Dexamethasone(dex a meth’ a sone)
Dexamethasone
Oral, topical dermatologic aerosol and gel, ophthalmic suspension: Aeroseb-Dex, Apo-Dexamethasone (CAN), DexPak TaperPak, Maxidex Ophthalmic, ratio-Dexamethasone (CAN)
Dexamethasone Sodium Phosphate
IV, IM, intra-articular, intralesional injection; respiratory inhalant; intranasal steroid; ophthalmic solution and ointment; topical dermatologic cream: Generic
PREGNANCY CATEGORY C
Drug Classes
Corticosteroid
Glucocorticoid
Hormone
Therapeutic Actions
Enters target cells and binds to specific receptors, initiating many complex reactions that are responsible for its anti-inflammatory and immunosuppressive effects.
Indications
Hypercalcemia associated with cancer
Cancer chemotherapy–induced nausea and vomiting
Short-term management of various inflammatory and allergic disorders, such as rheumatoid arthritis, collagen diseases (SLE), dermatologic diseases (pemphigus), status asthmaticus, and autoimmune disorders
Hematologic disorders: Thrombocytopenic purpura, erythroblastopenia
Trichinosis with neurologic or myocardial involvement
Ulcerative colitis, acute exacerbations of MS, and palliation in some leukemias and lymphomas
Cerebral edema associated with brain tumor, craniotomy, or head injury
Testing adrenocortical hyperfunction
Unlabeled uses: Antiemetic for cisplatin-induced vomiting, diagnosis of depression
Intra-articular or soft-tissue administration: Arthritis, psoriatic plaques
Respiratory inhalant: Control of bronchial asthma requiring corticosteroids in conjunction with other therapy
Intranasal: Relief of symptoms of seasonal or perennial rhinitis that responds poorly to other treatments
Dermatologic preparations: Relief of inflammatory and pruritic manifestations of dermatoses that are steroid responsive
Ophthalmic preparations: Inflammation of the lid, conjunctiva, cornea, and globe
Contraindications and Cautions
Contraindicated with infections, especially tuberculosis, fungal infections, amebiasis, vaccinia and varicella, and antibiotic-resistant infections, allergy to any component of the preparation used.
Use cautiously with renal or hepatic disease; hypothyroidism, ulcerative colitis with impending perforation; diverticulitis; active or latent peptic ulcer; inflammatory bowel disease; heart failure, hypertension, thromboembolic disorders; osteoporosis; seizure disorders; diabetes mellitus; lactation.
Available Forms
Tablets—0.25, 0.5, 0.75, 1, 1.5, 2, 4, 6 mg; elixir—0.5 mg/5 mL; oral solution concentrate—0.5 mg/0.5 mL; injection—4 mg/mL, 8 mg/mL, 10 mg/mL, 16 mg/mL, 20 mg/mL, 24 mg/mL; ophthalmic solution—0.1%; ophthalmic suspension—0.1%; ophthalmic ointment—0.05%
Dosages
Adults
Systemic administration
Individualize dosage based on severity of condition and response. Give daily dose before 9 AM to minimize adrenal suppression. If long-term therapy is needed, alternate-day therapy with a short-acting steroid should be considered. After long-term therapy, withdraw drug slowly to avoid adrenal insufficiency. For maintenance therapy, reduce initial dose in small increments at intervals until the lowest clinically satisfactory dose is reached.
Oral (dexamethasone)
0.75–9 mg/day.
Suppression test for Cushing syndrome: 1 mg at 11 PM; assay plasma cortisol at 8 AM the next day. For greater accuracy, give 0.5 mg every 6 hr for 48 hr, and collect 24-hr urine to determine 17-hydroxycorticosteroid (17-OHCS) excretion.
Suppression test to distinguish Cushing syndrome due to ACTH excess resulting from other causes: 2 mg every 6 hr for 48 hr. Collect 24-hr urine to determine 17-OHCS excretion.
IV or IM (dexamethasone sodium phosphate)
0.5–9 mg/day.
Cerebral edema: 10 mg IV and then 4 mg IM every 6 hr until cerebral edema symptoms subside; change to oral therapy, 1–3 mg tid, as soon as possible and taper over 5–7 days.
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