Dexamethasone

Indications
 Oral
Anti-inflammatory
Adult: 0.75-9 mg daily in 2-4 divided doses; may also be given via IM/IV admin.
Child: 1 mth-18 yr: 10-100 mcg/kg daily in 1-2 divided doses via oral admin, adjusted according to response; up to 300 micrograms/kg daily may be used in emergency situations.
Oral
As a screening test for Cushing's syndrome
Adult: 0.5 mg every 6 hr for 48 hr after determining baseline 24-hr urinary 17-hydroxycorticosteroid (17-OHCS) concentrations. During the second 24 hr of dexamethasone admin, urine is collected and analysed for 17-OHCS. Alternatively, after a baseline plasma cortisol determination, 1 mg may be given at 11 pm and plasma cortisol determined at 8 am the next morning. Plasma cortisol and urinary output of 17-OHCS are depressed after dexamethasone admin in normal individuals but remain at basal levels in patients with Cushing's syndrome.
Oral
Acute exacerbations in multiple sclerosis
Adult: 30 mg daily for 1 wk followed by 4-12 mg daily for 1 mth.
Child: 1 mth-12 yr: 100-400 mcg/kg daily in 1-2 divided doses; 12-18 yr: Initially 0.5-24 mg daily. Max. 24 mg daily.
Parenteral
Cerebral oedema caused by malignancy
Adult: As phosphate: 10 mg IV followed by 4 mg IM every 6 hr until response is achieved, usually after 12-24 hr. May reduce dosage after 2-4 days then gradually discontinued over 5-7 days. In severe cases, an initial dose of 50 mg IV may be given on day 1, with 8 mg every 2 hr, reduced gradually over 7-13 days. Maintenance dose: 2 mg 2-3 times daily.
Child: As phosphate: <35 kg: Initially 20 mg, then 4 mg every 3 hr for 3 days, then 4 mg every 6 hr for 1 day, then 2 mg every 6 hr for 4 days, then decrease by 1 mg daily. >35 kg: Initially 25 mg, then 4 mg every 2 hr for 3 days, then 4 mg every 4 hr for 1 day, then 4 mg every 6 hr for 4 days, then decrease by 2 mg daily. Doses are given via IV inj.
Intra-articular
Inflammatory joint diseases
Adult: 0.8-4 mg depending on the size of the affected joint. For soft-tissue inj, 2-6 mg may be used. May repeat inj every 3-5 days to every 2-3 wk.
Intravenous
Unresponsive shock
Adult: As phosphate: Initially, 40 mg or 1-6 mg/kg as a single IV inj, may repeat every 2-6 hr. Continue high-dose treatment only until patient's condition has stabilised and not to be continued beyond 48-72 hr.
Intravenous
Bacterial meningitis
Adult: 0.15 mg/kg 4 times daily, to be given 10-20 min before or with the 1st dose of anti-infective treatment. Treatment should be given for the first 2-4 days of the anti-infective treatment.
Child: As phosphate: 2 mth-18 yr: 150 mcg/kg every 6 hr for 4 days, starting before or with 1st dose of antibacterial treatment.
Intravenous
Prophylaxis of nausea and vomiting associated with cytotoxic therapy
Adult: Prevention: 10-20 mg 15-30 minutes before admin of chemotherapy on each treatment day. For continuous infusion regimen: 10 mg every 12 hr on each treatment day. For midly emetogenic regimen: 4 mg every 4-6 hr.
Ophthalmic
Ocular inflammation
Adult: As 0.1% suspension: Apply 1-2 drops into the affected eye/s 4-6 times daily in mild disease, up to hrly admin in more severe disease. As 0.05% ointment: Apply 0.5-1 inch ribbon of ointment into the conjunctival sac(s) up to 4 times daily. Reduce to once daily dosing once conditon has improved.
Contraindications
 Hypersensitivity; active untreated infections; ophthalmic use in viral, fungal disease of the eye.
Warnings / Precautions
 Patients with hypothyroidism; cirrhosis, hypertension, CHF, ulcerative colitis, thromboembolic disorders, osteoporosis, glaucoma, cataracts or TB of the eye, diabetes, peptic ulcer. Monitor blood glucose levels in diabetics and coagulation indices in patients on warfarin. Elderly, children and adolescent; pregnancy and lactation.
Adverse Reactions
 Growth retardation, osteoporosis, peptic ulcer, glaucoma and subcapsular cataracts, vertebral compression fractures. Cushing-like features, pancreatic dysfunction and pancreatitis, GI upsets, increased appetite, increased fragility of the skin. Increased susceptibility to infection. Topical application: Dermal atrophy, local irritation, folliculitis, delayed wound healing, systemic absorption and toxicity with occlusive dressing on application to large areas of the body and broken skin. Topical application to eye: Corneal ulcers, glaucoma and reduced visual ability. Inhalation: Hoarseness, candidiasis of mouth and throat. Intra-articular inj: Aseptic necrosis of bone and joint damage.
Potentially Fatal: HPA supression; CV collapse on rapid IV admin.
Overdose Reactions
 Treatment is supportive and symptomatic. In acute overdosage, gastric lavage or emesis may be used.
Drug Interactions
 Increased risk of hypokalaemia when used concurrently with potassium-depleting drugs such as amphotericin B and loop diuretics. Reduces efficacy of isoniazid, salicylates, vaccines and toxoids. Increased activity of dexamethasone and cyclosporin when used together. Concurrent use with aspirin or ethanol may lead to increased GI side effects.
Potentially Fatal: Reduced efficacy in combination with ephedrine, cholestyramine, phenytoin, phenobarbital and rifampicin.
See Below for More dexamethasone Drug Interactions
Food Interactions
 Dexamethasone interferes with calcium absorption. Limit caffeine.
Mechanism of Actions
 Dexamethasone is a synthetic glucocorticoid which decreases inflammation by inhibiting the migration of leukocytes and reversal of increased capillary permeability. It suppresses normal immune response.
Onset: As acetate: Prompt.
Duration: 72 hr.
Absorption: Readily absorbed from the GI tract (Oral).
Distribution: Readily crosses the placenta. Protein binding: About 77%.
Metabolism: Hepatic.
Excretion: Via urine (65% of the dose within 24 hr). Half-life: About 190 min.
Administration
 Should be taken with food.
Storage Conditions
 Intra-articular: Store at 15-30°C. Intravenous: Store at 15-30°C. Ophthalmic: Store at 15-30°C. Oral: Store at 15-30°C. Parenteral: Store at 15-30°C.
ATC Classification
 C05AA09 - dexamethasone ; Belongs to the class of products containing corticosteroids for topical use. Used in the treatment of hemorrhoids and anal fissures.
D07AB19 - dexamethasone ; Belongs to the class of moderately potent (group II) corticosteroids. Used in the treatment of dermatological diseases.
D07XB05 - dexamethasone ; Belongs to the class of moderately potent (group II) corticosteroids in other combinations. Used in the treatment of dermatological diseases.
D10AA03 - dexamethasone ; Belongs to the class of topical corticosteroids used in the treatment of acne.
H02AB02 - dexamethasone ; Belongs to the class of glucocorticoids. Used in systemic corticosteroid preparations.
A01AC02 - dexamethasone ; Belongs to the class of local corticosteroid preparations. Used in the treatment of diseases of the mouth.
R01AD03 - dexamethasone ; Belongs to the class of topical corticosteroids used for prophylaxis and treatment of allergic rhinitis.
S01BA01 - dexamethasone ; Belongs to the class of corticosteroids. Used in the treatment of inflammation of the eye.
S01CB01 - dexamethasone ; Belongs to the class of corticosteroids/antiinfectives/mydriatics combinations. Used in the treatment of eye diseases.
S02BA06 - dexamethasone ; Belongs to the class of corticosteroids used in the treatment of inflammation of the ear.
S03BA01 - dexamethasone ; Belongs to the class of corticosteroids used in ophthalmologic and otologic preparations.
Storage
 Intra-articular: Store at 15-30°C. Intravenous: Store at 15-30°C. Ophthalmic: Store at 15-30°C. Oral: Store at 15-30°C. Parenteral: Store at 15-30°C.
Available As
  • Dexamethasone Sodium 0.01%
  • Dexamethasone 0.01%
  • Dexamethasone Sodium Phosphate 0.01%
  • Dexamethasone Phosphate 0.01% w/v
  • Dexamethasone Sodium Phosphate 0.01% w/v
  • Dexamethasone 0.01% w/v
  • Dexamethasone Sodium Phosphate 0.01% w/w
  • Dexamethasone 0.01% w/w
  • Dexamethasone 0.02%
  • Dexamethasone 0.05%
  • Dexamethasone Sodium Phosphate 0.05%
  • Dexamethasone Phosphate 0.05%
  • Dexamethasone Phosphate 0.05% v/v
  • Dexamethasone Sodium Phosphate 0.05% w/v
  • Dexamethasone 0.05% w/v
  • Dexamethasone Sodium Phosphate 0.05% w/w
  • Dexamethasone Sodium Phosphate 0.055% w/v
  • Dexamethasone 0.1 %
  • Dexamethasone Phosphate 0.1%
  • Dexamethasone 0.1%
  • Dexamethasone Sodium Phosphate 0.1%
  • Dexamethasone Sodium 0.1%
  • Dexamethasone Phosphate 0.1% w/v
  • Dexamethasone Sodium 0.1% w/v
  • Dexamethasone 0.1% w/v
  • Dexamethasone Sodium Phosphate 0.1% w/v
  • Dexamethasone Sodium Phosphate 0.1% w/w
  • Dexamethasone 0.1% w/w
  • Dexamethasone Sodium Phosphate 0.10%
  • Dexamethasone Sodium Phosphate 0.10% w/v
  • Dexamethasone 0.10% w/v
  • Dexamethasone Phosphate 0.11% w/v
  • Dexamethasone Sodium 0.116% w/v
  • Dexamethasone Sodium Phosphate 0.14%
  • Dexamethasone Phosphate 0.5 mg
  • Dexamethasone 0.5 mg
  • Dexamethasone Sodium Phosphate 0.5%
  • Dexamethasone 0.5% w/v
  • Dexamethasone Phosphate 1 mg
  • Dexamethasone Sodium Phosphate 1 mg
  • Dexamethasone 1 mg
  • Dexamethasone 1% w/v
  • Dexamethasone 15 mg
  • Dexamethasone 2 mg
  • Dexamethasone Sodium 4 mg
  • Dexamethasone Sodium Phosphate 4 mg
  • Dexamethasone Phosphate 4 mg
  • Dexamethasone 4 mg
  • Dexamethasone 5 mg

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