Dexamethasone

How it works

It is a glucocorticoid with potent anti-inflammatory and immunosuppressant actions and minimal mineralocorticoid effect, reducing inflammatory mediator production and tissue oedema.

Prescribing in practice

• Corticosteroids should not be stopped abruptly after more than a short course because of the risk of adrenal insufficiency, and patients on prolonged therapy need a steroid treatment card and gradual withdrawal.
• It can cause hyperglycaemia, mood and sleep disturbance, increased infection risk and gastrointestinal effects, so use cautiously in diabetes, active infection and peptic ulcer disease.
• Even short courses may unmask or worsen infection, so exclude untreated systemic infection before use.

Monitoring

For more than brief use, monitor blood glucose, blood pressure, mood and signs of infection, and review the need for continued treatment.

Counselling the patient

• Do not stop suddenly if you have taken it for more than a few days.
• Tell other healthcare professionals you are taking a steroid, and carry a steroid card if on a longer course.
• Report signs of infection, marked mood change or high blood sugars.

Evidence & guidelines

Systemic corticosteroids such as dexamethasone are established for reducing airway oedema and perioperative swelling, with use guided by standard corticosteroid prescribing principles.