Dexamethasone Injection

How does it work?

Dexamethasone sodium phosphate is a type of medicine known as a corticosteroid. Corticosteroids are hormones produced naturally by the adrenal glands which have many important functions on every organ system. Corticosteroids affect the strength of heart muscle and its response to natural chemicals affecting heart rate. They affect the water and salt balance in the body and also enable the body to cope with stress. Stress includes changes in temperature, pain, fear, anxiety and illness and can be hazardous if the body is not equiped to cope, due to low levels of corticosteroids. Corticosteroids allow us to respond to stress by increasing the rate and force of the heartbeat, increasing blood supply to essential tissues (muscle, heart, brain), increasing the body's supply of energy by raising blood sugar and by several other effects on body systems. Dexamethasone sodium phosphate is a synthetic corticosteroid and is given as an injection into a vein (intravenously) or into a muscle (intramuscularly) in severe conditions when oral therapy is not possible. This includes the treatment of shock, a condition which can occur due to surgery, trauma or haemmorrhage and which is characterised by a loss of blood circulation to the vital organs. Once oral therapy is possible, individuals should be switched to dexamethasone tablets if corticosteroids are still required. Dexamethasone is also given in this way to decrease inflammation. It works by acting within cells to prevent the release of certain chemicals that are important in the immune system. These chemicals are normally involved in producing immune and allergic responses, resulting in inflammation. By decreasing the release of these chemicals in a particular area, inflammation is reduced. This can help control a wide number of disease states, characterised by excessive inflammation. They include severe allergic reactions and inflammation of the lungs in asthma. The injection may also be given directly into a joint to control inflammation of the joints in arthritis. Dexamethasone is used in much higher doses than the levels of corticosteroids produced naturally by the body, and as such, the usual actions of corticosteroids become exaggerated and can be observed as side effects of this medicine.

What is it used for?

Fluid retention and swelling in the brain (cerebral oedema) due to a brain tumour

Inadequate blood circulation (shock) due to surgical or accidental trauma or severe infection

Inflammatory disorders e.g. asthma, arthritis, severe allergic reactions, Crohn's disease, systemic lupus erythematosus

Injection into inflamed soft tissue e.g. inflammation of the membrane surrounding a tendon (tenosynovitis)

Joint injection in inflammatory disease of the joints (e.g. rheumatoid arthritis)

More serious allergic reaction causing swelling of the eyes, lips or tongue

Treatment of other inflammatory conditions requiring rapid and intense corticosteroid therapy

Warning!

If you are taking a corticosteroid for longer than three weeks you will usually be given a steroid card with your medicine. The card contains details of your prescriber, type of steroid, dose taken and the duration of treatment. It's purpose is to act as reminder that your medicine should not be stopped suddenly, and to provide information of your treatment in case of an accident. You should carry it with you at all times and show it to anyone who treats you (eg doctor, nurse, pharmacist, dentist).

If you are taking this medicine long-term, your doctor may need to temporarily increase your dose if you experience any any additional illness, trauma or surgery during treatment. Discuss this with your doctor.

If you have never had chickenpox you should avoid close personal contact with people who have chickenpox or shingles (herpes zoster). If you are exposed you should your doctor urgently, as these diseases can be life-threatening in people who are taking long-term steroids and whose immune system is suppressed.

You should not stop taking this medicine suddenly, particularly if you have been taking it for longer than 3 weeks. This is because long-term use of the medicine suppresses the natural production of corticosteroids by the adrenal glands. This means that the body becomes temporarily reliant on the medicine. When it is time to stop treatment the dose should be tapered down gradually, to allow the adrenal glands to start producing adequate amounts of natural steroids again. Follow the instructions given by your doctor or pharmacist.

This medicine may increase your susceptibility to infections and also mask the symptoms of these infections. Consult your doctor if you get an infection during treatment.

Although oral and injected corticosteroids are banned by the international olympic committee, injections of corticosteroids into joints are not.

Following joint injection, the occurrence of a distinct increase in pain accompanied by swelling, further restriction of joint movement, fever and malaise are suggestive of an infected arthritis. Antimicrobial treatment should be given to treat this complication.

Injections administered into joints are associated with a risk of infection. Any fluid present in the joint should be examined to exclude bacterial infection before starting treatment. These injections should only be given under sterile conditions.

Tests should be performed to exclude protozoal infection of the intestine (amoebiasis) and roundworm infection (strongyloidiasis) before starting treatment.

It is important not to overuse joints in which a benefit has been obtained by joint injection, as the inflammatory process may remain active.

Use with caution in

Children

Chronic kidney failure

Diabetes

Dormant (currently inactive) tuberculosis infection

Elderly people

Epilepsy

Family history of diabetes

Family history of glaucoma

Glaucoma

Heart failure

Herpes simplex virus infection of the eye

High blood pressure

History of allergies

History of or current mental disorder

History of steroid induced mental disturbances

Hypothyroidism

Liver cirrhosis

Liver failure

Migraine

Osteoporosis

Peptic ulcer

Post-menopausal women

Previous muscle disease (myopathy) caused by steroids

Schizophrenia

Not to be used in

Infection of the joint or surrounding tissue (joint injection only)

Infection throughout the body (systemic infection) unless treated with specific anti-infectives

Protozoal infection of the intestine

Unstable joints

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy. If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and Breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

This medicine should be used with caution during pregnancy, and only if the expected benefit to the mother is greater than any possible risk to the foetus. Seek medical advice from your doctor.

The safety of this medicine during breastfeeding has not been established. Seek medical advice from your doctor.

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

Difficulty in sleeping (insomnia)

Depression

Weight gain

Irregular menstrual cycle

Decreased functioning of the adrenal gland (adrenal suppression)

Thinning of the bones (osteoporosis)

Ulceration of the stomach or intestine

Increased susceptibility to infections

Acne

An extreme allergic reaction (anaphylaxis)

Increased risk of fractures of the bones

Breathing difficulties due to a narrowing of the airways (bronchospasm)

Increased hair growth (hirsutism)

Yeast infection of the moist areas of the body, especially the vagina (candidiasis)

Supression of growth in children and adolescents

Muscle wasting and weakness

The side effects listed above may not include all of the side effects reported by the drug's manufacturer. For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

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