Dexamethasone for multiple sclerosis
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What is dexamethasone used for?
Dexamethasone is a man-made glucocorticoid with powerful anti-inflammatory and immunosuppressive properties that is often used in the treatment of inflammatory and autoimmune disorders such as multiple sclerosis (MS). In MS, it is used for the management of acute relapses in people with MS.
Glucocorticoids like dexamethasone do not alter the overall progression of MS, but they do help ease symptoms during relapses, which are periods when old symptoms suddenly worsen or new symptoms appear.
Brand names for dexamethasone approved for use in MS include Dexamethasone Intensol. Generic versions of this medicine also are available.
A chemically similar glucocorticoid called betamethasone also can be used for treating acute exacerbations in MS. Brand names of this treatment as an MS therapy include Celestone Soluspan, Pod-Care 100C, and ReadySharp Betamethasone.
Therapy Snapshot
| Brand Name: | Dexamethasone Intensol |
| Chemical Name: | Dexamethasone |
| Usage: | Relapse management therapy for acute MS exacerbations |
| Administration: | Oral and injectable formulations |
How does dexamethasone work for MS?
MS relapses are driven by new inflammatory activity of certain immune cells, which causes damage to the brain and spinal cord.
Dexamethasone works mainly by binding to glucocorticoid receptors in immune cells, which normally recognize a naturally occurring hormone called cortisol. By binding these receptors, the therapy prompts immune cells to take on a less inflammatory state and dampens the production of inflammatory molecules, which can ultimately ease symptoms and speed the resolution of relapses.
This medication also reduces the permeability of blood vessels, preventing the migration of inflammatory cells from the blood into specific tissues where they could cause damage, including the brain and spinal cord.
Who with MS can take dexamethasone?
Dexamethasone may be used to manage symptoms during acute relapses of MS, but the exact treatment regimen typically is tailored based on the needs of the patient. Some relapses may be mild enough that they do not require treatment with corticosteroids, which do have certain side effects.
MS is usually diagnosed between the ages of 20 and 50, but also can occur in older patients, as well as in children and adolescents. The overall safety and efficacy of dexamethasone in older patients are similar to that of younger adults, though some side effects — such as fluid retention or high blood pressure — may be more common among elderly patients.
Corticosteroids also have similar safety and efficacy profiles in children. However, these medications can slow growth in young people whose bodies are still developing. Therefore, pediatric patients on corticosteroid treatment require careful monitoring.
Who should not take dexamethasone?
Dexamethasone should not be taken by anyone with an allergy to the medication or any of its components. It also should not be administered to individuals with a systemic fungal infection.
How is dexamethasone administered in MS?
Dexamethasone is available in oral and injectable formulations. Various corticosteroid-based protocols may be used to control MS relapses, based on the specific situation of the patient, as well as the preferences of the treating clinician.
Generally, treatment for acute relapses involves a high dose of corticosteroids administered for a few days, followed by gradually lower doses over the next days or weeks. This “tapering off” is recommended to prevent the onset of withdrawal symptoms that can occur when corticosteroids are suddenly stopped. These symptoms include anxiety, sweating, nausea, and insomnia.
According to dexamethasone’s label, daily doses of 30 mg of oral dexamethasone for one week, followed by 4–12 mg every other day for one month, may be effective for controlling relapses.
Treatment regimens also may include more than one corticosteroid for the different phases. For example, relapses can be effectively managed with 200 mg of prednisone for one week for the initial high-dose part, followed by either 80 mg prednisone or 4–8 mg dexamethasone every other day for a month as the taper.
| Administration | Oral and injectable formulations |
| Dosage | 30 mg for one week, then 4–12 mg |
| Timing | Daily for initial high dose; every other day for one month for lower dose |
Common side effects of dexamethasone
Some of the most common side effects of dexamethasone include:
- fluid retention and swelling
- increased appetite and weight gain
- mood changes and trouble sleeping
- skin abnormalities like acne or skin rash
- increased sweating
- hair growth
- neurological complaints such as headache or dizziness
- digestive problems like nausea or abdominal pain
- menstrual irregularities
- abnormal fat deposits, including in the face, neck, waist, and legs
Blood pressure and fluid retention
Dexamethasone can cause an increase in sodium and water retention, while prompting the body to excrete excessive calcium and potassium. It also can cause an elevation in blood pressure. Blood pressure and electrolyte levels should be monitored during treatment.
Behavioral and mood disturbances
Corticosteroids can cause mood and behavioral changes. These can include euphoria, depression, insomnia, or psychosis — characterized by hallucinations (sensing something that isn’t there) and/or delusions (fixed beliefs with no basis in reality).
Hormonal changes
Corticosteroids like dexamethasone mimic the activity of a naturally occurring hormone called cortisol, and can suppress the activity of the hypothalamic-pituitary-adrenal (HPA) axis, the system normally responsible for producing cortisol. Gradual tapering off of doses can decrease the risk of problems from HPA suppression.
Dexamethasone treatment also can cause Cushing’s syndrome, which occurs due to excessive cortisol levels in the body, or hyperglycemia — high blood sugar.
Infections and cancer
Because dexamethasone lowers the activity of the immune system, it can increase the risk of new infections or increase the severity of existing ones. However, infection symptoms can be masked in patients on dexamethasone, as many symptoms that usually indicate an infection (e.g., fever) are caused by the immune system’s attempt to fight off the infection.
A type of cancer called Kaposi’s sarcoma has been reported in patients on dexamethasone therapy, mostly when used in chronic conditions.
Eye problems
Cataracts, a clouding of the eye’s lens, or glaucoma, which is damage to the nerves that connect the eye to the brain, may be caused by corticosteroid use. Corticosteroids also can increase the risk of eye infection and should not be used in people with active ocular herpes simplex, a type of eye infection.
Heart and gastrointestinal perforations
In patients who have had a recent heart attack, dexamethasone can increase the risk of a rupture in the heart, so these medications should be used with extreme caution in these patients.
The medication also can increase the risk of gastrointestinal perforation — a tear in the digestive tract — in individuals with certain digestive problems, such as ulcers, ulcerative colitis, or certain intestinal infections.
Decreased bone density and slowed growth
Dexamethasone can cause a decrease in bone density and increase the risk of osteoporosis, in which the bones become weak and brittle. It also may slow normal growth in children and adolescents, who should be closely monitored during treatment.
Vaccination
Vaccines that contain a live or attenuated (weakened) virus should not be given to people on dexamethasone therapy, although killed or inactivated vaccines may be administered. Because vaccines work by activating the immune system to respond to a future threat, and dexamethasone reduces immune activity, this treatment is likely to reduce the effectiveness of vaccines.
Use in pregnancy and breastfeeding
According to animal studies, dexamethasone can cause damage to a developing fetus. It should only be used during pregnancy if the potential benefit of treatment outweighs the risk to the fetus. The potential risks and benefits of dexamethasone treatment should be discussed in detail between patients and their healthcare teams.
Infants who were exposed to substantial amounts of corticosteroids during pregnancy should be monitored after birth for signs of hormonal problems.
Dexamethasone is excreted in human breast milk, and it may cause hormonal problems or impair growth in nursing infants. According to its label, dexamethasone should not be used during breastfeeding; patients should discuss with their healthcare provider whether to take the medication or to breastfeed.
Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
FAQs about dexamethasone in MS
In MS, relapses are times when new symptoms suddenly appear or existing symptoms worsen, caused by damaging inflammation in the central nervous system. Corticosteroids like dexamethasone are used to dampen this inflammation, easing the symptoms of acute relapses and accelerating their resolution. Although useful for short-term symptom relief, corticosteroids do not affect the overall progression of MS.
Dexamethasone may cause harm to a developing fetus and should only be used during pregnancy if the risks are outweighed by the potential benefits of such treatment. Patients and their healthcare providers should discuss these decisions in detail based on the unique situation of the individual.
There is no known interaction between alcohol and dexamethasone. However, some corticosteroid side effects (e.g., increased blood pressure) are similar to the impact of alcohol on the body, and drinking alcohol while on dexamethasone may increase the chance that a person experiences these effects. People on dexamethasone are advised to talk to their healthcare team about whether and how much alcohol is safe to drink during treatment.
Since dexamethasone treatment is typically tailored to a person’s needs, and every person may respond differently to a given medication, it may be hard to predict when someone with MS will respond to this therapy. In the majority of MS patients, relapse symptoms ease within a few days of corticosteroid treatment, but this can vary greatly between different individuals.
Increased appetite and weight gain are common side effects of corticosteroids, including dexamethasone. Thinning scalp hair also is indicated on the medication’s label as a possible side effect. Patients should talk with their healthcare provider about any specific side effects they experience.
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