Dexametasona is powerful glucocorticorticoide synthetic with actions that resemble those of hormones steroids. It acts like Anti-inflammatory and Immune suppressant . Its power is of a 20-30 times the one of Hidrocortisona and 4-5 times greater than Prednisona .

Therapeutic use

Dexametasona is used to treat many inflammations and autoimmune diseases as reumatoide Arthritis Also provides to the patients of Cancer to him who are put under Chemotherapy to resist certain indirect effect of their anti-tumor treatment. The Dexametasona can increase to the effects Antieméticos of the antagonists of the receiver of 5-HT3 like Ondansetron . Also it is provided in small amounts (normally 5-6 tablets before and after some forms of dental surgery, like the extraction of Tooth of the judgment, an operation that often leaves to the pacientente with infamación of the cheeks. In the cerebral tumors (primary or metastáticos), dexametasona is used to resist the development of Edema that can at some time compress other cerebral structures. The Dexametasona also is administered in the compressions of the spinal marrow, for example when they are caused by a tumor. The Dexametasona also is used in certain malignant hemopatías, especially in the treatment of multiple Mieloma in which dexametasona is only administered or accompanied of Talidomida (such-dex) or in combination with Adriamicina and Vincristina (VAD)., some times jointly with Acetonida of triamcinolona becomes congested in the heel in the treatment of plantar Fascitis .

It is used to resist the allergic shock if it is administered in high doses. He is present in drops for the eyes and like spray nasal (commercial name Dexacort ).

The Dexametasona can be used in the context of adrenal congenital Hiperplasia to avoid Virilización of a feminine fetus. If one or both ancestors are carrying of mutations of gene CYP21A, the mother could begin a treatment with dexametasona with 7 weeks of Gestation . In 12ª week, a sample is taken from Vellosidades coriónicas that will determine if the fetus is man (in which case the treatment pauses) or woman. The following DNA analyzes can reveal if the feminine fetus is carrying of the mutation, in which case is due to continue the treatment until the moment of the birth. The indirect effect for the mother can be serious and the long term impact on the son is not clearly. Dexametasona also is administered to women at the risk of premature childbirth to stimulate the pulmonary maturation of the fetus. This has been associated with a low weight at the time of the birth, although not with an elevation of the rate of neonatal mortality.

The Dexametasona is used in the treatment of edema cerebral of pulmonary height, as well as of edema. Usually one takes in the medicine kit of the expeditions of ascent to mountains to help the montañistas to fight altitude sickness.

Use for the diagnosis

The Dexametasona also is used for the diagnosis, in particular, by its property to suppress hipotalámico-hipofisario-adrenal Axis . The patients who present/display clinical signs of excess of Glucocorticoids Syndrome of Cushing diagnose by means of the collection during 24 hours to detect Cortisol or by means of Test of the suppression of dexametasona . In this last one the answer of the organism to high doses of glucocorticoids is verified. It is realized of several forms. In most common, a patient one takes a dose during the night from 1 or 4 mgs from dexametasona, and the séricos levels of are moderate in the morning Cortisol . If the levels are relatively high (more than 5 µg/dl or150 nmol/l), the test is positive and the patient has an independent cortisol source or ACTH, indicating a syndrome of Cushing in which the tumor that it cause is not regulated by a feedback mechanism. If the ACTH levels lower a 50% at least, this would indicate Syndrome of Cushing, since Adenoma of hipófisis has a feedback mechanism that has reprogramado to livel more cortisol stop. The versions of greater duration carry out urine collections after oral administration of dexametasona after several days.

Veterinary use

Combined with Marbofloxacina and Clotrimazol, dexametasona is available with the name of Aurizon, Number CAS 115550-35-1, and it is used to treat presistentes infections of ear, especially in the dogs.

Contraindications

Some of these contraindicacioneses are related to:
  • The presence of gastrointestinal ulcer .
  • Syndrome of Cushing
  • Serious forms of cardiac insufficiency.
  • severe Hypertension .
  • decompensated Diabetes mellitus .
  • systemic Tuberculosis .
  • Viral, bacterial or fúngicas infections serious.
  • preexisting Glaucoma .
  • Osteoporosis

Indirect effect

If dexametasona or by injection is administered orally (parental) during a period greater than some days, the typical indirect effect of systemic glucocorticoids occur, like:
  • Malaise of stomach, increase of the sensitivity in the stomach acids, that can cause an ulcer of esophagus, stomach or duodeno.

  • Increase of the appetite that leads to a significant gain of weight.
  • Sometimes a latent diabetes is shown mellitus. The intolerance to the glucose in patients with preexisting diabetes gets worse.
  • Inmunosupresora action, in particular if it is administered jointly with immune suppressants like the cyclosporin. It could make progress the infections until putting the life in danger. In addition, it suppresses the fever like warning signal.
  • Psychiatric upheavals, that include changes in the personality, irritability, euphoria and odd habit.
  • Pathological Osteoporosis in the long term treatment, fractures (p.ej of hip)
  • Muscular atrophy, negative protein balance (catabolism)
  • High hepatic enzymes, greasy degeneration of the liver (normally reversible)
  • Cushingoide (syndrome that merges córtex adrenal hyperreagent that attend with adiposity, hypertension, bony demineralization, etc.)
  • Depression of adrenal is observed normally if it is administered more than 1,5 daily mgs during between three weeks and a month.
  • Sodium hypertension, retention and fluid, edema, worsening of the cardiac insufficiency (due to the activity of the mineralocorticoids)
  • Dependancy with abstinence syndrome.
  • Increase of the intraocular pressure, certain types of glaucoma and cataracts.
  • Dermatológicas: Acne, allergic dermatitis, dryness of the skin, petequias and hematomas, erythema, abnormalitys in the healing, increase of perspiration, rash, striae, suppression of the reaction to cutaneous tests, cutaneous fragility, thinning of the hair, urticaria hair.
  • Allergic reactions (infrequent): Anafilaxis, anafilactoides reactions and Angioedema (Highly improbable, since dexamentasona administa indeed for to be avoided anaphylactic reactions.) (
Other indirect effect have been observed and would be preucupantes if they had an impact greater than moderate. The treatments of short term against the allergic reactions, shock and for diagnoses usually do not bring about indirect effect of serious.

interactions

  • Antiinflammatories nonesteroideos and alcohol: increase of the ulcer risk
  • Mineralocoricoides: increase of the hypertension risk, edema and cardiac affections.
  • Oral antidiabeticses and insulin: the antidiabetic therapy is due to fit
  • Other interactions: with certain antibiotics, estrogens, efedrina and digoxina.

Dosage

  • Shock: of 4 to 8 mgs by intravenous route at the beginning, repeating if it is necessary until a dose of 24 mgs
  • Autoimmune diseases and inflammations: long term therapy with 0,5 to 1.5 mgs by oral route to the day. To avoid dose majors of 1.5 mgs since the indirect effect most frequently are high doses.
  • Adjuvant or it leaves from the chemotherapy: individualized.
  • For use diagnosis: special dosage according to case.

Use like dopante in competition

In 2005 Polish the basic skier Justyna Kowalczyk was disqualified of intercontinental competition takeover sub-23 in Germany and the condemned to a suspension by two years due to ifracciones by Doping with dexametasona. Finally it was reduced to a year in 2005 and later the sanction in the sport by arbitration court in December of 2005 retired. Later of 2006 gained a bronze medal in 30 feminine km of free style in the Olympic Games of winter in Turin

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