Corticosteroid — High Potency Pregnancy: Dexamethasone crosses the placenta. Should be used in pregnancy, particularly the first trimester, only if the benefit outweighs the risks to mother and child. Long-term/repeated therapy increases risk of intrauterine growth retardation; risk of neonatal adrenal insufficiency. (US label: Pregnancy Category C.)

Dexamethasone (Rheumatology)

Brand names: Neofordex, Dexamethasone phosphate

In rheumatology, dexamethasone is a potent long-acting corticosteroid used for short-term control of severe inflammatory and autoimmune flares and sometimes given by intra-articular or soft-tissue injection.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Active phase of rheumatic system disorders: systemic lupus erythematosus 6-16 mg/day. Active rheumatoid arthritis with severe progressive course: fast destructive forms 12-16 mg/day; with extra-articular manifestations 6-12 mg/day.

Route: Oral

Frequency: Daily (titrated to individual patient response and disease severity)

Max: Doses above 10 mg/day used in more severe disease; not otherwise numerically capped for rheumatic indications in the SPC

Initial dosage of dexamethasone usually varies from 0.5 to 10 mg daily depending on the disease; in more severe conditions doses above 10 mg/day may be required. Use lowest effective dose to minimise side effects; titrate to individual response. For long-term treatment of several conditions, after initial therapy glucocorticoid treatment should be switched from dexamethasone to prednisone/prednisolone to reduce adrenal cortex suppression. Discontinuation should be gradual (risk of acute adrenocortical failure after abrupt withdrawal of long-term high-dose treatment). Other indications in the SPC include cerebral oedema, acute asthma, acute skin diseases (8-40 mg/day, up to 100 mg), idiopathic thrombocytopenic purpura, palliative treatment of neoplastic disease, and antiemetic use. Take with or after food. Hepatic impairment: dose adjustment may be necessary in severe liver disease. Elderly: plasma concentrations may be higher and excretion slower, so dose should be reduced accordingly.

Dose adjustments

Renal

Patients undergoing active haemodialysis may show increased clearance of drug via the dialysate and thus require an adjustment of steroid dose.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substance or to any of the excipients
Systemic infection unless specific anti-infective therapy is employed
Stomach ulcer or duodenal ulcer
Vaccination with live vaccines during treatment with large therapeutic doses

Side effects

Weight gain, increased appetite, sodium and water retention, potassium loss, impaired carbohydrate tolerance / manifestation of latent diabetes mellitus
Suppression of hypothalamic-pituitary-adrenal axis and induction of Cushing's syndrome; growth suppression in childhood
Psychiatric disorders (depression, insomnia, euphoria to psychosis, aggravated schizophrenia)
Increased susceptibility to or exacerbation of infections; immunosuppression; hypersensitivity reactions including anaphylaxis
Elevated intraocular pressure, glaucoma, cataract, blurred vision; osteoporosis and negative calcium balance

Interactions

Fluoroquinolones (increased risk of tendinitis and tendon rupture)
Live vaccines (contraindicated with large doses; approx 8 weeks before to 2 weeks after)
Potassium-depleting agents e.g. amphotericin B, diuretics (observe for hypokalaemia)
Anticholinesterase agents (severe weakness in myasthenia gravis)
Oral anticoagulants / warfarin (altered anticoagulant response; monitor coagulation)
Antidiabetics (corticosteroids may raise blood glucose; adjust dose)
Macrolide antibiotics (decreased corticosteroid clearance)

Clinical monograph

How it works

It activates glucocorticoid receptors to suppress pro-inflammatory gene transcription and broadly dampen immune and inflammatory responses.

Prescribing in practice

Do not stop prolonged courses abruptly — adrenal suppression means the dose must be tapered, and patients need a steroid alert card and sick-day advice.
Long-term use risks osteoporosis, hyperglycaemia, infection, mood disturbance and gastrointestinal effects, so consider bone and gastric protection.
Being more potent and longer-acting than prednisolone, it has negligible mineralocorticoid effect; follow the SPC for equivalent dosing.

Monitoring

Monitor blood pressure, blood glucose, weight, bone health and signs of infection during prolonged corticosteroid therapy.

Counselling the patient

Never stop a long course suddenly and carry a steroid alert card.
Report signs of infection, mood changes or marked thirst.
Take with food and seek advice during intercurrent illness.

Evidence & guidelines

Corticosteroid efficacy in inflammatory rheumatic disease is well established by extensive clinical experience and trials.

Reference: RECOVERY Trial (NEJM 2021); EULAR GCA Guidelines 2018; BSR GCA Guidelines; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways