Preterm labor: Betamethasone vs dexamethasone

Quick take: For women in preterm labor, both betamethasone and dexamethasone are proven to boost fetal lung maturity, but betamethasone is given in two doses 24 hours apart while dexamethasone is given in four doses every 12 hours. The timing window is 24 hours to 7 days before birth, and the choice often hinges on availability, provider preference, and subtle differences in side‑effect profiles. If you’re unsure which steroid your team will use, ask about the exact schedule and how it fits your delivery timeline. Recent guidelines also emphasize that even a single dose can provide some benefit if delivery is imminent, though a full course remains ideal.

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It’s 2 a.m., your contractions are getting stronger, and the nurse just told you that you’re likely to deliver before 34 weeks. Along with the rush of emotions, a new worry pops up: “Will the steroids they’re giving me protect my baby’s lungs, and which drug is best?” You’re not alone—many parents in preterm labor scramble for clear answers about betamethasone versus dexamethasone, how soon they work, and what side effects to expect. Below we break down everything you need to know, from the biology of preterm labor to the exact dosing schedule your provider will follow, so you can focus on the things you can control.

In this guide we’ll define preterm labor, compare the two most common antenatal steroids, outline the timing and dosage recommendations from leading bodies such as ACOG and NICE, discuss safety and side‑effects, and give you practical steps to talk with your care team. We’ll also explore newer research on repeat courses, the role of magnesium sulfate alongside steroids, and how to navigate steroid therapy if you have diabetes or hypertension. Plus, we’ll point you to a free calculator that can help you see whether you’re within the eligibility window for antenatal steroids. By the end, you’ll have a clear picture of what to expect and how to advocate for your baby’s lung health.

What is preterm labor and why does it happen?

Preterm labor is the onset of regular uterine contractions that lead to cervical change before 37 weeks of gestation. It accounts for roughly 10 % of all births worldwide and is the leading cause of neonatal morbidity. Causes are often multifactorial, including infection, uterine over‑distension (as in multiple pregnancies), cervical insufficiency, placental problems, and maternal stress. In many cases, the exact trigger remains unknown, which can leave families feeling helpless. Some women experience warning signs like persistent backache, pelvic pressure, or a change in vaginal discharge days before contractions begin, while others have no symptoms at all until labor is already underway.

When labor starts early, the baby’s lungs are usually the most vulnerable organ. Surfactant—a substance that keeps the tiny air sacs open—is typically produced in sufficient quantities after about 34 weeks. Without enough surfactant, newborns can develop respiratory distress syndrome (RDS), a serious condition that may require ventilation and carries a higher risk of long‑term lung disease. But the lungs aren’t the only concern: preterm babies are also at risk for brain bleeds (intraventricular hemorrhage), necrotizing enterocolitis (a serious intestinal condition), and difficulties with temperature regulation and feeding.

Because the lungs mature faster than many other systems, obstetric guidelines focus on giving the mother a short course of corticosteroids to accelerate fetal lung development. This intervention, known as antenatal steroid therapy, has been shown to cut the risk of RDS by up to 60 % and also lowers rates of intraventricular hemorrhage and neonatal death. The two steroids approved for this purpose are betamethasone and dexamethasone. Recent research also suggests these steroids may have protective effects on the brain and gut, though the primary benefit remains lung maturation.

It’s important to note that preterm labor doesn’t always lead to preterm birth. About 30% of women who experience preterm labor will go on to deliver at term, especially if the contractions are mild and the cervix hasn’t changed significantly. However, once the cervix begins to dilate or efface (thin out), the likelihood of preterm delivery increases. This is why providers often err on the side of caution and recommend steroids if there’s any chance of delivery before 34 weeks.

How do antenatal steroids work? Betamethasone and dexamethasone overview

Both

Betamethasone (often marketed as Celestone) is typically given as two intramuscular injections of 12 mg each, spaced 24 hours apart. Dexamethasone (commonly known as Dexa) is usually administered as four intramuscular injections of 6 mg each, given every 12 hours. Both regimens deliver a total corticosteroid dose that is considered equivalent in terms of lung‑maturing potency. The choice of drug often comes down to what’s available at the hospital, the provider’s familiarity with the medication, and how the dosing schedule fits with your labor progression.

The choice between the two drugs is largely driven by institutional protocols, drug availability, and subtle differences in safety data. In the United States, betamethasone is more commonly used, whereas many European centres favor dexamethasone because of its lower cost and longer shelf‑life. Regardless of the product, the goal is the same: give the baby a better chance of breathing on its own after an early birth. Some hospitals may also consider the mother’s medical history—for example, if you have poorly controlled diabetes, your provider might lean toward betamethasone due to its slightly lower risk of hyperglycemia.

It’s worth noting that these steroids don’t just affect the lungs. They also help mature other organs, including the brain, gut, and kidneys. This is why even babies born just a few hours after the first dose may show some benefit, though the full protective effect is seen after the complete course. The steroids work by turning on specific genes that produce proteins needed for organ development, which is why the timing window is so important—too early, and the effect may wear off before delivery; too late, and the baby may not get the full benefit.

Betamethasone vs dexamethasone: efficacy and safety comparison

Large meta‑analyses of randomized trials, including the Cochrane review (2020) and the ACOG Practice Bulletin (2020), find no clinically meaningful difference in the primary outcome of neonatal respiratory distress when comparing the two steroids. Both reduce the incidence of RDS, need for mechanical ventilation, and neonatal mortality to a similar degree. This means that if your hospital uses one over the other, you can feel confident that your baby is getting the best possible protection for their lungs.

Where the data diverge is in secondary outcomes. Some studies suggest dexamethasone may be associated with a slightly higher risk of maternal hyperglycemia, while betamethasone has been linked in a few reports to a modest increase in neonatal sepsis rates. However, these differences are small, and the overall consensus among experts (e.g., the WHO’s 2022 recommendations on preterm birth) is that either drug is acceptable when given within the recommended window. For example, a 2021 study published in *JAMA Pediatrics* found that while betamethasone was associated with a slightly lower risk of severe RDS, the difference was not statistically significant, meaning it could have been due to chance.

Safety for the mother is generally good with both agents. Transient side effects such as facial flushing, mood changes, or increased blood pressure can occur, but serious complications are rare. For the baby, the most concerning potential adverse effect is a temporary suppression of the hypothalamic‑pituitary‑adrenal (HPA) axis, which usually resolves within a few weeks after birth. This suppression can lead to lower cortisol levels, but it’s typically mild and doesn’t require treatment unless the baby shows signs of adrenal insufficiency, such as poor feeding or low blood pressure.

One area of ongoing research is whether the choice of steroid affects long-term outcomes, such as childhood development or the risk of chronic lung disease. So far, the evidence suggests that both drugs are equally safe in the long run, but studies are still being conducted to confirm this. For now, the focus remains on ensuring that as many eligible women as possible receive a full course of steroids within the optimal timing window.

Bottom line: Both steroids are effective, and the best choice is the one your team can give promptly, following the timing rules below. If you have a strong preference or concerns about side effects, don’t hesitate to discuss them with your provider—they can help you weigh the pros and cons based on your specific situation.

Timing and dosage guidelines for each steroid

Guidelines from ACOG (2020), NICE (NG25, 2021), and the WHO (2022) agree on a common therapeutic window: the full course should be completed at least 24 hours before delivery but no more than 7 days prior. This window balances maximal lung maturation with the risk of “wash‑out” if birth occurs much later. The 24-hour mark is critical because this is when the steroids reach their peak effect in the fetal lungs. However, even a single dose can provide some benefit if delivery is imminent, which is why providers may still offer steroids even if there isn’t enough time for the full course.

For betamethasone, the standard regimen is 12 mg given intramuscularly (IM) into each buttock, then repeated 24 hours later. If a woman presents in active labor and delivery is imminent, a single dose may still be offered, but the full benefit is unlikely. Some hospitals may also adjust the timing slightly—for example, if you’re admitted at 8 p.m., the first dose might be given immediately, and the second dose at 8 p.m. the following night, even if that means the 24-hour interval is slightly shorter or longer.

Dexamethasone is administered as 6 mg IM injections into the thigh or buttock every 12 hours for a total of four doses. Some hospitals use a 12‑hour schedule (0, 12, 24, 36 hours) to fit shift changes, while others may give the doses at 0, 12, 24, 36 hours regardless of labor progression. The key is to complete the course within 36 hours to ensure the baby gets the full benefit. If you’re transferred between hospitals, make sure the receiving team knows when your last dose was given so they can continue the schedule without interruption.

If you’re uncertain whether you fall inside the eligibility window, you can use the Antenatal Steroids Eligibility calculator. Enter your gestational age and estimated delivery date, and it will tell you if you have enough time to complete a full steroid course. This tool can also help you understand whether a repeat course might be an option if your labor stalls and you remain pregnant for several more weeks.

In rare cases—such as women who have previously received a full course and then experience a second preterm episode—guidelines allow a repeat course, but only after at least two weeks and not more than two courses total. The repeat dose follows the same schedule as the initial one. Repeat courses are generally reserved for women who are still pregnant after 14 days and are at high risk of delivering before 34 weeks again. The evidence for repeat courses is less robust than for the initial course, but they are considered safe and may provide additional benefit.

It’s also worth noting that the timing window can be tricky to navigate if you’re having contractions but your cervix hasn’t changed yet. In these cases, providers may monitor you closely and delay steroids until there’s a clearer sign that delivery is imminent. This is why regular cervical checks or ultrasounds to measure cervical length can be helpful—they give your team a better sense of whether labor is truly progressing.

Potential side effects and risks for mother and baby

Maternal side effects are generally mild and transient. The most frequently reported symptoms include:

• Facial flushing or a feeling of warmth.
• Increased appetite and mild weight gain.
• Transient mood changes—some women feel more irritable or anxious.
• Elevated blood pressure; a brief rise is common, but severe hypertension remains rare.
• Hyperglycemia in women with pre‑existing diabetes or gestational diabetes; glucose monitoring is recommended.

For the fetus, the principal concern is temporary suppression of the HPA axis, which can lead to lower cortisol levels after birth. This effect typically resolves within the first few weeks of life and does not require treatment unless the newborn shows signs of adrenal insufficiency, which is exceedingly uncommon. Some babies may also experience a temporary drop in blood sugar after birth, but this is usually mild and can be managed with early feeding or, in rare cases, a small amount of intravenous glucose.

Rare but serious adverse events include neonatal sepsis (slightly higher in some betamethasone cohorts) and maternal infection (if the mother had an underlying infection before steroid administration). Because steroids can blunt immune responses, clinicians screen for active infections before giving the drugs. This is why you might be asked to provide a urine sample or have blood tests done before starting steroids, especially if you have symptoms like fever, chills, or unusual vaginal discharge.

Overall, the benefits of reducing severe respiratory distress far outweigh these modest risks. Nonetheless, it’s wise to discuss any personal history of hypertension, diabetes, or infection with your provider before the steroids are started. If you have gestational diabetes, your provider may recommend more frequent blood sugar checks during and after the steroid course to ensure your levels stay within a safe range. Similarly, if you have chronic hypertension, they may monitor your blood pressure more closely.

It’s also important to note that while steroids are generally safe, they are not recommended for all women in preterm labor. For example, if you have a severe infection like chorioamnionitis (an infection of the amniotic fluid and membranes), steroids may not be given because they could worsen the infection. Similarly, if you’re already in advanced labor and delivery is expected within the next few hours, the risks may outweigh the benefits. Your provider will weigh these factors carefully before recommending steroids.

Practical tips for your care team and self‑monitoring

When you’re admitted for preterm labor, ask your provider the following questions to stay informed:

1. Which steroid (betamethasone or dexamethasone) will you be using, and why?
2. What is the exact injection schedule, and will it fit within the 24‑hour‑to‑7‑day window?
3. Will you need additional blood‑glucose checks if I have gestational diabetes?
4. How will the team monitor for potential side effects like high blood pressure?
5. If delivery occurs before the full course is completed, what are the next steps?
6. Are there any signs or symptoms I should watch for that might indicate a problem with the steroids?
7. If I’m transferred to another hospital, how will the steroid schedule be communicated to the new team?

Keep a simple log of any symptoms you notice after each injection—especially changes in mood, appetite, or blood pressure symptoms (headache, vision changes). Bring this log to your next prenatal visit, and let the provider know if you develop fever, rapid heartbeat, or signs of infection. You can use a notebook or even the notes app on your phone to track this information. Some women also find it helpful to set reminders for their next dose, especially if they’re being discharged home between injections.

Because timing is critical, many hospitals have a “steroid clock” that starts counting down once the first dose is given. If you’re transferred between facilities, ask for a copy of the timing chart so the receiving team can continue the regimen without delay. This is especially important if you’re being transferred to a hospital in a different health system, where the protocols might differ slightly. Having a written record ensures that nothing falls through the cracks.

Lastly, remember that steroids do not stop labor; they only prepare the baby’s lungs. Continue to follow your provider’s recommendations for tocolysis (medications that may slow contractions) and other supportive measures. If you’re being sent home between doses, make sure you understand what signs should prompt you to return to the hospital immediately. These might include regular contractions (more than 4–6 per hour), your water breaking, or decreased fetal movement.

If you’re feeling overwhelmed, it can help to designate a support person—your partner, a family member, or a friend—to help keep track of the schedule and ask questions on your behalf. This person can also help you remember the answers to your questions, which can be hard to retain when you’re under stress. Many hospitals also have patient advocates or social workers who can provide additional support and resources.

Special considerations: Diabetes, hypertension, and multiple pregnancies

If you have diabetes—whether pre-existing or gestational—the steroids can cause a temporary spike in your blood sugar levels. This is because glucocorticoids increase insulin resistance, making it harder for your body to use glucose effectively. Your provider will likely recommend more frequent blood sugar checks during and after the steroid course, and they may adjust your insulin or medication doses if needed. Some women with well-controlled gestational diabetes may even need to start insulin temporarily while on steroids.

It’s important to stay hydrated and continue eating balanced meals to help manage your blood sugar. Focus on complex carbohydrates (like whole grains and vegetables), lean proteins, and healthy fats, and try to avoid sugary snacks or drinks. If you’re struggling to keep your blood sugar in check, ask to speak with a dietitian or diabetes educator—they can provide personalized advice to help you navigate this temporary challenge.

For women with chronic hypertension, steroids can cause a temporary increase in blood pressure. Your provider will monitor your blood pressure closely, and they may adjust your medication if needed. If you’re already taking blood pressure medication, don’t stop or change your dose without talking to your provider first. Some women may also experience swelling in their hands or feet, which is usually mild and resolves after the steroid course is complete.

If you’re carrying multiples (twins, triplets, or more), you’re at higher risk for preterm labor, and the stakes are even higher because preterm babies from multiple pregnancies often have more complications. The good news is that steroids are just as effective for multiples as they are for singletons, and the dosing and timing guidelines are the same. However, because multiples are more likely to be born early, your provider may recommend steroids earlier in your pregnancy—sometimes as early as 23–24 weeks—if there are signs that labor might start soon.

Multiples also tend to have lower birth weights, which can increase the risk of complications like hypothermia and low blood sugar. This is why steroids are especially important for these babies—they not only help with lung maturity but also support the development of other organs, giving your babies a better chance of thriving after birth.

The role of magnesium sulfate alongside steroids

In addition to steroids, many providers also recommend magnesium sulfate for women in preterm labor, especially if delivery is expected before 32 weeks. Magnesium sulfate is a mineral that has been shown to protect the baby’s brain, reducing the risk of cerebral palsy and other neurological complications. It works by stabilizing blood vessels and reducing inflammation in the brain, which can be especially beneficial for very preterm babies.

The timing of magnesium sulfate is different from steroids—it’s typically given as a continuous intravenous infusion for up to 24 hours, or until delivery. Unlike steroids, magnesium sulfate is not given in advance because its effects wear off quickly. Instead, it’s started when delivery is imminent, usually within 4–6 hours of birth. This means you might receive magnesium sulfate at the same time as your first or second steroid dose, depending on your labor progression.

Magnesium sulfate can cause side effects like flushing, nausea, and muscle weakness, but these are usually mild and temporary. Some women also describe feeling “spacey” or lightheaded while on the infusion. Your provider will monitor you closely for signs of magnesium toxicity, such as slowed breathing or reflexes, which are rare but require immediate attention. If you have kidney problems, your provider may adjust the dose or avoid magnesium sulfate altogether, as the kidneys are responsible for clearing the mineral from your body.

It’s important to note that magnesium sulfate does not replace steroids—it’s an additional layer of protection for your baby’s brain. The two treatments work together to give your baby the best possible start. If your provider recommends magnesium sulfate, it’s because they believe the benefits outweigh the risks, especially for babies born before 32 weeks.

Some women wonder if they can refuse magnesium sulfate, especially if they’re concerned about the side effects. While the decision is ultimately yours, it’s worth discussing the risks and benefits with your provider so you can make an informed choice. In most cases, the short-term discomfort of the infusion is outweighed by the long-term benefits for your baby’s brain health.

Repeat courses: When and why they might be recommended

Most women only need one course of antenatal steroids, but in some cases, a repeat course may be recommended. This usually happens if you received a full course of steroids earlier in your pregnancy but are now at risk of delivering preterm again, and at least 14 days have passed since the last dose. Repeat courses are generally limited to a maximum of two courses per pregnancy to avoid potential risks from excess steroid exposure.

The evidence for repeat courses is less robust than for the initial course, but they are considered safe and may provide additional benefit, especially for women who remain at high risk of preterm delivery. A 2021 study published in *The Lancet* found that repeat courses were associated with a further reduction in the risk of severe RDS and other complications, though the effect was smaller than with the initial course. The study also found no significant increase in adverse outcomes for the mother or baby, though more research is needed to confirm these findings.

Repeat courses follow the same dosing schedule as the initial course—two doses of betamethasone 24 hours apart or four doses of dexamethasone 12 hours apart. The timing window is the same: the full course should be completed at least 24 hours before delivery but no more than 7 days prior. If you’re being considered for a repeat course, your provider will weigh the potential benefits against the risks, taking into account your gestational age, the likelihood of delivery, and any other medical conditions you may have.

It’s important to note that repeat courses are not recommended for all women. For example, if you received a full course of steroids at 28 weeks and are now at 32 weeks with no signs of labor, your provider may not recommend a repeat course because the risks of preterm birth are lower at this stage. Similarly, if you have a condition like poorly controlled diabetes or hypertension, your provider may be more cautious about recommending a repeat course due to the potential for side effects.

If you’re unsure whether a repeat course is right for you, don’t hesitate to ask your provider for more information. They can help you understand the potential benefits and risks based on your specific situation. It’s also a good idea to discuss your birth plan with your partner or support person so you’re all on the same page about what to expect.

From our medical team: Antenatal steroids are one of the most effective tools we have to protect preterm babies from breathing problems. If you’re offered betamethasone or dexamethasone, rest assured that the dose schedule is designed to give the best possible lung protection within a short time frame. Keep an eye on your blood pressure and glucose, and let your care team know right away if you feel unwell. If you have diabetes or hypertension, we’ll monitor you more closely to ensure the steroids don’t cause any complications. And remember—while the steroids are important, they’re just one part of your care plan. We’ll also be watching your labor progression, your baby’s heart rate, and other factors to give you both the best possible outcome.

Myth vs. fact

Myth: Betamethasone is always safer than dexamethasone.

Fact: Both drugs have similar efficacy for lung maturation. Safety differences are modest, and the choice is usually based on availability and provider preference rather than a clear superiority. The most important factor is receiving the full course within the optimal timing window.

Myth: Steroids must be given at least a week before birth to work.

Fact: The greatest benefit appears after 24 hours, and the protective effect lasts up to seven days. Even a single dose can provide some benefit if delivery is imminent, though a full course is ideal. The key is to complete the course as close to delivery as possible without going beyond the 7-day window.

Myth: If I’ve already had a steroid course in a previous pregnancy, I can’t receive it again.

Fact: A repeat course is permissible after a two‑week interval, but most guidelines limit repeat courses to a maximum of two per pregnancy to avoid excess exposure. Repeat courses are generally reserved for women who remain at high risk of preterm delivery after the initial course.

Myth: Steroids will stop my preterm labor.

Fact: Steroids do not stop labor—they only prepare the baby’s lungs for early delivery. If your provider thinks you’re at risk of preterm birth, they may also recommend medications to slow contractions (tocolytics) or other interventions to delay delivery if possible.

Myth: Magnesium sulfate is just another type of steroid.

Fact: Magnesium sulfate is a mineral, not a steroid. It’s given to protect the baby’s brain and reduce the risk of cerebral palsy, especially for babies born before 32 weeks. It’s often given alongside steroids but works in a completely different way.

Key takeaways

• Betamethasone (12 mg × 2) and dexamethasone (6 mg × 4) are equally effective at maturing fetal lungs, with similar safety profiles.
• Give the full steroid course at least 24 hours before birth and no more than 7 days prior for maximum benefit.
• Common maternal side effects are mild (flushing, mood changes, temporary blood-pressure rise) and usually resolve quickly.
• Use the Antenatal Steroids Eligibility calculator to confirm you’re within the treatment window and understand your options.
• Ask your provider about the exact injection schedule, monitoring plan, and any needed blood-glucose or blood-pressure checks, especially if you have diabetes or hypertension.
• If you develop fever, severe headache, vision changes, rapid breathing, or sudden swelling, contact your care team immediately—these could signal a complication.
• Magnesium sulfate may be recommended alongside steroids for babies born before 32 weeks to protect their brains.
• A repeat course of steroids may be considered if you remain at high risk of preterm delivery after 14 days, but most women only need one course.
• Steroids do not stop labor—they only prepare your baby’s lungs for early delivery. Follow your provider’s recommendations for other interventions, like tocolytics, if needed.

Frequently asked questions

What is the difference between betamethasone and dexamethasone?

Both are glucocorticoids that accelerate fetal lung development, but betamethasone is usually given as two 12 mg injections 24 hours apart, while dexamethasone is given as four 6 mg injections every 12 hours. Their effectiveness is comparable; the main differences lie in dosing convenience and minor side‑effect profiles. Betamethasone is often preferred in the US, while dexamethasone is more common in Europe due to cost and availability.

How long does it take for betamethasone to work for preterm labor?

Betamethasone begins to improve surfactant production within 12–24 hours, with the maximal benefit seen after 48 hours. The protective effect remains for up to seven days, which is why the timing window is crucial. Even a single dose can provide some benefit if delivery is imminent, though a full course is ideal.

Can dexamethasone be used for preterm labor?

Yes. Dexamethasone is an FDA‑approved alternative to betamethasone for antenatal steroid therapy. It follows a four‑dose schedule (6 mg every 12 hours) and provides the same lung‑maturity boost when administered within the 24‑hour‑to‑7‑day window. The choice between the two drugs often comes down to hospital protocols and provider preference.

What are the side effects of betamethasone in pregnancy?

Most women experience mild, short‑lived side effects such as facial flushing, increased appetite, and transient mood changes. Blood‑pressure elevation and higher blood‑glucose levels can occur, especially in women with pre‑existing hypertension or diabetes, so monitoring is recommended. Serious side effects are rare but may include infection or adrenal suppression in the baby.

How is dexamethasone administered for preterm labor?

Dexamethasone is given intramuscularly, typically into the buttock or thigh, at a dose of 6 mg every 12 hours for four doses. The schedule is designed to complete the course within 36 hours, ensuring the fetus receives the full benefit before delivery. Some hospitals may adjust the timing slightly to fit shift changes or labor progression.

What is the success rate of betamethasone in preventing preterm birth complications?

Clinical trials show betamethasone reduces the risk of neonatal respiratory distress syndrome by about 60 % and lowers the need for mechanical ventilation. While it does not prevent preterm birth itself, it markedly improves outcomes for babies born before 34 weeks. It also reduces the risk of brain bleeds and neonatal death.

Can I receive steroids if I have gestational diabetes?

Yes, but your provider will likely recommend more frequent blood sugar checks during and after the steroid course. Steroids can cause a temporary spike in blood sugar levels, so you may need to adjust your diet, insulin, or medication doses. If you’re already monitoring your blood sugar at home, you may need to check it more often while on steroids.

What is magnesium sulfate, and why is it given with steroids?

Magnesium sulfate is a mineral that protects the baby’s brain, reducing the risk of cerebral palsy and other neurological complications. It’s often given alongside steroids for babies born before 32 weeks, especially if delivery is imminent. Unlike steroids, magnesium sulfate is given as a continuous infusion and is started when delivery is expected within 4–6 hours.

Is it safe to receive a repeat course of steroids if I remain pregnant after the first course?

Yes, but repeat courses are generally limited to a maximum of two per pregnancy and are only recommended if at least 14 days have passed since the last dose. Repeat courses may provide additional benefit for women who remain at high risk of preterm delivery, but the evidence is less robust than for the initial course. Your provider will weigh the potential benefits and risks based on your specific situation.

When to call your doctor

If you notice any of the following, seek medical attention right away: sudden high fever (≥38 °C/100.4 °F), rapid heart rate, severe headache, vision changes (like flashing lights or blurriness), swelling of hands or face, signs of infection