Relevance
The benefit of using dexamethasone or betamethasone in pregnant women at risk of preterm birth has been shown in countries with high health care costs.
However, the cost-effectiveness of this intervention in countries with low health care costs is unknown. A new study assessed the effectiveness and safety of antenatal glucocorticoid use in women in countries with low health care costs.
Side effects of dexamethasone[edit | edit code]
Expected side effects in sports
- Severe acne
- Muscle and ligament ruptures
- Problems with the gastrointestinal tract
- Adrenal dysfunction
- Fluid retention
Systemic side effects
From the nervous system and sensory organs:
delirium (confusion, agitation, restlessness), disorientation, euphoria, hallucinations, manic/depressive episode, depression or paranoia, increased intracranial pressure with optic papilla congestion syndrome (pseudotumor cerebri - more common in children, usually after too rapid dose reduction, symptoms - headache, decreased visual acuity or double vision); sleep disturbance, dizziness, vertigo, headache; sudden loss of vision (with parenteral administration in the head, neck, turbinates, scalp), formation of posterior subcapsular cataracts, increased intraocular pressure with possible damage to the optic nerve, glaucoma, steroid exophthalmos, development of secondary fungal or viral eye infections.
From the cardiovascular system and blood (hematopoiesis, hemostasis):
arterial hypertension, development of chronic heart failure (in predisposed patients), myocardial dystrophy, hypercoagulation, thrombosis, ECG changes characteristic of hypokalemia; with parenteral administration: flushing of the face.
From the gastrointestinal tract:
nausea, vomiting, erosive and ulcerative lesions of the gastrointestinal tract, pancreatitis, erosive esophagitis, hiccups, increased/decreased appetite.
From the side of metabolism:
Na+ and water retention (peripheral edema), hypokalemia, hypocalcemia, negative nitrogen balance due to protein catabolism, weight gain.
From the endocrine system:
suppression of adrenal cortex function, decreased glucose tolerance, steroid diabetes mellitus or manifestation of latent diabetes mellitus, Itsenko-Cushing syndrome, hirsutism, irregular menstruation, growth retardation in children.
From the musculoskeletal system:
muscle weakness, steroid myopathy, decreased muscle mass, osteoporosis (including spontaneous bone fractures, aseptic necrosis of the femoral head), tendon rupture; pain in muscles or joints, back; with intra-articular injection: increased pain in the joint.
From the skin:
steroid acne, stretch marks, skin thinning, petechiae and ecchymosis, delayed wound healing, increased sweating.
Allergic reactions:
skin rash, hives, facial swelling, stridor or difficulty breathing, anaphylactic shock.
Other side effects of dexamethasone:
decreased immunity and activation of infectious diseases, withdrawal syndrome (anorexia, nausea, lethargy, abdominal pain, general weakness, etc.).
Local reactions after parenteral administration:
burning, numbness, pain, paresthesia and infection at the injection site, scarring at the injection site; hyper- or hypopigmentation; atrophy of the skin and subcutaneous tissue (with intramuscular injection).
Eye shapes:
with long-term use (more than 3 weeks), it is possible to increase intraocular pressure and/or develop glaucoma with damage to the optic nerve, decreased visual acuity and loss of visual fields, the formation of posterior subcapsular cataracts, thinning and perforation of the cornea; possible spread of herpes and bacterial infections; Patients with hypersensitivity to dexamethasone or benzalkonium chloride may develop conjunctivitis and blepharitis.
Local reactions (when using ocular and/or ear forms):
irritation, itching and burning of the skin; dermatitis.
results
- The study included 2852 women and their 3070 fetuses. The women were observed in hospitals in Bangladesh, India, Kenya, Nigeria and Pakistan.
- The study was completed earlier than planned because the second interim analysis showed a clear benefit from steroid therapy.
- Neonatal death occurred in 278 of 1417 infants (19.6%) in the dexamethasone group and in 331 of 1406 infants (23.5%) in the placebo group (relative risk, 0.84; 95% CI, 0.72-0. 97; P=0.03).
- Stillbirth or neonatal death occurred in 393 of 1532 fetuses and infants (25.7%) in the dexamethasone group and in 444 of 1519 fetuses and infants (29.2%) in the placebo group (relative risk, 0.88; 95% CI, 0.78-0.99; P=0.04).
- The incidence of maternal bacterial infection was 4.8% with dexamethasone compared with 6.3% in the control group (relative risk, 0.76; 95% CI, 0.56-1.03).
- According to the safety analysis, there were no significant differences between the groups in the frequency of side effects.
Dexamethasone. Instructions for use.[edit | edit code]
Dexamethasone
is a glucocorticosteroid, which, according to Yuri Bombela, can be used in bodybuilding to suppress the secretion of cortisol. This is a grave mistake, since dexamethasone exhibits the same catabolic activity as cortisol, that is, it will lead to muscle breakdown, the development of brittle bones and fat deposition. Skin lesions develop quickly and immunity decreases. This is tantamount to introducing exogenous cortisol into the body, which will also suppress adrenal function.
Glucocorticoids are indeed used in sports and bodybuilding (Dexamethasone, Beclomethasone, Prednisolone), but only for a short-term increase in endurance (since this group belongs to stress hormones), as well as suppressing inflammation and pain when joints and ligaments are damaged. Drugs in this group destroy muscle tissue.
Use of Dexamethasone in sports.
● Briefly about the main thing. This drug is in demand in strength sports. It increases appetite and retains water. But along with the positive effects, dexamethasone has many side effects. And now more about this drug. ● Full article Dexamethasone is one of the most powerful hormonal drugs based on glucocorticosteroids. Glucocorticosteroids are synthetic drugs, analogues of endogenous (own) hormones produced by the adrenal cortex. Thus, using dexamethasone, you simply inject synthetic adrenal hormones into yourself. In contrast to anabolic steroids, the use of glucocorticosteroids is much more dangerous and is fraught with many serious side effects. However, dexamethasone is in great demand in all sports, especially in strength sports. Why is this so: - Firstly, this drug is much cheaper than anabolic steroids. — Secondly, it is sold in pharmacies without a prescription (although, in theory, this is a violation). Positive qualities of the drug 1. Anti-inflammatory effect This is its most important benefit in sports. There are no professional athletes who do not have pain in some joint or tendon. And the main cause of such pain is inflammation. Dexamethasone can literally relieve all joint pain within a day. It doesn’t matter where the inflammation is or what its cause is. The effect of dexamethasone will be the same. 2. Water retention In dosages slightly higher than the minimum, dexamethasone retains water in the body. The higher the dosage, the longer the delay. When water retention is small (1 - 2 liters), it has a very good effect on the joints. The joints are better lubricated, which again further reduces inflammation and leads to a decrease or complete disappearance of pain. In addition, joints that are better lubricated wear out less. But if you overdo it with dosages, then water retention can easily turn from a positive effect into a negative effect. Tested on myself (there was a delay of 3 - 4 liters of water). You will become clumsy and clumsy. Blood pressure will increase, there will be problems with sleep, etc. 3. Increased appetite Personally, I noticed an increase in appetite, even with small dosages, by about 20% - 30%. I want to eat more and more often. And the more you eat, the faster you will recover between workouts. In general, the spectrum of effects on the body of dexamethasone (as with any hormonal drugs) is very wide. But we, as athletes, are only interested in the 3 properties listed above. And so far everything looks very good, doesn’t it? Your appetite will increase, your pain will disappear, your joints will be better lubricated and wear out less! Beauty! But there are also side effects. Negative qualities of the drug 1. Decreased immunity Glucocorticosteroids directly affect the suppression of the immune system. I would say this is the most important side effect. Especially for athletes. But there is also good news. At average and below average dosages, this effect is rather weakly expressed. Go is not expressed at all. 2. Toxic effects on the stomach This “side” only occurs if you take dexamethasone tablets. But this action is quite pronounced. Food will be digested much worse and more slowly. Constant bloating. In some cases, even ulcers or worsening ulcers are possible. In general, when I took dexamethasone in tablets, I hated it. This is despite the fact that I have a fairly strong stomach. Therefore, my advice to you: use dexamethasone only in ampoules. This way you will protect yourself from at least one side effect. 3. Protein Catabolism In other words, dexamethasone will destroy your muscles! Sounds very ominous! In fact, everything is not so scary. Let's start with the fact that small dosages have a rather weak effect on protein catabolism. But this effect is easily eliminated by simply consuming a little more protein per day. Personally, when I used dexamethasone both in tablets and ampoules, I did not notice any decrease in muscle mass at all. Dosages Now we come to the most interesting part of the article. The instructions for dexamethasone indicate such a wide range of dosages that you absolutely do not understand how much to use. Moreover, dosages for athletes are not indicated there, but only various clinical cases are indicated. But for sports purposes, in most cases, dosages much lower than most of those indicated in the annotation are sufficient. If you want to relieve inflammation, joint pain and feel a little waterlogged, use a MAXIMUM of 2 mg per day! Tablets usually contain 0.5 mg of active ingredient per tablet. Ampoules – 4 mg in one ampoule. If you want to take 2 mg of dexamethasone per day, then: - Or 2 tablets in the morning and evening, - Or one ampoule every 2 days. But I advise you to start with lower dosages. Start with 1 mg per day: - Or 1 tablet morning and evening, Source: Fundamentals and nuances of sports pharmacology. Author Timko Ilya
Dexamethasone
Glucocorticosteroid (GCS) is a methylated derivative of fluoroprednisolone, inhibits the release of interleukin-1 and interleukin-2, interferon gamma from lymphocytes and macrophages. It has anti-inflammatory, antiallergic, desensitizing, antishock, antitoxic and immunosuppressive effects.
Suppresses the release of adrenocorticotropic hormone (ACTH) and beta-lipotropin by the pituitary gland, but does not reduce the content of circulating beta-endorphin. Inhibits the secretion of thyroid-stimulating hormone (TSH) and follicle-stimulating hormone (FSH).
Increases the excitability of the central nervous system (CNS), reduces the number of lymphocytes and eosinophils, increases the number of red blood cells (stimulates the production of erythropoietins).
Interacts with specific cytoplasmic receptors, forms a complex that penetrates the cell nucleus, stimulates the synthesis of mRNA, which induces the formation of proteins, incl. lipocortin, which mediate cellular effects. Lipocortin inhibits phospholipase A2, suppresses the release of arachidonic acid and suppresses the synthesis of endoperoxides, Pg, leukotrienes, which contribute to inflammation, allergies, etc.
Protein metabolism:
reduces the amount of protein in plasma (due to globulins) with an increase in the albumin/globulin ratio, increases the synthesis of albumins in the liver and kidneys; enhances protein catabolism in muscle tissue.
Lipid metabolism:
increases the synthesis of higher fatty acids and triglycerides (TG), redistributes fat (accumulation of fat mainly in the shoulder girdle, face, abdomen), leads to the development of hypercholesterolemia.
Carbohydrate metabolism:
increases the absorption of carbohydrates from the gastrointestinal tract (GIT); increases the activity of glucose-6-phosphatase, leading to an increase in the flow of glucose from the liver into the blood; increases the activity of phosphoenolpyruvate carboxylase and the synthesis of aminotransferases, leading to the activation of gluconeogenesis.
Water-electrolyte metabolism:
retains Na+ and water in the body, stimulates the excretion of K+ (MCS activity), reduces the absorption of Ca2+ from the gastrointestinal tract, “washes out” Ca2+ from the bones, increases the excretion of Ca2+ by the kidneys.
The anti-inflammatory effect is associated with inhibition of the release of inflammatory mediators by eosinophils; inducing the formation of lipocortin and reducing the number of mast cells that produce hyaluronic acid; with a decrease in capillary permeability; stabilization of cell membranes and organelle membranes (especially lysosomal ones).
The antiallergic effect develops as a result of suppression of the synthesis and secretion of allergy mediators, inhibition of the release of histamine and other biologically active substances from sensitized mast cells and basophils, a decrease in the number of circulating basophils, suppression of the development of lymphoid and connective tissue, a decrease in the number of T- and B-lymphocytes, mast cells, reducing the sensitivity of effector cells to allergy mediators, inhibiting antibody formation, changing the body's immune response.
In chronic obstructive pulmonary disease (COPD), the action is based mainly on inhibition of inflammatory processes, inhibition of development or prevention of swelling of the mucous membranes, inhibition of eosinophilic infiltration of the submucosal layer of the bronchial epithelium, deposition of circulating immune complexes in the bronchial mucosa, as well as inhibition of erosion and desquamation of the mucous membrane . Increases the sensitivity of beta-adrenergic receptors of small and medium-caliber bronchi to endogenous catecholamines and exogenous sympathomimetics, reduces the viscosity of mucus by inhibiting or reducing its production.
Antishock and antitoxic effects are associated with an increase in blood pressure (due to an increase in the concentration of circulating catecholamines and restoration of the sensitivity of adrenergic receptors to them, as well as vasoconstriction), a decrease in the permeability of the vascular wall, membrane protective properties, and activation of liver enzymes involved in the metabolism of endo- and xenobiotics.
The immunosuppressive effect is due to inhibition of the release of cytokines (interleukin1, interleukin2; interferon gamma) from lymphocytes and macrophages.
Suppresses the synthesis and secretion of ACTH, and secondarily the synthesis of endogenous corticosteroids. Inhibits connective tissue reactions during the inflammatory process and reduces the possibility of scar tissue formation.
The peculiarity of the action is significant inhibition of pituitary function and the almost complete absence of MCS activity. Doses of 1-1.5 mg/day inhibit the adrenal cortex; biological T1/2 - 32-72 hours (duration of inhibition of the hypothalamus-pituitary-adrenal cortex system).
In terms of the strength of glucocorticosteroid activity, 0.5 mg of dexamethasone corresponds to approximately 3.5 mg of prednisone (or prednisolone), 15 mg of hydrocortisone or 17.5 mg of cortisone.
