Samuel David Chinonyerem
Pharmacist, Founder of Torch & Parrot Nigeria
Community pharmacists in Nigeria are witnessing a troubling rise in dexamethasone misuse for cosmetic weight gain, a hidden public health threat demanding urgent action.
Healthcare professionals in community pharmacies across Ogun State and Lagos, Nigeria, are witnessing a disturbing rise in requests for dexamethasone tablets for nonmedical purposes, specifically cosmetic weight gain. Young adults, including teenagers and young women, frequently request the drug by its local nicknames: “yodi” (buttocks enhancer), “mawu mawu” (weight enhancer), or in some regions “sha ka dwade” (roughly “drink and explode/bust”). They seek it to boost appetite and achieve a fuller figure. This off-label, unsupervised use is a clear pharmacovigilance signal that warrants attention from regulators, healthcare providers, and the public.
Dexamethasone is a potent synthetic glucocorticoid approved for managing inflammatory and autoimmune conditions, severe allergies, asthma, rheumatic disorders, and certain cancers. The medicine’s potential side effects include increased appetite, fluid retention, and fat redistribution, which some individuals exploit. A 2020 investigation in Lagos pharmacies revealed heightened demand among teenagers and young women, who obtained the drug over the counter from chemists without prescriptions.
However, these come with serious health risks when used long-term or at high doses without medical supervision. Short-term misuse can cause insomnia, mood swings, and fluid retention. Prolonged use can result in iatrogenic Cushing’s syndrome, which is characterised by moon face, buffalo hump, and central obesity with limb wasting, along with steroid-induced diabetes, hypertension, osteoporosis, immunosuppression, and potentially life-threatening cardiovascular events, including cardiomyopathy, heart failure, and stroke. The “weight gain” is also often unhealthy, driven by fat redistribution and oedema rather than sustainable muscle mass, and abrupt cessation can cause adrenal crisis.
For example, a 2025 case report from Sokoto described a 20-year-old man who ingested 2-4 tablets (1 mg each) daily for six months under the Hausa term “sha ka dwade.” He developed severe complications, including steroid- induced dilated cardiomyopathy, recurrent cardiogenic shock, and cardioembolic stroke.
Frontline observations in Ogun State and Lagos pharmacies show that patients rarely disclose their true intent initially but readily admit it when questioned. Many return regularly for repeat supplies, signalling habitual use. Easy over-the-counter access in some outlets, despite regulations classifying dexamethasone as a prescription-only medicine, fuels the problem.
This trend is not unique to Nigeria. Similar patterns of corticosteroid misuse for weight gain and improved physical appearance have been documented in other low- and middle- income countries.
In Iraq, an Al-Najaf study of 320 nonprescription dexamethasone users found that most were women aged 16–25. Most got the drug easily from pharmacies or street vendors after friends or family suggested it. Nearly 75% were unaware of the side effects, and over half relapsed after stopping because they rapidly lost the weight. A separate study in Babylon Governorate found 80.8% of those misusing steroids for weight gain were women, many already presenting with mood swings, stretch marks, and early signs of Cushing's syndrome.
In Algeria, a study of 600 people seeking to gain weight found nearly one in five were regularly misusing oral corticosteroids, mostly women, averaging 25 years old, the majority sourcing them without a prescription.
In Egypt, the national Drug Authority issued an official warning of this issue after seeing cases like a 23-year-old woman who took dexamethasone for 6 months to gain weight. She went from 53 kg to 81 kg but ended up with full Cushing’s syndrome, moon face, buffalo hump, stretch marks, and period problems.
This emerging signal exposes critical gaps in public awareness and enforcement of dispensing regulations. However, underreporting remains common, and many users are unaware of the dangers.
Community pharmacists and other healthcare professionals are uniquely positioned to detect and report corticosteroid misuse, but they need active support from the Nigerian National Agency for Food and Drug Administration and Control (NAFDAC) to do so effectively. Various stakeholders in the health system could take actions to help this problem:
Healthcare professionals: Strictly refuse dispensing without a valid prescription. Offer clear, empathetic counselling on the risks and suggest safer, evidence-based alternatives (for example, nutritional counselling and lifestyle advice) for body image or weight concerns.
Regulators (NAFDAC): Strengthen enforcement of prescription status, launch targeted awareness campaigns, and consider stricter scheduling or controls in high misuse areas.
Public and media: Promote education on the hazards of “quick fix” weight gain remedies, actively countering harmful social media trends.
Pharmacovigilance community: Actively encourage reporting of suspected misuse and adverse events to NAFDAC to strengthen the evidence base for interventions.
This is far more than a cosmetic fad; it is a preventable public health threat carrying significant morbidity and mortality. By highlighting this signal from frontline observations, we urge collective action akin to responses against other forms of medicine misuse in Nigeria.
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Samuel David Chinonyerem
Pharmacist, Founder of Torch & Parrot Nigeria
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