Editing Dexamethasone (section)

==Medical uses==
[[File:Dexamethasone.jpg|thumb|Dexamethasone phosphate injection ampoules]]

===Anti-inflammatory===
[[File:Dexamethasone tablets.jpg|thumb|Dexamethasone tablets]]
Dexamethasone is used to treat many [[inflammation|inflammatory]] and [[autoimmune disease|autoimmune disorders]], such as [[rheumatoid arthritis]] and [[bronchospasm]].<ref>{{cite web | vauthors = Till J |title=Paramedic Clinical Training Aid |url= http://paramedic-info.com/PDA/index.html |access-date=30 August 2011 |url-status=dead |archive-url=https://web.archive.org/web/20120331110331/http://paramedic-info.com/PDA/index.html |archive-date=31 March 2012 }}</ref> [[Idiopathic thrombocytopenic purpura]], a decrease in numbers of [[platelet]]s due to an immune problem, responds to 40&nbsp;mg daily for four days; it may be administered in 14-day cycles. It is unclear whether dexamethasone in this condition is significantly better than other [[glucocorticoid]]s.<ref name="pmid19846889">{{cite journal | vauthors = Provan D, Stasi R, Newland AC, Blanchette VS, Bolton-Maggs P, Bussel JB, Chong BH, Cines DB, Gernsheimer TB, Godeau B, Grainger J, Greer I, Hunt BJ, Imbach PA, Lyons G, McMillan R, Rodeghiero F, Sanz MA, Tarantino M, Watson S, Young J, Kuter DJ | title = International consensus report on the investigation and management of primary immune thrombocytopenia | journal = Blood | volume = 115 | issue = 2 | pages = 168–86 | date = January 2010 | pmid = 19846889 | doi = 10.1182/blood-2009-06-225565 | doi-access = free }}</ref>

It is also given in small amounts before and/or after some forms of [[dental surgery]], such as the extraction of the [[wisdom teeth]], an operation that often causes puffy, swollen cheeks.<ref name="pmid8491244">{{cite journal |vauthors=Schmelzeisen R, Frölich JC |year=1993 |title=Prevention of postoperative swelling and pain by dexamethasone after operative removal of impacted third molar teeth |journal=European Journal of Clinical Pharmacology |volume=44 |issue=3 |pages=275–77 |doi=10.1007/BF00271371 |pmid=8491244 |s2cid=12528750}}</ref>

Dexamethasone is commonly given as a treatment for [[croup]] in children.<ref name=":3" /> A single dose can reduce the swelling of the airway to improve breathing and reduce discomfort.<ref name=":3">{{cite web |url=https://www.mayoclinic.org/diseases-conditions/croup/diagnosis-treatment/drc-20350354 |title=Croup – Diagnosis & Treatment |website=Mayo Clinic |access-date=13 October 2017 |quote=Dexamethasone is usually recommended because of its long-lasting effects (up to 72 hours). |archive-date=10 October 2017 |archive-url=https://web.archive.org/web/20171010063045/http://www.mayoclinic.org/diseases-conditions/croup/diagnosis-treatment/drc-20350354 |url-status=live }}</ref>

Dexamethasone is sometimes injected into the heel when treating [[plantar fasciitis]] or heel pain, sometimes in conjunction with [[triamcinolone acetonide]]. There is no evidence that this treatment helps in the long term, however, dexamethasone may provide short-term pain relief.<ref>{{cite journal | vauthors = Arnold MJ, Gruber J | title = Injected Corticosteroids for Plantar Heel Pain | language = en-US | journal = American Family Physician | volume = 97 | issue = 3 | pages = 169–170 | date = February 2018 | pmid = 29431981 | url = https://www.aafp.org/pubs/afp/issues/2018/0201/p169.html }}</ref>

It may be useful to counteract [[anaphylaxis|allergic anaphylactic shock]], however this is not usually recommended by clinical guidelines.<ref>{{cite journal | vauthors = Dodd A, Hughes A, Sargant N, Whyte AF, Soar J, Turner PJ | title = Evidence update for the treatment of anaphylaxis | journal = Resuscitation | volume = 163 | pages = 86–96 | date = April 2021 | pmid = 33895231 | doi = 10.1016/j.resuscitation.2021.04.010 | pmc = 8139870 | hdl = 1983/82ab8f32-67a9-4277-8750-2246aabf5d96 | hdl-access = free }}</ref>

It is present in certain [[eye drop]]s – particularly after [[eye surgery]] – and as a [[nasal spray]], and certain ear drops (can be combined with an antibiotic and an antifungal). Dexamethasone intravitreal steroid implants have been approved by the US [[Food and Drug Administration]] (FDA) to treat ocular conditions such as [[diabetic retinopathy|diabetic macular edema]], [[central retinal vein occlusion]], and [[uveitis]]. However, the evidence is poor quality relating to the treatment of uveitis, with the potential side effects ([[cataract]] progression and raised [[intraocular pressure]]) being significant, and the benefits not certainly greater than standard treatment.<ref>{{cite journal | vauthors = Reddy A, Liu SH, Brady CJ, Sieving PC, Palestine AG | title = Corticosteroid implants for chronic non-infectious uveitis | journal = The Cochrane Database of Systematic Reviews | volume = 2023 | issue = 8 | pages = CD010469 | date = August 2023 | pmid = 37642198 | pmc = 10464657 | doi = 10.1002/14651858.CD010469.pub4 }}</ref> Dexamethasone has also been used with antibiotics to treat acute [[endophthalmitis]].<ref>{{cite journal | vauthors = Emami S, Kitayama K, Coleman AL | title = Adjunctive steroid therapy versus antibiotics alone for acute endophthalmitis after intraocular procedure | journal = The Cochrane Database of Systematic Reviews | volume = 2022 | issue = 6 | pages = CD012131 | date = June 2022 | pmid = 35665485 | pmc = 9169535 | doi = 10.1002/14651858.CD012131.pub3 }}</ref>

Dexamethasone is used in transvenous screw-in [[artificial pacemaker|cardiac pacing leads]] to minimize the inflammatory response of the [[myocardium]]. The steroid is released into the myocardium as soon as the screw is extended and can play a significant role in minimizing the acute pacing threshold due to the reduction of inflammatory response. The typical quantity present in a lead tip is less than 1.0&nbsp;mg.{{medcn|date=June 2020}}

Dexamethasone may be administered before antibiotics in cases of [[bacterial meningitis]]. [[Gram-negative bacteria]] — to which the causative agent of bacterial meningitis, [[neisseria meningitidis]], belongs — have highly immunogenic [[lipopolysaccharides]] as a component of their cell membrane and trigger a strong inflammatory response. Pre-administration of dexamethasone before the administration of antibiotics acts to reduce that response, thus reducing hearing loss and neurological damage.<ref>{{cite journal |vauthors=Brouwer MC, McIntyre P, Prasad K, van de Beek D |date=September 2015|title=Corticosteroids for acute bacterial meningitis |journal=Cochrane Database of Systematic Reviews |volume=2015 |issue=9 |pages=CD004405 |doi=10.1002/14651858.CD004405.pub5 |pmc=6491272 |pmid=26362566 |doi-access=free }}</ref>

[[File:Dexamethasone phosphate for injection.jpg|thumb|A single ampoule of dexamethasone phosphate for injection]]

===Cancer===
People with [[cancer]] undergoing [[chemotherapy]] are often given dexamethasone to counteract certain [[Adverse drug reaction|side effects]] of their antitumor treatments. Dexamethasone can increase the [[antiemetic]] effect of [[5-HT3 antagonist|5-HT<sub>3</sub> receptor antagonists]], such as [[ondansetron]].<ref name="PMID10824073">{{cite journal | vauthors = Roila F, Ballatori E, Ruggeri B, DeAngelis V | title = Dexamethasone alone or in combination with ondansetron for the prevention of delayed nausea and vomiting induced by chemotherapy | journal = The New England Journal of Medicine | volume = 342 | issue = 21 | pages = 1554–59 | date = May 2000 | pmid = 10824073 | doi = 10.1056/NEJM200005253422102 | doi-access = free }}</ref> The exact mechanism of this interaction is not well-defined, but it has been theorized that this effect may be due to, among many other causes, inhibition of [[prostaglandin]] synthesis, [[antiinflammatory|anti-inflammatory]] effects, [[immunosuppression|immunosuppressive]] effects, decreased release of [[Endorphins|endogenous opioids]], or a combination of the aforementioned.<ref name="PMID12437261">{{cite journal | vauthors = Holte K, Kehlet H | title = Perioperative single-dose glucocorticoid administration: pathophysiologic effects and clinical implications | journal = Journal of the American College of Surgeons | volume = 195 | issue = 5 | pages = 694–712 | date = November 2002 | pmid = 12437261 | doi = 10.1016/s1072-7515(02)01491-6 }}</ref>

In [[brain tumor]]s (primary or metastatic), dexamethasone is used to counteract the development of [[edema]], which could eventually compress other brain structures.<ref>{{cite journal | vauthors = Kostaras X, Cusano F, Kline GA, Roa W, Easaw J | title = Use of dexamethasone in patients with high-grade glioma: a clinical practice guideline | journal = Current Oncology | volume = 21 | issue = 3 | pages = e493–e503 | date = June 2014 | pmid = 24940109 | pmc = 4059813 | doi = 10.3747/co.21.1769 }}</ref> It is also given in [[Spinal cord compression|cord compression]], where a tumor is compressing the spinal cord.{{medcn|date=June 2020}} Evidence on the safety and efficacy of using dexamethasone to treat malignant brain tumors is not clear.<ref name="pmid31346902">{{cite journal | vauthors = Jessurun CA, Hulsbergen AF, Cho LD, Aglio LS, Nandoe Tewarie RD, Broekman ML | title = Evidence-based dexamethasone dosing in malignant brain tumors: what do we really know? | journal = Journal of Neuro-Oncology | volume = 144 | issue = 2 | pages = 249–264 | date = September 2019 | pmid = 31346902 | pmc = 6700052 | doi = 10.1007/s11060-019-03238-4 | title-link = doi | doi-access = free }}</ref>

Dexamethasone is also used as a direct chemotherapeutic agent in certain [[hematological malignancy|hematological malignancies]], especially in the treatment of [[multiple myeloma]], in which dexamethasone is given alone or in combination with other chemotherapeutic drugs, including most commonly with [[thalidomide]] (Thal-dex), [[lenalidomide]], [[bortezomib]] (Velcade, Vel-dex),<ref name="pmid17043025">{{cite journal | vauthors = Harousseau JL, Attal M, Leleu X, Troncy J, Pegourie B, Stoppa AM, Hulin C, Benboubker L, Fuzibet JG, Renaud M, Moreau P, Avet-Loiseau H | title = Bortezomib plus dexamethasone as induction treatment prior to autologous stem cell transplantation in patients with newly diagnosed multiple myeloma: results of an IFM phase II study | journal = Haematologica | volume = 91 | issue = 11 | pages = 1498–505 | date = November 2006 | pmid = 17043025 }} {{free access}}</ref> or a combination of [[doxorubicin]] (Adriamycin) and [[vincristine]] or [[bortezomib]]/[[lenalidomide]]/dexamethasone.{{medcn|date=June 2020}}

===COVID-19===
{{Anchor|COVID-19}}
{{See also|COVID-19 drug repurposing research#Dexamethasone}}

Dexamethasone is recommended by the [[National Health Service]] in the UK and the [[National Institutes of Health]] (NIH) in the US for people with [[Coronavirus disease 2019|COVID-19]] who need either [[mechanical ventilation]] or [[oxygen therapy|supplemental oxygen]] (without ventilation).<ref name=":0">{{Cite web|title=Dexamethasone and COVID-19|url=https://www.sps.nhs.uk/articles/dexamethasone-and-covid-19/|access-date=22 July 2020|website=SPS – Specialist Pharmacy Service|archive-date=22 July 2020|archive-url=https://web.archive.org/web/20200722082343/https://www.sps.nhs.uk/articles/dexamethasone-and-covid-19/|url-status=dead}}</ref><ref name=":1">{{Cite web|title=Corticosteroids|url=https://www.covid19treatmentguidelines.nih.gov/immune-based-therapy/immunomodulators/corticosteroids/|access-date=12 July 2020|website=COVID-19 Treatment Guidelines|publisher=National Institutes of Health|archive-date=19 July 2020|archive-url=https://web.archive.org/web/20200719163110/https://www.covid19treatmentguidelines.nih.gov/immune-based-therapy/immunomodulators/corticosteroids/|url-status=live}}</ref>

The [[Infectious Diseases Society of America]] (IDSA) guideline panel suggests the use of glucocorticoids for people with severe COVID-19, defined as people with [[Oxygen saturation (medicine)|SpO<sub>2</sub>]] ≤94% on room air, and those who require supplemental oxygen, mechanical ventilation, or [[extracorporeal membrane oxygenation]] (ECMO).<ref name="IDSA">{{cite web|title=COVID-19 Guideline, Part 1: Treatment and Management|url=https://www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management/|access-date=22 July 2020|website=Infectious Diseases Society of America|quote=Recommendation 4. Among hospitalized people with severe* COVID-19, the IDSA guideline panel suggests glucocorticoids rather than no glucocorticoids. (Conditional recommendation, Moderate certainty of evidence)<br />Remark: Dexamethasone 6 mg IV or PO for 10 days (or until discharge if earlier) or equivalent glucocorticoid dose may be substituted if dexamethasone is unavailable. Equivalent total daily doses of alternative glucocorticoids to dexamethasone 6 mg daily are methylprednisolone 32 mg and prednisone 40 mg.<br />Recommendation 5. Among hospitalized people with COVID-19 without hypoxemia requiring supplemental oxygen, the IDSA guideline panel suggests against the use of glucocorticoids. (Conditional recommendation, Low certainty of evidence)|archive-date=6 October 2020|archive-url=https://web.archive.org/web/20201006214733/https://www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management//|url-status=live}}</ref> The IDSA recommends against the use of glucocorticoids for those with COVID-19 without hypoxemia requiring supplemental oxygen.<ref name="IDSA" />

The [[World Health Organization]] (WHO) recommends systemic corticosteroids rather than no systemic corticosteroids for the treatment of people with COVID-19 (strong recommendation, based on moderate certainty evidence).<ref name="WHO guidance" /> The WHO suggests not to use corticosteroids in the treatment of people with non-severe COVID-19 (conditional recommendation, based on low certainty evidence).<ref name="WHO guidance" />

The [[Oxford University]] [[RECOVERY Trial]] issued a press release announcing preliminary results that the drug could reduce deaths by about a third in participants on [[ventilator]]s and by about a fifth in participants on oxygen; it did not benefit people who did not require respiratory support.<ref name="oxford news">{{cite news|date=16 June 2020|title=Dexamethasone reduces death in hospitalized people with severe respiratory complications of COVID-19|website=University of Oxford|url=http://www.ox.ac.uk/news/2020-06-16-dexamethasone-reduces-death-hospitalised-patients-severe-respiratory-complications|access-date=16 June 2020|archive-date=16 June 2020|archive-url=https://web.archive.org/web/20200616145052/http://www.ox.ac.uk/news/2020-06-16-dexamethasone-reduces-death-hospitalised-patients-severe-respiratory-complications/|url-status=live}}</ref> A [[meta-analysis]] of seven clinical trials of critically ill COVID-19 participants, each treated with one of three different [[corticosteroid]]s found a statistically significant reduction in death.<ref name="Sterne 2020"/> The largest reduction was obtained with dexamethasone (36% compared to placebo).<ref name="Sterne 2020">{{cite journal | vauthors = Sterne JA, Murthy S, Diaz JV, Slutsky AS, Villar J, Angus DC, Annane D, Azevedo LC, Berwanger O, Cavalcanti AB, Dequin PF, Du B, Emberson J, Fisher D, Giraudeau B, Gordon AC, Granholm A, Green C, Haynes R, Heming N, Higgins JP, Horby P, Jüni P, Landray MJ, Le Gouge A, Leclerc M, Lim WS, Machado FR, McArthur C, Meziani F, Møller MH, Perner A, Petersen MW, Savovic J, Tomazini V, Veiga VC, Webb S, Marshall JC | collaboration = The WHO Rapid Evidence Appraisal for COVID-19 Therapies (REACT) Working Group | title = Association Between Administration of Systemic Corticosteroids and Mortality Among Critically Ill Patients With COVID-19: A Meta-analysis | journal = JAMA | date = September 2020 | volume = 324 | issue = 13 | pages = 1330–1341 | doi = 10.1001/jama.2020.17023 | pmid = 32876694 | pmc = 7489434 | s2cid = 221467783 | doi-access = free }}</ref><ref>{{cite journal | title = Corticosteroids in COVID-19 ARDS: Evidence and Hope During the Pandemic | vauthors = Prescott HC, Rice TW | journal = JAMA | date = September 2020 | volume = 324 | issue = 13 | pages = 1292–1295 | doi = 10.1001/jama.2020.16747 | pmid = 32876693 | s2cid = 221468015 | doi-access = free }}</ref>

In September 2020, the [[European Medicines Agency]] (EMA) endorsed the use of dexamethasone in adults and adolescents, from twelve years of age and weighing at least {{convert|40|kg|lb}}, who require supplemental oxygen therapy.<ref name="EMA PR">{{cite press release | title=EMA endorses use of dexamethasone in COVID-19 patients on oxygen or mechanical ventilation | website=[[European Medicines Agency]] (EMA) | date=18 September 2020 | url=https://www.ema.europa.eu/en/news/ema-endorses-use-dexamethasone-covid-19-patients-oxygen-mechanical-ventilation | access-date=21 September 2020 | archive-date=14 February 2021 | archive-url=https://web.archive.org/web/20210214060918/https://www.ema.europa.eu/en/news/ema-endorses-use-dexamethasone-covid-19-patients-oxygen-mechanical-ventilation | url-status=live }} Text was copied from this source which is copyright European Medicines Agency. Reproduction is authorized provided the source is acknowledged.</ref> Dexamethasone can be taken by mouth or given as an injection or infusion (drip) into a vein.<ref name="EMA PR" />

In November 2020, the [[Public Health Agency of Canada]]'s Clinical Pharmacology Task Group recommended dexamethasone for hospitalized patients requiring mechanical ventilation.<ref>{{Cite web |last=Public Health Agency of Canada |date=23 November 2020 |title=Ad-hoc COVID-19 Clinical Pharmacology Task Group: Statement on dexamethasone |url=https://www.canada.ca/en/public-health/corporate/mandate/about-agency/external-advisory-bodies/list/covid-19-clinical-pharmacology-task-group/statement-dexamethasone.html#a5 |url-status=dead |archive-url=https://archive.today/20201227053419/https://www.canada.ca/en/public-health/corporate/mandate/about-agency/external-advisory-bodies/list/covid-19-clinical-pharmacology-task-group/statement-dexamethasone.html%23a5 |archive-date=27 December 2020 |access-date=1 April 2022 |website=Government of Canada }}</ref> Although dexamethasone, and other glucocorticoids, reduce mortality in COVID-19 they have also been associated with an increased risk of secondary infections,<ref>{{cite journal | vauthors = Conway Morris A, Kohler K, De Corte T, Ercole A, De Grooth HJ, Elbers PW, Povoa P, Morais R, Koulenti D, Jog S, Nielsen N, Jubb A, Cecconi M, De Waele J | title = Co-infection and ICU-acquired infection in COIVD-19 ICU patients: a secondary analysis of the UNITE-COVID data set | journal = Critical Care | volume = 26 | issue = 1 | pages = 236 | date = August 2022 | pmid = 35922860 | pmc = 9347163 | doi = 10.1186/s13054-022-04108-8 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Meynaar IA, van Rijn S, Ottens TH, van Burgel ND, van Nieuwkoop C | title = Increased risk of central line-associated bloodstream infection in COVID-19 patients associated with dexamethasone but not with interleukin antagonists | journal = Intensive Care Medicine | volume = 48 | issue = 7 | pages = 954–957 | date = July 2022 | pmid = 35670819 | pmc = 9171741 | doi = 10.1007/s00134-022-06750-w }}</ref><ref>{{cite journal | vauthors = Scaravilli V, Guzzardella A, Madotto F, Beltrama V, Muscatello A, Bellani G, Monti G, Greco M, Pesenti A, Bandera A, Grasselli G | title = Impact of dexamethasone on the incidence of ventilator-associated pneumonia in mechanically ventilated COVID-19 patients: a propensity-matched cohort study | journal = Critical Care | volume = 26 | issue = 1 | pages = 176 | date = June 2022 | pmid = 35698155 | pmc = 9191402 | doi = 10.1186/s13054-022-04049-2 | doi-access = free }}</ref> secondary infections being a significant issue in critically ill COVID-19 patients.<ref>{{cite journal | vauthors = Maes M, Higginson E, Pereira-Dias J, Curran MD, Parmar S, Khokhar F, Cuchet-Lourenço D, Lux J, Sharma-Hajela S, Ravenhill B, Hamed I, Heales L, Mahroof R, Soderholm A, Forrest S, Sridhar S, Brown NM, Baker S, Navapurkar V, Dougan G, Bartholdson Scott J, Conway Morris A | title = Ventilator-associated pneumonia in critically ill patients with COVID-19 | journal = Critical Care | volume = 25 | issue = 1 | pages = 25 | date = January 2021 | pmid = 33430915 | pmc = 7797892 | doi = 10.1186/s13054-021-03460-5 | doi-access = free }}</ref>

The mechanism of action of dexamethasone involves suppression of late-stage [[interferon type I]] programs in severe COVID-19 patients.<ref>{{cite journal | vauthors = Sinha S, Rosin NL, Arora R, Labit E, Jaffer A, Cao L, Farias R, Nguyen AP, de Almeida LG, Dufour A, Bromley A, McDonald B, Gillrie MR, Fritzler MJ, Yipp BG, Biernaskie J | title = Dexamethasone modulates immature neutrophils and interferon programming in severe COVID-19 | journal = Nature Medicine | volume = 28 | issue = 1 | pages = 201–211 | date = January 2022 | pmid = 34782790 | pmc = 8799469 | doi = 10.1038/s41591-021-01576-3 | s2cid = 244132637 }}</ref>

=== Surgery ===
Dexamethasone is used fairly regularly, often as a single intravenous dose, during surgery to prevent postoperative nausea and vomiting, manage pain, potentially reduce the amount of pain medication required, and help reduce post-surgery hospitalisation time.<ref name=":2" /> The adverse effects of taking steroids after surgery on wound healing, blood sugar levels, and in diabetics are not completely understood; however, dexamethasone likely does not increase the risk of postoperative infections.<ref name=":2">{{cite journal | vauthors = Polderman JA, Farhang-Razi V, Van Dieren S, Kranke P, DeVries JH, Hollmann MW, Preckel B, Hermanides J | title = Adverse side effects of dexamethasone in surgical patients | journal = The Cochrane Database of Systematic Reviews | volume = 11 | issue = 11 | pages = CD011940 | date = November 2018 | pmid = 30480776 | pmc = 6426282 | doi = 10.1002/14651858.CD011940.pub3 }}</ref>

===Endocrine===
Dexamethasone is the treatment for the very rare disorder of [[glucocorticoid resistance]].<ref name="pmid8239231">{{cite journal | vauthors = Chrousos GP, Detera-Wadleigh SD, Karl M | title = Syndromes of glucocorticoid resistance | journal = Annals of Internal Medicine | volume = 119 | issue = 11 | pages = 1113–24 | date = December 1993 | pmid = 8239231 | doi = 10.7326/0003-4819-119-11-199312010-00009 | url = http://annals.org/pdfaccess.ashx?url=/data/journals/aim/19786/0000605-199312010-00009.pdf | access-date = 4 July 2020 | url-status = dead | s2cid = 26040431 | archive-url = https://web.archive.org/web/20170814034732/http://annals.org/pdfaccess.ashx?url=%2Fdata%2Fjournals%2Faim%2F19786%2F0000605-199312010-00009.pdf | archive-date = 14 August 2017 }}</ref><ref name="pmid18319312">{{cite journal | vauthors = Charmandari E, Kino T, Ichijo T, Chrousos GP | title = Generalized glucocorticoid resistance: clinical aspects, molecular mechanisms, and implications of a rare genetic disorder | journal = The Journal of Clinical Endocrinology and Metabolism | volume = 93 | issue = 5 | pages = 1563–72 | date = May 2008 | pmid = 18319312 | pmc = 2386273 | doi = 10.1210/jc.2008-0040 }}</ref>

In [[adrenal insufficiency]] and [[Addison's disease]], dexamethasone is prescribed when the patient does not respond well to [[prednisone]] or [[methylprednisolone]].{{medcn|date=June 2020}}

It can be used in [[congenital adrenal hyperplasia]] in older adolescents and adults to suppress [[adrenocorticotropic hormone]] (ACTH) production. It is typically given at night.<ref>Dan L. Longo, Anthony Fauci, Dennis Kasper, Stephen Hauser, J. Jerry Jameson and Joseph Loscalzo, [https://books.google.com/books?id=7gxjMV8hClsC&q=Harrison%27s+Principles+of+Internal+Medicine ''Harrison's Principles of Internal Medicine''], 18th edition, p. 3055</ref>

===Pregnancy===
Dexamethasone may be given to women at risk of delivering prematurely to promote [[Respiratory system#Development|maturation]] of the fetus's lungs. This administration, given from one day to one week before delivery, has been associated with [[low birth weight]], although not with increased rates of neonatal death.<ref name="pmid11275014">{{cite journal | vauthors = Bloom SL, Sheffield JS, McIntire DD, Leveno KJ | title = Antenatal dexamethasone and decreased birth weight | journal = Obstetrics and Gynecology | volume = 97 | issue = 4 | pages = 485–90 | date = April 2001 | pmid = 11275014 | doi = 10.1016/S0029-7844(00)01206-0 | s2cid = 33601749 }}</ref>

Dexamethasone has also been used during pregnancy as an [[off-label]] prenatal treatment for the symptoms of [[congenital adrenal hyperplasia]] (CAH) in female babies. CAH causes a variety of physical abnormalities, notably [[Intersex|ambiguous genitalia]]. Early prenatal CAH treatment has been shown to reduce some CAH symptoms, but it does not treat the underlying [[congenital disorder]]. This use is controversial: it is inadequately studied, only around one in ten of the fetuses of women treated are at risk of the condition, and serious adverse events have been documented.<ref>{{Cite web|url=http://content.time.com/time/health/article/0,8599,1996453,00.html|archive-url=https://web.archive.org/web/20160831150342/http://content.time.com/time/health/article/0,8599,1996453,00.html|url-status=dead|title=A Prenatal Treatment Raises Questions of Medical Ethics| vauthors = Elton C |date=18 June 2010|archive-date=31 August 2016|via=content.time.com}}</ref> Experimental use of dexamethasone in pregnancy for fetal CAH treatment was discontinued in Sweden when one in five cases had adverse events.<ref>{{cite journal | vauthors = Hirvikoski T, Nordenström A, Wedell A, Ritzén M, Lajic S | title = Prenatal dexamethasone treatment of children at risk for congenital adrenal hyperplasia: the Swedish experience and standpoint | journal = The Journal of Clinical Endocrinology and Metabolism | volume = 97 | issue = 6 | pages = 1881–83 | date = June 2012 | pmid = 22466333 | doi = 10.1210/jc.2012-1222 | doi-access = free }}</ref>

A small clinical trial found long-term effects on verbal working memory among the small group of children treated prenatally, but the small number of test subjects means the study cannot be considered definitive.<ref name="Hirvikoski_2007">{{cite journal | vauthors = Hirvikoski T, Nordenström A, Lindholm T, Lindblad F, Ritzén EM, Wedell A, Lajic S | title = Cognitive functions in children at risk for congenital adrenal hyperplasia treated prenatally with dexamethasone | journal = The Journal of Clinical Endocrinology and Metabolism | volume = 92 | issue = 2 | pages = 542–48 | date = February 2007 | pmid = 17148562 | doi = 10.1210/jc.2006-1340 | doi-access = free }}</ref><ref name="pmid21164263">{{cite journal | vauthors = Lajic S, Nordenström A, Hirvikoski T | journal = Endocrine Development| title = Long-term outcome of prenatal dexamethasone treatment of 21-hydroxylase deficiency | volume = 20 | pages = 96–105 | year = 2011 | pmid = 21164263 | doi = 10.1159/000321228 | isbn = 978-3-8055-9643-5 }}</ref>

===High-altitude illnesses===
Dexamethasone is used in the treatment of [[high-altitude cerebral edema]] (HACE), as well as [[high-altitude pulmonary edema]] (HAPE).<ref name="pmid29959871">{{cite journal |vauthors=Simancas-Racines D, Arevalo-Rodriguez I, Osorio D, Franco JV, Xu Y, Hidalgo R |title=Interventions for treating acute high altitude illness |journal=Cochrane Database Syst Rev |volume=6 |issue= 12|pages=CD009567 |date=June 2018 |pmid=29959871 |pmc=6513207 |doi=10.1002/14651858.CD009567.pub2 |url= }}</ref> It is commonly carried on mountain-climbing expeditions to help climbers deal with complications of [[altitude sickness]].<ref name=MedicalProblems>{{cite book | vauthors = Cymerman A, Rock PB | title = Medical Problems in High Mountain Environments. A Handbook for Medical Officers | publisher = US Army Research Inst. of Environmental Medicine Thermal and Mountain Medicine Division Technical Report | volume = USARIEM-TN94-2 | url = http://operationalmedicine.org/TextbookFiles/highmountain.pdf#page=19&zoom=auto,-76,314 | archive-url = https://web.archive.org/web/20170617133159/http://operationalmedicine.org/TextbookFiles/highmountain.pdf#page=19&zoom=auto,-76,314 | url-status = dead | archive-date = 17 June 2017 | access-date = 17 June 2020 | year = 1994 }}</ref><ref name="pmid17438328">{{cite journal | vauthors = Eledrisi MS | title = First-line therapy for hypertension | journal = Annals of Internal Medicine | volume = 146 | issue = 8 | pages = 615 | date = April 2007 | pmid = 17438328 | doi = 10.7326/0003-4819-146-8-200704170-00021 }}</ref>

===Nausea and vomiting===
Intravenous dexamethasone is effective for the prevention of nausea and vomiting in people who had surgery and whose post-operative pain was treated with long-acting spinal or epidural spinal opioids.<ref>{{cite journal | vauthors = Grape S, Usmanova I, Kirkham KR, Albrecht E | title = Intravenous dexamethasone for prophylaxis of postoperative nausea and vomiting after administration of long-acting neuraxial opioids: a systematic review and meta-analysis | journal = Anaesthesia | volume = 73 | issue = 4 | pages = 480–89 | date = April 2018 | pmid = 29226971 | doi = 10.1111/anae.14166 | doi-access = free }}</ref>

The combination of dexamethasone and a [[5-HT3 antagonist|5-HT<sub>3</sub> receptor antagonist]] such as [[ondansetron]] is more effective than a 5-HT<sub>3</sub> receptor antagonist alone in preventing postoperative nausea and vomiting.<ref name="pmid16670361">{{cite journal | vauthors = Kovac AL | title = Meta-analysis of the use of rescue antiemetics following PONV prophylactic failure with 5-HT3 antagonist/dexamethasone versus single-agent therapies | journal = The Annals of Pharmacotherapy | volume = 40 | issue = 5 | pages = 873–87 | date = May 2006 | pmid = 16670361 | doi = 10.1345/aph.1G338 | s2cid = 32843029 }}</ref>

===Sore throat===
A single dose of dexamethasone or another steroid speeds the improvement of a [[sore throat]].<ref>{{cite journal | vauthors = Sadeghirad B, Siemieniuk RA, Brignardello-Petersen R, Papola D, Lytvyn L, Vandvik PO, Merglen A, Guyatt GH, Agoritsas T | title = Corticosteroids for treatment of sore throat: systematic review and meta-analysis of randomised trials | journal = BMJ | volume = 358 | pages = j3887 | date = September 2017 | pmid = 28931508 | pmc = 5605780 | doi = 10.1136/bmj.j3887 }}</ref>