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 COVID-19: Risks in self-medicating with dexamethasone
COVID-19: Risks in self-medicating with dexamethasone

COVID-19 and the Risks in Self-Medicating with Dexamethasone

Self-medication, classically defined as "the taking of drugs, herbs or home remedies on one's initiative, or on the advice of another person, without consulting a doctor," is a public health problem seen all over the world.

In Ghana, it is estimated that one in every two Ghanaians is known to self-medicate with drugs obtained from pharmacies or herbal remedies from traditional healers.

The cost of medical care, the long wait times at hospitals, the ease of getting drugs from pharmacies, and the influence of family and friends are reasons for this practice. Often, the most significant dangers are posed by the side-effects of the drugs.

Ghanaians are known to try self-medicating to prevent and treat most ailments, even COVID-19, the global pandemic that has infected over 8 million people and killed over 440,000 since it broke out last year in Wuhan, China.

Social media is rife with all manner of remedies like inhalation of steam or drinking of Neem extracts. Hydroxychloroquine has been used too.

Last week, the Recovery Trial team at Oxford University in the UK reported that the drug dexamethasone reduced mortality in patients with severe COVID-19.

With this announcement, there is a risk that Ghanaians might consider self-medicating with dexamethasone to prevent or even treat COVID-19. However, due to the drug's side effect profile, self-medicating with it carries grave risks that need to be elucidated.

Dexamethasone belongs to a class of drugs called corticosteroids. These drugs are synthetic versions of a hormone called cortisol produced by the adrenal glands in the body.

Cortisol is released by the human body to prepare us for stressful situations and encounters. Cortisol increases blood pressure, breaks down carbohydrates, fats, and proteins to produce glucose and boost energy for stressful situations. It is also anti-inflammatory and an immunosuppressant.

For decades, doctors have used corticosteroids to treat inflammatory conditions like sepsis, cytokine storms, acute respiratory distress syndrome (ARDS), allergies, asthma, and autoimmune diseases like lupus and rheumatoid arthritis.

In the severe form of COVID-19, pneumonia can lead to ARDS (an inflammatory condition marked by the lungs filling with fluid), and a cytokine storm (an excessive immune response).

Pneumonia, ARDS, and the cytokine storm can lead to problems in oxygen uptake. These patients end up needing oxygen therapy either through masks or with the help of ventilators.

Corticosteroids like dexamethasone are givenorally and intravenously to suppress the excessive inflammation and immune response, a treatment that researchers at Oxford studied in over 2000 patients with severe COVID-19.

Per the news release from Oxford, dexamethasone showed no effect on the mild disease. It was also not used as a prophylactic to prevent one from contracting COVID-19 either.

It was most effective in patients with severe disease who needed oxygen therapy. Due to these facts and the side-effects of all corticosteroids, self-medicating with any of them to prevent COVID-19 or to treat the mild form carries grave risks.

Most often, patients with severe COVID-19 who need oxygen therapy have overwhelming inflammatory effects of the disease. This can be measured by inflammatory markers in the blood.

If these hyper-inflammatory conditions are not present, then taking a corticosteroid depresses the normal-functioning immune system and can make a mild or moderate presentation worse. The immunosuppression can also make one susceptible to other infections.

Taking any corticosteroid suppresses the body's production of cortisol. So after taking dexamethasone for several days, if one stops taking the drug abruptly, the body suddenly has no cortisol to make up for the exogenous supply it was receiving.

This stoppage leaves no hormone to help the body deal with stress and can result in corticosteroid withdrawal. Symptoms of withdrawal include intense fatigue, weakness, muscle, and joint pain, vomiting, abdominal pain, and diarrhea and can last over a week. In cases where large doses were used, an abrupt cessation can lead to a life-threatening condition called an Addisonian Crisis. The hallmarks of this crisis are very low blood pressure and hypovolemic shock that can lead to death.

In diabetics, dexamethasone causes a rise in blood glucose and makes the management of the condition difficult. Other side effects include weight gain, problems with wound healing, fractures, worsening of glaucoma, euphoria, and mad behavior (psychosis).

As shown, there are significant risks involved in self-medicating with corticosteroids. Unless one has a severe form of COVID-19, there are no benefits. Prevention is always better than cure, and where COVID-19 is concerned, that may be the best advice now. Instead of self-medicating with dexamethasone, let's do the three things that have been shown to reduce the transmission of the SARS-COV-2 virus - social distance, wash your hands and wear a face mask.

The writer is a Physician Anesthesiologist

Writer’s email: [email protected] 

 

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