Dexamethasone tablets and liquid: uses and steroid safety

Dexamethasone is a corticosteroid, which the NHS describes as a copy of a hormone the body makes naturally. It reduces swelling and calms the immune system. The NHS lists severe skin conditions, severe allergies including anaphylaxis, sickness, croup, eye inflammation and autoimmune conditions such as lupus among its uses, along with severe COVID-19, serious infections, side effects of cancer treatment and symptom control at the end of life. It comes as tablets, soluble tablets and drinkable liquid, and in hospital as an injection. UK brand names listed on the NHS page include Neofordex, Glensoludex and Martapan.

Most people take dexamethasone once a day, in the morning with or straight after breakfast, so it does not disturb sleep. Some people take it two or three times a day, with the last dose before six in the evening, and some conditions use every-other-day dosing. The NHS notes adult doses span a wide range and children's doses are calculated from height and weight. For croup in children it is usually a single one-off dose.

If you take it once a day and remember on the same day, take it then; if you only remember the next day, skip it. For several daily doses, take it at once unless the next is close. Never double up. One or two extra tablets once are unlikely to harm; contact NHS 111 if symptoms arise or excessive doses continue for days.

The NHS says people taking dexamethasone for more than three weeks, or above a stated daily amount, are given a blue steroid card. People using it for Addison disease, congenital adrenal hyperplasia, adrenal insufficiency or pituitary disorders carry a red steroid emergency card. Show whichever card you hold to any doctor, dentist or nurse treating you.

The NHS lists weight gain, indigestion, sleep problems and mild mood changes as common, and says these are less likely at lower daily doses. Eat a healthy balanced diet without increasing portion sizes, take tablets with meals, and use morning dosing for sleep.

Serious effects are more likely at higher doses or beyond a month. Contact a doctor about a rounded face with weight gain on the upper back or belly. Call NHS 111 or a doctor for infection signs, adrenal symptoms (severe nausea, dizziness, weakness), high blood sugar signs, low potassium symptoms, severe abdominal or back pain, breathlessness, limb swelling, vision change or unusual bleeding. Call 999 for vomiting black or bloody material, anaphylaxis or suicidal thoughts.

• 999: black or bloody vomit, throat swelling, thoughts of self-harm.

• NHS 111: fever, sore throat, painful urination, extreme thirst or fruity breath.

Several months or more of treatment can weaken bones and raise fracture risk, cause eyesight problems, and disturb blood sugar control in people with diabetes, who may need more frequent glucose checks. Children may grow more slowly, and clinicians monitor height and weight; growth usually recovers afterwards.

The NHS says most adults and children, including babies, can take dexamethasone. Tell your doctor about previous allergy, recent contact with shingles, chickenpox or measles, active infection or unhealed wounds, liver or kidney disease, mental health history, past tuberculosis, high blood pressure, heart failure or recent heart attack, diabetes, epilepsy, glaucoma, underactive thyroid, osteoporosis, stomach ulcers, myasthenia gravis, recent or planned vaccines, or pregnancy plans. Live vaccines are unsuitable; non-live flu, shingles and polio vaccines are safe options.

The NHS says dexamethasone can be used in pregnancy after discussion with your doctor, because steroids are commonly used and most doctors recommend continuing them. Your doctor may suggest switching to prednisolone, which is less likely to reach the baby, and extra scans may check growth late in pregnancy. Breastfeeding is generally fine for a healthy baby. No evidence suggests it reduces fertility.

Dexamethasone is prescription only. It does not affect contraception. Suspected side effects can be reported through the Yellow Card scheme.