Ophthalmics
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.
Viral Infections
Chickenpox and
measles 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.
Vaccination
Use of vaccine which does not kill the virus entirely (attenuated vaccines) should not be used in patients receiving small doses of
corticosteroids.
Tuberculosis
Active
tuberculosis 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.
Special Pathogens
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.
Infections
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
Corticosteroids 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.
Allergic Reaction
Rare cases of allergic reactions have occurred in patients taking
corticosteroid therapy including Dexamethasone.