Dexamethasone consumption without consultation or prescription of a registered medical practitioner may prove fatal for an asymptomatic patient – or one with mild to moderate Covid-19 symptoms – since the medicine has various side effects.
However, this medicine has proven effective in the treatment of critical Covid-19 patients and may reduce up to one-third of Covid-19 related deaths.
Experts said that there is no way this medicine should be used by the patients themselves. Even physicians too have to prescribe it on a case-by-case basis, since the medicine can suppress the immune system, and possibly make them susceptible to other infections and may even lead to death.
Prof Mosharraf Hossain, chairman of Respiratory Medicine at the Bangabandhu Sheikh Mujib Medical University (BSMMU) told Dhaka Tribune that dexamethasone is basically used on patients who are on life support.
How dexamethasone may prove fatal
Professor Mosharraf Hossain suggested not to use it at home and on asymptomatic, mild, and moderate symptomatic patients since dexamethasone may increase the infection level. He also advised usage of other medicines along with dexamethasone to minimize side effects arising from this medicine, albeit with a doctor’s advice.
“Dexamethasone may increase blood pressure, diabetes, or cause stomach ulcers. In such cases, extra medicines will be required to bring BP, diabetics, and ulcers under control,” Mosharraf said.
“If a doctor does not think about the side effects properly, a patient may die. Earlier we have seen patients dying from side effects arising from the use of hydroxychloroquine, azithromycin and ivermectin,” he added.
Dr Md Mohiuddin Ahmed, head of Respiratory Medicine at Dhaka Medical College Hospital (DMCH) also warned about the unauthorized use of dexamethasone.
He said: “Dexamethasone is a ‘double-edged sword’ type of medicine. Some patients may get a life while some may die due to the use of this medicine. It depends on the condition of a patient.”
“Dexamethasone increases diabetes, hypertension and other side effects. There is no scope to use this medicine without a prescription from a medical practitioner,” he said.
“This is not new. We have been using this medicine for 10-20 years for ICU patients,” he added.
Demand for dexamethasone increases
Recently an Oxford University research found that dexamethasone may reduce up to one-third of Covid-19 related deaths. But It can be used only on severely ill Covid-19 patients.
After the report was published in different media outlets, people rushed to pharmacies to buy the medicine, which increased its demand.
Sumon Biswas, a salesman of Lazz Pharma at Jashimuddin branch in Uttara said: “Some people are asking for dexamethasone from Tuesday evening. Currently, we do not have it in stock. We ordered it as people want it.”
Dr Abdur Rahim, a consultant at Kuwait Bangladesh Friendship Government Hospital, said: “We are using dexamethasone from the very beginning on our patients who are severely ill.”
“The medicine has no use at home. It would be a foolish move to buy this medicine to keep it stored at home and create a shortage, which will lead to price hike,” he said.
When and how dexamethasone can be used
BSMMU Prof Mosarraf Hossain said: “If a patient needs oxygen, at first we use a nasal cannula, then oxygen-masks to meet the oxygen demand. If they need higher levels of oxygen, we use a non-reveder mask and then hypro nasal cannula. If the condition does not improve, at the final stage we send a patient to life support [ventilation]. At this stage, dexamethasone can be used on a patient inside the Incentive Care Unit (ICU).”
“I prescribe 5ml injection three times a day in the first five days and then I divide the doses. These doses are reducing death rates by 20-30%, it is true,” he said.
“I request medical practitioners of all levels to look at the side effects of using dexamethasone, and not to overdose,” he added.
WHO: Steroid should be kept for serious coronavirus cases
A cheap steroid that can help save the lives of patients with severe Covid-19 should be reserved for serious cases, in which it has been shown to provide benefits, the World Health Organization said on Wednesday, reports Reuters.
WHO Chief Tedros Adhanom Ghebreyesus said the research was at last providing “green shoots of hope” in treating the virus, which has killed more than 400,000 people worldwide and infected more than 8 million.
Trial results announced on Tuesday, by researchers in Britain, showed that dexamethasone, a generic drug used since the 1960s to reduce inflammation in diseases such as arthritis, has cut death rates by around a third among the most severely ill coronavirus patients admitted to hospital.
