One cheap steroid treats croup, swollen brains and puffy wisdom-tooth cheeks
Dexamethasone turns up in a startling range of places: a single dose for a child with croup, eye drops after surgery, an injection before wisdom teeth come out, and treatment for brain swelling. Approved in 1958, this generic steroid is one the World Health Organization counts as essential.
Dexamethasone is a glucocorticoid carrying a fluorine atom, and it works by damping inflammation and suppressing the immune system. The packet credits its first synthesis in 1957 to Philip Showalter Hench, with medical approval following in 1958. Its effects typically appear within a day and last about three days. It can be swallowed, injected into muscle or vein, rubbed on as a cream or dropped into the eye.
Its uses span much of medicine. Doctors give it for rheumatic disease, skin conditions, severe allergy, asthma, COPD and brain swelling, alongside antibiotics in tuberculosis, and in preterm labour to improve the baby's outcome. In croup, one dose can shrink the swollen airway and ease breathing. Small doses around dental surgery limit the swelling after wisdom teeth are removed. It appears in eye, ear and nasal preparations, and implants placed inside the eye are FDA-approved for conditions such as diabetic macular oedema. For an immune platelet disorder, a regimen of 40 mg a day for four days is used, though it is unclear whether it beats other steroids there.
Not every use is backed by strong evidence. Heel injections for plantar fasciitis may ease pain briefly but show no long-term benefit. Clinical guidelines do not usually recommend it for anaphylactic shock. For uveitis, evidence is weak and the risks, including worsening cataracts and raised eye pressure, are significant.
Long-term use carries costs: thrush, bone loss, cataracts, bruising and muscle weakness. Pregnancy ratings differ by country; the United States places it in category C, while Australia rates the oral form category A. It is advised against during breastfeeding. In 2023 it ranked 246th among US prescriptions, with more than 1 million issued, and combinations with antibiotics such as ciprofloxacin also rank high.
Source: Dexamethasone
