Dexamethasone

[sloppydog]

Is anyone on Dexamethasone ?

I was speaking to my Endo as I also have addison's and asked why was I not on Dexamethasone in addition to my Solu-Cortef (I am on the cortisol Pump) as the Cortef is for addion's but I need a strong anti inflammatory in addition, as Cortef has 30 x more anti inflammatory properties than Cortef/Hydrocortione and much more then Prednisone or Prednisolone, so you need a much lower dose to give the same properties.

So wondering if anyone is on Dex and if so at what dosage during flares etc - and do you taper after a flare or remain on a maintenance dosage?

Thank you for reading this

I attached the chart he sent me

[PMRpro]

Lower dose doesn't always mean fewer problems - and although the antiinflammatory effect of dexamethasone lasts much longer, the half life is also much longer. Pred is used in rheumatolgy for simple 1x daily dosing without a risk of a build up of the drug. I've often wondered why daxamethasone is reserved for fairly specific situations - but the cost is also a factor I suspect with dexamethasone also being more expensive. It is also more difficult to taper the dose off so rheumies probably don't use it a lot.

[Jmiller623 in reply to PMRpro]

Dex actually is pretty cheap but not commonly carried on hand in pharmacies like prednisone. It’s carried more at hospital pharmacies. No one tapers it due to dose. Pills are too small to split - smaller diameter than a pencil eraser. I think they only come in 2 and 4 mg doses. It’s usually given in situations where inflammation needs to be immediately suppressed. This is only for a few days. It’s never ever given long term unless it’s an end of life situation. To answer your other question, see other post on this wall for MC:GC explanation and why using hydrocortisone or fludrocortisone is preferred in AI.

[Jmiller623]

Dexamethasone is used in 2 medical situations - brain inflammation and nausea due to chemotherapy. Otherwise, it’s rarely used. It is a very very strong anti-inflammatory with no mineralocorticoid effect.

Mineralocorticoid effect is what balances your salt and water reabsorption in the kidney and gut to keep your blood pressure stable. Glucocorticoid effect is what makes it an anti-inflammatory. GC effect is like when you make cortisol and adrenaline in times of stress which suppresses the immune system.

In those with Addisons, you’ve lost both the MC and GC function of your adrenals. You need a steroid that serves both functions. Dexamethasone is a sledgehammer for GC effect but has virtually no MC effect so your blood pressure would bottom out with just dexamethasone.

Best replacement for Addisons/adrenal insufficiency is hydrocortisone twice a day (8am and 1pm) or fludrocortisone once a day since they both have the highest and most balanced MC:GC effect. This is standard of care. If you live in no mans land with limited options, some docs give prednisone because it’s all that’s available and is cheap.

Does this answer your question/make sense?

[Joaclp in reply to Jmiller623]

Thank you for this explanation--better than any provided by my endocrinologist. I have adrenal insufficiency and take hydrocortisone and fludrocortisone with occasional added prednisone for flares of inflammation.

[PMRpro]

"Allergic" is the wrong word to use. That's like patients claiming they are allergic to antibiotics because they get diarrhoea - that isn't an allergy that is an intolerance. Steroids are themselves used to treat allergic reactions - and an allergy to prednisone is vanishingly rare. The fillers in the tablets is another matter.

Development of avascular necrosis is a risk - but a very rare risk. Or was it due to speeded up development of osteoarthritis? Which would probably have happened eventually anyway.

But your attitude really isn't helpful - IMHO you are scaring people unecessarily. Corticosteroids are life-savers - and a hip replacement is a preferable alternative to irreversible total loss of vision which is a risk in one of the conditions for which there is little alternative treatment.