Use of corticosteroids
may produce cloudy region on the lens (posterior subcapsular cataracts
), damage to the optic nerves, and may enhance the establishment of eye infections due to viruses, bacteria, or fungi
. The use of oral corticosteroids is not advised in the therapy of inflamed optic nerves and may lead to an increased risk of new events. Corticosteroids including Dexamethasone should not be used in active eye infection due to the virus.
can have a more severe or even fatal progression in children and adult patients on corticosteroids
including Dexamethasone. Children and adult patients who did not have these diseases, special care should be used to avoid exposure. If exposed to chickenpox, pretreatment with a vaccine (varicella
zoster immune globulin
) may be advised. If exposed to measles, pretreatment with immune globulin may be suggested. If chickenpox develops, therapy with antiviral agents should be taken into consideration.
Use of vaccine which does not kill the virus entirely (attenuated vaccines) should not be used in patients receiving small doses of corticosteroids
patients treated with corticosteroids
are at an increased risk. It should be restricted to use Dexamethasone for the management of active and severe tuberculosis in combination with a proper antituberculous regimen. If Dexamethasone is indicated in patients with inactive tuberculosis, close observation is needed as reactivation of the disease may happen. During prolonged corticosteroid therapy, these patients should use drugs to prevent disease.
The inactive disease may get activated or worsening of infections occurring during another condition due to pathogens, such as Amoeba, Cryptococcus etc. In such patients, Dexamethasone-induced suppression of the immune system may lead to spreading and hyperinfection of threadworm. It may often be accompanied by severe inflammation of the digestive tract and potentially fatal bloodstream infection. It is recommended that parasitic infection of the colon should be eliminated before starting Dexamethasone therapy in any patient diarrhea
. Also, corticosteroids
should be used with intensive care in patients with threadworm infection. Patients with cerebral malaria
should not use Dexamethasone.
Patients who are on Dexamethasone therapy are more sensitive to infections as compared to healthy individuals. The increased dose may increase the rate of existence of infectious complications. Use of Dexamethasone alone or in combination with other immunosuppressive drugs is related to infection with any kind of pathogen e.g. protozoa or bacteria. Corticosteroids
including Dexamethasone may worsen systemic fungal infections. In some cases, a combination of amphotericin B and hydrocortisone should not be used due to heart enlargement and heart failure. Dexamethasone should not be used in the presence of fungal infections unless they are required to control reactions which are life-threatening.
Endocrine System Problems
can produce suppression of the system that controls reactions to stress
and other body processes with the potential for inadequate corticosteroid levels after withdrawal of therapy. The improper functioning of adrenal glands may result from too rapid withdrawal of corticosteroids including Dexamethasone. This effect may be minimized by a gradual lowering of dose. The volume of blood cleared of Dexamethasone is decreased in patients with low thyroid hormone
and increased in patients with high thyroid level. In any condition of stress, the dose should not be discontinued. If the patient is already receiving steroids
, the dose may increase. Patients with changes in thyroid hormone may need a dose adjustment.
Heart-Kidney Related Problems
Use of corticosteroids
may lead to left ventricle wall rupture after a recent heart attack. All corticosteroids including Dexamethasone increase the excretion of calcium
. Medium to high doses of corticosteroids including Dexamethasone can cause a rise in blood pressure, sodium
and water retention, and increased potassium
excretion. Treatment with corticosteroids should be done with caution in patients with a high risk. Restricted salt diet
and potassium supplementation may be necessary.
Rare cases of allergic reactions have occurred in patients taking corticosteroid
therapy including Dexamethasone.