The coronavirus infection that broke out at the start of 2020 posed many challenges to the global medical community, one of them being the need to quickly identify a range of medicinal drugs and already available therapies that could be re-purposed to treat Covid-19 patients with symptoms of varying intensity. Dexamethasone was among the first drugs tested for efficacy against the novel SARS-CoV-2 infection. In the process of the study, it was discovered that this inexpensive and widely available medication could help save the lives of many Covid-19 patients who displayed grave symptoms and were in need of hospitalization or even artificial lung ventilation (ALV) support.
Dexamethasone for Covid-19 patients: what have the studies shown?
Research teams based in Britain and other countries have conducted multiple studies on the use of dexamethasone in Covid-19 patients and found that this widespread steroid improves the survival rates of seriously ill patients in need of ALV support by at least 33%. Furthermore, according to these works, the drug can decrease mortality in patients who need supplemental oxygen by at least one-fifth.
Thanks to the potent anti-inflammatory effect, dexamethasone helps cope with one of the most dangerous consequences of the coronavirus infection – an acute inflammatory reaction that can destroy the patient’s lungs and result in multi-organ failure. Here is more about what dexamethasone is, how it works, and why its use should be limited to the most severely affected Covid-19 patients only.
Dexamethasone is a synthetic glucocorticosteroid medication with robust anti-inflammatory and immunosuppressive action. It is commonly ordered for patients suffering from rheumatoid diseases, asthma attacks, allergic diseases, chronic obstructive lung disorders, and many other severe medical conditions. Its ability to penetrate the central nervous system allows dexamethasone to be successfully used in the treatment of patients with cerebral edema and for managing various symptoms associated with brain cancer therapies. Dexamethasone is available in the form of tablets, oral concentrates, and solutions for injections.
How do steroids work in general?
Steroid medications, dexamethasone included, can significantly reduce inflammation of varying types and locations. These drugs work by suppressing the activity of various tissue-destroying enzymes such as proteases, nucleases, matrix metalloproteinases, hyaluronidase, and others. Besides, they slow down the synthesis of inflammatory mediators and decrease the permeability of tissue barriers and vascular walls, thus preventing the migration of leukocytes to the site of inflammation and the formation of free radicals, all of which play a crucial role in causing inflammation in the body.
What does coronavirus do to immunity? Why suppress the immune system with steroids in Covid-19 patients?
There is an ongoing scientific debate as to what exactly causes death from coronavirus – the virus itself or an overly active response of the patient’s immune system to the infection. Scientists believe that some patients with severe cases of COVID-19 develop too high inflammation levels as an overactive immune response to the disease being present in the body. Many Covid-19 patients displaying severe symptoms have elevated levels of cytokines – proteins and peptides produced by cells of the immune system. One of the central functions of cytokines is to stimulate the work of macrophages, which are cells that capture and neutralize foreign and toxic substances. By fighting too hard and triggering active inflammatory processes, macrophages can damage healthy tissue cells (for example, damage lungs).
Dexamethasone is one of the most efficient treatments aimed specifically at removing the acute inflammatory process. Due to its powerful action on lymphocytes, this corticosteroid medication slows down the activity of the immune system, preventing overstimulation. Well-timed treatment with an anti-inflammatory agent, such as dexamethasone, can help relieve the symptoms of coronavirus-infected patients in severe stages of the disease, more specifically those requiring ALV support and supplemented oxygen.
Why isn’t it safe to use dexamethasone for Covid-19 prevention and early-stage disease treatment?
Healthy people should not take this drug to try to prevent COVID-19. Moreover, patients infected with Covid-19 who exhibit mild or moderate symptoms of this disease and do not have an acute inflammatory response should avoid taking dexamethasone since this steroid medicine will only suppress the immune system leaving them defenseless against the coronavirus infection. The medication helps when the disease becomes severe enough, and the inflammation is more dangerous than the virus itself. Scientists and medical experts further emphasize that any uncontrolled or excess use of this drug is unsafe since all steroids have a large number of serious side effects.
Which treatments help with mild Covid-19 symptoms? How to avoid getting infected?
People with lesser Covid-19 symptoms should not use the dexamethasone medication since suppressing the patient’s immune system at this stage of the disease would be counterproductive and significantly hinder further treatment. Other trusted and safe treatments that can help non-hospitalized patients manage their mild-to-moderate Covid-19 symptoms are:
- anti-SARS-CoV-2 mAb therapies (bamlanivimab + etesevimab, casirivimab + imdevimab, sotrovimab)
- convalescent plasma therapies.
People seeking to prevent the infection can choose to get immunized with one of the many Covid-19 vaccines available today, including:
- Johnson & Johnson’s Janssen
- mRNA vaccines
- viral vector vaccines.
Other measures that can help avoid getting infected with Covid-19 involve wearing a medical mask, maintaining adequate hand hygiene, sticking to the requirements of social distancing, getting timely tested, and isolating oneself when there has been an exposure.
In conclusion: can dexamethasone be a suitable Covid-19 treatment choice?
Numerous research works supported by successful clinical trials have shown that dexamethasone – a popular and trusted steroid drug with anti-inflammatory and immunosuppressive actions – can be a safe and effective therapeutic choice for Covid-19 ICU patients. The drug works by inhibiting the immune system of Covid-19 hospital patients and preventing the so-called “cytokine storm” – a sharp rise in the levels of various pro-inflammatory cytokines in the bloodstream that have damaging effects on human tissues and can cause a life-threatening acute respiratory distress syndrome (ARDS).
However, as effective as it may be, dexamethasone should never be taken by patients with mild-to-moderate Covid-19 symptoms and should never be self-prescribed by patients who haven’t received proper medical advice from their doctor. By using dexamethasone to manage relatively benign Covid-19 symptoms (those that do not require hospitalization or ALV), the patient risks having their immune system shut down and left defenseless against the coronavirus SARS-CoV-2 infection. Additionally, when used for extended periods, this anti-inflammatory agent can trigger several serious health problems such as obesity, diabetes, osteoporosis, glaucoma, and even mental disorders. For this reason, the drug should be prescribed with great care and to the most unwell Covid-19 patients only – those already hospitalized and receiving oxygen or ALV support.
Dexamethasone is a reliable and effective drug that belongs to the group of glucocorticosteroids, which has significant anti-inflammatory, anti-allergic, anti-oedemic, and immunosuppressive activity on the body. This synthetic medication works by imitating the effect of the cortisol hormone released naturally by the adrenal glands of the person.
Dexamethasone treats a wide range of severe diseases whose characteristic symptoms are swelling, inflammation, and states where the person’s immune system goes into overdrive. Some of the conditions that dexamethasone can be used for include bronchial asthma, severe allergic responses, autoimmune diseases like rheumatoid arthritis and lupus, blood/hormone disorders, eye disorders, skin diseases, bowel disorders, and cancer. Recently, the drug has been approved as an adjunct therapy for hospitalized COVID-19 patients in need of oxygen or ALV support.
Dexamethasone is available as a generic medication, as well as distributed under common brand names of Decadron, Baycadron, Ciprodex, Dextenza, Maxidex, and others. Dexamethasone comes in several dosage forms as oral concentrate (1 mg/mL); oral liquid (0.5 mg/5 mL); oral tablets (0.5 mg – 6 mg), and injection solution (4mg/mL, 10mg/mL). In intensive care, the drug is administered intravenously, while less severe patients take it orally.
The correct dosage of dexamethasone, its administration frequency, and overall duration of the treatment course are determined by the doctor individually for each patient with due consideration for their specific medical condition, the severity of symptoms, treatment response, and other factors.
Always take this glucocorticosteroid medication precisely as directed by your doctor, closely following the recommended dosing schedule. Do not start the treatment with dexamethasone at your sole discretion without getting a proper medical consultation first. Also, do not stop using this drug or change the dosage you were prescribed unless your doctor instructs you to do so.
Side effects of Dexamethasone
Dexamethasone, which has proven to be highly effective in treating hospitalized Covid-19 patients dependent on supplementary oxygen or requiring full ALV support, has a number of severe side effects such as enhanced thrombosis predisposition and increased incidence of stomach ulcers. Therefore, it should be taken with great caution and only by patients for whom its health benefits outweigh the risks.
When taken for a limited period and strictly as directed, dexamethasone is a relatively safe drug tolerated well by most patients. The most common side effects of this corticosteroid medication used for non-Covid illnesses include:
- indigestion, nausea, and vomiting
- acid reflux
- trouble sleeping
- increased appetite resulting in a quick gain of body weight
- water retention (manifests itself through swollen ankles, feet, and hands).
Rarer and more severe side effects that require the patient to seek urgent medical attention include:
- signs of an allergic reaction to the drug (rash, itching, swelling, and labored breathing)
- bone pains and painful joints
- heartbeat irregularities
- vision problems (blurriness of vision, tunnel vision, eye pain, increased eye pressure, bleedings)
- symptoms of intestinal bleeding
- mental changes
- muscle weakness/cramps
However, patients with coronavirus infection usually only require relatively low doses of this medication, which should reduce the likelihood of the adverse effects mentioned above.
It is not a complete list of side effects that dexamethasone can cause in some patients. If you experience any odd or worrisome symptoms after taking the drug orally or using it in any other form, tell your doctor as soon as possible.
Do not use dexamethasone if you know to be allergic to this medication or have any of the following medical conditions:
- fungal infections of any location
- hepatic or renal diseases
- TB or malaria
- thyroid dysfunctions
- vitamin deficiency
- eye diseases (glaucoma or cataracts)
- stomach ulcers
- mental illnesses
- congestive cardiac failure.
Patients diagnosed with some of the above-mentioned medical conditions might be advised to take lower doses of dexamethasone if the benefits of using this drug outweigh the risks. However, only a licensed doctor fully aware of the patient’s health history must make such medical decisions.
Some of the medicinal drugs that should not be taken at the same time with dexamethasone include:
- contraceptive pills
- nonsteroidal anti-inflammatory drugs (NSAIDs)
- hormonal treatments
- insulin or oral diabetes medications
- drugs that treat symptoms of senile dementia or Parkinson’s syndrome
This list does not list all medications that might interact dangerously with dexamethasone. Inform your doctor about any prescription and OTC drugs, herbal products, vitamins, and dietary supplements you are taking or have taken very recently.
General safety precautions
Patients using steroid medicines, such as dexamethasone, should avoid getting near people who are sick or infected – especially if the disease is as dangerous and contagious as chickenpox or measles. It is also unsafe to be around people who have been immunized recently with live MMR vaccines or vaccines for poliomyelitis, rotavirus, yellow fever, typhoid fever, chickenpox, and shingles.
Covid-19 patients treated with dexamethasone are at increased risk of developing secondary bacterial pneumonia, which will present itself more actively and with more severe symptoms due to the suppressed immunity. Besides, the synthesis of SARS-Cov-2 antibodies is also likely to be impaired, which means that the person who took dexamethasone when they had Covid-19 has a higher chance of getting sick a second time. For this reason, dexamethasone must only be administered to Covid-19 patients who display severe or critical Covid-19 symptoms.