What Is Dexamethasone?

Photo: The White House/Getty Images

Since President Trump publicly disclosed his positive COVID-19 test result last week, clear information about his condition has been hard to come by. After refusing to say whether Trump had ever been given supplemental oxygen, Sean Conley, the president’s physician, admitted Sunday that he’d omitted several details in order to present a rosier picture. “I didn’t want to give any information that might steer the course of illness in another direction,” he said. “It came off that we were trying to hide something, which wasn’t necessarily true.”

On Sunday, Conley also revealed that Trump has been treated with dexamethasone, an immunosuppressant steroid that can cause euphoric mood changes (among other things). Since then, people have posted online about their own experiences with the drug.

After Conley announced on Monday that Trump would be leaving Walter Reed, he told press that Trump was not on any fever-reducing medication like ibuprofen or aspirin. This is important because a fever can speak to the severity of COVID-19 symptoms. But as Céline Gounder, an infectious-disease specialist and CNN medical analyst, tweeted, dexamethasone is itself a fever-reducing medication.

Here’s what we know about dexamethasone and its use in treating COVID-19.

What does dexamethasone do?

Dexamethasone is a corticosteroid hormone that decreases the body’s natural immune response and reduces swelling and allergic-reaction symptoms. This medication treats a number of conditions, including asthma, IBS, Crohn’s disease, and a number of lymphomas. It is used to treat COVID-19 because serious cases can provoke an exaggerated immune response, releasing a large number of pro-inflammatory cytokines in what’s known as a “cytokine storm.” As an immunosuppressant, dexamethasone is thought to help reduce the likelihood of the body’s overreaction to the virus. Research has found dexamethasone to significantly reduce mortality among seriously ill (i.e. hospitalized) COVID-19 patients. Scientists have said it may prevent one in three deaths among patients on ventilators. (President Trump has not been reported to have been put on a ventilator — which is used when a patient can’t breathe properly or on their own — though he has been given supplemental oxygen at least twice.)

Who is dexamethasone for?

The very function of dexamethasone that makes it helpful in treating serious COVID-19 cases also makes it risky for more mild cases. The immune system’s response to COVID-19 is enormously important, and because dexamethasone suppresses the immune response, it might only increase the patient’s risk of becoming seriously ill. It is not recommended for patients not on oxygen support; patients who haven’t received oxygen who were given dexamethasone actually died at a slightly higher rate (though not a statistically significant one).

“In the early phase of the illness, the immune system is your friend,” Martin J. Landray, a professor of medicine and epidemiology at Oxford University and author of the pioneer dexamethasone study told the Times. “It’s fighting the virus, and dampening it is not a good idea.”

What does it mean that Trump has been given dexamethasone?

Because dexamethasone is typically given to patients with severe cases of COVID-19, some doctors have questioned its use in treating Trump, whom Conley has described as doing “very well.”

Bob Wachter, chair of the Department of Medicine at the University of California San Francisco, wrote on Twitter that the use of dexamethasone indicates medical concern, and that it seems likely evidence of pneumonia was found. Given these factors, he writes that a potential Monday release from Walter Reed (as mentioned by Trump’s physicians) is an “awful call.” Abraar Karan, an internal medicine doctor at the Brigham and Women’s Hospital and Harvard Medical School, echoed this concern.

What are the side effects of dexamethasone?

Another reason doctors say dexamethasone shouldn’t be given to patients with mild COVID-19 is because of the potential for serious side effects. Notably, the drug can negatively impact a patient’s mental state, leading to anxiety, irritability, depression, and changes to mood, including mania. It can also cause difficulty talking, walking, and thinking. Blurred vision, irregular heartbeat, headaches, numbness in the limbs, and pounding in the ears are also common symptoms.

In rare but reported cases, dexamethasone has also been linked to grandiose delusions and psychosis.

What Is Dexamethasone?