Deksametasoni

Deksametasoni, also known as dexamethasone, is a synthetic glucocorticoid used for its anti-inflammatory and immunosuppressive properties. It is employed in a wide range of conditions that involve inflammation, immune system overactivity, or edema, and it comes in various forms for systemic, local, and ocular use.

Mechanism and pharmacology: dexamethasone binds to glucocorticoid receptors, altering gene transcription to reduce the production of inflammatory mediators such as cytokines and prostaglandins. It also stabilizes lysosomal membranes, suppresses immune cell activity, and can modulate metabolism. It is a long-acting glucocorticoid, with a biological effect that can persist for more than a day, depending on dose and duration.

Indications: it is used to treat and manage many inflammatory and autoimmune diseases (eg, rheumatoid arthritis, asthma, chronic obstructive pulmonary disease, inflammatory bowel disease, dermatologic conditions), as well as certain allergic reactions, hematologic or solid tumor regimens as part of chemotherapy, and to prevent chemotherapy-induced nausea and cerebral edema. In severe cases of COVID-19, dexamethasone has been shown to reduce mortality in patients requiring supplemental oxygen or ventilation.

Administration and forms: available as oral tablets, injectable solutions (intravenous or intramuscular), topical preparations, and ophthalmic or other localized formulations. Dosing and duration are tailored to the condition and balance desired anti-inflammatory effects against potential systemic side effects.

Adverse effects and cautions: side effects may include increased infection risk, hyperglycemia, weight gain, osteoporosis, hypertension, mood changes, peptic ulcers, cataracts, and skin thinning with prolonged use. Long-term therapy requires gradual tapering to prevent adrenal insufficiency. Contraindications include systemic fungal infections and caution is advised in pregnancy, diabetes, peptic ulcer disease, and in the context of live vaccines. Drug interactions can occur with NSAIDs and CYP3A4 modifiers.