Talk:Dexamethasone/Archive 1

Archive 1

effects of decadron

--71.162.55.149 05:02, 26 August 2006 (UTC) To the first poster, pertussin is used to treat cough caused by infections such as the flu, and keflex is an antibiotic. These 2 drugs are not related to steroids. The symptoms you are describing are most likely caused by narcotics (or other anesthetics) that were given to you during or immediately after your proccedure, which can cause respiratory depression (the most common are opioids, such as morphine). Narcan is usually given to counter this, but its effects are short and you must be constantly monitered for symptoms of respiratory depression. As for legal actions against your doctor... you probably signed a consent form that states you are aware of the possible side effects and that you accept treatment anyway, and unless they made you sign it after giving you sedatives or other CNS-affecting drugs your options are probably limited. The one to "blame" would probably be the anethesiologist becuase they are the ones in charge of maintaining breathing and sedation during the procedure.

To the second poster, steroids cause a sense of well-being, which is one of the benefits of giving it to oncology patients as it increases appetite. All steroids must be tapered off slowly, to prevent the symptoms you described above (among others). Steroids also can cause mood swings, and people taking them may have days were they feel euphoric and other days were they feel depressed.

How long does Dexamethasone stay in the body

I've been on dexamethasone for 7 to 8 weeks following spinal fusion for metastatic bone cancer, which is also in lungs. Prescribed 8mg daily which went on for several weeks, then dropped to 6mg immediately followed by sudden chest infection and extreme loss of energy. Prescribed antiobiotics and dexamethasone increased back to 8mg until antiobiotic course complete. Have decreased dexamethasone by 1mg dosage over period of weeks to a 2mg daily dosage. Today 10Nov decreased by 2mg so now dosage is 2mg. I gained 10kilos in 8 weeks and now taking appetite suppresant prescribed by doctor. I am also taking sleeping tablets at night so I don't stare at the ceiling for hours on end. If my dexamethasone dosage reduction goes to plan I should be dosage free in a week ie 17Nov. What I want to know is how long this drug stays in the body. Does it depend on how long I've been taking it and how much I have had? Or, is it a case of you stop taking the drug one day and the next day it is out of one's system?

—Preceding unsigned comment added by Lynne Mee (talk • contribs) 20:46, 9 November 2006

As the article already indicates, the half-life of the drug in the body is 36-54 hours. So 1/2 the amount remains in the body at around 2 days, 1/4 by about 4 days, and by 1 week under 10% left. However remember that this tail-off level will be from the final very low dosage that you take. Secondly is the issue of steroid action on you body - this does not in fact tail-off to zero (one hopes). High doses of steroids suppress the natural production of the body's own cortisone and a large part of having to slowly reduce oral steroid medication is to allow the body's own production to restart. Hence patients on high dose steroids are warned not to stop their medication abruptly else they risk having no corticosteroid activity in their body, which may result in the medical emergency of Addisonian crisis. So once the dose & effectiveness of dexamethasone is slowly dropped below a minimum level, you own body restarts making its own weaker low-potency steroid necessary for normal health. Hence at the point that you finally discontinue the dexamethasone, its dosage and hence effectiveness will already have been dropped below the suppressive physiological level and your body will be making up the difference. The practical short answer to you question is therefore that at the point you stop the dexamethasone, it will already be at an insignificant dose as your body's own normal steroid production will be back in operation.

The weight gained may then be lost with suitable diet and exercise as for anyone else (generally doctors advocate 1/2 to 1 pound a week and certainly not more then 2 pounds a week). The weight you gained will not be entirely from the dexamethasone, but also in part due to the reduced activity following your surgery and this I hope should now be improving anyway. Of course wikipedia is not the forum for specific medical advice (your activity levels will also depend of pre-existing and ongoing health factors unknown to the rest of us) and issues are best discussed with your own doctors and healthcare team. :-) David Ruben ^Talk 02:33, 10 November 2006 (UTC)

time to PPC?

what is the time to peak plasma concentration in humans? This is difficult to find, since pages are endlessly talking about combinations with other drugs or else referring to dogs and rats. What is an authoritative source for pharmacokinetics in general?

4.238.161.211 19:49, 1 August 2007 (UTC)

dexamethasone suppression test

I'm not sure if the explanation of the dexamethasone suppression test is as clear as it could be... or wholly correct for that matter. Firstly, in a normal individual, a low dose of dexamethasone should cause a drop in cortisol levels. This should be added as a reference point. An ACTH-producing tumor (as the mentioned pituitary adenoma of Cushing's disease) would not change with a low dose, and the patient would still have high cortisol. A higher dose of dexamethasone (eg 8mg) would cause reduced cortisol, however. For a tumor that produces its own cortisol or for chronic steroid supplementation, the cortisol levels wouldn't change even with the higher dose of dexamethasone. It seems to me that it's better to frame this idea in terms of what's causing the syndrome rather than if there's feedback. rhetoric 13:22, 21 October 2007 (UTC)

Frank Sinatra and use in otolaryngology

Have heard [1] that Frank Sinatra wanted an ENT specialist on call whenever he was to give a performance, with Decadron and other "appropriate medication" handy. What value would the stuff have been to an ENT doctor, and what sort of emergency might Frank have feared? If anything, a steroid might have aggravated a sore throat, it would seem. knoodelhed (talk) 09:40, 13 August 2008 (UTC)

Dexamethasone to jump start osteoblasts in vitro

It seems that many researchers use dexamethasone to drive/force activation/expression of Alkaline phosphatase in their mono-cultures of osteoblasts. Anyone knows about the origins and rationale for this? Just reading this article it seems that is not inspired by their natural physiological interactions/stimuli. Benkeboy (talk) 10:25, 3 July 2009 (UTC)

== Dexamethasone is an anti inflammatory drug that is used for inflammation. -mcdreamer

Dexamethasone side affect

I have been married for thirty years this September to a wonderful woman. We like many married couples have had our ups and downs with raising a family, etc. Just this last sunday my wife who I had noticed in the last several weeks was acting irritable and I asked what was the problem. Well, she told me that she was unhappy with the way things had gone during our marriage and she was tired of dealing with our grown childrens problems and that she had taken a job with a company out of state, and that she was leaving. Of course I am leaving out assorted details of our conversation from there on. Of course trying to make sense out of this sudden behavior I approached her best friend and talked with her about the situation, she was totally hit off guard by this. As we talked more and she mentioned that my wife had been avoiding her in the last few weeks and did not open up to her like she normally did. I asked her if perhaps she thought that she was seeing someone inwhich she told me no because my wife adord me. My wife left for the weekend to travel to see my daughter, about three hundred miles away, this weekend. Today Saturday, I picked up our mail and found a statement from our doctor. When I looked at the statement I was shocked to see that she had been recieveing 1mg injections of Dexamethasone for high cholesteral since May of 2009 about every week. Not knowing what this medication was I came to this website to read about it. I was shocked when I read the side affects, irritability, sleeplesness, skin problems,etc as she exhibits quite a few of these symptons. Incidently I did ask her if she was seeing someone in which she promised that she was not. One thing that is odd though and does not appear to fit the side affect symptons is she has lost approxamitaly 50 lbs. in the last 6 months and I do not believe she is taking diet medications. She is 50 years old, we live in a small rural community about 60 miles from the nearest city of 100,000. We moved to this small town 5 years a —Preceding unsigned comment added by Trimble5 (talk • contribs) 20:29, 27 February 2010 (UTC)

When this drug is given for asthma related emergencies in the pre-hospital setting, it can cause an intense burning sensation of the genitals in female patients and some male patients. ≈Danielle Connell, FDNY Paramedic, station 44" — Preceding unsigned comment added by Danie5000 (talk • contribs) 05:12, 31 December 2010 (UTC)

IV vs PO

While working in an ER the question has come up; can you use IV Decadron as a PO medication? Several nurses say they have been taught yes, but now we cannot find documentation to back it up. Thanks for the input.

Since Decadron is dexamethasone sodium phosphate, it seems it would be possible to give it orally. While we use a differend brand name in our country (CZ), according to the SmPC the sodium phosphate is rapidly hydrolysed into dexamethasone alone, which is rapidly absorbed. I don't know if that is any help to you. I would suggest checking the SmPC of your corresponding preparation. Janek78 08:24, 1 December 2006 (UTC)

I'm a FDNY Paramedic. In our ALS protocol for asthma and COPD, we give it standing order 12mg IVB or IM, single dose. We're taught to treat asthmatics aggressively, and most of our asthmatics will wait ours after their attack starts before they call 911. Many of them also have an intubation historyDanie5000 (talk) 01:37, 1 January 2011 (UTC)

Short term use reactions

I was given a low dose for three days to counter some inflamation brought about by exposure to heavy amounts of airborne dusts. I was told there would be no side effects and the demamthasone cleared up my problems in one day. But........while taking the drug I felt fantastic, the best I'd ever felt emotionally, I mean I felt as if I could take over the world. It was amazing how great I felt. One day after stopping the drug, I experienced personality changes, sweating, visual distortions, anger, insomnia, and felt like I was in hell. It took several days and the loss of my job to get over felling that badly. I've researched this online but have found nothing regarding short term use (three days) and bad reactions. Any ideas on what caused this?

As a FDNY Paramedic, our Asthma protocol states that we can give Dexamethasone for asthmatics IVB. It should be noted that it should be pushed over 2 mins. Anything under 2 minutes can cause stomach upset and projectile vomitting. — Preceding unsigned comment added by Danie5000 (talk • contribs) 05:09, 31 December 2010 (UTC)

Also, for reasons that escape me, any woman that has been given the drug IVB experiences a very intense burning sensation in the genitals that eventually goes away. I've only had one male patient experience it but all my female patients, I normally warn them and tell them that the sensation will go away Danie5000 (talk) 01:40, 1 January 2011 (UTC)

Error in 3D ball image of molecule

In 3D ball image of molecule, one of the carbons is wrongly shown white in the lower right ! Great image. --Moochowping (talk) 19:17, 28 January 2011 (UTC) .

Controversy: Dexamethasone and LGBT

Since the publishing of this article on a Seattle-based website, there have been mutterings within the British LGBT community about a "gay cure". Angry blogs, rants on Facebook and threads on other sites have sprung up in response to comments attributed in the offending article to one Maria New, a paediatric endocrinologist.

New is reported to have said that the use of this drug in 46XX foetuses should also prevent girls from growing into lesbian or bisexual women. New's research partner, psychologist Heino F. L. Meyer-Bahlburg, wrote a paper called "What Causes Low Rates of Child-Bearing in Congenital Adrenal Hyperplasia?" In it, he writes: "CAH women as a group have a lower interest than controls in getting married and performing the traditional child-care/housewife role. As children, they show an unusually low interest in engaging in maternal play with baby dolls, and their interest in caring for infants, the frequency of daydreams or fantasies of pregnancy and motherhood, or the expressed wish of experiencing pregnancy and having children of their own appear to be relatively low in all age groups".

What is making LGBT people - gay women and trans men in particular - angry about this is that they feel that there is no need to cure these natural phenomena, that the world is richer for the diversity of sexual and gender expressions, and that the use of this drug to treat butch girls in-utero would grant unwarranted respectability to other "gay cures" such as psychotherapy or aversion therapy.

Articles such as this one, published in The Guardian, reveal the concern within transgender communities that surgeries to shorten the clitori of babies with CAH are akin to performing sex reassignment surgery without consent. —Preceding unsigned comment added by 89.195.194.147 (talk) 08:14, 1 July 2010 (UTC)

This is only one part of a bigger controversy about prenatal use of dexamethasone. Galileo's Middle Finger by Alice Dreger (a critic of this use, obviously) spends 3 chapters basically describing this use as a serious ethical and regulatory failure, and makes a number of verifiable assertions which I don't think are reflected in this version of the article. Now one thing I certainly learned from that book is the importance of not jumping into a controversy without understanding it in detail, so I am not going to make an edit before checking the relevant details as best I can, but I may not get around to that for some time (if ever) so I also want to encourage anyone else who sees this to look in to it as well. Rafaelgr (talk) 13:04, 24 August 2016 (UTC)

More in-depth Pharmacodynamics???

Can we get some more elaboration on this statement. I get that it is cited, but we should briefly summarize. From the sounds of it, the authors are explaining the MOA of ondansetron better than they are the dexamethasone. Sigh, I guess I will do it. "Cancer patients undergoing chemotherapy are given dexamethasone to counteract certain side effects of their antitumor treatments. Dexamethasone can augment the antiemetic effect of 5-HT3 receptor antagonists, such as ondansetron." Aglo123 (talk) 21:52, 12 September 2016 (UTC)

Update: just did a slight overhaul to the first paragraph of the "Cancer" section: PLEASE HELP ME AND ADD MORE! I don't have the time to spare, otherwise I'd make it even better! Thanks! Aglo123 (talk) 23:18, 12 September 2016 (UTC)

Skeletal and space-filling model incongruity

The skeletal structure and the article refer to the molecule having a methyl group at the 16-position. However, it does not appear to be there in the ball and stick model, appearing to be two hydrogen atoms instead. I do not have the know-how to modify this, so I thought I would bring attention to it. 172.78.31.154 (talk) 05:27, 27 February 2018 (UTC)

Good eye. The ball and stick model is indeed incorrect. I have removed it for now. It can be returned when/if it is fixed. -- Ed (Edgar181) 21:40, 1 March 2018 (UTC)

It has been fixed, so I have returned the image to the article. -- Ed (Edgar181) 12:21, 3 March 2018 (UTC)

PONV & Long-acting neuraxial opioids

New section with citation added

Joined with other section on N and V Doc James (talk · contribs · email) 13:46, 25 November 2018 (UTC)

It is often difficult to understand comments on Wikpedia talk pages...

because of all the acronyms/abbreviations. Please, especially if not linked, explain or at least give an English version of these things when first used. The onus should be on the IP [see what I mean?] to make these clear. That is the way it is in scholarly publications. So, what is MEDRS? Kdammers (talk) 02:28, 18 June 2020 (UTC)

Sorry. MEDRS is shorthand for WP:MEDRS, which is itself a shortcut to Wikipedia:Identifying reliable sources (medicine). Hallucegenia (talk) 05:23, 18 June 2020 (UTC)

References for synthesis section

There's a citation needed tag in the synthesis section of this article. Here are some sources that might be useful and are more recent than the 1958 articles currently cited:

• https://www.sciencedirect.com/topics/chemistry/dexamethasone
• https://books.google.co.uk/books?id=Jjc7KYWZdOYC&lpg=PA349&dq=Synthesis%20of%20Essential%20Drugs%20dexamethasone&pg=PA358#v=onepage&q&f=false

Ben (talk) 08:15, 25 June 2020 (UTC)

Two things:

1. It looks like the scheme in the synthesis section, File:Dexamethasone synth.png, has the wrong stereochemistry at one of the methyl groups on the 5-membered ring. Compare it to File:Dexamethasone structure.svg and File:Dexamethasone-from-xtal-Mercury-3D-bs.png. The latter is based on an X-ray structure determination: J. W. Raynor, W. Minor, M. Chruszcz (2007). "Dexamethasone at 119 K". Acta Crystallographica Section E. 63: o2791–o2793. doi:10.1107/S1600536807020806.{{cite journal}}: CS1 maint: multiple names: authors list (link)

2. The following 2006 reference outlines a slightly different synthetic route compared to the 1958 papers cited here: Synthesis of Essential Drugs. Elsevier. 2006. pp. 357–358. ISBN 9780080462127. {{cite book}}: Cite uses deprecated parameter |authors= (help)

Ben (talk) 20:42, 28 June 2020 (UTC)

Justification of revert

Please specifically state which parts of this edit you disagree with and why, and only revert those parts. Blanked reverting of an entire edit is not helpful. For example:

• Why should the recent research on ARDS not be mentioned in the Research section of this article?
• Why should the dates of press release and preprint of the COVID research not be mentioned, even though a tag in the article specifically asked for an update?
• Why should the estimated numbers-needed-to-treat for saving lives not be mentioned, while other estimates from the same press release are mentioned?
• Why should the NIH recommendation on dexamethasone treatment of COVID patients not be mentioned?

Cheers, AxelBoldt (talk) 16:04, 13 July 2020 (UTC)

Because of the WP:PAGs. Primary sources, press release, preprints: no. WP:MEDRS: yes. For background, WP:WHYMEDRS is a clueful essay. Alexbrn (talk) 16:06, 13 July 2020 (UTC)

As you know, the Best Advice section of MEDRS contains the following paragraph:

If conclusions are worth mentioning (such as large randomized clinical trials with surprising results), they should be described appropriately as from a single study:

"A large, NIH-funded study published in 2010 found that selenium and Vitamin E supplements, separately as well as together, did not decrease the risk of getting prostate cancer and that vitamin E may increase the risk; they were previously thought to prevent prostate cancer." (citing PMID 20924966)

Given time a review will be published, and the primary sources should preferably be replaced with the review.

Can we agree that the conclusions of the recent large ARDS trial [2] are worth mentioning in this article's Research section and justify a treatment in accordance with the MEDRS Best Advice example above? AxelBoldt (talk) 16:34, 13 July 2020 (UTC)

No, because we lack the secondary context, which is required to give weight (as it says in the bits of MEDRS qualifying the bit you cherry-picked): "Therefore, such sources should generally be entirely omitted (see recentism)". There are a few occasions when primary sources are needed; this isn't one of them. In time, there will be decent sources. Let's wait until then. The quality of primary research in this area has already proved problematic in the wider world, and Wikipedia needs to be careful not to get swept into that. Alexbrn (talk) 16:48, 13 July 2020 (UTC)

You are right in saying there are occasions where primary sources are needed, but you did not argue why this isn't one of them. You are glossing over the word "generally" in the sentence of the guideline you cited. In fact the Best Advice paragraph I quoted is specifically designed to exemplify those exceptional occasions where primary sources can be mentioned without secondary context, as is clear from the sentence "Given time a review will be published, and the primary sources should preferably be replaced with the review." And it describes those occasions with the phrase "such as large randomized clinical trials with surprising results" which applies here. The results of this Lancet study reporting on a large randomized clinical trial are surprising since no treatment for ARDS currently exists. This is not an in vitro or animal study, which MEDRS specifically cautions against. MEDRS/Best Advice supports my position, not yours.

In addition, we are currently arguing over the Research section of the article, not over the sections describing medical use. The study is relevant to that section and worth mentioning. I don't see how omitting it could help our readers or improve the encyclopedia.

AxelBoldt (talk) 18:34, 13 July 2020 (UTC)

Because it might be flawed. We need reviews to validate primary research, because Wikipedia is only meant to carry accepted knowledge. For a rough idea of when primary research might be useful there's the (unfinished) WP:MEDFAQ. If you want further input, I suggest a query at WT:MED. Alexbrn (talk) 18:49, 13 July 2020 (UTC)

The report of the study's findings certainly constitutes accepted verifiable knowledge. I'm not advocating for making any factual claims beyond that. The study was included in this meta study of steroid use in ARDS [3], was the basis of this Critical Care Alert by the Emergency Medicine Residents Association [4], and was included in this review of emerging pharmacological therapies for ARDS [5].

I don't think perusing an incomplete FAQ will help, seeing that the first guideline you quoted at me already supported my position, as I outlined above and you didn't contest. AxelBoldt (talk) 00:51, 14 July 2020 (UTC)

I did contest it as cherry picking. I oppose inclusion of this primary source. It is not accepted knowledge it is primary research, as reported by the researchers. Alexbrn (talk) 01:38, 14 July 2020 (UTC)

So the fact that this research was reported on by the researchers is accepted knowledge, perfectly suitable for the Research section of this article. It is primary research of a large randomized clinical trial with surprising results, which can be added to the article following the best practices example in Medrs. AxelBoldt (talk) 15:42, 14 July 2020 (UTC)

No, for the reasons I have given. I shall not respond further unless some new/acceptable sourcing is produced. Do not mistake my lack of response for agreement to add this content. Alexbrn (talk) 15:51, 14 July 2020 (UTC)

It appears we are at an impasse. Would it be acceptable if I invite input from WT:MED? AxelBoldt (talk) 19:29, 14 July 2020 (UTC)

As already suggested many messages ago. Alexbrn (talk) 19:41, 14 July 2020 (UTC)

Remove per MEDRS. Has there been any general discussion on easing MEDRS for COVID-related research like this? --Hipal/Ronz (talk) 20:11, 14 July 2020 (UTC)

An entire section on ARDS based on a single RCT doesn't fit with my understanding of MEDRS. Because of the rate of new publications in the COVID-19 field, it could be argued that we might use primary sources to update or supplement existing secondary sources (but not contradict them) in Research sections, but not as stand-alone sources that imply biomedical claims. The points about dates of press release, and estimated numbers-needed-to-treat are a matter for WP:DUE. There would need to be a case made for including such detail about a single trial, which would quite probably not be included in analogous cases. The NIH recommendation on dexamethasone treatment of COVID patients was already in the article and nobody has added or removed it as part of the contested edits. --RexxS (talk) 21:37, 14 July 2020 (UTC)

Yes, and if anything current circumstances dictate if anything we should be more strict, not more lax, in adhering to WP:MEDRS. Alexbrn (talk) 04:12, 15 July 2020 (UTC)

agree as well--Ozzie10aaaa (talk) 23:53, 15 July 2020 (UTC)

Country approvals for COVID-19 treatment

Some countries have specifically approved Dexamethasone for treating COVID-19. See this RECOVERY Trial diff for examples. Do we want to add/repeat that information here? --Whywhenwhohow (talk) 02:06, 7 September 2020 (UTC)