Information for the patient

This leaflet is designed to help you understand your medicine. If you have any questions or worries ask your doctor or pharmacist. At the end of this leaflet you will find more information about Dexamethasone as well as some things to remember about your medicine. Please keep this leaflet until you have finished your medicine, you may want to read it again.

What is Dexamethasone used for?

Dexamethasone can be used to reduce inflammation or to treat a number of different diseases of the immune system.

In general Dexamethasone can be used in medical emergencies, whenever its use may be life-saving.

When should Dexamethasone not be given?

Dexamethasone may not be suitable for you if you suffer from certain allergies or other medical conditions. Before Dexamethasone is given to you make sure you tell your doctor if you suffer or have ever suffered from any of the following:

• hypersensitivity to any ingredient in this medicine
• an infection that affects the whole body
• joint infections, especially at the injection site

What precautions should be taken?

While taking Dexamethasone you may need to be examined by your doctor more frequently.

Extra supervision by your doctor may be necessary in some cases. You must tell your doctor if you have or have ever had any of the following:

• Osteoporosis (thinning of the bones)
• Hypertension (very high blood pressure)
• Heart disease
• Diabetes
• TB (tuberculosis)
• Glaucoma (raised eye pressure)
• Serious affective disorders especially steroid psychosis - (psychiatric illness made worse by steroids)
• Muscle disease caused by corticosteroids
• Liver disease
• Kidney disease
• Epilepsy
• Stomach ulcers
• Migraine
• Certain parasitic infections
• Stunted growth
• Cushings syndrome

It is important that you avoid close contact with anybody who is suffering from measles, chicken-pox or shingles if you have not previously suffered from these diseases. If you are in contact with anybody who has one of these illnesses, or you develop measles or chicken-pox while taking Dexamethasone tell your doctor immediately.

You should always carry a 'steroid treatment' card which gives clear guidance on the special care to be taken when you are using this medicine. Show this to any doctor, dentist or nurse who may be giving you treatment.

Even after your treatment has finished you must tell anyone who is giving you treatment that you have taken steroids.

If you are in an accident or need an operation, tell your doctor that you are taking dexamethasone.

There may be an increased risk of premature infants developing cerebral palsy if they are treated with dexamethasone. A decision on whether to use dexamethasone needs to be made, based on the individual case.

Dexamethasone should not be used as part of your treatment if you have had a head injury or stroke as it is unlikely to benefit you and may even be harmful.

Are you going on holiday?

If you think you may need a vaccination, tell your doctor you are taking dexamethasone.

What other medicines are you taking?

Other medicines may affect how Dexamethasone works or Dexamethasone may affect how they work. Tell your doctor if you are using (or intend to use) any other medicines.

Other drugs that reduce the effect of Dexamethasone are:

• Antibiotics such as rifampicin, rifabutin.
• Drugs for epilepsy e.g. carbamazepine, phenytoin, phenobarbital, primidone, ephedrine, phenylbutazone.
• Drugs used in the treatment of breast cancer e.g. aminoglutethimide.

Some medicines may not work as well when Dexamethasone is taken at the same time:

The effectiveness of

• drugs used to treat diabetes (hypoglycaemic agents)
• drugs used to treat high blood pressure (anti-hypertensives)
• diuretics (water pills)
• drugs which regulate heart beat (cardiac glycosides) are reduced when dexamethasone is taken.

Dexamethasone affects acetazolamide, loop diuretics, thiazide diuretics and carbenoxolone, these drugs are used to lower potassium levels.

The effects of drugs which prevent blood clotting; (coumarin anticoagulants e.g. warfarin) may be increased by Dexamethasone and frequent tests may be required.

Dexamethasone may affect the action of salicylates e.g. aspirin in patients with low prothrombin levels in the blood.

Pregnancy

If you are pregnant, or suspect that you are pregnant or if you are breastfeeding then you must tell your doctor. Your doctor will decide if Dexamethasone can be given to you.

Ability to drive or operate machinery

As far as is known, Dexamethasone has no effect on alertness or concentration.

How should Dexamethasone be given?

How much:

The dose is chosen by your doctor and usually depends on how serious your condition is. The normal dose range is 0.3-4 mg. The frequency of these injections may vary from every 3-5 days to every 2-3 weeks. Once your condition has improved the dosage will be reduced or another corticosteroid such as 'Prednisolone' may be given. For more serious conditions such as acute asthma, a higher dose may be necessary.

A dose of 8-16 milligrams followed by 5 milligrams every 6 hours is usual in the case of brain swelling after brain surgery until the condition improves. You may need continuous dosing to reduce pressure within your skull if you have a brain tumour.

Children:

The dosage is chosen by the doctor to suit the needs of the patient. A dose of 0.2-0.4 milligrams per kilogram of body weight is usual.

How the injections are given:

Injections are given slowly into a muscle or under the skin, by your doctor. Dexamethasone Injections can also be given intravenously, locally (directly where you need it) or rectally.

What to do if someone accidentally takes too much

As your doctor will be keeping a close eye on you it is unlikely you will be given too much, however, too high a dose of Dexamethasone may cause

• swelling of the throat (glottis oedema)
• skin allergy (urticaria)
• difficulty in breathing (bronchospasm)

When will I stop taking Dexamethasone

Do not stop taking Dexamethasone just because your complaints seem to have disappeared. If you stop too early or too suddenly your condition may worsen, you may get withdrawal symptoms. Always discuss your treatment with your doctor who will tell you how to reduce the dose gradually if treatment can be stopped. Symptoms of withdrawal include fever, pain in muscle and joint, inflammation of nose lining (rhinitis), weight loss, itchy skin, eye inflammation (pink eye - conjunctivitis).

What undesirable effects may Dexamethasone cause?

The occurrence of side effects can be minimised by taking the lowest possible dose for the shortest possible time. If you have any of these side effects or any others tell your doctor. He will review your case and do what is best for you.

• lowered resistance or response to stress
• stunted growth in infants, children and teenagers
• irregularities in the menstrual cycle (periods) or complete absence of periods
• Cushingoid faces (e.g. 'moon' face)
• hirsutism (excess hair especially in women)
• weight gain
• increased sweating
• reduced carbohydrate tolerance which needs more antidiabetic therapy
• increased appetite
• loss of protein and calcium balance
• increased chance of picking up infections or mild infections get worse e.g. chicken pox
• osteoporosis (thinning of bones)
• bone disease
• sodium and water retention and/or potassium loss due to high carbon dioxide levels (hypokalaemic alkalosis)
• high blood pressure
• extreme mood swings
• depression
• inability to sleep (insomnia)
• schizophrenia may get worse (schizophrenia aggravation)
• epilepsy gets worse (more fits)
• severe unusual headache and visual disturbance
• increased eye pressure (glaucoma)
• eye disorders and eye infection
• indigestion
• stomach ulcers
• pain in abdomen and back (pancreatitis)
• skin disorders such as bruising, acne, slow healing of wounds
• hypersensitivity reactions (allergic reactions) e.g. rash, itch and difficulty in breathing
• blood clots (thrombosis)
• brief burning, redness and swelling at the injection site
• damage to the joint at the injection site
• damaged tendons
• Candidiasis (thrush)

If you suffer from any of the above side effects or any other effects that you think may be due to your medicine, tell your doctor or pharmacist.

How should you store Dexamethasone?

The hospital will store Dexamethasone in a fridge or below 25° C in the dark. Do not freeze Dexamethasone ampoules. As with all medicines Dexamethasone should be kept in a safe place out of reach of children. There is a 'use by' date on the pack. This medicine should not be used after this date.