Occurrence, fate, effects, and risks of dexamethasone: Ecological implications post-covid-19

Ndeke Musee, Lemme Prica Kebaabetswe, Shepherd Tichapondwa, Gosaitse Tubatsi, Ntombikayise Mahaye, Samuel Keeng Leareng, Philiswa Nosizo Nomngongo

Research output: Contribution to journalReview articlepeer-review

20 Citations (Scopus)


The recent outbreak of respiratory syndrome-coronavirus-2 (SARS-CoV-2), which causes coronavirus disease (COVID-19), has led to the widespread use of therapeutics, including dexam-ethasone (DEXA). DEXA, a synthetic glucocorticoid, is among the widely administered drugs used to treat hospitalized COVID-19 patients. The global COVID-19 surge in infections, consequent increasing hospitalizations, and other DEXA applications have raised concerns on eminent adverse ecological implications to aquatic ecosystems. Here, we aim to summarize published studies on DEXA occurrence, fate, and effects on organisms in natural and engineered systems as, pre-COVID, the drug has been identified as an emerging environmental contaminant. The results demonstrated a significant reduction of DEXA in wastewater treatment plants, with a small portion, including its transformation products (TPs), being released into downstream waters. Fish and crustaceans are the most susceptible species to DEXA exposure in the parts-per-billion range, suggesting potential deleterious ecological effects. However, there are data deficits on the implications of DEXA to marine and estuarine systems and wildlife. To improve DEXA management, toxicological outcomes of DEXA and formed TPs should entail long-term studies from whole organisms to molecular effects in actual environmental matrices and at realistic exposure concentrations. This can aid in striking a fine balance of saving human lives and protecting ecological integrity.

Original languageEnglish
Article number11291
JournalInternational Journal of Environmental Research and Public Health
Issue number21
Publication statusPublished - 1 Nov 2021


  • Anti-inflammatory drug
  • Drinking water
  • Glucocorticoid
  • Surface water
  • Transformation
  • Wastewater

ASJC Scopus subject areas

  • Pollution
  • Public Health, Environmental and Occupational Health
  • Health, Toxicology and Mutagenesis


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