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dexamethasone

 
American Heritage Dictionary:

dex·a·meth·a·sone

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(dĕk'sə-mĕth'ə-sōn', -zōn') pronunciation
n.
A synthetic glucocorticoid used primarily in the treatment of inflammatory disorders.

[dexa- (blend of DECA-HEXA-) + METH(YL) + probably alteration of (CORTI)SONE.]


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Gale Encyclopedia of Cancer:

Dexamethasone

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Key Terms: Addison's disease, Elute, Glucocorticoid, Hyperglycemia, Induction therapy, Palliation.

Definition

Dexamethasone is a synthetic glucocorticoid. Its naturally occuring counterparts are hydrocortisone and cortisone. Although the drug is used in a variety of ways, in general, it reduces inflammation and depresses the immune system. Dexamethasone may also be called by its brand name, Decadron.

Purpose

Dexamethasone is used in the treatment of many disorders. For example, it may be used:

  • as replacement therapy in the treatment of Addison's disease
  • in the management of various inflammatory disorders, such as rheumatoid arthritis
  • to coat drug-eluting stents, which are devices used in treating coronary artery disease to reduce the chance that previously clogged arteries will become blocked again
  • in managing such allergic disorders as asthma
  • as induction therapy prior to stem cell transplantation

Patients with ulcerative colitis may benefit from dexamethasone therapy, as might those with exacerbations of multiple sclerosis. Such blood disorders as thrombocytopenic purpura or erythroblastopenia, may also be managed with dexamethasone.

Dexamethasone is often prescribed to patients with cancer. In some cases, the drug is part of the drug treatment for the disease, and in other cases it is used to manage side effects caused by the treatment or the cancer itself. For example, dexamethasone may be given to treat nausea and vomiting associated with chemotherapy.

Dexamethasone may be used to decrease abnormally high levels of potassium that develop in association with cancer. In some cases, it may be used as palliation in leukemia or lymphoma. Because of its antiinflammatory properties, dexamethasone may help reduce swelling in the brain caused by a brain tumor. It may also help prevent hypersensitivity reactions associated with drugs like paclitaxel. Dexamethasone is also commonly used to treat nausea associated with chemotherapy. It is particularly useful with the drug cisplatin, which frequently causes nausea and vomiting.

In non-Hodgkin's lymphoma (NHL), dexamethasone is part of a drug regimen known as DHAP. Here, dexamethasone is given with chemotherapy drugs called cisplatin and cytarabine. Also in treating NHL, dexamethasone may be used in a regimen caled "m-BACOD," which also includes the administration of methotrexate, leucovorin, bleomycin, doxorubicin, cyclophosphamide, and vincristine. Dexamethasone may also be helpful in patients with multiple myeloma. In the EDAP regimen, dexamethasone is given with etoposide, cytosine arabinoside (cytarabine), and cisplatin; in VAD, it is given with vincristine and doxorubicin.

Description

Patients should not stop taking dexamethasone without first consulting their physician. When dexamethasone treatment stops, it must be gradually reduced over time before it can be completely discontinued. Sudden withdrawal of glucocorticoids may result in adrenal insufficiency.

When possible, the drug should be taken before nine A.M. to imitate the time that the body's corticosteroid levels are typically at their highest. A child taking dexamethasone will be carefully monitored to ensure the drug is not affecting his or her growth. Patients taking large doses of dexamethasone should try to take the drug with meals. Antacids may be recommended between meals to reduce gastrointestinal effects and to prevent peptic ulcer.

Recommended Dosage

Dexamethasone is available in oral, intravenous (IV), topical, ophthalmic, or inhaled form. In cancer patients, the oral and IV routes are used most frequently. The pill is available in several color-coded dosages [0.25 milligrams (mg), 0.5mg, 0.75mg, 1.5mg, 4mg, and 6mg]. Dexamethasone should be given very slowly by the IV route.

Dosages to treat disease are highly individualized, but generally start at 0.75 to 9.0 mg per day. The lowest therapeutic dose should be given, though amounts given may need to be increased during times of stress. Dosages of medications may be changed based on factors specific to the individual. The following dosages are general guidelines for dexamethasone when it is used in conjunction with chemotherapy agents:

  • DHAP. Forty milligrams of dexamethasone is given in pill or IV form per day for the first four days of treatment, followed by cisplatin and cytarabine.
  • M-BACOD. Six milligrams per meter square (mg/m2) of dexamethasone is given as a pill on the first five days of treatment.
  • EDAP. Forty milligrams of dexamethasone is given in pill form on the first four days of treatment. It is given again on days 9-12, and 17-20.

When used to prevent or manage nausea or vomiting associated with chemotherapy, dexamethasone is given in the following dosages: 4–20 mg IV every 4–6 hours. Alternatively, a one-time dose of 10–20 mg may be given IV. When pills are preferred, 4–8 mg of dexamethasone may be given four times, every four hours. When used to prevent hypersensitivity reactions in paclitaxel treatment, 20mg should be given orally twelve and six hours before treatment begins.

Precautions

Dexamethasone should be used cautiously in patients with kidney or liver problems, hypothyroidism, high blood pressure, or a history of heart attack. Patients with diabetes mellitus should monitor blood sugar levels carefully, as hyperglycemia may result. If changes occur, patients should notify their doctors immediately. Sudden cessation of dexamethasone therapy is dangerous for patients on therapy for longer than two weeks. The drug should be gradually withdrawn under a physician's guidance.

Side Effects

Adverse effects vary widely, and depend on the dosage and route of the drug. Certain drugs may result in decreased blood levels, and therefore render dexamethasone less effective. Patients taking the following drugs should be carefully monitored for decreased levels of dexamethasone: phenytoin, phenobarbitol, ephedrine, and rifampin. Conversely, some drugs, such as troleandomycin, may increase blood levels of dexamethasone.

Because of its immunosuppressive properties, dexamethasone may decrease the signs and symptoms of infection. Depending on the amount of drug being administered, patients may consider taking measure to prevent infection by avoiding crowded areas and washing their hands frequently. Patients should inform their doctor if they notice a fever, sore throat, or cuts or abrasions that don't heal. Laboratory tests may also be affected—false negative results may occur in the nitroblu-tetrazolium test for bacterial infections.

Glucocorticoids, such as hydrocortisone, tend to make the body retain salt. Although dexamethasone's salt-retaining properties are not as severe as hydrocortisone's, salt retention may result in fluid and electrolyte imbalances. Patients at risk may experience high blood pressure or even congestive heart failure. Weight gain or swelling may indicate salt and fluid retention.

Other adverse effects may include headache, dizziness, insomnia, increased appetite, mood swings, menstrual changes, muscle weakness, acne and/or sweating. Depression may be worsened with dexamethasone use. Some men experience changes in the motility and number of their sperm with steroid treatment. Patients should talk to their doctors about any unusual symptoms they experience. In cancer patients, increased appetite may actually be beneficial.

Dexamethasone crosses the placenta and is excreted in breast milk. If a pregnant woman is taking large doses of the drug, her newborn should be monitored for evidence of hypoadrenalism. Optimally, breast-feeding should be avoided. There is some concern that dexamethasone, in large quantities, suppresses growth or disrupts the baby's normal corticosteroid production.

Interactions

Patients should discuss all their medications, prescription and non-prescription, with their doctor. If dexamethasone is administered in amounts that suppress the immune system, live vaccines, such as small pox, should not be administered. Dexamethasone may alter the effect of anticoagulant drugs. Frequent laboratory tests should be performed to monitor blood levels. If dexamethasone is given with diuretics, potassium levels may be abnormally low, and should be frequently monotired. Doctors may recommend that patients on long-term therapy follow a potassium-rich diet.

Resources

Books

Wilson, Billie A., Margaret T. Shannon, and Carolyn L. Stang. Nurses Drug Guide 2000. Stamford, CT: Appleton & Lange, 2000.

Periodicals

Hesketh, P. J. "New Treatment Options for Chemotherapy-Induced Nausea and Vomiting." Supportive Care in Cancer 12 (August 2004): 550–554.

Kumar, S., M. Q. Lacy, A. Dispenzieri, et al. "Single-Agent Dexamethasone for Pre-Stem Cell Transplant Induction Therapy for Multiple Myeloma." Bone Marrow Transplantation 34 (September 2004): 485–490.

Liu, X., I. de Scheerder, and W. Desmet. "Dexamethasone-Eluting Stent: An Anti-Inflammatory Approach to Inhibit Coronary Restenosis." Expert Review of Cardiovascular Therapy 2 (September 2004): 653–660.

Organizations

American Society of Health-System Pharmacists (ASHP). 7272 Wisconsin Avenue, Bethesda, MD 20814. (301) 657-3000. .

United States Food and Drug Administration (FDA). 5600 Fishers Lane, Rockville, MD 20857-0001. (888) INFOFDA. .

—Tamara Brown, R.N.; Rebecca J. Frey, PhD

Drug Info:

Dexamethasone

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Brand names: AK-Dex®, Cortastat®, Cortastat® L.A., Cortidex™, Cortidex™ L.A., Dalalone D.P®, Dalalone L.A®, Dalalone®, Deca 4™, Deca L.A. 8™, Decadron®, Decadron-LA®, Dexacort® PH Turbinaire, Dexacort® Respihaler, Dexone L.A.®, DexPak™ TaperPak, Maxidex®, Ocu-Dex®, Primethasone™, Primethasone™ L A, Robadex™ LA, Solurex™

Chemical formula:



Dexamethasone ear solution

What is dexamethasone ear solution?

DEXAMETHASONE (Decadron®) is a corticosteroid. It helps to reduce swelling, redness, itching, and allergic reactions. Dexamethasone treats inflammatory conditions of the outer ear. Generic dexamethasone ear solution is not yet available.

What should I tell my health care provider before I take this medicine?

They need to know if you have any of these conditions:
• history of middle ear infections
• infection; fungal, viral, tubercular or other bacterial
• perforated ear drum
• an unusual or allergic reaction to dexamethasone, corticosteroids, other medicines, foods, dyes, or preservatives

How should I use this medicine?

Dexamethasone ear solution is for use in the ear only. Do not take by mouth. Follow the directions on the prescription label. Wash hands before and after use. Lie on your side or tilt head so that ear is up. Pull the earlobe up and back (adults), or down and back (children), and drop in the prescribed number of drops (usually 4—5 drops); avoid touching the ear with the dropper tip. Keep head tilted for about 5 minutes or insert a soft cotton gauze 'wick' in the ear to prevent the medication from running out. Replace the cotton at least once a day. Do not use more often than directed.

Contact your pediatrician or health care professional regarding the use of this medicine in children. Special care may be needed.

What drug(s) may interact with dexamethasone?

It is unlikely that when dexamethasone is used in the ear it will interact with medicines taken by mouth. However, tell your prescriber or health care professional about all other medicines you are taking, including non-prescription medicines, nutritional supplements, or herbal products. Also tell your prescriber or health care professional if you are a frequent user of drinks with caffeine or alcohol, if you smoke, or if you use illegal drugs. These may affect the way your medicine works. Check with your health care professional before stopping or starting any of your medicines.

What should I watch for while taking dexamethasone?

Check with your prescriber or health care professional if your condition has not improved after 2 or 3 days. Check with your prescriber or health care professional before using dexamethasone for any future ear problems.

What side effects may I notice from using dexamethasone?

If dexamethasone is used for long periods of time other serious side effects may develop. Report any other unusual effects to your prescriber or health care professional as soon as you can.

Side effects that usually do not require medical attention (report to your prescriber or health care professional if they continue or are bothersome):
• burning or stinging in the ear

Where can I keep my medicine?

Keep out of the reach of children.

Store at room temperature between 15 and 30 degrees C (59 and 86 degrees F); do not freeze. Throw away any unused medicine after the expiration date.

Last updated: 7/1/2002

Important Disclaimer: The drug information provided here is for educational purposes only. It is intended to supplement, not substitute for, the diagnosis, treatment and advice of a medical professional. This drug information does not cover all possible uses, precautions, side effects and interactions. It should not be construed to indicate that this or any drug is safe for you. Consult your medical professional for guidance before using any prescription or over the counter drugs.

Oxford A-Z of Medicinal Drugs:

dexamethasone

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A corticosteroid with anti-inflammatory activity. It is used for the treatment of inflammatory conditions (including rheumatic disease) and nausea and vomiting associated with cancer chemotherapy and it is injected intravenously to treat shock and cerebral oedema (swelling of the brain). Dexamethasone is also used in the diagnosis of Cushing's disease. A prescription only medicine, it is available as tablets or an oral solution, as a solution for intravenous injection or local injection into joints or around tendons, as eye drops or ointment, and as ear drops.

Side effects:
see corticosteroids. In addition, perineal or scrotal irritation and pain can occur if intravenous injections are given too rapidly.

Precautions and interactions with other drugs:
see corticosteroids.

Proprietary preparations:
Dexsol (oral solution); Maxidex (eye drops); Minims Dexamethasone (single-dose eye drops); Maxitrol (combined with neomycin, polymyxin B sulphate, and hypromellose); Otomize (combined with acetic acid and neomycin sulphate); Sofradex (combined with framycetin sulphate and gramicidin); Tobradex (combined with tobramycin).

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Oxford Dictionary of Biochemistry:

dexamethasone

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9α-fluoro-16α-methylprednisolone; a synthetic glucocorticoid with negligible mineralocorticoid activity that has actions similar to adrenal corticosteroids.





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Saunders Veterinary Dictionary:

dexamethasone

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A synthetic glucocorticoid used primarily as an anti-inflammatory agent in various conditions, including autoimmune diseases, hypersensitivity reactions and shock; it is also used in a screening test for the diagnosis of cushing's syndrome, and for the termination of pregnancy in cattle.

  • d. suppression test — the determination of blood cortisol levels before and after administration of dexamethasone assists in diagnosing Cushing's syndrome and identifying the cause, depending on the protocol and dose used. Dexamethasone suppresses pituitary secretion of ACTH in normal animals and therefore the blood level of cortisol is decreased; low doses do not suppress cortisol levels in dogs with pituitary-dependent Cushing's syndrome, high doses do. Cortisol production by functional adrenal tumors is not affected by dexamethasone.
Wikipedia on Answers.com:

Dexamethasone

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Dexamethasone
Systematic (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
Clinical data
AHFS/Drugs.com monograph
MedlinePlus a682792
Pregnancy cat. C(US)
Legal status ℞ Prescription only
Routes Oral, IV, IM, SC and IO
Pharmacokinetic data
Bioavailability 80-90%
Protein binding 70%
Metabolism hepatic
Half-life 36-54 hours
Excretion renal
Identifiers
CAS number 50-02-2 YesY
ATC code A01AC02 C05AA09, D07AB19, H02AB02, R01AD03, S01BA01, S02BA06, S03BA01
PubChem CID 5743
DrugBank DB01234
ChemSpider 5541 YesY
UNII 7S5I7G3JQL YesY
KEGG D00292 YesY
ChEBI CHEBI:41879 YesY
ChEMBL CHEMBL384467 YesY
Chemical data
Formula C22H29FO5 
Mol. mass 392.461 g/mol
SMILES eMolecules & PubChem
 N(what is this?)  (verify)

Dexamethasone is a potent synthetic member of the glucocorticoid class of steroid drugs. It acts as an anti-inflammatory and immunosuppressant. When taken orally, it is 26.6 times more potent than the naturally occurring hormone cortisol and 6.6 times more potent than prednisone.

Contents

Therapeutic use

Anti-inflammatory

Dexamethasone is used to treat many inflammatory and autoimmune conditions, such as rheumatoid arthritis and bronchospasm.[1] Idiopathic thrombocytopenic purpura, decreased numbers of platelets due to an immune problem, responds to 40 mg daily for 4 days; it may be administered in 14-day cycles. It is unclear whether dexamethasone in this condition is significantly better than other glucocorticoids.[2]

It is also given in small amounts[3] (usually 5-6 tablets) before and/or after some forms of dental surgery, such as the extraction of the wisdom teeth, an operation which often leaves the patient with puffy, swollen cheeks.

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 post-eye surgery drops – and as a nasal spray (trade name Dexacort), and certain ear drops (Sofradex, when combined with an antibiotic and an antifungal).

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 is often administered before antibiotics in cases of bacterial meningitis. It then acts to reduce the inflammatory response of the body to the bacteria killed by the antibiotics (bacterial death releases pro-inflammatory mediators that can cause a response which is harmful to the patient), thus improving prognosis and outcome.[4]

Oncologic uses

Cancer patients undergoing chemotherapy are given dexamethasone to counteract certain side-effects of their antitumor treatment. Dexamethasone can augment the antiemetic effect of 5-HT3 receptor antagonists like ondansetron.

In brain tumours (primary or metastatic), dexamethasone is used to counteract the development of edema, which could eventually compress other brain structures. Dexamethasone is also given in cord compression where a tumor is compressing the spinal cord.

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),[5] or a combination of Adriamycin (doxorubicin) and vincristine (VAD).

Endocrine

Dexamethasone is the treatment for the very rare disorder of glucocorticoid resistance.[6][7]

In adrenal insufficiency and Addison's disease, dexamethasone is prescribed when the person doesn't respond well to prednisone or methylprednisolone.

Obstetrics

Dexamethasone may be given to women at risk of delivering prematurely in order to promote maturation of the fetus' lungs. This has been associated with low birth weight, although not with increased rates of neonatal death.[8]

High altitude illnesses

Dexamethasone is used in the treatment of high altitude cerebral edema as well as pulmonary edema. It is commonly carried on mountain climbing expeditions to help climbers deal with altitude sickness. British mountain climber Peter Kinloch was provided with a shot of dexamethasone shortly before his death, after summiting Mount Everest.[9][10]

Off-label use

Congenital adrenal hyperplasia

Dexamethasone has been used as an off-label pre-natal treatment for the symptoms of congenital adrenal hyperplasia (CAH) in female fetuses. CAH causes a variety of physical abnormalities, notably ambiguous genitalia in girls. Early pre-natal CAH treatment has been shown to reduce some CAH symptoms, but it does not treat the underlying congenital disorder.

A 2007 Swedish clinical trial found that treatment may cause cognitive and behavioural defects, but the small number of test subjects means the study cannot be considered definitive. Administration of pre-natal dexamethasone has been the subject of controversy over issues of informed consent and because treatment must predate a clinical diagnosis of CAH in the female fetus. The treatment has also raised concerns in the LGBT community following an essay[11] posted to the forum of the Hastings Center, a think tank devoted to bioethics, which quoted published research that suggested that pre-natal treatment of female fetuses could prevent those fetuses from becoming lesbians after birth, may make them more likely to engage in "traditionally" female-identified behaviour and careers, and more interested in bearing and raising children. Referring to a prospective father who attempted to mitigate the effects of the fraternal birth order effect on increasing the chances of homosexuality in male children by using a surrogate mother, the essay suggests that pre-natal "dex" treatments constitute the first known attempt to use an in utero method to attempt to reduce the incidence of homosexuality in humans.[12]

A medical consensus in 2010 by the Endocrine Society and affiliated organizations indicated that prenatal dexamethasone for CAH should be regarded as experimental and should only be used in Institutional Review Board-approved controlled clinical trials at centers large enough to collect meaningful data.[13]

Abuses

Dexamethasone has also been used in the hope of enhancing sports performance.[14]

Long term use of dexamethasone under the brand name Oradexon is widespread among prostitutes in Bangladesh in spite of the dangers, because it helps them develop fat easily.[15][16]

Diagnostic use

Dexamethasone is also used in a diagnostic context, namely in its property to suppress the natural pituitary-adrenal axis.

Patients presenting with clinical signs of glucocorticoid excess (Cushing's syndrome) are generally diagnosed by a 24-hour urine collection for cortisol or by a dexamethasone suppression test. During the latter, the response of the body to a high dose of glucocorticoids is monitored. Various forms are performed. In the most common form, a patient takes a nighttime dose of either 1 or 4 mg of dexamethasone, and the serum cortisol levels are measured in the morning. If the levels are relatively high (over 5 µg/dL or 150 nmol/L), then the test is positive and the patient has an autonomous source of either cortisol or ACTH, indicating Cushing's syndrome where the tumor does not have a feedback mechanism. If ACTH levels are lowered by at least 50%, this would indicate Cushing's disease, since the pituitary adenoma has a feedback mechanism that has been reset to a higher level of cortisol. Longer versions rely on urine collections on oral dexamethasone over various days.

Veterinary use

Combined with marbofloxacin and clotrimazole, dexamethasone is available under the name Aurizon , CAS number 115550-35-1, 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.[17]

Contraindications

Some of these contraindications are relative:

Side effects

If dexamethasone is given orally or by injection (parenteral) over a period of more than a few days, side-effects common to systemic glucocorticoids may occur. These may include:

  • Stomach upset, increased sensitivity to stomach acid to the point of ulceration of esophagus, stomach, and duodenum
  • Increased appetite leading to significant weight gain
  • A latent diabetes mellitus often becomes manifest. Glucose intolerance is worsened in patients with preexisting diabetes.
  • Immunsuppressant action, particularly if given together with other immunosuppressants such as cyclosporine. Bacterial, viral, and fungal disease may progress more easily and can become life-threatening. Fever as a warning symptom is often suppressed.
  • Psychiatric disturbances, including personality changes, irritability, euphoria, mania
  • Osteoporosis under long term treatment, pathologic fractures (e.g., hip)
  • Muscle atrophy, negative protein balance (catabolism)
  • Elevated liver enzymes, fatty liver degeneration (usually reversible)
  • Cushingoid (syndrome resembling hyperactive adrenal cortex with increase in adiposity, hypertension, bone demineralization, etc.)
  • Depression of the adrenal gland is usually seen, if more than 1.5 mg daily are given for more than three weeks to a month.
  • Hypertension, fluid and sodium retention, edema, worsening of heart insufficiency (due to mineral corticoid activity)
  • Dependence with withdrawal syndrome is frequently seen.
  • Increased intraocular pressure, certain types of glaucoma, cataract (serious clouding of eye lenses)
  • Dermatologic: Acne, allergic dermatitis, dry scaly skin, ecchymoses and petechiae, erythema, impaired wound-healing, increased sweating, rash, striae, suppression of reactions to skin tests, thin fragile skin, thinning scalp hair, urticaria.
  • Allergic reactions (though infrequently): Anaphylactoid reaction, anaphylaxis, angioedema.

Other side effects have been noted, and should cause concern if they are more than mild.

The short time treatment for allergic reaction, shock, and diagnostic purposes usually does not cause serious side effects.

Novelist Michael Cox believed his first book, The Meaning of Night was a side effect of prescription Dexamethasone giving him both "formidable energy" while quelling his creative doubts.[18]

Interactions

  • NSAIDs and alcohol: increased risk of gastrointestinal ulceration
  • Mineralocorticoids: increased risk of hypertension, edema and heart problems
  • Oral antidiabetic drugs and insulin: antidiabetic therapy may have to be adjusted

Other interactions (with certain antibiotics, estrogens, ephedrine, digoxin) are known.

Dosage

  • Shock: 4 to 8 mg intravenously initially, repeat if necessary to a total dose of 24 mg.
  • Autoimmune diseases and inflammations: longterm therapy with 0.5 to 1.5 mg oral per day. Avoid more than 1.5 mg daily, because serious side effects are more frequently encountered with higher doses.
  • Adjuvant to or part of chemotherapy: individual schedule
  • Diagnostic purposes: special schedule

Synthesis

To synthesise dexamethasone, 16β-methylprednisolone acetate is dehydrated to the 9,11 dehydro derivative. 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.[19] [20]

Dexamethasone synth.png

References

  1. ^ Till, John. "Paramedic Clinical Training Aid". http://paramedic-info.com/PDA/index.html. Retrieved 30 August 2011. 
  2. ^ Provan D, Stasi R, Newland AC, et al. (January 2010). "International consensus report on the investigation and management of primary immune thrombocytopenia". Blood 115 (2): 168–86. doi:10.1182/blood-2009-06-225565. PMID 19846889. http://bloodjournal.hematologylibrary.org/content/115/2/168.full. 
  3. ^ Schmelzeisen R, Frölich JC (2004). "Prevention of postoperative swelling and pain by dexamethasone after operative removal of impacted third molar teeth". European Journal of Clinical Pharmacology 44 (3): 275–277. doi:10.1007/BF00271371. PMID 8491244. http://www.springerlink.com/content/m6158q104028nkl5/. 
  4. ^ van de Beek D, de Gans J, McIntyre P, Prasad K (2007). Van De Beek, Diederik. ed. "Corticosteroids for acute bacterial meningitis". Cochrane Database Syst Rev (1): CD004405. doi:10.1002/14651858.CD004405.pub2. PMID 17253505. http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD004405/frame.html. 
  5. ^ Harousseau, JL; Attal, M; Leleu, X; Troncy, J; Pegourie, B; Stoppa, AM; Hulin, C; Benboubker, L et al. (2006). "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. PMID 17043025. http://www.haematologica.org/cgi/reprint/91/11/1498. 
  6. ^ Chrousos GP, Detera-Wadleigh SD, Karl M (December 1993). "Syndromes of glucocorticoid resistance". Ann Intern Med 119 (11): 1113–24. doi:10.1059/0003-4819-119-11-199312010-00009. PMID 8239231. http://www.annals.org/content/119/11/1113.full. 
  7. ^ Charmandari E, Kino T, Ichijo T, Chrousos GP (May 2008). "Generalized Glucocorticoid Resistance: Clinical Aspects, Molecular Mechanisms, and Implications of a Rare Genetic Disorder". J Clin Endocrinol Metab 93 (5): 1563–72. doi:10.1210/jc.2008-0040. PMC 2386273. PMID 18319312. http://jcem.endojournals.org/cgi/content/full/93/5/1563. 
  8. ^ Bloom SL, Sheffield JS, McIntire DD, Leveno KJ (2001). "Antenatal dexamethasone and decreased birth weight" (– Scholar search). Obstet Gynecol 97 (4): 485–90. doi:10.1016/S0029-7844(00)01206-0. PMID 11275014. http://www.greenjournal.org/cgi/content/full/97/4/485. [dead link]
  9. ^ Cymerman, A; Rock, PB. Medical Problems in High Mountain Environments. A Handbook for Medical Officers. USARIEM-TN94-2. US Army Research Inst. of Environmental Medicine Thermal and Mountain Medicine Division Technical Report. http://archive.rubicon-foundation.org/7976. Retrieved 2010-09-06. 
  10. ^ "First-Line Therapy for Hypertension". Annals of Internal Medicine 146 (8): 615. April 17, 2007. http://www.annals.org/cgi/reprint/146/8/615.pdf. 
  11. ^ Dreger, Alice. "Preventing Homosexuality (and Uppity Women) in the Womb?". http://www.thehastingscenter.org/Bioethicsforum/Post.aspx?id=4754&blogid=140. Retrieved 11 October 2011. 
  12. ^ Elton, Catherine (2010-06-18). "A Prenatal Treatment Raises Questions of Medical Ethics". TIME. http://www.time.com/time/health/article/0,8599,1996453,00.html?xid=rss-mostpopular. Retrieved 2010-07-05. 
  13. ^ . http://www.nxtbook.com/tristar/endo/day4_2010/index.php?startid=8. 
  14. ^ "FIS Doping Control statement on Kowalcyzk (Digitized version)". June 13, 2005. http://www.fis-ski.com/data/document/info-kowalczyk.pdf. Retrieved July 30, 2006. 
  15. ^ "A new danger for sex workers in Bangladesh". The Guardian. 5 April 2010. http://www.guardian.co.uk/society/2010/apr/05/sex-workers-bangladesh-steroid. 
  16. ^ "Bangladesh's dark brothel steroid secret". BBC News. 30 May 2010. http://news.bbc.co.uk/2/hi/world/south_asia/10173115.stm. 
  17. ^ "Trichlormethiazide and Dexamethasone for veterinary use". Wedgewood Pharmacy. http://www.wedgewoodpharmacy.com/monographs/trichlormethiazide.asp. Retrieved 2008-01-23. 
  18. ^ The Times 4 April 2009 Michael Cox: Publisher's editor who scored a...
  19. ^ Arth, Glen E.; Fried, John; Johnston, David B. R.; Hoff, Dale R.; Sarett, Lewis H.; Silber, Robert H.; Stoerk, Herbert C.; Winter, Charles A. (1958). Journal of the American Chemical Society 80 (12): 3161. doi:10.1021/ja01545a063. 
  20. ^ Taub, D.; Hoffsommer, R. D.; Slates, H. L.; Wendler, N. L. (1958). Journal of the American Chemical Society 80 (16): 4435. doi:10.1021/ja01549a095. 

External links
Mineralocorticoids
(3-one, 4-ene,
no FG at 16)
Glucocorticoids
(3-one, 4-ene,
11-FG,
17-hydroxy)
Pregnenedione
(+20-one)
Rimexolone • HALOGENATED, WITH FG AT 16: Flunisolide • Triamcinolone • Amcinonide • Fluocinolone acetonide (Fluocinonide)
Pregnadienediol
(+21-hydroxy)
Prednisone (Meprednisone) • HALOGENATED AT 9: Fluorometholone • HALOGENATED, WITH FG AT 16: Fluocortolone (Clocortolone, Diflucortolone, Fluocortin) • Desoximetasone
Pregnadienetriol
(+11-hydroxy)
Pregnatriene
(+2-ene)
Other/ungrouped
HALOGENATED: Loteprednol • HALOGENATED, WITH FG AT 16: Fludroxycortide • Formocortal • Mometasone furoate
Aldosterone antagonists
Synthesis modifiers
Stomatological preparations (A01)
Caries prophylactic agents
Anti-infectives and antiseptics
Corticosteroids (Glucocorticoids)
Dexamethasone • Hydrocortisone • Triamcinolone
Other
Antihemorrhoidals for topical use
Antivaricose therapy
Capillary stabilising agents
Decongestants and other nasal preparations (R01)
Topical
Antiallergic agents,
excluding corticosteroids
Other nasal preparations
Systemic use:
Sympathomimetics

M: RES

anat(n, x, l, c)/phys/devp

proc, drug(R1/2/3/5/6/7)
Anti-infectives
Corticosteroids
Analgesics and anesthetics

M: EAR

anat(e/p)/phys/devp

proc, drug(S2)

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American Heritage Dictionary. The American Heritage® Dictionary of the English Language, Fourth Edition Copyright © 2007, 2000 by Houghton Mifflin Company. Updated in 2009. Published by Houghton Mifflin Company. All rights reserved.  Read more
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Drug Info. Gold Standard. Copyright © 2008 by Gold Standard. All rights reserved.  Read more
 Oxford A-Z of Medicinal Drugs. Market University Press. © 2000, 2003, 2010 An A-Z of Medicinal Drugs. All rights reserved.  Read more
 Oxford Dictionary of Biochemistry. Oxford University Press. Oxford Dictionary of Biochemistry and Molecular Biology © 1997, 2000, 2006 All rights reserved.  Read more
Saunders Veterinary Dictionary. Saunders Comprehensive Veterinary Dictionary 3rd Edition. Copyright © 2007 by D.C. Blood, V.P. Studdert and C.C. Gay, Elsevier. All rights reserved.  Read more
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