Dexamethasone is used to treat conditions such as arthritis, blood/hormone/immune system disorders, allergic reactions, certain skin and eye conditions, breathing problems, certain bowel disorders, and certain cancers. It is also used as a test for an adrenal gland disorder (Cushing's syndrome).
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.
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. 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 2nd 24 hr of dexamethasone admin, urine is collected & analysed for 17-OHCS. Alternatively, after a baseline plasma cortisol determination, 1 mg may be given at 11 pm & plasma cortisol determined at 8 am the next morning. Plasma cortisol & urinary output of 17-OHCS are depressed after dexamethasone admin in normal individuals but remain at basal levels in patients w/ Cushing’s syndrome. 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 mgdaily. Max. 24 mg daily. 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 & not to be continued beyond 48-72 hr. Bacterial meningitis: Adult: 0.15 mg/ kg 4 times daily, to be given 10-20 min before or w/ the 1st dose of anti-infective treatment. Treatment should be given for the 1st 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 o w/ 1st dose of antibacterial treatment. Prophylaxis of nausea & vomiting associated w/cytotoxic therapy: Adult: Prevention: 10-20 mg 15-30 mins 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. 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. w/ 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.
Diuretics and/or cardiac glycosides, since potassium loss may be enhanced.This is a particular risk in patients using cardiac glycosides; since hypokalaemia increases the toxicity of these drugs.
Antidiabetics, since glucocorticoids may impair glucose tolerance, thereby increasing the need for antidiabetic drugs.
Non-steroidal anti-inflammatory drugs, since the incidence and/or severity of gastro-intestinal ulceration may increase.
Oral anti-coagulants since glucocorticoids may alter the need for these drugs.
Glucocorticoids may be less effective when used concomitantly with liver enzyme inducing drugs,such as rifampicin, ephedrine, barbiturates, phenytoin and primidone.
If patients undergoing long-term therapy with glucocorticoids are concomitantly given salicylates, any reduction in glucocorticoid dosage should be made with caution, since salicylate intoxication has been reported in such cases.
Antacids;especially those containing magnesium trisilicate,have been reported to impair the gastro-intestinal absorption of glucocorticoids. Therefore, doses of one agent should be spaced as far as possible from the other.
Hypersensitivity; active untreated infections; ophth use in viral, fungal disease of the eye. Patients w/ 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 & coagulation indices in patients on warfarin. Elderly, child & adolescent; pregnancy & lactation.
Growth retardation, osteoporosis, peptic ulcer, glaucoma & subcapsular cataracts, vertebral compression fractures. Cushing-like features, pancreatic dysfunction & 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 & toxicity w/ occlusive dressing on application to large areas of the body & broken skin. Topical application to eye: Corneal ulcers, glaucoma & reduced visual ability. Inhalation: Hoarseness, candidiasis of mouth & throat. Intra-articular inj: Aseptic necrosis of bone & joint damage. HPA supression; CV collapse on rapid IV admin.
This has been associated with low birth weight, although not with increased rates of neonatal death. Dexamethasone has also been used during pregnancy as an off-label prenatal treatment for the symptoms of congenital adrenal hyperplasia (CAH) in female babies. The benefits of using dexamethasone while breastfeeding will usually outweigh any risks. Dexamethasone does pass into breast milk, but low doses taken by the mother are unlikely to significantly affect a nursing baby.
Overdosage is unlikely, however, treatment of overdosage is by supportive and symptomatic therapy
Tablet: Store in a cool & dry place, protected from light & moisture.
Injection: Store below 30° C, protected from light.Do not freeze. Keep medicines out of the reach of children
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