Dexamethasone adverse effects

High-dose dexamethasone (40 mg/day) is an option for patients who cannot tolerate chemotherapy or have few high-risk features. Response rates are approximately 40% to 50% in previously untreated patients.37 Advantages of this regimen include ease of administration and lack of hematologic adverse effects. 

Lenalidomide is an immunomodulating agent related to thalidomide that was recently approved for the treatment of patients with multiple myeloma and myelodysplastic syndrome (MDS). Lenalidomide lacks the common side effects of thalidomide, such as constipation and peripheral neuropathy. Interim analyses of two phase III trials show that lenalidomide in combination with dexamethasone produces higher response rates than dexamethasone alone in relapsed and refractory myeloma. Adverse effects of lenalidomide include diarrhea, nausea, muscle cramps, hematologic side effects and deep vein thrombosis.42... 

Buspirone (BuSpar) [Anxiolytic] WARNING Closely monitor for worsening depression or emergence of suicidality Uses Short-term relief of anxiety Action Antianxiety antagonizes CNS serotonin receptors Dose Initial 7.5 mg PO bid T by 5 mg q2-3d to effect usual 20-30 mg/d max 60 mg/d Contra w/ MAOI Caution [B, /-] Avoid w/ severe hepatic/renal insuff Disp Tabs SE Drowsiness, dizziness, HA, N, EPS, serotonin synd, hostility, depression Notes No abuse potential or physical/psychologic d endence Interactions T Effects W/ erythromycin, clarithromycin, itraconazole, ketoconazole, diltiazem, verapamil, grapefruit juice effects W/ carbamazepine, rifampin, phenytoin, dexamethasone, phenobarbital, fluoxetine EMS T Sedation w/ concurrent EtOH use grapefruit juice may T risk of adverse effects OD May cause dizziness, miosis, N/V symptomatic and supportive... 

D. Dexamethasone is a fluorinated glucocorticoid that is more potent and longer acting than cortisol. While devoid of salt-retaining activity in therapeutic doses, this glucocorticoid does possess most of the adverse effects observed with cortisol. Because it lacks mineralocorticoid activity, dexamethasone is not used in replacement therapy. 

Although dexamethasone is commonly associated with transient adverse effects, several randomized trials have shown that it rapidly reduces oxygen requirements and shortens the duration of ventilation. A randomized study was designed to evaluate the effects of... 

However, there is still controversy about the use of single or repeat courses. It seems that betamethasone is more active in reducing neonatal deaths and produces fewer adverse effects than dexamethasone (367). 

The use of postnatal glucocorticoids in very premature infants is controversial although dexamethasone reduces bronchopulmonary dysplasia, it has been associated with severe adverse effects (407). In 220 infants with a birth-weight of 501-1000 g randomized to placebo or dexamethasone (0.15 mg/kg/day for 3 days and tapering over a period of 7 days) the relative risk of death or chronic lung disease... 

No adverse effects are to be expected after a single injection of a high dose of a glucocorticoid, but some serious complications have been observed with repeated use, including both infections and the known direct adverse effects of glucocorticoids. Cases of ventricular dysrhythmias and atrial fibrillation have been reported (SEDA-18, 391). With pulse therapy, the nature of the injected glucocorticoid seems to be important for example, hydrocortisone, which is more rapidly metabolized, seems to be better tolerated than dexamethasone (SEDA-6, 331). 

Stark AR, Carlo WA, Tyson JE, Papile LA, Wright LL, Shankaran S, Donovan EF, Oh W, Bauer CR, Saha S, Poole WK, Stoll BJ. National Institute of Child Health and Human Development Neonatal Research Network. Adverse effects of early dexamethasone in extremely-low-birth-weight infants. National Institute of Child Health and Human Development Neonatal Research Network. N Engl J Med 2001 344(2) 95-101. 

Short courses of dexamethasone generally cause no adverse effects, although rapid injection can cause intense genital or perineal pain. Mild insomnia and epigastric discomfort can occur. 

Dexamethasone may cause side-effects typical of corticosteroid administration. Many of its more serious adverse effects occur on long-term treatment, while other generally less serious effects may become apparent during shortterm treatment periods. These may include ... 

Iontophoresis in the ear to relieve pain was reported by Albrecht in 1911 [47]. He used cocaine in high concentrations (20%-40%), copper electrodes, and uncontrolled high current (1.5-2 mA) on perforated tympanic membranes. Despite excellent anesthesia, many of his patients were vertiginous during and after treatment, with some patients suffering permanent loss of hearing. However, relatively recent studies have demonstrated that the use of lidocaine [48], A-acetylcysteine [49], or dexamethasone and fosfomycin [50] in iontophoresis to the ear has no adverse effects in either animal or clinical trials. Echols et al. [51] confirmed that lidocaine could be iontophoresed in the middle ear for at least 30 minutes at 1 mA without any adverse effects. 

In a report on the use of albendazole 15 mg/kg/day in two divided doses for 14 days in the treatment of persistent neurocysticercosis (10), adverse reactions were monitored in 43 patients with seizures and a sohtary cysticercal cyst, who had not been treated before. In aU patients CT scans confirmed the presence of a solitary cyst less than 2 cm in diameter. Antiepileptic treatment was continued. In seven patients dexamethasone 8 mg/day in four divided doses was given for the first 5-7 days after the start of treatment. Follow-up CT scans at 4-10 weeks after the start of treatment showed responses in 20 patients, with complete disappearance in seven patients and a reduction to 50% of the pretreatment size in the other 13. There were adverse effects in 15 patients, with a maximum on the fifth day after the start of treatment. Six patients had severe headaches, 11 had partial seizures, and 2 had epileptic seizures and severe postictal hemiparesis that persisted for a week or more. Because of these serious adverse effects treatment was discontinued in seven patients and dexamethasone was added in those patients who were not already taking it, although its use proved questionable. Adverse effects were seen in three of seven patients who took prophylactic steroid therapy and in 12 of 36 patients who did not. 

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