Dexamethasone Explained

Verifiedfields:changed
Watchedfields:changed
Verifiedrevid:443584169
Alt2:Ball-and-stick model of the dexamethasone molecule
Tradename:Decadron, Ozurdex, Dexycu, others
Dailymedid:Dexamethasone
Pregnancy Au:A
Routes Of Administration:By mouth, intravenous, intramuscular, subcutaneous, intraosseous, intravitreal, eye drop
Atc Prefix:A01
Atc Suffix:AC02
Atc Supplemental:,,,,,,,
Legal Au:S4
Legal Au Comment:[1]
Legal Ca:Rx-only
Legal Uk:POM
Legal Us:Rx-only
Legal Us Comment:[2] [3] [4]
Legal Eu:Rx-only
Legal Eu Comment:[5] [6]
Legal Status:Rx-only
Bioavailability:80–90%
Protein Bound:77%
Metabolism:Liver
Elimination Half-Life:biological half-life: 36 to 54 hours; plasma half-life: 4 to 5 hours[7] [8]
Excretion:Urine (65%)
Cas Number:50-02-2
Pubchem:5743
Iuphar Ligand:2768
Drugbank:DB01234
Chemspiderid:5541
Unii:7S5I7G3JQL
Kegg:D00292
Chebi:41879
Chembl:384467
Pdb Ligand:DEX
Iupac Name:(8S,9R,10S,11S,13S,14S,16R,17R)-9-Fluoro-11,17-dihydroxy-17-(2-hydroxyacetyl)-10,13,16-trimethyl-6,7,8,9,10,11,12,13,14,15,16,17-dodecahydro-3H-cyclopenta[''a'']phenanthren-3-one
C:22
H:29
F:1
O:5
Smiles:O=C(CO)[C@]3(O)[C@]2(C[C@H](O)[C@]4(F)[C@@]1(C(=CC(=O)C=C1)CC[C@H]4[C@@H]2C[C@H]3C)C)C
Stdinchi:1S/C22H29FO5/c1-12-8-16-15-5-4-13-9-14(25)6-7-19(13,2)21(15,23)17(26)10-20(16,3)22(12,28)18(27)11-24/h6-7,9,12,15-17,24,26,28H,4-5,8,10-11H2,1-3H3/t12-,15+,16+,17+,19+,20+,21+,22+/m1/s1
Stdinchikey:UREBDLICKHMUKA-CXSFZGCWSA-N
Melting Point:262

Dexamethasone is a fluorinated glucocorticoid medication used to treat rheumatic problems, a number of skin diseases, severe allergies, asthma, chronic obstructive lung disease, croup, brain swelling, eye pain following eye surgery, superior vena cava syndrome (a complication of some forms of cancer),[9] and along with antibiotics in tuberculosis. In adrenocortical insufficiency, it may be used in combination with a mineralocorticoid medication such as fludrocortisone. In preterm labor, it may be used to improve outcomes in the baby. It may be given by mouth, as an injection into a muscle, as an injection into a vein, as a topical cream or ointment for the skin or as a topical ophthalmic solution to the eye. The effects of dexamethasone are frequently seen within a day and last for about three days.[10]

The long-term use of dexamethasone may result in thrush, bone loss, cataracts, easy bruising, or muscle weakness.[10] It is in pregnancy category C in the United States, meaning that it should only be used when the benefits are predicted to be greater than the risks.[11] In Australia, the oral use is category A, meaning it has been frequently used in pregnancy and not been found to cause problems to the baby.[12] It should not be taken when breastfeeding.[10] Dexamethasone has anti-inflammatory and immunosuppressant effects.[10]

Dexamethasone was first synthesized in 1957 by Philip Showalter Hench and was approved for medical use in 1958.[13] [14] [15] It is on the World Health Organization's List of Essential Medicines.[16] In 2021, it was the 260th most commonly prescribed medication in the United States, with more than 1million prescriptions.[17] [18] It is available as a generic medication.[19]

Medical uses

Anti-inflammatory

Dexamethasone is used to treat many inflammatory and autoimmune disorders, such as rheumatoid arthritis and bronchospasm.[20] Idiopathic thrombocytopenic purpura, a decrease in numbers of platelets due to an immune problem, responds to 40 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 glucocorticoids.[21]

It is also given in small amounts[22] before and/or after some forms of dental surgery, such as the extraction of the wisdom teeth, an operation which often causes puffy, swollen cheeks.

Dexamethasone is commonly given as a treatment for croup in children, as a single dose can reduce the swelling of the airway to improve breathing and reduce discomfort.[23]

It is injected into the heel when treating plantar fasciitis, sometimes in conjunction with triamcinolone acetonide.

It is useful to counteract allergic anaphylactic shock, if given in high doses.

It is present in certain eye drops – 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 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.[24] Dexamethasone has also been used with antibiotics to treat acute endophthalmitis.[25]

Dexamethasone is used in transvenous screw-in 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 mg.

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 act to reduce that response, thus reducing hearing loss and neurological damage.[26]

Cancer

People with cancer undergoing chemotherapy are often given dexamethasone to counteract certain side effects of their antitumor treatments. Dexamethasone can increase the antiemetic effect of 5-HT3 receptor antagonists, such as ondansetron.[27] 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, anti-inflammatory effects, immunosuppressive effects, decreased release of endogenous opioids, or a combination of the aforementioned.[28]

In brain tumors (primary or metastatic), dexamethasone is used to counteract the development of edema, which could eventually compress other brain structures. It is also given in cord compression, where a tumor is compressing the spinal cord. Evidence on the safety and efficacy of using dexamethasone to treat malignant brain tumors is not clear.[29]

Dexamethasone is also used as a direct chemotherapeutic agent in certain 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),[30] or a combination of doxorubicin (Adriamycin) and vincristine or bortezomib/lenalidomide/dexamethasone.

COVID-19

Dexamethasone is recommended by the National Health Service in the UK and the National Institutes of Health (NIH) in the US for people with COVID-19 who need either mechanical ventilation or supplemental oxygen (without ventilation).[31] [32]

The Infectious Diseases Society of America (IDSA) guideline panel suggests the use of glucocorticoids for people with severe COVID-19, defined as people with SpO2 ≤94% on room air, and those who require supplemental oxygen, mechanical ventilation, or extracorporeal membrane oxygenation (ECMO).[33] The IDSA recommends against the use of glucocorticoids for those with COVID-19 without hypoxemia requiring supplemental oxygen.

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). The WHO suggests not to use corticosteroids in the treatment of people with non-severe COVID-19 (conditional recommendation, based on low certainty evidence).

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 ventilators and by about a fifth in participants on oxygen; it did not benefit people who did not require respiratory support.[34] A meta-analysis of seven clinical trials of critically ill COVID-19 participants, each treated with one of three different corticosteroids found a statistically significant reduction in death. The largest reduction was obtained with dexamethasone (36% compared to placebo).[35] [36]

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 40kg (90lb), who require supplemental oxygen therapy.[37] Dexamethasone can be taken by mouth or given as an injection or infusion (drip) into a vein.

In November 2020, the Public Health Agency of Canada's Clinical Pharmacology Task Group recommended dexamethasone for hospitalized patients requiring mechanical ventilation.[38] Although dexamethasone, and other glucocorticoids, reduce mortality in COVID-19 they have also been associated with an increased risk of secondary infections,[39] [40] [41] secondary infections being a significant issue in critically ill COVID-19 patients.[42]

The mechanism of action of dexamethasone involves suppression of late-stage interferon type I programs in severe COVID-19 patients.[43]

Surgery

Dexamethasone is used fairly regularly to prevent postoperative nausea and vomiting, manage pain (potentially reduce the amount of pain medications needed), and to help reduce the amount of time spent in the hospital following surgery.[44] It is often given as a single dose during surgery by intravenous administration. The adverse effects of taking steroids after surgery on wound healing, blood sugar levels, and in people with diabetes are not completely understood, however it is likely that dexamethasone does not increase the risk of postoperative infections.

Endocrine

Dexamethasone is the treatment for the very rare disorder of glucocorticoid resistance.[45] [46]

In adrenal insufficiency and Addison's disease, dexamethasone is prescribed when the patient does not respond well to prednisone or methylprednisolone.

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.[47]

Pregnancy

Dexamethasone may be given to women at risk of delivering prematurely to promote 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.[48]

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 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.[49] Experimental use of dexamethasone in pregnancy for fetal CAH treatment was discontinued in Sweden when one in five cases had adverse events.[50]

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.[51] [52]

High-altitude illnesses

Dexamethasone is used in the treatment of high-altitude cerebral edema (HACE), as well as high-altitude pulmonary edema (HAPE).[53] It is commonly carried on mountain-climbing expeditions to help climbers deal with complications of altitude sickness.[54] [55]

Nausea and vomiting

Intravenous dexamethasone is effective for 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.[56]

The combination of dexamethasone and a 5-HT3 receptor antagonist such as ondansetron is more effective than a 5-HT3 receptor antagonist alone in preventing postoperative nausea and vomiting.[57]

Sore throat

A single dose of dexamethasone or another steroid speeds improvement of a sore throat.[58]

Contraindications

Contraindications of dexamethasone include,[59] but are not limited to:

Adverse effects

The exact incidence of the adverse effects of dexamethasone is not available, hence estimates have been made as to the incidence of the adverse effects below based on the adverse effects of related corticosteroids and on available documentation on dexamethasone.[60] [61] [62] [63] [64]

Common

Unknown frequency

Withdrawal

Sudden withdrawal after long-term treatment with corticosteroids can lead to:[60]

Interactions

Known drug interactions include:[60]

Pharmacology

Pharmacodynamics

As a glucocorticoid, dexamethasone is an agonist of the glucocorticoid receptor (GR).[65] It is highly selective for the GR over the mineralocorticoid receptor (MR),[66] and in relation to this, has minimal mineralocorticoid activity.[67] [68] This is in contrast to endogenous corticosteroids like cortisol, which bind to and activate both the GR and the MR. Dexamethasone is 25 times more potent than hydrocortisone (cortisol) as a glucocorticoid. Its affinity (Ki) for the GR was about 1.2nM in one study.

The activation of the GR by dexamethasone results in dose-dependent suppression of the hypothalamic–pituitary–adrenal axis (HPA axis) and of production of endogenous corticosteroids by the adrenal glands, thereby reducing circulating endogenous concentrations of corticosteroids like cortisol and corticosterone.

Dexamethasone poorly penetrates the blood–brain barrier into the central nervous system due to binding to P-glycoprotein.[69] However, higher doses of dexamethasone override the export capacity of P-glycoprotein and enter the brain to produce central activation of GRs. In conjunction with the suppression of endogenous corticosteroids by dexamethasone, this results in skewed ratios of activation of peripheral versus central GRs as well as skewed ratios of activation of GRs versus MRs when compared to non-synthetic corticosteroids. These differences can have significant clinical relevance.

Chemistry

Dexamethasone is a synthetic pregnane corticosteroid and derivative of cortisol (hydrocortisone) and is also known as 1-dehydro-9α-fluoro-16α-methylhydrocortisone or as 9α-fluoro-11β,17α,21-trihydroxy-16α-methylpregna-1,4-diene-3,20-dione.[70] [71] The molecular and crystal structure of dexamethasone has been determined by X-ray crystallography.[72] It is a stereoisomer of betamethasone, the two compounds differing only in the spatial configuration of the methyl group at position 16 (see steroid nomenclature).[73]

Synthesis

To synthesize dexamethasone, 16β-methylprednisolone acetate is dehydrated to the 9,11-dehydro derivative.[74] [75] This is then reacted with a source of hypobromite, such as basic N-bromosuccinimide, to form the 9α-bromo-11β-hydrin derivative, which is then ring-closed to an epoxide. A ring-opening reaction with hydrogen fluoride in tetrahydrofuran gives dexamethasone.

History

Dexamethasone was first synthesized by Philip Showalter Hench in 1957.[76] [14] It was introduced for medical use in 1958.[77]

On 16 June 2020, the RECOVERY Trial announced preliminary results stating that dexamethasone improves survival rates of hospitalized patients with COVID-19 receiving oxygen or on a ventilator. Benefits were only observed in patients requiring respiratory support; those who did not require breathing support saw a worse survival rate than the control group, although the difference may have been due to chance.[78] A preprint containing the full dataset was published on 22 June 2020, and demand for dexamethasone surged after publication of the preprint.[79] The preliminary report was published in The New England Journal of Medicine on 18 July 2020.[80] The final report was published in February 2021.[81]

The World Health Organization (WHO) states that dexamethasone should be reserved for seriously ill and critical patients receiving COVID-19 treatment in a hospital setting,[82] and the WHO Director-General stated that "WHO emphasizes that dexamethasone should only be used for patients with severe or critical disease, under close clinical supervision. There is no evidence this drug works for patients with mild disease or as a preventative measure, and it could cause harm."[83] In July 2020, the WHO stated they are in the process of updating treatment guidelines to include dexamethasone or other steroids.[84] In September 2020, the WHO released updated guidance on using corticosteroids for COVID-19.[85] [86]

In July 2020, the European Medicines Agency (EMA) started reviewing results from the RECOVERY study arm that involved the use of dexamethasone in the treatment of patients with COVID-19 admitted to the hospital to provide an opinion on the results and in particular the potential use of dexamethasone for the treatment of adults with COVID-19.[87] [88] In September 2020, the EMA received an application for marketing authorization of dexamethasone for COVID-19.[89]

Society and culture

Price

Dexamethasone is inexpensive.[90] In the United States a month of medication is typically priced less than .[10] In India, a course of treatment for preterm labor is about .[90] The drug is available in most areas of the world.[90]

Nonmedical use

Dexamethasone is given in legal Bangladesh brothels to prostitutes not yet of legal age, causing weight gain aimed at making them appear older and healthier to customers and police.[91]

Dexamethasone and most glucocorticoids are banned by sporting bodies including the World Anti-Doping Agency.[92]

Veterinary use

Combined with marbofloxacin CAS number 115550-35-1and clotrimazole, dexamethasone is available under the name Aurizon, CAS number 50-02-2, and used to treat difficult ear infections, especially in dogs. It can also be combined with trichlormethiazide to treat horses with swelling of distal limbs and general bruising.[93]

External links

Notes and References

  1. Web site: Dexamethasone Juno (Juno Pharmaceuticals Pty Ltd) . . https://web.archive.org/web/20230318025927/https://www.tga.gov.au/resources/prescription-medicines-registrations/dexamethasone-juno-juno-pharmaceuticals-pty-ltd . 18 March 2023 . live.
  2. Web site: Ozurdex- dexamethasone implant . DailyMed . 30 October 2020 . 27 March 2022 . 27 March 2022 . https://web.archive.org/web/20220327232705/https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=4b204f44-6e8a-4d17-803c-268f0b04679f . live .
  3. Web site: Dexamethasone sodium phosphate solution/ drops . DailyMed . 31 July 2020 . 27 March 2022 . 27 January 2022 . https://web.archive.org/web/20220127213839/https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=6bdcefbe-51e3-4ca4-afda-5aeca7b6fa73 . live .
  4. Web site: Dexycu- dexamethasone injection, suspension . DailyMed . 20 December 2021 . 27 March 2022 . 27 March 2022 . https://web.archive.org/web/20220327234559/https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=583d70ed-bc42-465b-983d-c770db58406f . live .
  5. Web site: Ozurdex EPAR . European Medicines Agency (EMA) . 17 September 2018 . 24 October 2020 . 27 October 2020 . https://web.archive.org/web/20201027062744/https://www.ema.europa.eu/en/medicines/human/EPAR/ozurdex . live .
  6. Web site: Neofordex EPAR . European Medicines Agency (EMA) . 25 July 2014 . 24 October 2020 .
  7. Dogra P, Vijayashankar NP . Dexamethasone Suppression Test . StatPearls . 14 September 2020 . 14 September 2020 . 31194457.
  8. Jobe AH, Milad MA, Peppard T, Jusko WJ . Pharmacokinetics and Pharmacodynamics of Intramuscular and Oral Betamethasone and Dexamethasone in Reproductive Age Women in India . Clinical and Translational Science . 13 . 2 . 391–99 . March 2020 . 31808984 . 7070803 . 10.1111/cts.12724.
  9. Book: Wilkinson IB . 13 July 2017 . Oxford Handbook of Clinical Medicine . 176 . OUP Oxford . 978-0-19-968990-3 .
  10. Web site: Dexamethasone. The American Society of Health-System Pharmacists. 29 July 2015. live. https://web.archive.org/web/20170831175940/https://www.drugs.com/monograph/dexamethasone.html. 31 August 2017.
  11. Web site: Dexamethasone Use During Pregnancy. Drugs.com. 9 June 2016. Dexamethasone is only recommended for use during pregnancy when there are no alternatives and benefit outweighs risk.. live. https://web.archive.org/web/20160517153059/http://www.drugs.com/pregnancy/dexamethasone.html. 17 May 2016.
  12. Web site: Prescribing medicines in pregnancy database. Australian Government. 22 April 2014. 3 March 2014. Drugs which have been taken by a large number of pregnant women and women of childbearing age without any proven increase in the frequency of malformations or other direct or indirect harmful effects on the fetus having been observed.. live. https://web.archive.org/web/20140408040902/http://www.tga.gov.au/hp/medicines-pregnancy.htm. 8 April 2014.
  13. Web site: Drugs@FDA: Dexamethasone . U.S. Food and Drug Administration (FDA) . 27 March 2022 . 30 November 2017 . https://web.archive.org/web/20171130231459/https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&ApplNo=011664 . live .
  14. Book: Rankovic Z, Hargreaves R, Bingham M . Drug discovery and medicinal chemistry for psychiatric disorders. 2012. Royal Society of Chemistry. Cambridge. 9781849733656. 286. live. https://web.archive.org/web/20160305022353/https://books.google.ca/books?id=J4Mq3Lm1R7kC&pg=PA286. 5 March 2016.
  15. Book: Fischer J, Ganellin CR . Analogue-based Drug Discovery . 2006 . John Wiley & Sons . 9783527607495 . 485 . 17 June 2020 . 10 January 2023 . https://web.archive.org/web/20230110032815/https://books.google.com/books?id=FjKfqkaKkAAC&pg=PA485 . live .
  16. Book: ((World Health Organization)) . World Health Organization model list of essential medicines: 22nd list (2021) . 2021 . 10665/345533 . World Health Organization . World Health Organization . Geneva . WHO/MHP/HPS/EML/2021.02 . free .
  17. Web site: The Top 300 of 2021 . ClinCalc . 14 January 2024 . 15 January 2024 . https://web.archive.org/web/20240115223848/https://clincalc.com/DrugStats/Top300Drugs.aspx . live .
  18. Web site: Dexamethasone - Drug Usage Statistics . ClinCalc . 14 January 2024.
  19. Web site: Competitive Generic Therapy Approvals . U.S. Food and Drug Administration (FDA) . 29 June 2023 . 29 June 2023 . 29 June 2023 . https://web.archive.org/web/20230629233651/https://www.fda.gov/drugs/generic-drugs/competitive-generic-therapy-approvals . live .
  20. Web site: Till J . Paramedic Clinical Training Aid . 30 August 2011 . dead . https://web.archive.org/web/20120331110331/http://paramedic-info.com/PDA/index.html . 31 March 2012 .
  21. 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 . 6 . International consensus report on the investigation and management of primary immune thrombocytopenia . Blood . 115 . 2 . 168–86 . January 2010 . 19846889 . 10.1182/blood-2009-06-225565 . free .
  22. Schmelzeisen R, Frölich JC . Prevention of postoperative swelling and pain by dexamethasone after operative removal of impacted third molar teeth . European Journal of Clinical Pharmacology . 44 . 3 . 275–77 . 1993 . 8491244 . 10.1007/BF00271371 . 12528750 .
  23. Web site: Croup – Diagnosis & Treatment . Mayo Clinic . 13 October 2017 . Dexamethasone is usually recommended because of its long-lasting effects (up to 72 hours). . 10 October 2017 . https://web.archive.org/web/20171010063045/http://www.mayoclinic.org/diseases-conditions/croup/diagnosis-treatment/drc-20350354 . live .
  24. Reddy A, Liu SH, Brady CJ, Sieving PC, Palestine AG . Corticosteroid implants for chronic non-infectious uveitis . The Cochrane Database of Systematic Reviews . 2023 . 8 . CD010469 . August 2023 . 37642198 . 10464657 . 10.1002/14651858.CD010469.pub4 . 29 August 2024 .
  25. Emami S, Kitayama K, Coleman AL . Adjunctive steroid therapy versus antibiotics alone for acute endophthalmitis after intraocular procedure . The Cochrane Database of Systematic Reviews . 2022 . 6 . CD012131 . June 2022 . 35665485 . 9169535 . 10.1002/14651858.CD012131.pub3 .
  26. Brouwer MC, McIntyre P, Prasad K, van de Beek D . September 2015. Corticosteroids for acute bacterial meningitis . Cochrane Database of Systematic Reviews . 2015 . 9 . CD004405 . 10.1002/14651858.CD004405.pub5 . 6491272 . 26362566 . free .
  27. Roila F, Ballatori E, Ruggeri B, DeAngelis V . Dexamethasone alone or in combination with ondansetron for the prevention of delayed nausea and vomiting induced by chemotherapy . The New England Journal of Medicine . 342 . 21 . 1554–59 . May 2000 . 10824073 . 10.1056/NEJM200005253422102 . free .
  28. Holte K, Kehlet H . Perioperative single-dose glucocorticoid administration: pathophysiologic effects and clinical implications . Journal of the American College of Surgeons . 195 . 5 . 694–712 . November 2002 . 12437261 . 10.1016/s1072-7515(02)01491-6 .
  29. Jessurun CA, Hulsbergen AF, Cho LD, Aglio LS, Nandoe Tewarie RD, Broekman ML . Evidence-based dexamethasone dosing in malignant brain tumors: what do we really know? . J Neurooncol . 144 . 2 . 249–264 . September 2019 . 31346902 . 6700052 . 10.1007/s11060-019-03238-4 . free . doi.
  30. 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 . 6 . 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 . Haematologica . 91 . 11 . 1498–505 . November 2006 . 17043025 .
  31. Web site: Dexamethasone and COVID-19. 22 July 2020. SPS – Specialist Pharmacy Service. 22 July 2020. https://web.archive.org/web/20200722082343/https://www.sps.nhs.uk/articles/dexamethasone-and-covid-19/. dead.
  32. Web site: Corticosteroids. 12 July 2020. COVID-19 Treatment Guidelines. National Institutes of Health. 19 July 2020. https://web.archive.org/web/20200719163110/https://www.covid19treatmentguidelines.nih.gov/immune-based-therapy/immunomodulators/corticosteroids/. live.
  33. Web site: COVID-19 Guideline, Part 1: Treatment and Management. 22 July 2020. Infectious Diseases Society of America. 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)
    Remark: Dexamethasone 6 mg IV or PO for 10 days (or until discharge if earlier) or equivalent glucocorticoid dose may be substituted if dexamethasone unavailable. Equivalent total daily doses of alternative glucocorticoids to dexamethasone 6 mg daily are methylprednisolone 32 mg and prednisone 40 mg.
    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). 6 October 2020. https://web.archive.org/web/20201006214733/https://www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management//. live.
  34. News: 16 June 2020. Dexamethasone reduces death in hospitalized people with severe respiratory complications of COVID-19. University of Oxford. 16 June 2020. 16 June 2020. https://web.archive.org/web/20200616145052/http://www.ox.ac.uk/news/2020-06-16-dexamethasone-reduces-death-hospitalised-patients-severe-respiratory-complications/. live.
  35. 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 . The WHO Rapid Evidence Appraisal for COVID-19 Therapies (REACT) Working Group . 6 . Association Between Administration of Systemic Corticosteroids and Mortality Among Critically Ill Patients With COVID-19: A Meta-analysis . JAMA . September 2020 . 324 . 13 . 1330–1341 . 10.1001/jama.2020.17023 . 32876694 . 7489434 . 221467783 . free .
  36. Corticosteroids in COVID-19 ARDS: Evidence and Hope During the Pandemic . Prescott HC, Rice TW . JAMA . September 2020 . 324 . 13 . 1292–1295 . 10.1001/jama.2020.16747 . 32876693 . 221468015 . free . 2 September 2020 . 3 December 2020 . https://web.archive.org/web/20201203011845/https://jamanetwork.com/journals/jama/fullarticle/2770275 . live .
  37. EMA endorses use of dexamethasone in COVID-19 patients on oxygen or mechanical ventilation . European Medicines Agency (EMA) . 18 September 2020 . 21 September 2020 . 14 February 2021 . https://web.archive.org/web/20210214060918/https://www.ema.europa.eu/en/news/ema-endorses-use-dexamethasone-covid-19-patients-oxygen-mechanical-ventilation . live . Text was copied from this source which is copyright European Medicines Agency. Reproduction is authorized provided the source is acknowledged.
  38. Web site: Public Health Agency of Canada . 23 November 2020 . Ad-hoc COVID-19 Clinical Pharmacology Task Group: Statement on dexamethasone . dead . 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#a5 . 27 December 2020 . 1 April 2022 . Government of Canada .
  39. 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 . 6 . Co-infection and ICU-acquired infection in COIVD-19 ICU patients: a secondary analysis of the UNITE-COVID data set . Critical Care . 26 . 1 . 236 . August 2022 . 35922860 . 9347163 . 10.1186/s13054-022-04108-8 . free .
  40. Meynaar IA, van Rijn S, Ottens TH, van Burgel ND, van Nieuwkoop C . Increased risk of central line-associated bloodstream infection in COVID-19 patients associated with dexamethasone but not with interleukin antagonists . Intensive Care Medicine . 48 . 7 . 954–957 . July 2022 . 35670819 . 9171741 . 10.1007/s00134-022-06750-w .
  41. Scaravilli V, Guzzardella A, Madotto F, Beltrama V, Muscatello A, Bellani G, Monti G, Greco M, Pesenti A, Bandera A, Grasselli G . 6 . Impact of dexamethasone on the incidence of ventilator-associated pneumonia in mechanically ventilated COVID-19 patients: a propensity-matched cohort study . Critical Care . 26 . 1 . 176 . June 2022 . 35698155 . 9191402 . 10.1186/s13054-022-04049-2 . free .
  42. 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 . 6 . Ventilator-associated pneumonia in critically ill patients with COVID-19 . Critical Care . 25 . 1 . 25 . January 2021 . 33430915 . 7797892 . 10.1186/s13054-021-03460-5 . free .
  43. 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 . 6 . Dexamethasone modulates immature neutrophils and interferon programming in severe COVID-19 . Nature Medicine . 28 . 1 . 201–211 . January 2022 . 34782790 . 8799469 . 10.1038/s41591-021-01576-3 . 244132637 .
  44. Polderman JA, Farhang-Razi V, Van Dieren S, Kranke P, DeVries JH, Hollmann MW, Preckel B, Hermanides J . 6 . Adverse side effects of dexamethasone in surgical patients . The Cochrane Database of Systematic Reviews . 11 . 11 . CD011940 . November 2018 . 30480776 . 6426282 . 10.1002/14651858.CD011940.pub3 .
  45. Chrousos GP, Detera-Wadleigh SD, Karl M . Syndromes of glucocorticoid resistance . Annals of Internal Medicine . 119 . 11 . 1113–24 . December 1993 . 8239231 . 10.7326/0003-4819-119-11-199312010-00009 . 4 July 2020 . dead . 26040431 . https://web.archive.org/web/20170814034732/http://annals.org/pdfaccess.ashx?url=%2Fdata%2Fjournals%2Faim%2F19786%2F0000605-199312010-00009.pdf . 14 August 2017 .
  46. Charmandari E, Kino T, Ichijo T, Chrousos GP . Generalized glucocorticoid resistance: clinical aspects, molecular mechanisms, and implications of a rare genetic disorder . The Journal of Clinical Endocrinology and Metabolism . 93 . 5 . 1563–72 . May 2008 . 18319312 . 2386273 . 10.1210/jc.2008-0040 .
  47. Dan L. Longo, Anthony Fauci, Dennis Kasper, Stephen Hauser, J. Jerry Jameson and Joseph Loscalzo, Harrison's Principles of Internal Medicine, 18th edition, p. 3055
  48. Bloom SL, Sheffield JS, McIntire DD, Leveno KJ . Antenatal dexamethasone and decreased birth weight . Obstetrics and Gynecology . 97 . 4 . 485–90 . April 2001 . 11275014 . 10.1016/S0029-7844(00)01206-0 . 33601749 .
  49. Web site: A Prenatal Treatment Raises Questions of Medical Ethics. https://web.archive.org/web/20160831150342/http://content.time.com/time/health/article/0,8599,1996453,00.html. dead. Elton C . 18 June 2010. 31 August 2016. content.time.com.
  50. Hirvikoski T, Nordenström A, Wedell A, Ritzén M, Lajic S . Prenatal dexamethasone treatment of children at risk for congenital adrenal hyperplasia: the Swedish experience and standpoint . The Journal of Clinical Endocrinology and Metabolism . 97 . 6 . 1881–83 . June 2012 . 22466333 . 10.1210/jc.2012-1222 . free .
  51. Hirvikoski T, Nordenström A, Lindholm T, Lindblad F, Ritzén EM, Wedell A, Lajic S . Cognitive functions in children at risk for congenital adrenal hyperplasia treated prenatally with dexamethasone . The Journal of Clinical Endocrinology and Metabolism . 92 . 2 . 542–48 . February 2007 . 17148562 . 10.1210/jc.2006-1340 . free .
  52. Lajic S, Nordenström A, Hirvikoski T . Endocrine Development. Long-term outcome of prenatal dexamethasone treatment of 21-hydroxylase deficiency . 20 . 96–105 . 2011 . 21164263 . 10.1159/000321228 . 978-3-8055-9643-5 .
  53. Simancas-Racines D, Arevalo-Rodriguez I, Osorio D, Franco JV, Xu Y, Hidalgo R . Interventions for treating acute high altitude illness . Cochrane Database Syst Rev . 6 . 12. CD009567 . June 2018 . 29959871 . 6513207 . 10.1002/14651858.CD009567.pub2 .
  54. Book: Cymerman A, Rock PB . Medical Problems in High Mountain Environments. A Handbook for Medical Officers . US Army Research Inst. of Environmental Medicine Thermal and Mountain Medicine Division Technical Report . USARIEM-TN94-2 . https://web.archive.org/web/20170617133159/http://operationalmedicine.org/TextbookFiles/highmountain.pdf#page=19&zoom=auto,-76,314 . dead . 17 June 2017 . 17 June 2020 . 1994 .
  55. Eledrisi MS . First-line therapy for hypertension . Annals of Internal Medicine . 146 . 8 . 615 . April 2007 . 17438328 . 10.7326/0003-4819-146-8-200704170-00021 .
  56. Grape S, Usmanova I, Kirkham KR, Albrecht E . Intravenous dexamethasone for prophylaxis of postoperative nausea and vomiting after administration of long-acting neuraxial opioids: a systematic review and meta-analysis . Anaesthesia . 73 . 4 . 480–89 . April 2018 . 29226971 . 10.1111/anae.14166 . free .
  57. Kovac AL . Meta-analysis of the use of rescue antiemetics following PONV prophylactic failure with 5-HT3 antagonist/dexamethasone versus single-agent therapies . The Annals of Pharmacotherapy . 40 . 5 . 873–87 . May 2006 . 16670361 . 10.1345/aph.1G338 . 32843029 .
  58. Sadeghirad B, Siemieniuk RA, Brignardello-Petersen R, Papola D, Lytvyn L, Vandvik PO, Merglen A, Guyatt GH, Agoritsas T . 6 . Corticosteroids for treatment of sore throat: systematic review and meta-analysis of randomised trials . BMJ . 358 . j3887 . September 2017 . 28931508 . 5605780 . 10.1136/bmj.j3887 .
  59. Web site: Decadron, Dexamethasone Intensol (dexamethasone) dosing, indications, interactions, adverse effects, and more. Medscape Reference. WebMD. 11 December 2013. live. https://web.archive.org/web/20131212220123/http://reference.medscape.com/drug/decadron-dexamethasone-intensol-dexamethasone-342741#showall. 12 December 2013.
  60. Web site: Product Information Dexamethsone (dexamethasone). TGA eBusiness Services. Aspen Pharmacare Australia Pty Ltd. 10 August 2010. 11 December 2013. PDF. 28 January 2017. https://web.archive.org/web/20170128131300/https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2010-PI-06682-3. live. (Accept terms and conditions to open PDF, which doesn't work in archived version)
  61. Web site: Product Information Dexmethsone Injection. TGA eBusiness ServicesAspen Pharmacare Australia Pty Ltd. Aspen Pharmacare Australia Pty Ltd. 2 March 2011. 11 December 2013. PDF. 29 January 2017. https://web.archive.org/web/20170129093042/https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2011-PI-02528-3. live. (Accept terms and conditions to open PDF, which doesn't work in archived version)
  62. Web site: Dexamethasone tablet [ECR Pharmaceuticals]]. DailyMed. ECR Pharmaceuticals. December 2010. 11 December 2013. live. https://web.archive.org/web/20131213040029/http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=428cc7bb-e0f9-466c-b38f-11ac22cda752. 13 December 2013.
  63. Web site: Dexamethasone Tablet BP 2.0 mg – Summary of Product Characteristics (SPC). electronic Medicines Compendium. Merck Sharp & Dohme Limited. 26 January 2018. 17 June 2020. 17 June 2020. https://web.archive.org/web/20200617215029/https://www.medicines.org.uk/emc/product/5411/smpc. live.
  64. Web site: Dexamethasone 4.0 mg/ml injection – Summary of Product Characteristics (SPC). electronic Medicines Compendium. Merck Sharp & Dohme Limited. 4 December 2013. 11 December 2013. dead. https://web.archive.org/web/20150508054341/http://www.medicines.org.uk/emc/medicine/8369/SPC/Dexamethasone+4.0mg+ml+injection/. 8 May 2015.
  65. Cole TJ . Glucocorticoid action and the development of selective glucocorticoid receptor ligands . Biotechnol Annu Rev . Biotechnology Annual Review . 12 . 269–300 . 2006 . 17045197 . 10.1016/S1387-2656(06)12008-6 . 9780444527240 .
  66. Meijer OC, de Kloet ER . A Refill for the Brain Mineralocorticoid Receptor: The Benefit of Cortisol Add-On to Dexamethasone Therapy . Endocrinology . 158 . 3 . 448–454 . March 2017 . 27967238 . 10.1210/en.2016-1495 . 7311584 . free .
  67. Book: De Groot LJ, Chrousos G, Dungan K, Feingold KR, Grossman A, Hershman JM, Koch C, Korbonits M, McLachlan R, New M, Purnell J, Rebar R, Singer F, Vinik A, Nicolaides NC, Pavlaki AN, Maria Alexandra MA, Chrousos GP . Glucocorticoid Therapy and Adrenal Suppression . Endotext . 2000 . MDText.com . 25905379 . https://www.ncbi.nlm.nih.gov/books/NBK279156/ . 17 June 2020 . 1 July 2020 . https://web.archive.org/web/20200701151045/https://www.ncbi.nlm.nih.gov/books/NBK279156/ . live .
  68. Liu D, Ahmet A, Ward L, Krishnamoorthy P, Mandelcorn ED, Leigh R, Brown JP, Cohen A, Kim H . A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy . Allergy, Asthma, and Clinical Immunology . 9 . 1 . 30 . August 2013 . 23947590 . 3765115 . 10.1186/1710-1492-9-30 . free .
  69. De Kloet ER . Why Dexamethasone Poorly Penetrates in Brain . Stress . 2 . 1 . 13–20 . October 1997 . 9787252 . 10.3109/10253899709014734 .
  70. Book: Elks J . The Dictionary of Drugs: Chemical Data: Chemical Data, Structures and Bibliographies. 14 November 2014. Springer. 978-1-4757-2085-3. 366–. live. https://web.archive.org/web/20170215024945/https://books.google.com/books?id=0vXTBwAAQBAJ. 15 February 2017.
  71. Book: Index Nominum 2000: International Drug Directory. January 2000. Taylor & Francis. 978-3-88763-075-1. 310–. live. https://web.archive.org/web/20170824142254/https://books.google.com/books?id=5GpcTQD_L2oC&pg=PA310. 24 August 2017.
  72. Raynor JW, Minor W, Chruszcz M . 2007 . Dexamethasone at 119 K . Acta Crystallographica Section E . 63 . 6 . o2791–93 . 10.1107/S1600536807020806 . 2007AcCrE..63o2791R .
  73. Antignac JP, Le Bizec B, Monteau F, Andre F . Differentiation of betamethasone and dexamethasone using liquid chromatography/positive electrospray tandem mass spectrometry and multivariate statistical analysis . Journal of Mass Spectrometry . 37 . 1 . 69–75 . January 2002 . 11813313 . 10.1002/jms.260 . 2002JMSp...37...69A .
  74. Arth GE, Fried J, ((Johnston DBR)), Hoff DR, Sarett HL, Silber RH, Stoerk HC, Winter CA . Journal of the American Chemical Society . 1958 . 80 . 3161–63 . 12 . 16-Methylated steroids. II. 16α-Methyl analogs of cortisone, a new group of anti-inflammatory steroids. 9α-Halo derivatives . 10.1021/ja01545a063 .
  75. Taub D, Hoffsommer RD, Slates HL, lWendler NL . 16β-Methyl cortical steroids . Journal of the American Chemical Society . 1958 . 80 . 4435 . 16. 10.1021/ja01549a095.
  76. Web site: Dexamethasone. 17 June 2020. 18 June 2020. 1 October 2020. https://web.archive.org/web/20201001110933/https://targetcivils.in/1089/. dead.
  77. Khan MO, Park KK, Lee HJ . Antedrugs: an approach to safer drugs . Current Medicinal Chemistry . 12 . 19 . 2227–39 . 2005 . 16178782 . 10.2174/0929867054864840 .
  78. Web site: 16 June 2020. Dexamethasone in COVID-19. 18 June 2020. www.gpni.co.uk. 17 June 2020. https://web.archive.org/web/20200617192738/https://www.gpni.co.uk/wp-content/uploads/2020/06/DEXAMETHASONE-IN-COVID-19.pdf. live.
  79. Mahase E. June 2020. Covid-19: Demand for dexamethasone surges as RECOVERY trial publishes preprint. BMJ. 369. m2512. 10.1136/bmj.m2512. 32576548. free.
  80. Horby P, Lim WS, Emberson JR, Mafham M, Bell JL, Linsell L, Staplin N, Brightling C, Ustianowski A, Elmahi E, Prudon B, Green C, Felton T, Chadwick D, Rege K, Fegan C, Chappell LC, Faust SN, Jaki T, Jeffery K, Montgomery A, Rowan K, Juszczak E, Baillie JK, Haynes R, Landray MJ . 6 . July 2020 . Dexamethasone in Hospitalized Patients with Covid-19 – Preliminary Report . New England Journal of Medicine . 384 . 8 . 693–704 . 10.1056/NEJMoa2021436 . 32678530 . 7383595 . free . doi .
  81. Horby P, Lim WS, Emberson JR, Mafham M, Bell JL, Linsell L, Staplin N, Brightling C, Ustianowski A, Elmahi E, Prudon B, Green C, Felton T, Chadwick D, Rege K, Fegan C, Chappell LC, Faust SN, Jaki T, Jeffery K, Montgomery A, Rowan K, Juszczak E, Baillie JK, Haynes R, Landray MJ . 6 . Dexamethasone in Hospitalized Patients with Covid-19 . N Engl J Med . 384 . 8 . 693–704 . February 2021 . 32678530 . 7383595 . 10.1056/NEJMoa2021436 . free . doi .
  82. News: 17 June 2020. Important to use dexamethasone only for serious COVID cases – WHO. 18 June 2020. 17 June 2020. https://web.archive.org/web/20200617200600/https://www.reuters.com/article/us-health-coronavirus-who-dexamethasone/important-to-use-dexamethasone-only-for-serious-covid-cases-who-idUSKBN23O2MT. live.
  83. Web site: WHO Director-General's opening remarks at the media briefing on COVID-19. 22 June 2020. 26 June 2020. World Health Organization. 12 September 2020. https://web.archive.org/web/20200912202605/https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---22-june-2020. live.
  84. Web site: Q&A: Dexamethasone and COVID-19. 12 July 2020. World Health Organization (WHO). 11 October 2020. https://web.archive.org/web/20201011115730/https://www.who.int/news-room/q-a-detail/q-a-dexamethasone-and-covid-19/. live.
  85. ((World Health Organization)) . 2020 . Corticosteroids for COVID-19: living guidance, 2 September 2020 . World Health Organization . 10665/334125 . WHO/2019-nCoV/Corticosteroids/2020.1 . 2 September 2020 . 11 October 2020 . https://web.archive.org/web/20201011091829/https://www.who.int/publications/i/item/WHO-2019-nCoV-Corticosteroids-2020.1 . live .
  86. WHO updates clinical care guidance with corticosteroid recommendations . World Health Organization (WHO) . 2 September 2020 . 27 March 2022 . 6 May 2021 . https://web.archive.org/web/20210506094931/https://www.who.int/news-room/feature-stories/detail/who-updates-clinical-care-guidance-with-corticosteroid-recommendations . live .
  87. EMA starts review of dexamethasone for treating adults with COVID-19 requiring respiratory support . European Medicines Agency (EMA) . 24 July 2020 . 27 July 2020 . 30 January 2021 . https://web.archive.org/web/20210130205543/https://www.ema.europa.eu/en/news/ema-starts-review-dexamethasone-treating-adults-covid-19-requiring-respiratory-support . live . Text was copied from this source which is copyright European Medicines Agency. Reproduction is authorized provided the source is acknowledged.
  88. News: EMA to review results from study testing common steroid drug against COVID-19 . Reuters . 24 July 2020 . 27 July 2020 . 27 July 2020 . https://web.archive.org/web/20200727203429/https://www.reuters.com/article/us-health-coronavirus-ema-dexamethasone-idUSKCN24P1KH . live .
  89. Web site: EMA receives application for marketing authorisation of Dexamethasone Taw COVID-19 . European Medicines Agency (EMA) . 2 September 2020 . 2 September 2020 . 3 September 2020 . https://web.archive.org/web/20200903082812/https://www.ema.europa.eu/en/news/ema-receives-application-marketing-authorisation-dexamethasone-taw-covid-19 . live .
  90. Web site: Dexamethasone for Accelerating Lung Maturation in Preterm Babies . 29 July 2015. live. https://web.archive.org/web/20151222111212/http://www.who.int/selection_medicines/committees/expert/19/applications/Dexamethasone_29_C_NI.pdf. 22 December 2015.
  91. Web site: Dummett M . 30 May 2010 . Bangladesh's dark brothel steroid secret . . live . https://web.archive.org/web/20120222194217/http://www.bbc.co.uk/news/10173115 . 22 February 2012 .
  92. Web site: Prohibited In-Competition: Glucocorticoids . World Anti-Doping Agency . 16 July 2018 . 16 July 2018 . https://web.archive.org/web/20180716170139/https://www.wada-ama.org/en/content/what-is-prohibited/prohibited-in-competition/glucocorticoids . dead .
  93. Web site: Trichlormethiazide and Dexamethasone for veterinary use . Wedgewood Pharmacy . 23 January 2008 . live . https://web.archive.org/web/20071212125537/http://www.wedgewoodpharmacy.com/monographs/trichlormethiazide.asp . 12 December 2007 .

This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Dexamethasone".

Except where otherwise indicated, Everything.Explained.Today is © Copyright 2009-2024, A B Cryer, All Rights Reserved. Cookie policy.