPA axis suppression
24
Literature analysis of 24 papers
Positive Content
20
Neutral Content
1
Negative Content
3
Article Type
0
3
6
3
24
1.

Does dexamethasone induce more neuropsychological side effects than prednisone in pediatric acute lymphoblastic leukemia? A systematic review.

Author: WarrisL T, van den Heuvel-EibrinkM M, den HoedM A H, AarsenF K, PietersR, van den AkkerE L T

ALL treatment
Neuropsychological side effects

Dexamethasone and prednisone are commonly used steroids for treating childhood acute lymphoblastic leukemia. This review found no clinically significant differences between the two drugs on cognitive, mood, or behavioral outcomes. This suggests that both drugs may be safe in terms of neuropsychological side effects.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

3.

Study protocol: DexaDays-2, hydrocortisone for treatment of dexamethasone-induced neurobehavioral side effects in pediatric leukemia patients: a double-blind placebo controlled randomized intervention study with cross-over design.

Author: van HulstA M, VerwaaijenE J, FioccoM F, PluijmS M F, GrootenhuisM A, PietersR, van den AkkerE L T, van den Heuvel-EibrinkM M

Overcome neurobehavioral problems
Neurobehavioral side effects

Dexamethasone, a highly effective treatment for pediatric acute lymphoblastic leukemia (ALL), can induce serious neurobehavioral side effects, impacting health-related quality of life (HRQoL). Previous studies suggest that these side effects may be related to cortisol depletion of the mineralocorticoid receptor in the brain. This study aims to replicate the findings of a previous trial, which suggested that adding physiological hydrocortisone during dexamethasone treatment could alleviate these neurobehavioral problems.

Clinical Trial ProtocolA plan for conducting a clinical trial. It describes in detail the purpose, design, methodology, and statistical considerations of the trial, ensuring the transparency and consistency of the trial.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

4.

FGF21 Enhances Therapeutic Efficacy and Reduces Side Effects of Dexamethasone in Treatment of Rheumatoid Arthritis.

Author: SunXu, XieYin-Zhuo, JiangYuan-Yuan, WangGuan-Ying, WangYu-Jia, MeiYu, GaoRong-Hui, LiYan-Hua, XiaoWei, WangWen-Fei, LiDe-Shan

RA treatment
Reduce dexamethasone side effects

This study investigated the efficacy of FGF21 combined with dexamethasone for the treatment of rheumatoid arthritis (RA) in mice. The study found that FGF21 combined with dexamethasone was more effective than either treatment alone and reduced the side effects of dexamethasone.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

5.

Dexamethasone prodrug nanomedicine (ZSJ-0228) treatment significantly reduces lupus nephritis in mice without measurable side effects - A 5-month study.

Author: ZhaoZhifeng, JiaZhenshan, FosterKirk W, WeiXin, QiaoFangfang, JiangHaochen, JinYan, LiGuojuan, ChenNingrong, ZhaoGang, ThieleGeoffrey M, MedlinJennifer L, O'DellJames R, WangDong

Improved survival
Lupus nephritis treatment
Reduced nephritis incidence

This study investigated the long-term efficacy and safety of a macromolecular prodrug nanomedicine based on dexamethasone (ZSJ-0228) in lupus-prone NZB/W F1 mice.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, N.I.H., ExtramuralResearch funding provided by the NIH to external research institutions and researchers.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

7.

Potential biomarkers screening to predict side effects of dexamethasone in different cancers.

Author: JiangDa, JinHui, ZuoJing, KongYan, ZhangXue, DongQian, XuZhihong, LiYing

Dexamethasone side effects

This study aimed to identify potential biomarkers associated with the side effects of dexamethasone in different tumors.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

8.

Adverse side-effects of dexamethasone in surgical patients - an abridged Cochrane systematic review.

Author: PoldermanJ A W, Farhang-RaziV, van DierenS, KrankeP, DeVriesJ H, HollmannM W, PreckelB, HermanidesJ

Postoperative nausea and vomiting prophylaxis
Delayed wound healing
Increased glucose levels
Wound infection

This meta-analysis found that dexamethasone did not increase the risk of postoperative wound infection.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

9.

Adverse side effects of dexamethasone in surgical patients.

Author: PoldermanJorinde Aw, Farhang-RaziViolet, Van DierenSusan, KrankePeter, DeVriesJ Hans, HollmannMarkus W, PreckelBenedikt, HermanidesJeroen

Early discharge
PONV prevention
Pain management
Postoperative complications

Dexamethasone is widely used in the perioperative period for various purposes, but its long-term effects are well-documented. This study explores whether a single steroid load during surgery has negative effects during the postoperative period.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

10.

Adverse side effects of dexamethasone in surgical patients.

Author: PoldermanJorinde Aw, Farhang-RaziViolet, Van DierenSusan, KrankePeter, DeVriesJ Hans, HollmannMarkus W, PreckelBenedikt, HermanidesJeroen

Early discharge
PONV prophylaxis
Pain management
Adrenal insufficiency
Diabetes mellitus
High blood pressure
Hyperglycemia
Increased infection risk
Osteoporosis

Dexamethasone is used for various purposes in the perioperative period, but its long-term effects are not well understood. While long-term steroid use is known to have negative effects, the impact of a single steroid load during surgery on the postoperative period is not yet studied.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

11.

Micelle-Forming Dexamethasone Prodrug Attenuates Nephritis in Lupus-Prone Mice without Apparent Glucocorticoid Side Effects.

Author: JiaZhenshan, WangXiaobei, WeiXin, ZhaoGang, FosterKirk W, QiuFang, GaoYangyang, YuanFang, YuFang, ThieleGeoffrey M, BronichTatiana K, O'DellJames R, WangDong

Improved safety
Lupus nephritis treatment
Nephritis resolution
Reduced immune complex deposition
Survival improvement

This study investigated the use of a polyethylene glycol-based macromolecular prodrug (ZSJ-0228) of dexamethasone to treat lupus nephritis (LN). ZSJ-0228 was more effective in reducing proteinuria and improving survival than daily dexamethasone, with fewer adverse effects.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, N.I.H., ExtramuralResearch funding provided by the NIH to external research institutions and researchers.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

13.

Comparative analysis of Lacistema pubescens and dexamethasone on topical treatment of skin inflammation in a chronic disease model and side effects.

Author: da SilvaJosiane M, ConegundesJéssica L M, PintoNícolas C C, MendesRenata F, CastañonMaria Christina M N, ScioElita

Anti-inflammatory activity

This study evaluated the anti-inflammatory properties of a pharmaceutical formulation containing the hexane fraction of Lacistema pubescens in mice. The formulation demonstrated chronic topical anti-inflammatory activity, comparable to dexamethasone, without significant cutaneous or systemic adverse effects.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

14.

Predicting the neurobehavioral side effects of dexamethasone in pediatric acute lymphoblastic leukemia.

Author: WarrisLidewij T, van den AkkerErica L T, AarsenFemke K, BieringsMarc B, van den BosCor, TissingWim J E, SassenSebastiaan D T, VeeningMargreet A, ZwaanChristian M, PietersRob, van den Heuvel-EibrinkMarry M

Neurobehavioral side effects

This study investigated whether the very low-dose dexamethasone suppression test (DST) or measuring trough levels of dexamethasone could predict the occurrence of neurobehavioral side effects in pediatric patients with acute lymphoblastic leukemia (ALL). Patients with glucocorticoid hypersensitivity experienced significantly more symptoms associated with dexamethasone-induced depression.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

15.

Common and Rare Ocular Side-effects of the Dexamethasone Implant.

Author: Fassbender AdeniranJanelle M, JusufbegovicDenis, SchaalShlomit

Macular edema treatment
Well-tolerated
Cataract
Implant migration
Infection
Ocular hypertension
Vitreomacular traction

Dexamethasone (DEX) implant is generally well-tolerated but may lead to ocular hypertension and cataract.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

17.

The Evaluation of the Therapeutic Efficacy and Side Effects of a Macromolecular Dexamethasone Prodrug in the Collagen-Induced Arthritis Mouse Model.

Author: QuanLingdong, ZhangYijia, DusadAnand, RenKe, PurdueP Edward, GoldringSteven R, WangDong

Reduced bone loss

A study in mice with collagen-induced arthritis (CIA) found that a single dose of N-(2-hydroxypropyl) methacrylamide (HPMA) copolymer-dexamethasone conjugate (P-Dex) showed similar therapeutic efficacy as daily dose equivalent dexamethasone (Dex). P-Dex treatment prevented systemic bone loss associated with glucocorticoid (GC) treatment. These findings suggest that P-Dex may be a useful treatment for rheumatoid arthritis.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, N.I.H., ExtramuralResearch funding provided by the NIH to external research institutions and researchers.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

19.

Does dexamethasone induce more neuropsychological side effects than prednisone in pediatric acute lymphoblastic leukemia? A systematic review.

Author: WarrisL T, van den Heuvel-EibrinkM M, den HoedM A H, AarsenF K, PietersR, van den AkkerE L T

ALL treatment
Neuropsychological side effects

Dexamethasone and prednisone are commonly used steroids for treating childhood acute lymphoblastic leukemia. This review found no clinically significant differences between the two drugs on cognitive, mood, or behavioral outcomes. This suggests that both drugs may be safe in terms of neuropsychological side effects.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

20.

Macromolecular prodrug of dexamethasone prevents particle-induced peri-implant osteolysis with reduced systemic side effects.

Author: RenKe, DusadAnand, YuanFang, YuanHongjiang, PurdueP Edward, FehringerEdward V, GarvinKevin L, GoldringSteven R, WangDong

Prevents osteolysis
Reduced systemic toxicity

This study investigated the use of a macromolecular prodrug, P-Dex, to prevent wear particle-induced osteolysis in a murine prosthesis failure model. P-Dex, a dexamethasone conjugate, was equally effective as free dexamethasone in preventing osteolysis but without the systemic bone loss associated with glucocorticoids.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, N.I.H., ExtramuralResearch funding provided by the NIH to external research institutions and researchers.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

21.

Impact of perioperative dexamethasone on postoperative analgesia and side-effects: systematic review and meta-analysis.

Author: WaldronN H, JonesC A, GanT J, AllenT K, HabibA S

Pain relief
Reduced opioid use
Shorter recovery time
Increased blood glucose

This systematic review evaluated the impact of a single i.v. dose of dexamethasone on postoperative pain in adults. Dexamethasone had small but statistically significant analgesic benefits.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
Research Support, N.I.H., ExtramuralResearch funding provided by the NIH to external research institutions and researchers.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

22.

Dexamethasone prodrug treatment prevents nephritis in lupus-prone (NZB × NZW)F1 mice without causing systemic side effects.

Author: YuanFang, NelsonRichard K, TaborDana E, ZhangYijia, AkhterMohammed P, GouldKaren A, WangDong

Lupus nephritis treatment

A nephrotropic dexamethasone prodrug (P-Dex) was found to be more effective than dexamethasone in treating lupus nephritis in mice, with reduced systemic toxicities.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, N.I.H., ExtramuralResearch funding provided by the NIH to external research institutions and researchers.

Language : English

23.

Platelet-rich plasma protects tenocytes from adverse side effects of dexamethasone and ciprofloxacin.

Author: Zargar BaboldashtiNasim, PoulsenRaewyn C, FranklinSarah L, ThompsonMark S, HulleyPhilippa A

Accelerated tendon repair

Platelet-rich plasma (PRP) may be able to prevent the adverse effects of glucocorticoids and fluoroquinolone antibiotics on tendon healing.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

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