Dexamethasone in pregnancy: for what is prescribed?

Pregnancy is a period when you need to be extremely selective about taking medication. After all, even the most "harmless" drug can cause irreparable harm to the developing fetus, as well as adversely affect the whole process of gestation. However, there are situations when it is impossible to do without certain drugs: for example, the hormonal drug Dexamethasone is prescribed often enough during pregnancy, despite the fact that the instructions do not contain a recommendation for its use in a given period. Why is this happening, and how does Dexamethasone act on a woman’s body and on the development of an unborn child?

Dexamethasone when planning pregnancy

Dexamethasone is a synthetic analogue of the hormone of the adrenal cortex. It stabilizes the production and exchange of the corresponding hormones, therefore, it is suitable for the correction of hyperandrogenism - an increased content of androgens in the blood. Very often it is the imbalance of these hormonal substances, which are also called "male", that leads to the development of infertility or to spontaneous abortion.

It often happens when a woman is prescribed Dexamethasone when planning a pregnancy, and after that she continues treatment until the baby is born.

Specialists calm the patients who are worried about this appointment: the dose of Dexamethasone, which is prescribed by the doctor, is not so large as to cause negative reactions from the woman’s body or fetus. Much more dangerous is the very state of hyperandrogenism. Therefore, if necessary, the drug is taken on the recommendation of a doctor - after passing all the required tests.

Hyperandrogenism is determined by analyzing 17cc: if values greater than normal are detected, then Dexamethasone is prescribed to normalize testosterone production.

As with pregnancy, the drug is applied to the treatment course, and the dosage is selected individually.

Can I take dexamethasone during pregnancy?

In pregnancy, Dexamethasone is most often used to stimulate the baby’s pulmonary system, or to prevent preterm labor. If preterm labor begins, the doctor injects special medicines to stop it, and then injects Dexamethasone. A timely injection allows you to prepare your lungs for breathing, even if the baby is premature: thanks to this, the baby will be able to inhale independently immediately after birth.

However, the preparation of the lungs is not the only reason why doctors actively use Dexamethasone during pregnancy. Often the period of gestation is interrupted due to the increased production of androgens in the female body - male hormonal substances. To normalize their products and prevent interruptions, use Dexamethasone.

It is advisable to use the drug if the fetus is found a rare deficiency of hormones of the adrenal cortex. Thus, with the help of Dexamethasone, it is possible to prevent the development of diseases of the respiratory system in a baby.

Any adequate doctor will not enter a hormonal drug without appropriate indications. The appointment takes into account possible adverse events, contraindications. Often, Dexamethasone comes to the rescue if the health of the mother and baby is in danger. In such a situation, the doctor may not even consider the presence of contraindications.

[1]

Indications Dexamethasone during pregnancy

Androgen oversupply is not the only indication for using Dexamethasone. During pregnancy, medication may prescribe:

• with a sharp decrease in blood pressure;
• with heart attack, dangerous blood loss, burn injury;
• with severe intoxication;
• with the development of sepsis, purulent meningitis;
• with strong manifestations of toxicosis in the later stages;
• with allergic dermatosis;
• during tumor processes, cerebral edema;
• with pneumonia.

With multiple births, or with the risks of premature birth, Dexamethasone may be prescribed during pregnancy to open the baby’s lungs. If the threat of preterm birth does not exist, then there is no need to use the drug. Dexamethasone prophylaxis during pregnancy is carried out in the amount of 6 mg four times every 12 hours at the first signs of premature onset of labor.

[2], [3]

Pharmacodynamics

Dexamethasone is a representative of semi-synthetic corticosteroids with glucocorticoid activity. During pregnancy, the drug shows anti-inflammatory and immunosuppressive activity, affects the quality of energy and glucose metabolism, affects the factor stimulating the hypothalamus and trophic hormone adenohypophysis.

The principle of action of glucocorticoid drugs has not been fully investigated. Presumably, they act at the cell level. In the cellular cytoplasm there is a pair of receptor systems. By linking to glucocorticoid receptors, corticoids detect anti-inflammatory and immunosuppressive effects, correct glucose metabolism. And through communication with mineralocorticoid receptors, the regulation of the metabolism of sodium, potassium, as well as water-electrolyte balance occurs.

Active glucocorticoid dissolves in lipids and easily enters the cell structure through the cell membrane.

Dexamethasone together with catecholamines, insulin and glucagon provides energy storage and utilization processes. The liver activates the formation of glucose and glycogen. In muscular and other peripheral tissues, the mode of mobilization of amino acids and the careful use of glucose is activated: these substances are necessary for the intrahepatic processes of gluconeogenesis.

Dexamethasone increases renal blood circulation and glomerular filtration rate, slows down the synthesis of vasopressin, potentiates the excretion of acids from the body. At the same time, the contractile activity of the heart muscle and the tone of the peripheral vessels increase.

[4], [5], [6], [7], [8]

Pharmacokinetics

Limit concentrations of Dexamethasone are detected over five minutes with intravenous infusion, and over 60 minutes with intramuscular injection.

With intravenous infusion, the effect of the drug begins instantly, and with intramuscular injection - after eight hours. The period of action of the active ingredient after intramuscular injection can range from 17 to 28 days.

Dexamethasone phosphate is converted to dexamethasone in serum and joint fluid fairly quickly. In serum, about 77% is associated with albumin. Metabolism occurs mostly in the liver, to a lesser extent in the kidneys and other tissues.

The biological half-life can be from 24 to 72 hours. Withdrawal occurs predominantly with urinary fluid.

[9]

Dosing and administration

Dexamethasone is available in:

• in tablet form (0.5 mg each);
• in the form of a solution in ampoules for intramuscular and intravenous injections (4 mg / ml);
• in the form of eye drops;
• in the form of an eye suspension.

The dosage regimen is set individually, taking into account the indications, the patient's well-being and her reaction to the treatment.

In urgent emergencies, dexamethasone is administered intravenously slowly (either by jet injection or drip). In normal practice, the drug is more often administered in the form of intramuscular injections. For dilution of the solution for intravenous infusion using a physiological solution of NaCl, or 5% glucose solution.

Dexamethasone injections intramuscularly is prescribed in an individually selected amount: at first, a somewhat overestimated dose of the drug is administered, then this amount is gradually reduced to the optimal and extremely effective dose. The average dosage may be from 0.5 to 9 mg of the drug per day. The intravenous drip is used in case of premature onset of labor, when the aim is to open the infant’s lungs with an incomplete formation of the respiratory system. Sometimes additional administration of the drug may be required immediately before delivery.

How many times can you prick Dexamethasone during pregnancy? There is no definite answer to this question, since the appointment is always individual and is selected for each specific case separately. Some women are given a one-time medication, and in other situations, treatment is required throughout the entire period of pregnancy. Long-term treatment is usually carried out using a dexamethasone tablet form.

Tablets are taken in the morning or before bedtime, or twice a day, in an individually determined amount. The average single amount of the drug - ½ tablet. Such a treatment regimen is most often used, when at first a woman takes an excessive dosage, which is gradually reduced and, if necessary, reduced to "no." With the expected long period of treatment, intramuscular injections are first administered, then the patient is transferred to maintenance therapy with Dexamethasone tablets.

There is also a form of medication in the form of an ophthalmic solution. Dexamethasone eye drops are not prohibited during pregnancy, but they are used only if you have a medical recommendation: for iritis or iridocyclitis, bacterial conjunctivitis. Drops do not have systemic effects, and their local use does not harm pregnancy and the fetus. Apply Dexamethasone up to 3 times a day, 1-2 drops in the affected eye (unless the doctor has appointed otherwise).

In case of bronchitis, pneumonia, asthma, laryngeal edema, the doctor may recommend inhalation medication. Dexamethasone inhalation during pregnancy is allowed, but the procedures are performed under medical supervision, and the entire period of inhalation treatment should not exceed 7-10 days.

Eye drops, or suspension-drops, in some cases, it is allowed to drip into the nasal cavity - for example, during sinusitis, rhinopharyngitis, pollinosis. Dexamethasone in the nose during pregnancy can alleviate the course of allergic rhinitis, reduce inflammation and intoxication. However, such drops can not be applied more than 3 times a day, and more than seven days in a row. Moreover, the medication should not be used without valid indications - for example, in case of a common cold, when it is possible to use safer drugs.

[17]

Cancellation of treatment

Many women who have to take the drug for a long time are worried: how will Dexamethasone cancel during pregnancy? Indeed, this question is relevant, since it is impossible to stop treatment with this medicine abruptly. Dexamethasone is canceled as smoothly as possible, moving to ¼ from the usual dosage for 10 days. What is it for? The bottom line is that the human body independently produces hormones that are similar in structure to Dexamethasone. Against the background of drug treatment, the hormone's own production is suppressed: the principle of feedback is activated. With abrupt cancellation of therapy, the body does not have time to adapt to the disturbed hormonal status. As a result, hypocorticism develops. Manifestations of such a pathological condition consist in the fact that the previously present problems are quickly exacerbated, laboratory indicators deteriorate, and blood pressure drops are observed. To avoid all this, care must be taken to stop taking Dexamethasone.

Sometimes, when removing the threat of interruption, the medication is canceled, and then a repeated course of Dexamethasone is prescribed during pregnancy. This should not be frightening: repeated treatment may be offered approximately 3-4 weeks after the first and is considered safe.

[18], [19], [20], [21], [22]

Dexamethasone at different stages of pregnancy

Let's summarize a little. Dexamethasone in clinical practice can be used in such situations:

• Danger to woman's life. Dexamethasone can be included in the resuscitation scheme with a strong allergic process, with cerebral edema, as well as in the event that another life-threatening condition develops (bronchospasm, a complicated attack of bronchial asthma).
• Risk of miscarriage. Dexamethasone in early pregnancy is prescribed to prevent premature termination of the gestation process, or to inhibit such interruption at the initial stage of its development (if hyperandrogenism becomes the cause of this pathology - increased production of male sex hormones).
• Danger of preterm labor. If there is a risk that the child will be born prematurely and will be premature, then Dexamethasone is connected to speed up the adaptation of the infant's respiratory system to an independent respiratory function.
• Disorders in the development of the fetus. Dexamethasone in late pregnancy will be prescribed without fail if the fetus is diagnosed with congenital intrauterine hyperplasia of the adrenal cortex. This is a relatively rare pathology that requires mandatory medical correction.
• Autoimmune disease in women. Dexamethasone is included in the schedule of appointments during pregnancy, if a woman has a complicated course of dermatosis, connective tissue diseases, rheumatoid arthritis, and severe endocrine disorders.
• Malignant pathology during pregnancy. Dexamethasone is used as a drug that inhibits the division of abnormal cells.

In some cases, the doctor includes in the treatment regimen Dexamethasone as a prophylactic agent, preventing the recurrence of autoimmune pathology. Such an appointment is considered not so much in terms of the negative impact on the course of pregnancy or fetal development, but in terms of preventing a sharp exacerbation of the disease, which can cause much greater damage than the use of the drug.

[23], [24], [25],

Contraindications

Dexamethasone during pregnancy will not be prescribed if the patient suffers from at least one of the following conditions:

• ulcerative processes in the digestive tract (stomach, intestines);
• gastritis, gastroduodenitis;
• systemic osteoporosis;
• acute infectious processes;
• HIV infection;
• psychotic disorders;
• heart disease;
• tendency to hypertension;
• increased intraocular pressure;
• diabetes;
• kidney disease;
• overweight;
• chronic insufficient kidney and / or liver function;
• thyrotoxicosis.

The list of contraindications is quite extensive, so the doctor must find out all possible painful conditions in a woman, so that Dexamethasone during pregnancy has only a positive effect.

[10], [11], [12], [13]

Side effects Dexamethasone during pregnancy

The severity of side effects during treatment with Dexamethasone depends on the dose of the drug being taken. As the patients themselves tell, the most frequent are such undesirable manifestations:

• metabolic changes (increased sweating, swelling, an increase in fat mass, mainly in the upper half of the body, elevated levels of calcium, potassium, sodium in the blood);
• endocrine changes (adrenal hypofunction, increased sensitivity to sugar-containing products);
• changes in the central nervous system (neurosis, convulsions, orientation disorders, migraine-like pains, dizziness, depressions, sleep disorders);
• digestive disorders (nausea, bloating, change in appetite);
• violations of the heart and blood vessels (bradyarrhythmia, thrombosis, heart failure);
• allergic processes;
• osteoporosis;
• withdrawal syndrome

[14], [15], [16]

Overdose

Overdose occurs rarely and manifests itself in an acute form: so far only isolated cases have been recorded.

As a rule, an excess of the drug reveals itself as an increase in adverse events - most often Cushing's syndrome develops.

The specific antidote is not defined today. The treatment is carried out taking into account the identified symptoms, prescribe also supportive drugs.

Hemodialysis is considered ineffective and does not accelerate the elimination of Dexamethasone from the circulatory system.

[26], [27], [28]

Interactions with other drugs

Dexamethasone is not mixed in the same syringe or drip system with any other drugs, but only with physiological NaCl solution or 5% glucose solution.

Dexamethasone should not be taken orally with non-steroidal anti-inflammatory drugs to avoid irritating the digestive system.

Macrolide drugs, ketoconazole can increase the concentration of dexamethasone in the blood plasma. Phenytoin, Ephedrine, Phenobarbital - on the contrary, reduce the effect of the medication.

Dexamethasone reduces the therapeutic effect of antidiabetic and antihypertensive drugs, but increases the activity of heparin and albendazole.

When used in combination, the effectiveness of coumarin anticoagulants may be impaired.

Duphaston and Dexamethasone are medicines that are often prescribed together. This combination may slightly change the half-life of the glucocorticoid and enhance its biological effect. The clinical significance of this effect has not been determined.

It is prohibited to use Dexamethasone and Ritordin together during labor, as this may cause pulmonary edema in the parturient.

The combination of Dexamethasone and Thalidomide can cause toxic epidermal necrolysis.

[29]

Storage conditions

Dexamethasone is stored in normal room conditions, in rooms with a temperature range from +15 to + 25 ° C, away from children's access, from direct sunlight and heating devices. Do not subject the drug to freezing.

[30]

Shelf life

Dexamethasone ampoules can be stored for up to five years.

[31],

Analogs: what can replace Dexamethasone during pregnancy

Dexamethasone belongs to synthetic glucocorticosteroids, is a methylated fluoroprednisolone derivative. The drug interacts with certain cytoplasmic receptors, with the formation of a system that induces protein synthesis.

Dexamethasone is involved:

• in protein metabolism, reducing the number of plasma globulins, increasing the formation of albumin in the kidneys and liver, accelerating protein catabolism in muscle tissues;
• in fat metabolism, increasing the production of triglycerides and higher fatty acids, redistributing fat in the body;
• in carbohydrate metabolism, increasing the absorption of carbohydrates in the digestive system, stimulating glucose-6-phosphatase, activating phosphoenolpyruvate carboxylase and the production of aminotransferases;
• in water-salt metabolism, retaining sodium ions and water, stimulating the excretion of potassium ions, reducing the absorption of calcium ions from the digestive tract, reducing the degree of bone mineralization.

The following drugs are considered structural analogues of Dexamethasone:

• Decadron
• Dexazon
• Dexon
• Maxidex

Often prescribed during the preparation of the female body for pregnancy or in the process of gestation, the hormonal drug Metipred does not belong to structural analogues, since its active substance is methylprednisolone. These medicines are not interchangeable, have different efficacy in different pathological spectra.

[32], [33], [34], [35], [36]

Usage Reviews

Usually reviews on the Internet are left by women who are faced with the need to use Dexamethasone during pregnancy or when planning it. The necessity of taking the medication almost always justifies itself: expectant mothers can successfully carry out the child, who is born without disturbances from the respiratory system.

Positive feedback from patients confirms the opinions of doctors who do not advise to neglect the use of Dexamethasone, if there are valid reasons for his appointment. The medical specialist who prescribes this drug always weighs all the risks and dangers, takes into account contraindications: there is no doubt about this, because the doctor is fully responsible for the life and health of the woman and her future baby.

The use of Dexamethasone in pregnancy has been practiced for many years, and its effect on the body has been studied quite carefully. Therefore, such treatment can be considered safe if it is really necessary.