Potential Adverse Effects of Dexamethasone Therapy on COVID-19 Patients: Review and Recommendations

Abstract

In the context of the coronavirus disease 2019 (COVID-19) pandemic, the global healthcare community has raced to find effective therapeutic agents against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). To date, dexamethasone is the first and an important therapeutic to significantly reduce the risk of death in COVID-19 patients with severe disease. Due to powerful anti-inflammatory and immunosuppressive effects, dexamethasone could attenuate SARS-CoV-2-induced uncontrolled cytokine storm, severe acute respiratory distress syndrome and lung injury. Nevertheless, dexamethasone treatment is a doubleedged sword, as numerous studies have revealed that it has significant adverse impacts later in life. In this article, we reviewed the literature regarding the adverse effects of dexamethasone administration on different organ systems as well as related disease pathogenesis in an attempt to clarify the potential harms that may arise in COVID-19 patients receiving dexamethasone treatment. Overall, taking the threat of COVID-19 pandemic into account, we think it is necessary to apply dexamethasone as a pharmaceutical therapy in critical patients. However, its adverse side effects cannot be ignored. Our review will help medical professionals in the prognosis and follow-up of patients treated with dexamethasone. In addition, given that a considerable amount of uncertainty, confusion and even controversy still exist, further studies and more clinical trials are urgently needed to improve our understanding of the parameters and the effects of dexamethasone on patients with SARS-CoV-2 infection.

Preliminary study regarding the predicted body weight-based dexamethasone therapy in patients with COVID-19 pneumonia

“…The efficacy of corticosteroid therapy at the dose using mg/kg based on the actual bodyweight was controversial [ 19 ]. Indeed, obesity and DM often recognized in overweight patients are the risks of severe COVID-19 according to previous reports, and hyperglycemia and infection are the major concerns related to the administration of corticosteroids [ 16 , 17 , 20 ]. Indeed, not only cytokine storm but also multiple mechanisms including respiratory dysfunction, pro-thrombotic environment, blocked autophagy, and fat deposition due to obesity are contributing to the poor prognosis of obese patients with COVID-19 [ 12 , 21 ].…”

Treatment paradigms in Parkinson's Disease and Covid-19

“…The use of corticosteroids has been connected to a potential neuropsychiatric impairment with about 2-60% of patients presenting with mood swings, depression, mania, suicidality, anxiety, confusion, and behavior changes, along with impairment of their sleep pattern ( Chen et al, 2021 ; Dubovsky, Arvikar, Stern, & Axelrod, 2012 ; Noreen, Maqbool, & Madni, 2021 ). The term “steroid psychosis,” which is often used in the literature to describe such phenomena, is considered by many rather misleading, as neuropsychiatric impairment exhibits a vast diversity of symptoms.…”

Dexamethasone-Loaded Ureasil Hydrophobic Membrane for Bone Guided Regeneration

“…However, it has disadvantages due to its hydrophobicity, lack of selectivity, and low bioavailability, requiring high doses to reach the therapeutic level. Therefore, it may result in undesirable side effects, such as osteoporosis, increased blood sugar concentration, hypertension, and stomach and intestinal bleeding [ 5 ].…”